Clinical and Economic Outcomes from the Installation of an Advanced Air Purification Technology in a Long Term Care Facility

As of 2022, the United States has 55.6 million people aged 65 and older, accounting for 16.9% of the total population [1]. This number is expected to reach 94.7 million by 2060 [2,3]. With the aging population, the demand for long-term care facilities (LTCFs) is increasing. Approximately 2.1 million people in the United States live in LTCFs, including over 1.2 million nursing home residents [2,4,5]. Indoor air quality in LTCFs is crucial due to its impact on healthcare-associated infections (HAIs) [4,6,7]. Older adults in LTCFs are susceptible to HAIs due to age-related factors and facility-related factors [8-10]. Within the nursing home population alone, there are an estimated 1.13 to 2.68 million infections [11]. Infection prevention and control programs in LTCFs primarily focus on hand hygiene, respiratory tract infection prevention, surface cleaning, personal protective equipment, training, and education [12]. However, these programs often overlook airborne pathogens, despite 69-80% of all infection-causing pathogens being airborne [13]. 

Respiratory diseases affect 10% of the U.S. population aged 65 and older, leading to decreased lung function and increased mortality [2,14,15]. Volatile organic compounds (VOCs) commonly found in indoor air contribute to pulmonary impairment, which is particularly risky for older adults with compromised respiratory systems [16,17]. An Advanced Air Purification Technology (AAPT), using a five-stage system, was developed to comprehensively remediate airborne contaminants, including VOCs and pathogens [18]. The AAPT, which is installed in the facility’s heating, cooling, and air conditioning (HVAC) system, combines proprietary VOC filters, a high-dose ultraviolet germicidal irradiation (UVGI) chamber, and HEPA filtration to provide contaminant free air on a single pass through the system. It does not produce harmful byproducts or ozone. 

The goal of the study was to assess the impact of AAPT compared to HEPA filtration only. The comprehensive remediation of airborne contaminants by the AAPT was expected to reduce pathogen load, VOC levels, and the rate of illness and infection in LTCFs.

This study was originally published in the Journals of Gerontology: Medical Sciences with the title “The Effects of an Advanced Air Purification Technology on Environmental and Clinical Outcomes in a Long-Term Care Facility” [19]. The study was conducted at a LTCF to assess the impact of an AAPT on environmental and clinical outcomes compared to standard HEPA filtration. The Institutional Review Board approved the study, and the AAPT was retrofitted onto the facility’s rooftop. Two air filtration zones were evaluated on two different resident floors over a 15-month period. The control floor had only HEPA filtration, while the study floor had AAPT remediation and HEPA filtration. The physical layout, construction materials, and contractors were identical for both floors. Staff and residents were blinded to the study. 

Environmental testing was conducted at five locations on both floors, including resident rooms, dining areas, and community areas. VOC canister testing, airborne fungal and bacterial sampling, and surface sampling from commonly touched surfaces were performed at each location. Additional airborne fungal and bacterial sampling was conducted in the bathroom of resident rooms. The biological airborne and swab samples were analyzed by a third-party laboratory using proprietary methods. Viable bacteria and fungi were quantified and identified. The VOC load in each room was measured using the EPA TO-15 methodology. 

Statistical analyses, such as paired t-tests, one-way analysis of variance, and nonparametric tests, were used to assess pre- and post-installation differences in airborne and surface metrics, as well as clinical data. The study included all residents and staff on both floors, with no exclusions. Adjusted odds ratios and 95% confidence intervals were calculated, and SPSS 24.0 (IBM, Armonk, NY) software was used for data analysis.

The previously published study analyzed the clinical and environmental data from of the control floor and study floor to assess the effectiveness of an AAPT in reducing pathogens and improving clinical outcomes [19]. The demographics of the control and study floor were comparable, showing that the two floors were equivalent and suitable for statistical comparisons. The analysis of the environmental results showed a significant reduction in airborne pathogens (98.83%) and VOC levels (89.88%) after the installation of the AAPT, as compared to pre-installation values. The study floor demonstrated a substantial decrease in both airborne and surface pathogen loads compared to the control floor. The reduction in surface pathogens was attributed to the decreased pathogen load in the air. The study revealed a 39.6% reduction in HAIs on the study floor compared to the control floor. Additionally, a retrospective evaluation demonstrated a 53.5% reduction in HAIs on the study floor pre- vs. post-installation. The study also found a significant decrease in staff call-outs of 47%. 

By removing/reducing two common vectors if illness, infectious airborne and surface pathogens, over HEPA filtration, the AAPT drove reductions in HAIs and staff illness. These positive clinical outcomes translate to improved resident wellness and safety, as well as economic benefits for the LTCF. The reduction in HAIs increases the facility's reimbursement rates and improves its overall ranking. The study emphasized the importance of high-quality air purification in LTCFs and highlighted the novel application of the AAPT in pathogen and VOC remediation. The AAPT's effectiveness is not reliant on human intervention, in contrast to hand hygiene and surface cleaning practices, which can vary in effectiveness due to compliance and technique. The study concluded that the AAPT is an effective solution for reducing airborne contaminants and improving indoor air quality in LTCFs, with potential for broader application and further research in different LTCF environments [19].

The advanced air purification technology was provided to Phoebe Ministries Allentown through a nonmonetary grant by LifeAire Systems. Date of award: August 2018. The study conduct and data verification occurred independently.

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