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A numerical study of ventilation strategies for infection risk mitigation in general inpatient wards.

ABSTRACT: Aerial dispersion of human exhaled microbial contaminants and subsequent contamination of surfaces is a potential route for infection transmission in hospitals. Most general hospital wards have ventilation systems that drive air and thus contaminants from the patient areas towards the corridors. This study investigates the transport mechanism and deposition patterns of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) within a typical six bedded general inpatient ward cubicle through numerical simulation. It demonstrates that both air change and exhaust airflow rates have significant effects on not only the airflow but also the particle distribution within a mechanically ventilated space. Moreover, the location of an infected patient within the ward cubicle is crucial in determining the extent of infection risk to other ward occupants. Hence, it is recommended to provide exhaust grilles in close proximity to a patient, preferably above each patient's bed. To achieve infection prevention and control, high exhaust airflow rate is also suggested. Regardless of the ventilation design, all patients and any surfaces within a ward cubicle should be regularly and thoroughly cleaned and disinfected to remove microbial contamination. The outcome of this study can serve as a source of reference for hospital management to better ventilation design strategies for mitigating the risk of infection.

SUBMITTER: Satheesan MK

PROVIDER: S-EPMC7090571 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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A numerical study of ventilation strategies for infection risk mitigation in general inpatient wards.

Satheesan Manoj Kumar MK Mui Kwok Wai KW Wong Ling Tim LT

Building simulation 20200222 4

Aerial dispersion of human exhaled microbial contaminants and subsequent contamination of surfaces is a potential route for infection transmission in hospitals. Most general hospital wards have ventilation systems that drive air and thus contaminants from the patient areas towards the corridors. This study investigates the transport mechanism and deposition patterns of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) within a typical six bedded general inpatient ward cubicle through numer ...[more]

PMID: 32211123

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Project description:BackgroundThere is an increase in the number of individuals who receive care at home. A significant proportion of these patients acquire infections during their care episode. Whilst there has been significant focus on strategies for infection prevention and control in acute care environments, there is a lack of research into infection prevention in a home care setting.ObjectivesTo understand (1) if and how home care nurses identify patients at high risk of infection and (2) the strategies they use to mitigate that risk.DesignA qualitative descriptive study, using semi-structured interviews.SettingA large not for profit home care agency located in the New York region of the United States.ParticipantsFifty nurses with a range of experience in home care nursing.MethodsPurposive and snowball sampling was used to recruit nurses from across the home care agency with varied years of work experience. Interviews were audio recorded and transcribed. The interviews explored how home care nurses evaluate their patients' risk of developing an infection and if/how they modify the plan of care based on that risk. Data were analysed using thematic analysis.ResultsThree themes were derived from the data; assessing a patient's risk of infection, the risk assessment process, and strategies for mitigating infection risk. Factors identified by nurses as putting a patient at higher risk of infection included being older, having diabetes, inadequate nutrition; along with inadequate clinical information available at start of care. The patient's knowledge and understanding of infection prevention, and the availability and knowledge of caregivers were also important, as was the cleanliness of the home environment. Given the context of home care, where nurses have little control over the environment and care processes in-between visits, the main strategy for infection prevention was patient and caregiver education. Nurses also discussed the importance of their own infection prevention behaviours, and the ability to adjust a patient's plan of care according to their infection risk.ConclusionsThe study highlights the complexity of the risk assessment process in relation to infection. Existing guidelines for infection prevention and control do not adequately cover the home care environment and more research needs to determine which interventions (such as patient/caregiver education) would be most effective to prevent infections in the home care setting.

Project description:Background and objectivesLarger weight gain and higher ultrafiltration rates have been associated with poorer outcomes among patients on dialysis. Dietary restrictions reduce fluid-related risk; however, adherence is challenging. Alternative fluid mitigation strategies include treatment time extension, more frequent dialysis, adjunct peritoneal dialysis, and wearable ultrafiltration devices. No data regarding patient preferences for fluid management exist. A survey was designed, tested, and administered to assess patient-stated preferences regarding fluid mitigation.Design, setting, participants, & measurementsA written survey concerning fluid-related symptoms, patient and treatment characteristics, and fluid management preferences was developed. The cross-sectional survey was completed by 600 patients on hemodialysis at 18 geographically diverse ambulatory facilities. Comparisons of patient willingness to engage in volume mitigation strategies across fluid symptom burden, dietary restriction experience, and patient characteristics were performed.ResultsFinal analyses included 588 surveys. Overall, if allowed to liberalize fluid intake, 44.6% of patients were willing to extend treatment time by 15 minutes. Willingness to extend treatment time was incrementally less for longer treatment extensions; 12.2% of patients were willing to add a fourth weekly treatment session, and 13.5% of patients were willing to participate in nocturnal dialysis three nights per week. Patients more bothered by their fluid restrictions (versus less bothered) were more willing to engage in fluid mitigation strategies. Demographic characteristics and symptoms, such as cramping and dyspnea, were not consistently associated with willingness to engage in the proposed strategies. More than 25% of patients were unsure of their dry weights and typical interdialytic weight gains.ConclusionsPatients were generally averse to treatment time extension>15 minutes. Patients more bothered (versus less bothered) by their prescribed fluid restrictions were more willing to engage in volume mitigation strategies. Additional study of patient-stated preferences in hemodialysis treatment practices is needed to guide patient care and identify deficiencies in patient treatment and disease-related knowledge.

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A numerical study of ventilation strategies for infection risk mitigation in general inpatient wards.

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A numerical study of ventilation strategies for infection risk mitigation in general inpatient wards.

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