The Covid-19 pandemic had devastating consequences for the UK care home sector, with the CQC reporting more than 39,000 deaths between 10 April 2020 and 31 March 2021.
At first, PPE was in short supply and the emphasis was placed on cleaning, before the World Health Organization (WHO) declared in November 2020 that the chief risk of Covid transmission came from inhaling aerosols rather than touching surfaces. Pathogens like Covid-19 exist in aerosols emitted by ill people when they breath, talk, cough or sneeze, which remain suspended in the air in poorly ventilated indoor spaces.
Research published by the Department of Health and Social Care found that being in a properly ventilated room can reduce the risk of Covid-19 infection by more than 70%. Another report examining aerosol-transmitted influenza determined that enhancing indoor air quality could be as effective in reducing the transmission of viruses as vaccinating 50-60% of the population.
The WHO’s recommended air change rate is now 10 litres of fresh air per person per second (l/p/s), a target that many care homes – even in relatively new buildings – cannot achieve.
Mechanical ventilation systems are often non-existent or lack the efficiency to deal with infectious particulate matter. Natural ventilation is not a viable option during winter when care home occupants need to be kept warm without spiralling heating costs.
That’s where air purification can help, bridging the gap between the desired fresh air delivery rate and that actually achievable, without relying on opening windows.
“Our family members understandably complain about cold drafts, so ventilation is a real challenge”, says Anita Astle MBE, Managing Director of Wren Hall (Nottingham) and member of the Board of Directors at the National Care Association. “ By purifying the air instead of bringing in outdoor air, we are able to help prevent viral transmission, keep everyone warm and save on energy costs for heating. It’s a complete solution and we can all detect a difference in the freshness of the air.”
Care homes typically place air purifiers in heavily occupied, communal areas, such as lounge or dining room spaces, where infection is most likely to spread among residents. This helps prevent outbreaks and protects visiting relatives and staff, as well as residents. Portability is important, allowing units to be moved around to support events, such as game or cinema nights when people congregate in one area:
“The portability of the units is a distinct advantage”, explains Carl Richmond, CEO at Brookvale care home (Prestwich). “ It enables us to move them around to where they’re needed most on any given day, depending on the activities taking place. We think of them as fellow members of staff, working around the clock to protect us all.”
But with a wide choice of air purification products and technologies on the market, care homes naturally need guidance before making an investment.
The UK SAGE committee is the best source and recommends that “ Air cleaning devices where the primary principle of operation is based on fibrous filtration (i.e. HEPA13 filters) or germicidal UV (UVC) are likely to be beneficial if deployed correctly. These devices are recommended for settings where the ventilation is poor, and it is not possible to improve it by other means.”
The SAGE guidance goes on to warn about unproven technologies that, in addition to being potentially ineffective, could emit harmful by-products: “Devices based on other technologies (ionisers, plasma, chemical oxidation, photocatalytic oxidation, electrostatic precipitation) have a limited evidence base that demonstrates effectiveness against SARS-CoV-2 and/or may generate undesirable secondary chemical products that could lead to health effects such as respiratory or skin irritation. These devices are therefore not recommended unless their safety and efficacy can be unequivocally and scientifically demonstrated by relevant test data.”
Rayners care home (Amersham) heeded the advice and, after doing their research, realised that the air purifiers needed to be robust, with a powerful fan to ensure that air circulation is not limited to the space around the device itself but reaches far and wide within a shared space:
“We had come across HEPA and UVC separately and Rensair’s ‘double whammy’ combining both technologies in one compact unit appealed to us”, says Jim Matthews, CEO at Rayners. “The entrapment of particles prior to destruction with UVC is important, otherwise stray virus particles may still get through the system. The other key attribute was powerful air circulation’.
An investment in air purification may be driven by the Covid pandemic but it’s equally effective against many other seasonal viruses and infections, from flu to the common cold. It also brings other benefits, including the removal of odours and general wellbeing due to the beneficial impact on people’s cognitive functions. Another substantial benefit, especially at present, is cost savings on energy consumption from keeping windows closed, which can quickly offset the capital cost of the air purifier devices.
Needless to say, continued vaccination is essential and many would describe this infection control method as the first line of defence for care home residents. But the reality is that vaccines, while they limit the severity of the infection, do not prevent the spread. Care homes therefore need to take every precaution. “New vaccine-resistant variants could potentially emerge”, warns Anita Astle. “We will do everything in our power to protect those in our care and avoid further outbreaks. We certainly feel safer with our Rensair air purifier units as the first line of defence.”
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