Residential Care Homes

My first job was as a care assistant in residential nursing homes in the UK operated by the local council. In the late 1960’s we did not have the benefits of en-suite bathrooms, but relied on communal washrooms, commodes, chamber pots and sluice rooms for sanitary arrangements for the residents. Needless to say, the overwhelming memory of those days was the pervasive smell of urine, faeces, cooking smells and bleach in these establishments. Significant improvements in sanitary provision, cleaning and disinfection, and professionalism of staff have raised the standards of living for the residents (and improved working conditions); however ‘odour’ events can still occur. These events can be unpleasant for residents and staff and give rise to complaints – and can give an often misleading impression of the residential/care home if witnessed by visitors.

The OrionAire technology was originally developed for odour control in a residential care home as the inventor’s uncle was kept apart from the residents because of a stoma and a penchant for spicy foods! The units were subsequently use to control odour in a room with two residents suffering from C.diff., and it was noted that no further cases were recorded at the home – indicating the potential of the technology for infection control. A subsequent NHS trial confirmed observations that the technology was effective in removing airborne micro-organisms (including MRSA).

OrionAire technology has been used for nearly 20 years to improve air quality in many locations, including residential care and nursing homes, domestic homes, offices, commercial kitchens and restaurants, aircraft, private yachts, cruise liners, cars, clean-rooms, laboratories, flood- and smoke-damaged buildings and food-processing factories: ask for a free demonstration!

OrionAire.

The rapidly aging population and their increasingly complex medical conditions have seen an increased demand for residential- and nursing- care home accommodation in all developed (first-world) countries. This demand has led providers of such services to improve personal care and facilities to remain commercially viable and competitive.

One way to improve the resident’s experience is to improve indoor air quality in the premises, which will provide significant health and well-being benefits.

Care assistants/aides, domestic cleaners and nursing staff perform a wide range of services, including personal care of residents (such as showering, bathing and assistance with toileting) and cleaning and disinfection (C&D) tasks. Although cleaning tasks are performed to remove soil, dirt, and dust from surfaces in the resident’s room and bathroom, they have an important role in infection prevention. The main reason for the focus on disinfection is the growing awareness and concern about the prevalence of drug-resistant pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA) in hospitals, residential and care establishments and in the community. Furthermore Clostridium difficile is the major cause of enteric infections among elderly persons. Patients returning after exposures to these pathogens in hospitals can be carriers – which further compromises the health of the other residents and staff.

Infection prevention:

Respiratory infections such as colds and influenza, Legionnaires disease, tuberculosis and even methicillin-resistant Staphylococcus aureus (MRSA) can be spread by infected aerosols.

(Aerosol production from a cough and a sneeze.)

A resident, visitor, or staff member with influenza can expel as many as 302,200 particles in a single cough – and up to 63% of these particles can be in the respirable size fraction, indicating that these particles could reach the alveolar region of the lungs and cause infection if inhaled by another person in the room.

Similarly, a sneeze can generate up to 40,000 droplets, the vast majority of which are less than 100 microns across — the width of a human hair.

Gastro-intestinal diseases, particularly Norovirus infections can also be spread by aerosols produced by toilets,
see: https://hsl.gov.uk/resources/case-studies/vomiting-larry-visualising-contamination,
and sufferers; a single episode of vomiting or diarrhoea can release 1014 infectious viruses into the air in a resident’s room!

Aerosol production from toilet ‘sneeze’ and from vomiting (‘Vomiting Larry’)

 

 

 

 

 

 

 

Within 60 seconds of a toilet being flushed the average-sized bathroom can be covered by a faecal cloud of bacteria, urine and faecal matter – and the aerosol can spread up to 20 feet away. Even after repeated flushing, toilet surfaces and bowl water can remain contaminated with faecal bacteria, including Clostridium difficile.

Diagram of the faecal cloud in patient room and bathroom.

As well as pathogenic micro-organisms, residents and staff in care/nursing homes are exposed to other airborne bacteria and their spores, moulds and mould spores, viruses and yeasts; pollen and animal dander and dust (usually a mixture of discarded human skin flakes and hair, dust-mites and their droppings, and fibres from clothing and furnishings).

There is also a growing awareness that regular exposure to some common C&D products (particularly those containing bleach or ammonia) can cause or exacerbate respiratory illnesses, including asthma and chronic bronchitis among domestic cleaners, health-care workers and even residents (?) C&D products are among the leading causes of occupational asthma, because of their high volatility, spray application, and use in (usually) small and poorly ventilated spaces i.e. residents’ rooms and en-suite bathrooms.

