Infections in Nursing Homes: An Expensive and Increasing Threat – Part 2

Read part one here.

3 Ways to Prevent Infection Spread in Nursing Home

Compared to hospitals of the same size, long-term care facilities have four times fewer infection-prevention specialists. So, nursing homes must be particularly innovative in their approach.

Following are three critical and cost-effective strategies.

Disinfect the air.

At hospitals and nursing homes alike, hand-hygiene lapses are inevitable and surface cleaning is inherently inadequate; bacterial levels on bed rails will rebound within just 3 hours of disinfection.

So care facilities must augment surface-cleaning and hand-hygiene protocols with continuous air dis-infection. When pathogens are removed from the air, they can’t be inhaled or ingested by residents and won’t land on surfaces that residents or staff touch.

Novaerus’ ultra-low energy plasma technology, used in nursing homes worldwide, destroys viral, bacterial, and fungal pathogens on contact and is safe for continued use around the most vulnerable populations.  

One study found Novaerus technology reduced airborne C. difficile by 99.6% within 20 minutes and 99.9% after 40 minutes. In another study, the technology reduced Influenza A aerosols by 99.9% within 20 minutes.

Novaerus units are also highly effective against multiple drug-resistant Mycobacterium tuberculosis, a “perennial threat” to nursing home residents.

The same technology also eradicates unpleasant odours, a benefit greatly appreciated by nursing-home staff.

Recruit — and retain — more experienced personnel.

Hiring more skilled healthcare workers “ultimately leads to cost savings,” concluded a cost analysis of infection outcomes in nursing homes.

Experienced staff are more likely to recognize early symptoms of infection, such as fever, elevated heart rate, altered mental status, or not eating — symptoms that patients themselves may not report because of dementia, stroke, or medication side-effects.

In addition, staff with more tenure are more familiar with the residents, so they’re better able to notice when an individual’s behaviour is out of the ordinary.

Monitor antibiotic use more closely.

The world’s superbug crisis is largely driven by antibiotic overuse and misuse, and nursing homes contribute in a big way. Two-thirds of nursing-home residents are prescribed antibiotics each year, and 25% to 75% of these prescriptions are inappropriate.

Nursing homes must follow more stringent antibiotic guidelines, such as those described in the U.S. government’s Core Elements of Antibiotic Stewardship for Nursing Homes.

Nursing home patients suffer a wide variety of infections, including urinary tract infections, lower respiratory tract infections, skin and soft-tissue infections, and gastroenteritis caused by c. difficile or norovirus. Infections that seem mild at first can spread — a UTI can become a bloodstream infection — and quickly become fatal.

Given the severe risks and steep costs of infection spread among residents, it is urgent that nursing homes invest in the personnel and technology necessary to halt this crisis.

Novaerus Closes the Infection Control Loop with Defend 1050, All-in-One Air Disinfection and Purification Device

The Defend 1050 is a medical-grade, portable device that uses a combination of plasma and filter technology to safely disinfect and purify indoor air, supplementing surface and hand hygiene for comprehensive infection control.

Dublin, Ireland, June 28, 2018 – Novaerus, an Irish company specialising in non-chemical air disinfection using patented ultra-low energy plasma, today announced the launch of the Defend 1050. The Defend 1050 is a portable, easy to use device ideal for rapid disinfection and purification of the air in large spaces and high-risk situations such as operating theatres, ICUs, IVF labs, emergency and waiting rooms, and construction zones.

The Defend 1050 uses ultra-low energy plasma technology – a highly effective method of rapid pathogen destruction – and a multi-stage high performance filter system from Camfil® to reduce infection, adsorb odours, neutralise volatile organic compounds (VOCs), and trap particulate as small as 0.3µm.

Independent tests completed to date show that the Defend 1050 at max. speed reduces:

  • Mycobacterium smegmatis (surrogate for Mycobacterium tuberculosis) by 97% in 30 minutes (30m3 space)
  • Influenza A by 99.9% in 10-20 minutes (28.5m3 space)
  • Staphylococcus epidermidis by 99.9% in 15 minutes (30m3 space)
  • Aspergillus niger by 99.99% in 30 minutes (15.9m3 space)
  • Nitrogen Dioxide (NO2) by 100% in 6 minutes (16m3 space)
  • VOCs at a clean air delivery rate (CADR) of 596 m3/hr
  • PM1.0 at a CADR of 860 m3/hr (19.7m3 space)
  • PM2.5 at a CADR of 870 m3/hr (19.7m3 space)

The Defend 1050 combines six coils of Novaerus’ patented, NASA-tested, ultra-low energy plasma technology with a M5 pre-filter, a genuine H13 HEPA filter certified in accordance with EN-1822, and carbon/molecular filter from Camfil, a world leader in high quality air filtration.

“We created the Defend 1050 in response to a growing demand from our customers for a mobile, rapid remediation solution for airborne pathogens and VOCs in high-risk situations,” said Dr. Kevin Devlin, EVP of product at Novaerus. “As a problem solver, the Defend 1050 is the perfect complement to our filter-free units, the Protect 800 and Protect 200, which are designed to be operated continuously to maintain optimal indoor air quality.”

Since 2009, Novaerus has been researching and developing plasma technology that is unmatched in its ability to safely destroy airborne pathogens that lead to infection in populated indoor spaces. The patented technology uses short-exposure, ultra-low energy plasma that has been tested and shown by several respected laboratories – including Airmid, Aerosol, Microbac, and Ames – to deactivate pathogens on contact.

“We now know conclusively that infection can be transmitted on air currents over large distances, by direct and indirect contact or a combination of all three routes.” said Dr. Felipe Soberon, chief technology officer at Novaerus. “The Defend 1050 is ideal for mitigating the risk of airborne dissemination of infection and contamination of surfaces and hands by reducing the bioburden in the air.”

