Aged Care – Preventing infections 

and harm from indoor air pollution

 

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Care Home environmental risks

Care home residents share air, space, food and equipment, so they also share organisms, such as viruses and bacteria, that can easily cause infection outbreaks, such as viruses and bacteria.

Organisms which are common causes of outbreaks, such as the influenza virus, can survive and present a risk for one to two days and norovirus up to seven days, while common outbreak-causing bacteria such as S pyogenes and MRSA can survive for several months ^[1].

Many residents have underlying conditions and weakened immune systems and are at significantly greater risk from harmful viruses and bacteria, which can lead to serious health problems and even death. In fact, more people in the UK died in care homes than in hospitals due to COVID-19^[2].

And it is not just infections, other common indoor air pollutants carry particular risks for the aged. For example, an increase of just 0.9 parts per million of carbon monoxide causes a significant increase in cardiovascular hospital admissions in the elderly^[3]. About 10% of those over 65 suffer from asthma or COPD and are at higher than normal risk of lung damage and asthma attacks caused by indoor air pollution^[4].

Infection prevention and control

In any shared living space such as care homes, there are also shared infectious agents – usually bacteria or viruses – that from time to time cause infection outbreaks^[5].

In care homes, the opportunities for infection outbreaks are abundant and the consequences can be severe: all outbreaks – even of pathogens as common as noroviruses – can result in the death of residents.

Types of outbreaks

The most common types of disease outbreaks in care homes are outbreaks of respiratory infections (often caused by influenza viruses), and gastrointestinal infections (often caused by noroviruses)^[5].

Indeed, some organisms can cause more than one type of infection; for example, MRSA can cause skin, urinary tract, and bloodstream infections^[6].

Utsumi’s 2012 literature review of 206 infection outbreaks in care facilities for older people, the:

• Respiratory tract was involved in 45% of outbreaks.
• Gastrointestinal tract in 36%.
• Skin in 7%. 
• Eyes in 2%. 

Just four organisms – influenza virus, norovirus, salmonella and S pyogenes – made up more than 50% of all infectious agents involved.

Modes of infection transmission in care homes

Infectious agents spread^[1]:

1. Through physical contact – a person touches, or is touched by, someone or something that is contaminated with the infectious agent.
2. Through droplets – small droplets containing the infectious agent are spread by coughing or sneezing and land directly on another person, or on an object from which the organism spreads through physical contact;
3. By airborne infection – a person directly inhales the exhaled breath of an infected person; this is how Covid-19 spreads, for example;
4. By airborne dissemination – the infectious agent is disseminated in the air – for example, during bed-making or dressing changes – and lands on a person or object from which it can spread via the physical contact route;
5. Through ingestion – a person eats contaminated food or water.

Outbreak prevention and control

Traditionally, the defence against outbreaks has been to train all staff to follow standard physical infection control precautions (SICPs). However, such precautions were demonstrably never wholly effective, especially where the infection is airborne,  as exemplified by Covid-19, where ultimately the only defence was to literally ban all non-monitored personnel from entry.

The advent of a remarkable new technology, Airora, when combined with SICPS,  offers a far higher level of defence against outbreaks.

Airora is a molecular diffuser, which uniquely replicates outdoor air chemistry to create a continuous hydroxyl cascade throughout an entire indoor space. That hydroxyl cascade has been independently shown to achieve:

• A 99.9999% kill rate of airborne, high concentration, hard to kill MS-2 in minutes^[7].
• A 99.9999% kill rate of high concentration MRSA on glass in 1 hour^[8] and on all types of surface a 99.9% kill rate in 16 hours.
• A >99% reduction in transmitted live bacteria over 600mm^[9] in a simulated sneeze test with a high concentration of bacteria.

By testing against MS2, the US Centre for Disease Control (CDC) confirms that hydroxyl radicals will inactivate pathogens in levels 1 – 4 of that Spaulding Classification, including all those in the coronavirus family (which includes the SARS-CoV-2 coronavirus that causes COVID-19). Level 5 Mycobacteria are basically no different in structure to other more susceptible bacteria, and as Airora produces a never-ending supply of hydroxyls, even clumps of cells, thick layers and heavy cell walls will eventually succumb.

