Clean air should be the first line of defence for care homes

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 breathe, talk, cough or sneeze, which remain suspended in the air in poorly ventilated indoor spaces.

Ventilation mitigates the risk of infection

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 second per person (l/s/p) for ‘non-residential settings’, which refers to public and private indoor spaces characterised by a heterogeneous occupancy rate with people not belonging to the same household. That is a target that many care homes – even in relatively new buildings – simply 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.

Air purification is a practical solution

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. This delivers cost savings on energy consumption, which can quickly offset the capital cost of the air purifier devices.

“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 technical guidance from SAGE is clear

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.”

The benefits extend well beyond Covid

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.

Apart from energy savings, commercial benefits extend to a reputational uplift too, in terms of a care homes’ CQC ratings. To prevent further outbreaks of Covid variants, the CQC is currently rolling out infection prevention & control (IPC) inspections across care homes in England, with results published on their web site. The purpose is to provide assurances to the public that locations are safe and well prepared for the winter.

Care home managers can raise the bar by placing portable, hospital-grade air purifiers in communal areas. This approach not only helps with the IPC inspection, but also with the overall CQC rating. If improvement is needed in the all-important ‘Safety’ category, then a care home cannot attain an ‘Outstanding’ rating in any of the other 4 categories. It’s also a visible reassurance to residents and their families that precautionary measures are being taken seriously.

Indoor air regulation is on its way

Although the case for clean indoor air in care homes is clearcut, there is no regulation in place to enforce compliance with the WHO’s clean air delivery rate guidelines. That looks set to change very soon, driven by the pandemic and worsening ambient air quality.

The Clean Air (Human Rights) Bill, tabled by Green party peer Baroness Jenny Jones, has had its second reading at the House of Lords. If made law, it would tackle all forms of air pollution, both indoor and outdoor, and involve the UK Health Security Agency in setting and reviewing pollutants and their limits.

One stipulation requires owners of buildings which— (i) are used as places of work and to which health and safety provisions apply; or (ii) are regularly accessed by members of the public, including children, to assess and report concentrations of indoor air pollutants measured in accordance with the most up to date ISO standards.

The Clean Air (Human Rights) Bill is now due to pass on to the House of Lords’ Committee and Report stages. The initiative goes hand in hand with the latest Indoor Air Quality (IAQ) report from the National Engineering Policy Centre (NEPC). Commissioned by Government Chief Scientific Adviser Sir Patrick Vallance, with a foreword by England Chief Medical Officer Professor Chris Whitty, the report calls for a radical reform of ventilation and infection resilience across all buildings and public transport, with a heavy emphasis on IAQ standards being set, monitored and regulated.

Better safe than sorry

Needless to say, continued vaccination is essential to combat future Covid variants 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 of disease.

Care homes therefore need to take every precaution and removing pathogens is the most effective defence mechanism. With air purification, residents can be afforded extra care and protection without breaking the bank.