Many air cleaning methods in use by healthcare facilities today rely on filters to capture pathogens. But without deactivating those pathogens first, the filter can become a safe haven for viable pathogens to colonise. The Novaerus plasma technology solves that problem by killing airborne pathogens before they become trapped in the filter.

“Novaerus has done an incredible job of bringing together the benefits of their patented plasma technology and our high-performance filters”, said Paul Flanagan, general manager of Camfil Ireland, “As an emerging global leader in portable non-chemical air disinfection, Novaerus is a natural partner for us. By being embedded in Novaerus units, Camfil’s filters can be deployed at the point of care, when and where they are needed most.”

The Defend 1050 can be moved easily by staff and plugged into any power outlet. It has five fan speeds to accommodate different room sizes and noise level requirements.

The Defend 1050 is now available for ordering in Europe and for pre-order in the USA.

About Novaerus

Novaerus is on a mission to reduce indoor airborne pollutants that lead to infection, allergies, asthma, and irritation. We envision a world where indoor spaces foster rather than detract from human health, productivity, and wellbeing. The patented plasma technology used in Novaerus portable devices was invented in Ireland in 2006. Clinical trials began in Europe in 2008 and a radical upgrade of the technology was completed in 2011. In 2016, Novaerus purchased Plasma Air and sister company, Aerisa, adding HVAC bipolar ionization technology to our portfolio and expanding into industrial and commercial applications.

For more information about Novaerus, visit

About Camfil

For more than half a century, Camfil has been helping people breathe cleaner air. As a leading manufacturer of premium clean air solutions, we provide commercial and industrial systems for air filtration and air pollution control that improve worker and equipment productivity, minimize energy use, and benefit human health and the environment. We firmly believe that the best solutions for our customers are the best solutions for our planet, too. That’s why every step of the way – from design to delivery and across the product life cycle – we consider the impact of what we do on people and on the world around us. Through a fresh approach to problem-solving, innovative design, precise process control and a strong customer focus we aim to conserve more, use less and find better ways – so we can all breathe easier.

The Camfil Group is headquartered in Stockholm, Sweden, and has 28 manufacturing sites, six R&D centres, local sales offices in 26 countries, and 4,180 employees and growing. We proudly serve and support customers in a wide variety of industries and in communities across the world. To discover how Camfil can help you to protect people, processes and the environment, visit us at

Fighting Superbugs: We Have the Power

Health officials around the world agree: the superbug crisis has reached the “red alert” stage.

Since the 1940s, antibiotics have dramatically reduced illness and death from infectious diseases; penicillin alone has saved about 200 million lives. But thanks to overuse in humans and animals, antibiotics are losing their power to fight bacteria.

Infections once easily treated with penicillin now require rounds and rounds of multiple antibiotics. Eventually, some bacterial strains will become untreatable, rendering C-sections, hip replacements, and chemotherapy too risky for patients.

“[Antibiotic resistance] is very serious indeed – it’s killing people around the world at the rate of hundreds of thousands of year,” cautioned one infectious disease epidemiologist. “And we all expect it to get worse if something isn’t done now.”

But what can be done?

Health officials’ top priority is the development of new antibiotics, and in 2016, 193 countries signed a United Nation declaration to encourage drug research. “We need governments, the pharmaceutical industry, health professionals and the agricultural sector to follow through on their commitments to save modern medicine,” said England’s chief medical officer.

But developing new antibiotics is a long, slow, and very expensive process. It can take 10 years to bring a new drug to market and 23 years for the investment to start paying off.

The world can’t afford to sit and wait.

In the meantime, we all — governments, employers, individuals — can take immediate action to combat the superbug crisis. The strategy must be two-pronged: 1.) halting antibiotic overuse, in both humans and farm animals, and 2.) preventing infections.

Stopping Antibiotic Overuse — in Humans and Livestock

Antibiotics are useless against viral infections, such as colds, coughs, bronchitis, the flu, and many ear and sinus infections. And yet, out of habit or in response to patient demand, doctors routinely prescribe antibiotics for these conditions. In the United States, more than 30 per cent of oral antibiotic prescriptions — about 47 million per year — are unwarranted, according to a study published in the Journal of the American Medical Association.

Worldwide, medical authorities are working to halt this practice. In 2015, the U.S. government set a goal of reducing inappropriate outpatient antibiotic use by at least half by 2020, and The National Health Service of England reduced antibiotic prescriptions by 5 per cent in one year and is striving for further reductions.

At the same time, behavioural scientists are studying ways of spurring doctors to stop prescribing unnecessary antibiotics, and medical organizations are educating patients to stop requesting them. As one doctor noted, it’s an uphill battle: “For some reason, faith in the body’s natural ability to heal itself has waned, and everyone believes that an antibiotic is the only possible cure that could help.”

Another critical strategy in the fight against superbugs: curbing antibiotic overuse in cattle, chicken, turkeys, and pigs. Two-thirds of antibiotics consumed in the European Union and 70 per cent consumed in the United States are given to healthy farm animals, either to promote growth or prevent diseases common in overcrowded conditions.

This is no small problem, as antibiotic-resistant bacteria jump easily from the animals to humans, via farmworkers, anyone handling raw and contaminated meat, and anyone swimming in or drinking water contaminated with animal faeces.

The U.S. government, a decade behind the European Union, has finally enacted rules to limit antibiotic use in livestock. But the rules have loopholes and don’t ban all antibiotic use, and some countries have no such laws.