More than 700 000 chemicals are in use in modern society: indoor sources include those released from materials of construction (particularly glues and paints), cleaning compounds, carpets, the operation of photocopiers and other office equipment, pesticides and biocides. There is also a significant input from people in the environment in the form of ‘bio-effluent’ (body odours and flatulence), and a plethora of solvents, volatile organic compounds (VOCs) and other chemicals found in perfumes, body sprays and cosmetics! Outdoor sources such as vehicle exhaust fumes and vented air can also contribute to the chemical mixture.

People who suffer a chemical sensitivity or allergic reaction to one or more airborne contaminants are often referred to as suffering from Sick Building Syndrome (SBS), however their condition improves when they leave the building. A similar condition is known as Multiple Chemical Sensitivity (MCS) – where sufferers have a high sensitivity or allergic reaction to specific chemicals or biological materials. Because many of the symptoms of SBS and MCS are referred to as ‘non-specific’, the conditions are often regarded as psychological/psychiatric or even psychosomatic in nature – even where is little evidence to indicate this. It has been estimated that over 11 million people in the US suffer from moderate to severe MCS! Building Related Illness (BRI) is a more specific condition – where a diagnosed illness is attributed to exposure to air in the affected building. Perhaps the best known BRI is Legionnaire’s Disease; however both tuberculosis and fungal infections are on the increase – particularly in social housing and in hospitals.

Given that people typically spend 90% of their time indoors (some residents may spend all their time in a care/residential facility) it is not surprising that continuing exposure to poor indoor air quality (IAQ) can cause other health issues, including:-

1. asthma: a number of indoor air pollutants including the house dust mite, tobacco smoke and vapours from electronic cigarettes, respirable micro-particulates (PM2.5), VOCs, formaldehyde, oxides of nitrogen (NOx), mould spores, bacterial endotoxins (fragments of cell walls), and formaldehyde are all known to play an important role in the development of sensitization and subsequent onset of asthma symptoms. The prevalence of allergic asthma is increasing in the UK, with over 5 million people per year requiring medical treatment.

2. house dust mite allergy: The house dust mite thrives in the warm, humid conditions found in modern premises– and lives in carpets, soft furnishings bedding and mattresses. They feed on moulds which break down the dead skin flakes from humans and animals. The mites themselves do not cause the problem, but their faecal pellets contain an allergen which causes respiratory problems: sneezing, runny nose, rhinitis, wheezing, dry persistent cough and tightness of breath (asthma). Other symptoms include eczema and dermatitis, joint pain and muscle aches. Up to 1000 mites have been reported in one gram of dust, and the average bed contains 10,000 dust mites and in excess of 2,000,000 faecal pellets! Control of mites is achieved by reducing the relative humidity to below 50%, when the mites dry out and die – removing carpets and the use of mite-proof bedding may be necessary in severe cases. Any activities that release dust into the air e.g. vacuuming, making beds and mattress turning will exacerbate the symptoms.

3. eczema: the most common form of eczema is atopic eczema (also known atopic dermatitis) which can be triggered by airborne allergens including house dust mites, mould spores, pollen and animal dander. Atopic eczema is common in the UK affecting up to 5% of the population, and

4. pet allergy: it has been estimated that about one third of people with allergies are sensitive to their pets, birds or other animals. In cats and dogs the allergens are carried in their saliva and sweat – and can remain airborne for hours, in hamsters and smaller pets it is in their urine. Symptoms of pet allergy include breathing difficulties, wheezing and coughing, irritation of the eyes, skin irritation, eczema and asthma.

It is apparent that the air that we breathe can cause health problems: Sick Building Syndrome, Building Related Illness, Multiple Chemical Sensitivity, asthma, eczema, pet allergy, hay fever and dust mite allergy to name but a few! The obvious answer is to remove any known contaminants and allergens from the air to reduce exposure and improve health.

The most efficient and effective treatment for indoor air is based on QuantumTM technology, available in the OrionAire units. These units operate by generating a contained non-thermal plasma which destabilizes compounds and materials in the air using high-voltage forces and oxidative stress, effectively breaking them down into their component elements. Terminal electrostatic filtration of the treated air removes inert particulates with efficiency greater than 0.1 microns (more efficient than HEPA filtration).
This combination treatment rapidly denatures nuisance odours and VOCs, and kills all micro-organisms – including bacteria and bacterial endospores, mould spores and viruses. There is no carry-over of harmful chemicals such as ozone, free radicals or hydroxyls from the process so it can be used continuously to improve IAQ in any location – domestic, workplace or public areas, and so improve health by providing clean air.

Test data from independent UK-accredited laboratories and case studies are available upon request.

If you have a problem involving Indoor Air Quality, please contact the technical team at
Orion 4 Systems Limited –

 

Dr. David L. Webber. 12th April, 2019.
Company Microbiologist.

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