To say it’s been a tough 18 months for healthcare facilities is a vast understatement. It’s been beyond challenging for maintenance and engineering managers, who often have had to respond to the COVID-19 pandemic by making quick decisions in response to changing conditions and realigning limited resources — all in an effort to protect the health and safety of patients and staff.
“It was very stressful,” says Gary Brown, director of engineering with Texas Children’s Hospital in Houston. “There was a lot of improvisation and education and learning.”
Among the lessons many managers and their departments had to address involved the implementation of products and technology designed to control the spread of the coronavirus. Among the highest-profile and most-discussed of these technologies is ultraviolet C (UVC) radiation technology that disinfects air, water and nonporous surfaces.
UVC technology is not new to Texas Children’s Hospital.
“We've had UV lighting in all of our patient air-handling units for seven to 10ten years,” Brown says. “We've felt it important both from an air quality standard, as well as a maintenance improvement for those air handling units.
“Most of them that we have are in air handlers adjacent to the chilled water coils, and we have more than 100 air handling units.”
Texas Children's Hospital is made up of three different hospitals. The main campus in Houston contains more than 3 million square foot in seven buildings —-- four inpatient and three outpatient and research —-- with 954 beds.
Air-handling units have become critical for creating safe and comfortable indoor environments in the local climate.
“Here in Houston, I don't think it matters how thick the coil is,” he says. “You get too thick, you lose efficiency. We have to pre-cool, so we put in a lot of outside air- handling units. All they're doing is pre-cooling and trying to do a little bit of drying out of the air before it gets to our regular air-handler units.”
Initially, the department invested in UV technology for a maintenance challenge it was facing.
“The biggest attraction was the ongoing problems we experienced with trying to keep up with bacteria buildup and fungal buildup in the drain pans of air handlers,” Brown says. “You're always having to use tablets, and over a period of time, the tablets eat away at the galvanized drain pans, which rust through or would break up and clog the drain.
“That wasn't helping the coil buildup, so after we installed several units. We started seeing how well it worked on the coils — keeping buildup down, as well as no more tablets and no more chemicals — that made a big difference to us from a maintenance perspective.”
Brown says the department bought into the technology based on careful research and recommendations.
“It came after a gradual understanding of the technology and then some testimonials from some of my colleagues,” he says. “When you attend ASHE every year, you certainly get to be exposed to a lot of different technologies and have a chance to have dialogue with other facility people.”
The department also was careful to address the potential safety risks related to UVC technology, which can cause severe burns of the skin and eye injuries. In addition, some UVC lamps generate ozone, which can cause irritation to breathing passages.
“All of our windows that are put in air handlers now have the UV film on them, and the staff have been trained through the safety department, so they know they can't be in the room while that unit is on,” Brown says. “There's also a sign that's hung on the windows that are open to the hallway. They usually pull the blinds so no one can physically walk in the hallway and be exposed to the UV light.”
The pandemic outbreak in February 2020 prompted discussions of UVC technology and its effectiveness in deactivating the SARS-CoV-2 virus, which causes COVID-19.
“There was talk about it in terms of an air quality standard,” Brown says. “You really have to have a lot of UVC light when you're passing 500 cubic feet per minute across a coil for it to be able to kill on first exposure, and we don't always have that.”
The hospital’s UVC units are located within its HVAC systems. It does not use any upper-room UVC systems in its facilities. But at the pandemic’s outbreak, the department considered other applications for UVC technology
“From an environmental services standpoint, they purchased several moving units and started using them in some areas — the ORs, for example,” Brown says. “Once a patient is discharged in some of our high-risk areas, we also use UV technology that is on a stand. Our environmental services team goes in and exposes the room to UV light. There are several of those machines that we still have that they pull in and park.”
Another potential application sought to address shortages of personal protection equipment for hospital staff that have challenged healthcare facilities throughout the pandemic.
“When there was a shortage of masks, the hospital experimented with trying to sanitize masks, but they never got to a comfort level utilizing that technology,” he says. “It had a tendency to shorten the life of the mask because it would eat away at the elastics that went around the ears, and there was an odor to the mask once they'd done that.”
Staying the course
The pandemic prompted many hospitals to rethink and revise a range of processes and activities in order to protect patients and staff from the coronavirus, but Brown says the department generally stayed the course when it came to UVC technology.
“We didn't change anything, although we did replace quite a few of the unit's bulbs just to have fresh sets of bulbs in there,” he says. ”We have them on monthly maintenance, but we typically look at trying to change them out annually. We've certainly done a little bit of a refresh on some of the more critical areas — the ORs, the bone marrow hematology oncology, and the NICU units.”
The department’s two-pronged effort to prevent the spread of COVID-19 also included a review of its air filtration materials and practices.
“From a UV standpoint, again just in the areas that we called high risk that were immunocompromised, we refreshed those units,” he says. “We installed new UV bulbs and then verified the filters. We typically change filters based upon a pressure drop, so we verified efficiency to see that we didn't need to go ahead and change filters, that we still had some runtime left on those. If they were borderline, we went ahead and changed them out.
“We just wanted to make sure we were maintaining above a MERV 13 rating on a lot of our filter units. There was more of an emphasis put on the filtration than there on the UV from an infection-control perspective.”
Brown says his department relied on the expertise of the hospital’s infection control department to address changes in air filtration.
“We partnered with them and verified all their requests, which were for the MERV 13 filters,” he says. “They follow a lot of the CDC guidelines, so we took a lot of instruction from them because we're certainly not experts in that area. The filter manufacturer also assured us the fabrics or the material they use were stopping any of the particulates that could carry some of the COVID spurs.”
Dan Hounsell is senior editor for the facility market. He has written about facility management for more than 25 years.