Retailers and consumers need to pick up the slack: Restaurants must stop selling antibiotic-laden meat, and consumers must stop buying it.

Progress is happening, albeit slowly. Chains such as Subway, McDonald’s, and In-N-Out Burger are shifting away from meat raised with antibiotics. But Olive Garden, Starbucks, and Burger King are among those receiving an “F” grade for taking no such action.

Preventing Infections That Require Antibiotics

Halting antibiotic overuse is imperative, but it’s only part of the superbug solution. We must also work to prevent the bacterial infections that have become harder to treat, as well as the viral infections that are treated inappropriately with antibiotics. After all, if fewer people show up at the doctor with a sore throat, whatever its cause, fewer antibiotics will be prescribed.

Preventing infection can be accomplished with simple measures:

  • Increasing vaccination rates. Anyone with the flu is more susceptible to a superbug infection, yet flu vaccination rates in the United States hover below 45 per cent for adults and are dismal in Europe as well.
  • Better handwashing practices. Seventy per cent of adults admit they’ve bypassed the soap in public bathrooms, and most of us don’t wash for the recommended 20 seconds. It’s important to wash with soap and warm water after coughing, sneezing, blowing your nose, feeding your pet, gardening, or visiting a sick person.
  • Cleaning the air. Even universal handwashing can’t contain influenza, because the virus can spread via airborne particles, which contain 8.8 times more virus than surface particles. Countless other viral and bacterial particles waft through our buildings, day and night, spreading all manner of infections. Yet today’s technology makes it easy and cost-effective for employers, schools, and medical facilities to rid the indoor air of these pathogens.

Superbugs won’t be vanquished any time soon, but the good news is, we’re well equipped to control the conditions that unleashed them. 

The Superbug Crisis is Here – And it is Dire

Back in 1999, infectious disease specialists were worried. Antibiotics, the most important medical development of the 20th century, were losing their power to combat dangerous bacteria, and few new drugs were in development.

As a British medical report noted at the time: “In the closing years of the century, there is an uneasy sense that micro-organisms are ‘getting ahead’ and that therapeutic options are narrowing.”

Today, infectious disease specialists are no longer uneasy. They’re panicked.

Overuse of antibiotics has unleashed “superbugs,” harmful bacterial strains resistant to the drugs that revolutionized medicine in the 1940s.

In the United States, more than 2 million people are infected by drug-resistant bugs each year, and 23,000 die of their infections, according to the U.S. Centers for Disease Control and Prevention (CDC). Globally, drug-resistant bacteria cause an estimated 700,000 deaths annually and are on pace to kill 10 million people a year by 2050 — more than currently die from cancer.

“If we are not careful,” a CDC official cautioned, “the medicine chest will be empty when we go there to look for a lifesaving antibiotic for somebody who has a deadly infection.”

The situation is so dire that the World Health Organization (WHO) has issued its first list of “priority pathogens”— bacteria with such severe antibiotic resistance they’re considered urgent threats to human health. WHO is imploring governments and pharmaceutical companies to accelerate the development of new antibiotics.

“The pipeline is practically dry,” said a WHO official upon release of the report. Companies have little incentive to invest in drugs that can take a decade to develop and are usually used as short-term treatment.

Meanwhile, as drug companies dawdle, superbugs proliferate.

A study of 48 children’s hospitals, for example, tracked infections of Enterobacteriaceae, a family of bacteria that includes Salmonella and E. coli, and found the percentage of cases resistant to multiple antibiotics increased 7-fold from 2007 to 2015, a finding the lead author called “ominous.”

In the study, children with resistant strains of the bacteria remained hospitalized, on average, for four more days than the children with more easily treated infections. Enterobacteriaceae, on the WHO’s list of priority pathogens, are responsible for many serious, sometimes fatal, infections that arise in hospitals and nursing homes.

Worldwide, infections once easily treated with penicillin, like tuberculosis, now require rounds and rounds of multiple antibiotics. Treating a drug-resistant strain of TB can now require 14,000 pills, take up to two years to treat, and cost nearly 30 times more than TB that responds to conventional antibiotics.

It is estimated that 70 per cent of bacteria around the world have already developed resistance to antibiotics.

What happens when the first-line and second-line antibiotics fail? Minor infections can become deadly, and doctors resort to using drugs previously shelved because they were considered too toxic.

At some point, for some infections, we may be left without any drugs at all.

In 2015, Canadian researchers found, the only remaining oral drug used for gonorrhoea treatment failed in 6.7 per cent of the patients at a Toronto clinic. Doctors now have just one effective treatment left: an injectable antibiotic called ceftriaxone.

And in 2016, for the first time, an American patient was infected with a strain of E. coli resistant to one of the “last resort” antibiotics, colistin, a drug that lost favour in the 1970s because of its harsh side effects, including respiratory distress and kidney damage.

The patient recovered after being treated by a different drug, but health officials fear this incident is a bad omen. “It is the end of the road for antibiotics unless we act urgently,” a CDC official said at the time.

The Dawn of the Superbug Era

Historically speaking, the rise and fall of antibiotics has happened in a blip. Penicillin, the first antibiotic, began production on a large scale in the 1940s. Discovery of new antibiotics peaked in the 1950s and 60s, but no new class has been developed since 1984.

“If antibiotics were telephones, we would still be calling each other using clunky rotary dials and copper lines,” quipped one microbiologist.

These old-school drugs worked well — until they didn’t. The dawn of the superbug era can be traced largely to overuse of antibiotics.

Antibiotics are worthless against viral infections like the common cold, flu, bronchitis, many sinus infections, and most sore throats, yet patients routinely exit the doctor’s office with an antibiotic prescription in hand.

