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Reducing airborne infections in primary health care


The novel coronavirus spread as a pandemic in early 2020. The disease causes respiratory and intestinal symptoms and, like a general infection, muscle aches and headaches. Most people react mildly to this illness but a small proportion of those infected have severe symptoms: around 5% of confirmed infections have led to death according to the statistics from the end of March. Old age and underlying immunosuppressive diseases predispose to a more serious infection.


Restrictions, protective equipment and hygiene


The pandemic has made people around the world aware of good hand and coughing hygiene. In addition, the use of protective masks, which has long been considered a specialty mainly in Asian countries, is now a hot topic in other parts of the world as well. The mandatory or recommended use of masks is tricky for people in Western countries where people are accustomed to individuality and openness, but various restrictions concerning mobility and meeting other people have become popular.


Restrictions, protective equipment and hygiene are all based on the same logic – because viruses are self-replicating particles that leap from target to target with robot-like efficiency and due to the lack of medicine and vaccine, the effects on humans cannot be stopped or prevented without blocking the transmissions chains. The society needs ways to put out airborne diseases because waiting for vaccines could take years.


Droplet transmittable or airborne disease?


Many diseases are known for their ability to transmit through air, like various pox diseases and pertussis (also known as whooping cough), but for those diseases there are preventive measures in the form of vaccines. The speed how SARS and its related diseases MERS and the current variant Sars-Covid-19 spreads is more problematic.


Adequate droplet protection is widely acknowledged but given safety distances (1,5-2 meters) may not be enough if a person moves and breathes more heavily than usually, for example while running. In addition, there are situations where distances cannot be kept, such as in health care, and procedures in which liquid particles smaller than normal droplets are transferred into the air. Such aerosol-like particles can move over a longer distance in a room, and in China it has also been reported that SARS has spread from one room to another possibly through air conditioning.


The need for isolation rooms and air decontamination in health care


The protective measures in primary health care usually include isolation rooms in the bed wards and protective face masks for the staff with the required surgical class FFP3. Basically, the health care workers who are in direct contact with patients are protected and the patients in single bed wards do not spread their illness more widely. However, there are potential gaps for viruses to spread – normally patient rooms do not have adequate negative pressure nor equipped with their own air purification or airlock. Such high demand isolation rooms are usually found only in infection or lung disease units at the central hospital level. 


The spread of aerosol-transmittable diseases could be prevented by improving air purification in rooms and planning air conditioning as a whole, even if the rooms don’t need to become hospital-level isolation rooms. It’s important that the staff would be potentially less exposed to viral aerosols in the spaces where patients are treated with mucus extractors or other aerosol producing procedures.


Efficient and high-quality healthcare under normal conditions ensures that the patient receives adequate treatment and isolation according to the illness in appropriate settings. However, the 21st century has repeatedly highlighted the threat of new droplet transmittable and airborne diseases, and that brings the reducing of respiratory air pollutants into focus. Also, the workplace safety has received more attention: how to create a safe place for both the patients and the staff who take care for them? Should a new standard be created for the indoor air of a health care facility – air that is clean enough to be safe?


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