key: cord-312394-djjarc0f
authors: Lynch, Richard M.; Goring, Reginald
title: Practical Steps to Improve Air Flow in Long-Term Care Resident Rooms to Reduce COVID-19 Infection Risk
date: 2020-04-10
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2020.04.001
sha: 
doc_id: 312394
cord_uid: djjarc0f

Abstract The potential for spread of COVID-19 infections in Skilled Nursing Facilities and other Long-Term Care sites poses new challenges for Nursing Home Administrators to protect patients and staff. It is anticipated that as Acute Care Hospitals reach capacity, Nursing Homes may retain COVID-19 infected residents longer prior to transferring to an Acute Care Hospital. This article outlines 5 pragmatic steps that Long-Term Care facilities can take to manage airflow within resident rooms to reduce the potential for spread of infectious airborne droplets into surrounding areas including hallways and adjacent rooms, using strategies adapted from negative pressure isolation rooms in acute care facilities.

Practical Steps to Improve Air Flow in Long-Term Care Resident Rooms to Reduce COVID-19 3

Infection Risk 4 5

Keywords: COVID, Corona, Skilled Nursing Facilities, airborne infection isolation, respiratory droplets, 6

Long Term Care, Hotel 7 8

Abstract 9

The potential for spread of COVID-19 infections in Skilled Nursing Facilities and other Long-Term Care 10 sites poses new challenges for Nursing Home Administrators to protect patients and staff. It is anticipated 11 that as Acute Care Hospitals reach capacity, Nursing Homes may retain COVID-19 infected residents 12 longer prior to transferring to an Acute Care Hospital. This article outlines 5 pragmatic steps that Long-13

Term Care facilities can take to manage airflow within resident rooms to reduce the potential for spread 14 of infectious airborne droplets into surrounding areas including hallways and adjacent rooms, using 15 strategies adapted from negative pressure isolation rooms in acute care facilities. Step #1 -Estimate Total Room Volume, Ventilation, and Differential Pressure -As an example, in a 15' 61 by 20' room with 8' ceilings, the total room volume is 2,400 cubic feet. Assuming the ASHRAE 170 62 guideline of 2 ACH, the room is receiving approximately 80 cubic feet per minute (cfm) of outdoor air 63 from the rooftop air handler along with some recirculated air. Estimate room pressure at the hallway door 64 using a manometer, tissue or plastic to determine air current direction. contact the Industrial Hygienist to design appropriate safe retrofit options. Anticipate higher energy costs 78 and increased noise as conditioned make-up air is drawn from hallways into rooms and discharged 79 outdoors.

Step #3 -Increase Efficiency of Filtration -AII rooms are typically equipped with MERV 7 prefilters and 82 MERV 14 final filters which remove up to 98% of airborne particles as small as 0.3 to 1.0 microns in 83 diameter (typical diameter of respiratory droplets). Place lower efficiency filters on HVAC return 84 registers to reduce airborne droplets entering the return air stream. Discuss these options for increasing 85 filter efficiency with your HVAC contractor to ensure compatibility with your HVAC system. 86

Step #4 -Keep Doors to Hallways Closed -Keep doorways between hallways and resident rooms closed 88 to maintain negative pressure differential. If the bathroom is where the exhaust is being discharged, keep 

How COVD-19 Spreads

Letter to Facility Managers 113

Natural Ventilation for Infection Control in 116

World Health Organization

SARS-CoV-2 as Compared with SARS-CoV-1

Persistence of coronaviruses on inanimate surfaces 122 and their inactivation with biocidal agents

American Society of Heating, 125 Refrigeration and Air Conditioning Engineers

The authors have no conflicts of interest Body Word count = 1067 Abstract Word Count 103