Each year, more than 30% of U.S. oral antibiotic prescriptions — including half of all prescriptions for acute respiratory conditions — are unwarranted, according to a study published in the Journal of the American Medical Association.

Consider the sore throat: Only about 18 per cent of adults who show up at the doctor with a sore throat test positive for strep and actually need antibiotics. Yet, the JAMA study found, 72 per cent of sore-throat patients are prescribed these drugs.

What’s the harm beyond wasted money?

Well, the unwarranted antibiotic, while doing zilch to fight the virus, will destroy some of the “good,” infection-fighting bacteria in the body. At the same time, other bacteria will outwit the drug and multiply. Over time, these drug-resistant bacteria will spread to others. That’s just one of the many ways bacteria can become resistant to antibiotics.

Also fueling the superbug crisis: the common practice of giving antibiotics to livestock to make them grow faster and stay healthy in their overcrowded facilities. This practice accounts for 80 percent of antibiotic use in the U.S.

It is imperative that these trends be reversed. Otherwise, as the director general of WHO cautioned, “a common disease like gonorrhea may become untreatable. Doctors facing patients will have to say, ‘I’m sorry – there’s nothing I can do for you.’” 

Legionnaires’ Disease: No Longer a Mystery, Still a Threat

In the summer of 1976, reports of a mysterious and terrifying infection outbreak dominated American news: 34 people died suddenly and 220 were hospitalized after visiting Philadelphia.

Patients developed headaches, chest pain, chills, and fevers up to 107 degrees. Autopsies of the deceased revealed lungs that resembled Brillo pads. Was it swine flu? Food poisoning? “Super” gonorrhoea? A terrorist attack? Theories abounded.

Months later, concluding the most extensive medical investigation in history, a microbiologist peered into a microscope and identified the cause: a previously unknown bacteria. Officials named it Legionella after the victims, military veterans who’d attended a convention of the American Legion.

Today, Legionnaires’ disease is no mystery. We know where it lurks and how it’s spread. We know between 8,000 and 18,000 people in the United States are hospitalized yearly with Legionnaires’ disease, along with tens of thousands more around the globe. We know the bacteria kills 10 per cent of those who contract the disease —  and 25 per cent of those stricken in a healthcare facility.

And yet, Legionella continues to wreak havoc, because little is done to contain it.

“Legionnaires’ disease in hospitals is widespread, deadly, and preventable,” said a CDC official, Anne Schuchat, M.D.

The disease garners headlines after mass outbreaks — on cruise ships, at conventions, at healthcare facilities — but these outbreaks account for just 4 per cent of total cases in the United States.

Incidence of Legionnaires’ disease more than tripled in the United States between 2000 and 2011. Worldwide, cases are vastly underreported. In England and Wales, a national surveillance program detects clusters of the disease and investigates the sources of infection. Today, as researchers have noted, Legionnaires’ is considered “an increasingly important disease from a public health standpoint.”

How Legionella Spreads

The Legionella bacteria actually cause two conditions: Legionnaires’ disease, a virulent form of pneumonia that must be treated with antibiotics, and Pontiac fever, a mild, flu-like condition that resolves within a week. Since Pontiac fever resembles other conditions and doesn’t require medical attention, many cases of Legionella infection go unreported — and the source remains unidentified.

Legionnaires’ disease and Pontiac fever aren’t contagious. Patients become infected by inhaling the airborne droplets of contaminated water, typically at facilities with large water systems, such as convention centres, prisons, schools, and healthcare facilities. (Legionella is found naturally in lakes and streams, but in amounts too low to cause disease.)

Investigators eventually traced the 1976 Philadelphia outbreak to contaminated vapour that rose from air conditioning cooling units atop a hotel. The droplets fell to the street below, where they were inhaled by pedestrians and sucked into the hotel lobby by fans on the side of the building.

In the decades since, air conditioning cooling towers have been ground zero for numerous Legionnaires’ cases, including the largest recorded outbreak, at a hospital in Spain, where some 800 patients were thought to have been infected.

Other Legionella breeding grounds have been identified, too: hot tubs, fountains, showerheads, whirlpool baths, hotel ice machines, and supermarket mist sprayers. At a flower show in the Netherlands and a fair in Belgium, attendees contracted Legionnaires’ disease from whirlpool spas in the exhibition halls. At a South Dakota restaurant and a hospital in Wisconsin, dozens were infected by mist sprayed from decorative fountains.

Legionella also thrives in respiratory devices such as humidifiers, vaporizers, nebulizers, and can grow in parts of building water systems that are continually wet, such as pipes, valves, and fittings.

Who’s Susceptible to Legionella Infection

Those at greatest risk of falling ill from Legionella are the medically vulnerable: people over age 50, current or former smokers, diabetes or lung disease patients, and anyone with a weakened immune system. That’s why hospital outbreaks are particularly deadly.

Still, relatively healthy people can become infected, especially if they work near contaminated water sources. For example, employees at wastewater treatment plants may be at elevated risk for infection, as sewage and aeration ponds can contain very high concentrations of Legionella.

Patients typically come down with symptoms within 2 to 10 days after exposure. Infection rates are highest in the summer when air conditioners kick into heavy use and water chemistry changes due to warmer outdoor temperatures. But Legionnaires’ disease can strike at any time of the year.

Preventing the Growth and Spread of Legionella

For facility maintenance managers, preventing Legionella infection has become a serious responsibility. After a deadly outbreak at a UK art centre, caused by a contaminated air conditioning system, the centre’s governing council and architect were charged with corporate manslaughter. Though they were acquitted after a trial, they were fined for safety breaches.

Protecting patients and patrons from Legionella infection requires vigilance on two fronts: keeping water systems clean and cleaning the surrounding air.