Airora is not aware of any pathogens which will not ultimately succumb to hydroxyl radical attack.

Once Airora’s technology is deployed, new sources of infection are effectively removed just as quickly.

If the source of infection is destroyed, then the likelihood of infection is clearly greatly reduced. Consider each of the potential modes of transmission listed above:

1. Through physical contact - As Airora sanitises all surfaces 24/7 it is highly unlikely that one can become infected by touching a surface, of from a third party that has touched an infected surface.

However, touching a person who is already infected remains a mode of transmission.

2. Through droplets - As Airora destroys most of the infectious content from coughing / sneezing / exhalation in seconds before it has travelled just 600mm, such a mode of transmission becomes far less likely.

Infectious droplets from sneezes and the like are mostly either destroyed by Airora before they reach a surface or shortly thereafter. 

3. By airborne infection - As Airora rapidly destroys all types of airborne infectious content (including Covid-19), this mode of transmission becomes highly unlikely.
4. By airborne dissemination - As Airora rapidly destroys all types of airborne infectious content, this mode of transmission becomes highly unlikely.
5. Through ingestion - If the water or food is locally contaminated from the air or being placed on an infected surface or being sneezed / coughed over, then Airora will likely destroy the infectious contamination before it is ingested.

If the water or food has been contaminated elsewhere, or the contamination is within the water or food, not on the surface, Airora will not be able to destroy it.

Overall, by continuously removing the sources of infection from the air and surfaces, Airora appreciably reduces the likelihood of infection from almost all potential modes of transmission.

Control of unhealthy or unpleasant indoor pollution

Airora’s hydroxyl cascade does far more than just destroy all types of air or surface borne germs. Airora destroys or neutralises allergens and odours and most other irritants and harmful pollutants throughout entire indoor spaces.

Airora breaks down and removes most gaseous indoor pollutants

For example;

• Airora rapidly oxidises potentially harmful carbon monoxide (CO) into less harmful carbon dioxide (CO2), and;
• Airora also breaks down all types of potentially harmful Volatile Organic Compounds (VOCs), including formaldehyde.

Airora protects asthmatics and COPD sufferers from allergens and chemical irritants

• Airora’s hydroxyl cascade neutralises all types of allergen (pollens etc.), both within the air and on surfaces, by damaging their protein and tertiary structures so that they are no longer recognised by the body's immune system.
• Airora breaks down and removes chemical irritants, for example from cleaning sprays.

Airora destroys all types of Odour

Keeping indoor air odour free and feeling fresh and clean in multi-occupancy buildings can be challenging, especially in care homes.

Fortunately, one of the most immediately noticeable impacts of Airora is that it also destroys (not just masks) all types of both organic and inorganic odour, giving indoor air that fresh, clean feeling that we all so enjoy in the ‘great outdoors’.

The following is typical of what our independent consumer groups told us regarding their Airora ‘fresh air’ indoor experience:

“outdoors”   “in a spa”   “on holiday by the sea”   “mountains”   “forests”

Airora – nothing else comes close!

You can find out all about Airora at airora.com

And contact us at support@airora.com

References:

1. Infection outbreaks in care homes: prevention and management, Nursing Times September 2017 / Vol 113 Issue 9
2. Malla Paty, S., The coronavirus is most deadly if you are older and male, Nature vol. 585, 2020, pp. 16-17.
3. Barnett, A.G. et al., The effects of air pollution on hospitalizations for cardiovascular disease in elderly people in Australian and New Zealand cities, Environmental Health Perspectives, vol. 114, 2006, pp. 1018–1023.
4. Rowlatt, J., Toxic air puts six million at risk of lung damage, BBC chief environment correspondent, February 2021.
5. Utsumi M et al (2010) Types of infectious outbreaks and their impact in elderly care facilities: a review of the literature. Age and Ageing; 39: 3, 299-305.
6. Steer JA et al (2012) Guidelines for prevention and control of group A streptococcal infection in acute healthcare and maternity settings in the UK. Journal of Infection; 64: 1, 1-18.
7. UK Health Protection Agency Test Report HPA 40/06
8. UK Health Protection Agency Test Report HPA 63/07
9. BRE Test Report PR120286-1000 19th May 2021