For years, prevention efforts at hotels, hospitals and other large venues have focused solely on the water half of the equation. Legionella bacteria are wily and hardy, easily adapting to their environment, surviving for long periods — even in chlorinated drinking water systems — and then pouncing when conditions are just right.

Water temperature plays a big role in Legionella growth. Because Legionella thrives in warm water, experts recommend hot water temperature be kept at 55 degrees Celsius (131 °F) or above. But this can be a challenge; in some countries, regulations that keep residents and hotel patrons from being scalded by showers also keep maximum temperatures too low to halt Legionella growth.

Stagnating water also allows Legionella to flourish. Facilities must take precautions during hotel renovations or off-peak seasons; hospitals must know which showers are rarely used.

Countless other water-related scenarios can promote Legionella growth. An inadequate disinfectant is introduced. Vibrations from construction cause a change in water pressure. Heating or filtering processes degrade water quality, using up extra disinfectant.

Legionella water management programs are both critical and complex, typically requiring expertise from microbiologists, industrial hygienists, or environmental health specialists.

Also critical — but much simpler — are strategies to clean the air.

In order for Legionella-contaminated vapour to be inhaled and attack the lungs, the bacteria must remain airborne. So, prevention efforts must focus on making the air less hospitable for the bacteria to survive and proliferate.

At this point, much remains unknown about how precisely Legionella is transmitted from water to air. It’s unclear, for example, what air temperature and humidity are best for the bacteria to thrive and how long Legionella can survive in the air.

What we do know: Legionella can travel long distances. In a Danish study of a Pontiac fever outbreak, bacteria were recovered 200 meters downwind of an aeration pond at a water treatment plant. And epidemiological studies have suggested Legionella can be dispersed greater than 10 kilometres from wastewater treatment plants.

What’s more, certain strains of airborne Legionella can survive for several hours, under the right conditions.

It’s therefore essential for facilities to deploy continuous and strategically placed air purification technology. Novaerus air disinfection technology has been shown in laboratory testing to reduce infectious, gram-negative bacteria like Legionella.

The year following the Philadelphia Legionella outbreak, investigators used blood samples to identify the bacteria as the culprit in other unsolved infection outbreaks, dating back to 1957. But as a documentary of the discovery noted, it is likely that Legionnaires’ disease “has been killing us for thousands of years.”

Now that we know so much more about Legionella — where it thrives, how it’s transmitted, and how to prevent its spread in the water and air — we are well equipped to stop the bacteria in its tracks. 

Sick Building Syndrome – It’s Up In The [Hospital] Air

It’s a terrible irony: around the globe, countless buildings that were designed for healing are actually making their occupants sick.


Studies show that sick building syndrome (SBS), considered a “a major occupational hazard,” may be especially prevalent among employees in healthcare facilities.


Among the symptoms experienced by nurses and other healthcare workers: headaches, nausea, itchy skin, throat irritation, watery eyes, and impaired concentration.


“SBS manifests as weakness and fatigue, reduced productivity and increased absence from work,” according to a study of sick building syndrome among nurses, published in the Global Journal of Health Science. “Considering the nurse’s important role in saving the lives of patients and hospital infection control, this is notable.”


To say the least! Certainly anyone responsible for the wellbeing of a healthcare facility’s employees should be aware of SBS symptoms and the potential for hospitals and nursing homes to trigger them.


Air pollution in office buildings has drawn much attention and is easier to research than in the hospital environment; the presence of infected patients, the common use of latex, as well as a highly mobile workforce make it more challenging for scientists to design high-quality studies on SBS in hospitals.


Nonetheless, a number of careful studies have assessed sick building syndrome in the healthcare arena and concluded it’s a problem.


For example, a study examining three Iranian hospitals found that 86% of nurses experienced sick building syndrome, with headache and fatigue among the most common symptoms reported. In addition, among those nurses reporting SBS symptoms, 90.7% sensed a foul odor coming from toilets, medicines, hospital kitchens, and chlorine.


SBS in healthcare facilities appears to be global concern. A hospital study in Spain found
“unpleasant odor, irritation and watery eyes, sore throat, redness and inflammation of the skin” as the most common symptoms. One Swedish study noted, “the high complaint rate . . . shows a need to improve the indoor environment in hospitals.” Another Swedish study concluded that “more focus is needed on the indoor environment in schools and day care centres, hospitals and nursing homes for elderly.”


Sick building syndrome is well known to be caused by a combination of biological pollutants (such as bacteria, viruses, and molds) and chemical contaminants (mainly volatile organic compounds, aka VOCs, emitted by furniture, carpeting, adhesives, cleaning solutions, and personal-care products).


Given the ubiquity of drugs, detergents, disinfectants, and solvents in hospitals and nursing homes — not to mention the virus and bacteria particles floating about — it is hardly surprising that SBS is common in the healthcare environment.


In the United States, most hospitals are older buildings, not designed to minimize the effects of high-VOC building materials, gases from anesthesia, lab chemicals, dust from renovations, and the like. Hospital floors are typically made of vinyl tile, requiring continuous waxing and stripping.


As sick building syndrome and the hazards of indoor air pollution gain more attention, green building will become the norm. Newly built hospitals are using low-VOC construction materials and installing roof gardens, windows that open, and natural flooring that can be cleaned with just soap and water. At some point in the distant future, sick building syndrome may become a thing of the past.


But for now, hospitals, nursing homes, and other healthcare facilities must work with they have.


Among the various remedies for SBS — improving ventilation, banning perfumes and VOC-emitting products, replacing carpeting and furniture, and so on — the most effective and practical may be to clean the air.


In the past, air purification was either inadequate or too expensive, but technology has advanced to the point where cost-effective purification systems can remove the tiniest and most damaging toxic airborne particles, whether biological or chemical in origin.


At this point, most of us can’t escape exposure to indoor pollutants. However, those in charge of healthcare facilities can take steps to control the toxins that make its highly valuable employees ill.

Sick Building Syndrome: The Triggers

For any given case of sick building syndrome (SBS), the trigger can be hard to pinpoint.


In fact, the mystery is part of the very definition of the syndrome. The U.S. Environmental Protection agency defines SBS as “situations in which building occupants experience acute health and comfort effects that appear to be linked to time spent in a building, but no specific illness or cause can be identified.”


But this much is certain: SBS symptoms — headaches, nausea, fatigue, itchy skin, throat irritation, watery eyes, and impaired concentration — are linked with exposure to both chemical and biological contaminants.


Science has not yet identified specific measurements of indoor contaminants that put workers at risk, according to the U.S. Centers for Disease Control and Prevention (CDC), and it’s likely that different varieties and amounts of pollutants affect individuals in different ways.


For one building occupant, the gases emanating from cleaning products or new hallway carpeting may be the source of nausea; for another, it may be cooking odors emanating from the hospital kitchen. And what is annoying to one person may be debilitating to another.


Nonetheless, research has identified the most common SBS sources, and anyone responsible for the wellbeing of a facility’s occupants should be aware of them.


First, let’s talk chemicals. Thanks to workplace smoking bans and lower smoking rates, tobacco toxins have become less of a hazard to indoor air quality. However, volatile organic compounds (VOCs) remain a huge threat in the workplace and school environments.


VOCs are toxic gases emitted by the products we walk on, sit on, wear, and use to do our jobs every single day. In other words, carpets, desks, shelving, upholstery, adhesives, copy machines, and personal products such as shampoos, perfumes, lotions, and hand sanitizers. Products needn’t even be scented, or emit obvious odors, to trigger symptoms. Deodorants, cosmetics, and cleaning supplies designated as “unscented” may actually contain chemicals used cover up odors emitted by other ingredients.


What these products have in common: they all contain compounds refined from petroleum, and they’re everywhere.


In fact, indoor concentrations of VOCs are often 10 times higher indoors than outdoors. In urban areas, new research shows, the compounds contribute just as much to air pollution as vehicles.


But VOCs are not the only source of toxins wafting around “sick” buildings. Bacteria, viruses, mold, dust mites, insect droppings, and pollen are among the biological contaminants that can trigger the syndrome.


What’s more, not all the triggers of SBS originate from within the building. About 11 percent of the contaminants — such as vehicle exhaust, construction materials, and tobacco smoke — waft in from the outdoors via vents and windows.


Just as some people are more susceptible to SBS due to their genetic makeup and health status, some buildings are more susceptible due to their construction.


Sick building syndrome dates back to changes in building construction that followed the 1973 oil embargo against the United States. To save on fuel for heating and air conditioning, buildings lowered ventilation standards by two-thirds, requiring a paltry 5 cubic feet per minute (cfm) of outside air per occupant. In other words, buildings became practically air tight.


These days, U.S. building codes have improved considerably, typically requiring a ventilation rate of 20 cfm per person. However, many older buildings have not been upgraded, and standards vary greatly around the globe. In dense urban areas with limited land for high-rise construction, buildings often lack adequate ventilation.


Besides, workers can experience sick building symptoms even at 20 cfm. According to the Environmental Advisory Council, ventilation rates would have to exceed 53 cfm per person to make SBS vanish.


But ventilation alone can’t clear up the problem — not when a building is cleaned with chemicals that emit VOCs, lined with toxic carpeting, contaminated by mold within the HVAC system, or occupied by staff who wear VOC-emitting perfumes.


A building’s interior design can also contribute to SBS. For example, the arrangement of cubicles and offices can compromise indoor air flow and exacerbate the itchy eyes, respiratory problems, nausea and other symptoms triggered by biological and chemical pollutants.


In short, indoor environments are highly complex, and occupants are exposed to a mix of chemical and biological contaminants from a vast array of sources.


However, just because the cause of SBS is complex does not mean the solution is equally complex. In fact, technology has progressed to the point where a single remedy — air purification — can, quite effectively, rid a room of pollutants as different as nausea-inducing gases and allergy-inducing pollen.

The Headaches of Sick Building Syndrome

Sick building syndrome may sound like one of those nebulous conditions supported by questionable science.


Far from it.


Sick building syndrome (SBS) is, in fact, well defined and well documented — “a major occupational hazard,” as one research  paper put it, and a “growing problem in the United States and around the world,” according to another.


Sick building syndrome is a cluster of medical symptoms that are triggered by exposure to indoor air pollutants and linked to time spent in a particular building. In other words, if the symptoms clear up when folks leave the building, you’re looking at SBS.


Symptoms vary from person to person but include headaches, nausea, fatigue, itchy skin, throat irritation, watery eyes, impaired memory and concentration.


The syndrome should be on the radar of anyone responsible for the wellbeing of a building’s occupants. Whether your facility houses a school, nursing home, hospital, business, or organization, you can’t ignore a fact that’s becoming increasingly clear: the contemporary office environment can be toxic.


A general feeling of tiredness is often the most prevalent symptom, notes Occupational & Environmental Medicine, a BMJ journal: “It usually starts within a few hours of coming to work, and improves within minutes of leaving the building.” The typical headache is usually described as a dull “pressure on the head.” Also common: “the sensation of a blocked or stuffy nose” and “a feeling of dryness of the throat” that can be particularly problematic among those who spend most of their day on the phone.


For some employees, the symptoms are downright debilitating. “As soon as I entered the building, it felt like the breath was sucked out of me,” noted a New York web designer who suffered from SBS.


Others experience less acute but more constant symptoms. As another affected person put it: “The suffering becomes the norm. But once you move out of the sick building, THAT is when you really become aware of just how low the bar was set on the air quality in the toxic indoor environment you got used to suffering in.”


The misery of building occupants can get expensive for companies. Each year, sick building syndrome costs organizations an estimated $200 billion in worker productivity, efficiency, absenteeism, and higher staff turnover. By some estimates, companies annually lose 2% in productivity alone due to poor air quality. They may even face legal ramifications, as personal-injury lawsuits filed over sick building syndrome on the rise in some regions. Some companies have been forced to foot expensive bills for furniture replacement, partial or total evacuation of the building, remediation, and reconstruction.


Sick building syndrome is linked with exposure to two categories of pollutants: chemical contaminants (primarily gases emitted by furniture, adhesives, office machines, perfumes, and other products containing compounds refined from petroleum) and biological contaminants (bacteria, viruses, molds, pollen, insect droppings). The syndrome is particularly common in healthcare facilities, including nursing homes and hospitals.


Sometimes sick building syndrome is obvious — for example, when absenteeism spikes or when an odor is so unpleasant that everyone’s talking about how nauseous they feel. More often, indoor pollutants do their damage silently, and many employees suffer without consulting management, so it takes a while before people put two and two together.


Although many buildings today are designed and constructed with the goal of preventing sick building syndrome, older facilities — where the vast majority of companies and organizations are housed — must work with what they have. As Occupational & Environmental Medicine noted, sick building syndrome occurs even in buildings that “fully comply with current design standards in terms of temperature, ventilation, and lighting.”


In most buildings, occupants can’t escape exposure to indoor pollutants, but those in charge can take many steps to control them.


Among the various remedies for SBS — improving ventilation, replacing carpeting and furniture, and banning perfumes and other products that emit toxic gases — one effective and practical way is to clean the air.


In the past, air purification was either inadequate or too expensive, but technology has advanced to the point where cost-effective purification systems can remove the tiniest and most damaging toxic airborne particles, whether biological or chemical in origin.


For occupants of “sick” buildings — whether employees, students, hospital patients, or nursing home residents — the symptoms range from irritating to unbearable. Fortunately, for those in charge of facilities, air purification can be a relatively simple means of improvement.

Urban Air Pollution – It’s Common Scents

For most schools and employers, air pollution isn’t high on the list of concerns. After all, car exhaust and gas fumes aren’t fouling the air inside classrooms and cubicles. Even those idling yellow school buses have cleaned up their act; today’s buses are 60 times cleaner than those built a generation ago.


Yet students, staff, and employees actually do face an air quality threat — from pollutants wafting about indoors.


The culprit: harmful gaseous emissions from shampoos, perfumes, lotions, printer ink, cleaning solvents, glues, hand sanitizers, and other products that contain compounds refined from petroleum.


In fact, in urban areas, consumer products now cause as much air pollution, in the form of volatile organic compounds (VOCs), as exhaust-spewing tailpipes, according to a new study published in Science.


“These volatile chemical products now contribute fully one-half of emitted VOCs in 33 industrialized cities,” write the study’s authors, scientists affiliated with the National Oceanic and Atmospheric Association (NOAA).


As vehicles get cleaner, it’s critical we turn attention to these less visible sources of pollution, notes one of the researchers, University of Colorado scientist Brian McDonald, Ph.D., “The stuff we use in our everyday lives can impact air pollution.”


That impact is huge — two to three times greater than previously estimated, according to the researchers. And the implications are greatest for workplaces, school campuses, and other enclosed environments where most of us spend our days.


Indoor concentrations of VOCs are often 10 times higher indoors than outdoors, the NOAA authors note.


You can’t see the gases emitted when custodians sanitize the cafeteria, the handyman repaints the conference room, or cologne-wearing staff walk the hallways. But the products they use contaminate the air just the same.


In fact, many of these products are designed to remain airborne. Whereas gas is store in airtight containers, “you wear perfume or use scented products so that you or your neighbor can enjoy the aroma,” notes atmospheric chemist Jessica Gilman, Ph.D., one of the NOAA researchers.


Even if the aromas released by sandalwood cologne and coconut-scented shampoos are pleasant (at least to some!), the potential health effects are decidedly not. Headaches, nausea, shortness of breath, skin irritation, fatigue, dizziness, blurry vision, and difficulty concentrating are just some of the symptoms linked to gases emitted from consumer products.


Products needn’t even be scented to trigger these symptoms. Deodorants, cosmetics, lotions, and cleaning supplies labeled “unscented” may actually contain chemicals used to mask the odor of other ingredients.


Among individuals, chemical sensitivity varies considerably. What is annoying to one person may be debilitating to another. But it’s clear that large segments of the population are affected, in one way or another, by VOC pollution.


More than 30% of Americans find scented products irritating, and 19% reported adverse health effects from air fresheners, according to two surveys published in the Journal of Environmental Health. In another survey, 30% of adults with asthma said air fresheners caused them breathing difficulties. For the most sensitive, even miniscule amounts of chemical vapors can trigger an asthma attack.


But damaging effects of indoor air pollution likely extend beyond the acute. Exposure to certain VOCs has been linked to lung disease, cancer, and neurological problems, according to the U.S. Centers for Disease Control and Prevention.


A review published in The Lancet listed air pollution among the top five global mortality threats, designating “ambient particulate matter pollution” as the largest air pollution risk. As the NOAA scientists noted, VOCs wafting in the air can react to produce this damaging particulate matter.Given the documented links between VOCs and health problems, use of toxic consumer products is now considered a health and safety issue in the workplace.


Businesses, organizations, and schools are taking a variety of approaches to protect those who work indoors.


Worldwide, countless campuses, health centers, restaurants, auditoriums, and churches have banned scented products or have created “scent-free” sections. Some municipalities have banned chemical air fresheners in city-owned restrooms and workplaces and switched to using less toxic cleaning and maintenance products.


But these approaches, while certainly helpful, inevitably fall short — and sometimes provoke a backlash.


As one woman — a human resources professional and a “perfume nut”— blogged, the issue of whether to ban scents in the workplace “is a big conundrum and an absolute minefield for us HR people.” She asks:  “Is this a case of the PC Police taking things one step too far? Where does it stop?”


But even if employers and schools could, without controversy, ban scented products, it’s impossible to outlaw every consumer product that emits VOCs. There are simply too many. And in addition to the products we know release toxic gases, countless others have yet to be identified.


A more practical response to the “big conundrum” faced by organizations that operate indoors: clean the air.


That’s right. We can’t rid the world of toxic products — at least not yet — but technology makes it possible to purge indoor air of the toxic particles these products emit.


Even better, the same purification devices that remove VOCs also remove bacteria, viruses, mold, and other air contaminants that make people sick.


Installing these devices is a lot simpler than convincing the HR department to ban perfume.

Asthma, Allergies, and Absenteeism

Given the huge toll the flu takes on schools, it’s always a relief for staff when winter fades into spring and the elm trees start blooming. Except for this: the end of flu season means the beginning of allergy season.

Fever and chills may be over, but runny noses, itchy eyes, and sneezes are in store for millions who walk the K-12 hallways or join circle time at preschool.

“Allergen levels in schools can be significantly higher than in the home environment,” note researchers at the National Institutes of Environmental Health Sciences, in a study of indoor allergens at school and daycare environments.

In the United States alone, allergies and asthma account for more than 10 million missed school days per year, enough to compromise academic performance in those with sensitivity. Asthma is the most prevalent chronic illness in children, affecting about 10% of school-age kids, and that number is on the rise for unknown reasons. Asthma is also a known occupational health problem among teachers and teacher’s aides.

Among school-aged children, asthma is the top cause of absenteeism, and these absences are often triggered by the proliferation of springtime allergens in the school environment, such as grass and tree pollens floating about, along with some surprising perennial sources.

Interestingly, while influenza and allergies have entirely different causes and strike in different seasons, these conditions have an important commonality: they are often transmitted through airborne particles.

This means allergies, like the influenza virus, can be contained by purifying indoor air — a highly effective and cost-effective mitigation strategy that is often overlooked.

Children in daycare and elementary school classrooms are at particularly high risk of exposure to airborne allergens. Not only are these classrooms loaded with potential “allergen reservoirs” — such as upholstered furniture, pillows, toys, books, and stuffed animals — but younger kids are constantly on the move. When these kids plop on the beanbags, shake out blankets, flip through books, or toss soft toys about, they launch allergens into the air.

As a research team of Texas immunologists put it, younger kids are “typically more physically active in schoolrooms thus increasing air turbulence.”

Schools Must Step Up to Clear the Air

It’s long been known that exposure to allergens at home triggers watery eyes, runny nose, fatigue, and other allergy symptoms in children. Parents of sensitive kids are urged to take all the usual precautions: keep pets super clean, have kids bathe nightly, zealously vacuum and dust, replace carpeting with hardwood or linoleum, dump houseplants with mouldy soil, and keep the kitchen crumb-free, so as to fend off allergy-triggering cockroaches.

It’s not easy to keep a household free of allergens — but it’s also not enough. After all, kids spend 8 hours a day, 5 days a week at school, where the top allergen sources may be entirely different. For example, mice.

The School Inner-City Asthma Study, which tracked students at 37 American public schools, found mice allergen in 99.5 per cent of samples taken from classroom floors, desks, and chairs. The mice allergen levels detected at school were significantly higher than mouse allergens detected in the students’ homes.

The more exposure to school mouse allergens, the greater the children’s asthma symptoms, the researchers found. In fact, children with mouse allergen exposure at the 75th percentile experienced asthma symptoms on 12 additional days over the school year compared to kids at the 25th percentile of exposure, according to the authors.

Numerous other studies suggest that students are exposed to cat and dog allergens at school — allergens that hitch a ride to the classroom via the clothing and hair of pet-owning students and staff, then find their way onto surfaces and into the air. Dust mite and cockroach allergens also have also been detected in surface and airborne samples from daycares and schools, research shows.

The bottom line, according to the National Institutes of Health researchers: “Indoor air quality in schools and daycare environments can affect millions of people including students and staff.

Allergen exposures at schools may be so high, according to the researchers, that all the zealous cleaning parents do at home may be for naught.

“It is essential,” they conclude, “to establish cost-effective approaches to reduce allergen levels in these indoor environments.”

So what can schools do to help alleviate all the runny noses and itchy eyes?

Well, in one study, a Swedish school had tremendous success lowering cat allergen levels — except that “rigorous,” the term used by researchers, doesn’t even begin to describe the study’s intervention measures. Children from pet-free households were taught separately and used a separate school entrance, school clothes were worn and laundered only at the school, and teachers changed clothes before entering the classroom.

Not exactly a realistic model!

And school custodians can only do so much to keep school floors, cafeteria tables, and desks free from allergens. Schools are active, busy, lively places, and allergens inevitably get launched into the air. While improved ventilation systems may help some schools, a far more cost-effective approach is to use today’s technology to clean the air.