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Healthcare acquired infections (HAIs): What’s in the air?

Airborne bacteria and other pathogens can cause healthcare acquired infections (HAI). Get the facts and protect yourself.

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When a person catches an illness in the hospital or other healthcare facility, it is called a healthcare-acquired infection (HAI), also known as a nosocomial infection or hospital-acquired infection. These infections take a toll on patients, healthcare workers, caretakers, and health systems at large.

“Results from studies clearly indicate that, each year, hundreds of millions of patients are affected by healthcare-associated infections around the world.”

The World Health Organization (WHO) reports that most countries do not have systems to document HAIs. Many nations with HAI surveillance systems struggle to keep accurate data due to the complexity and lack of standardized criteria for diagnosing HAIs. While it is difficult to pinpoint an exact number, “results from studies clearly indicate that, each year, hundreds of millions of patients are affected by healthcare-associated infections around the world.”1

HAIs happen far more often in developed nations than most would like to admit.

HAIs happen far more often in developed nations than most would like to admit. For example, about 1.7 million Americans (one in ten patients) are infected in U.S. hospitals every year. Almost 100,000 of them die.2 In Canada, 220,000 HAIs occur (one in eight) every year and about 8,000 of those people die.3 It’s estimated that 2.6 million people in the European Union (EU) are affected by HAIs every year, resulting in at least 90,000 deaths.4 There is limited public information for China.5

Multidrug resistant bacteria: “Superbugs”

A growing body of evidence suggests that drug-resistant superbugs, which some scientists are calling "nightmare bacteria," are spreading more quickly inside U.S. hospitals than previously thought.6

A growing body of evidence suggests that drug-resistant superbugs, which some scientists are calling "nightmare bacteria," are spreading more quickly inside U.S. hospitals than previously thought.

When they're not drug-resistant, most bacterial infections can easily be treated with antibiotics. However, antibiotic resistance of strains within families of bacteria is a concern. Other multidrug resistant (MDR) bacteria known to cause hospital acquired infections include:

  • Methicillin-resistant Staphylococcus aureus (MRSA): This bacteria is resistant to many antibiotics and can cause a range of health issues from skin infections to sepsis, pneumonia, and bloodstream infections.7
  • Carbapenem-resistant Klebsiella pneumoniae (CRKP): Klebsiella pneumoniae (K. pneumoniae) is a bacteria commonly found in the human intestines. It does not cause health problems until a person is exposed to it outside of the intestinal tract. For infection to occur, K. pneumoniae must enter the respiratory tract to cause pneumonia or the blood to cause a bloodstream infection. Healthy people rarely get K. pneumoniae infections.
    Carbapenems are a class of antibiotics usually used as a last line of defense against certain bacterial infections (gram-negative) that are resistant to other antibiotics. This makes the development of CRKP especially concerning.8
  • MDR Pseudomonas aeruginosa: This bacterium primarily infects patients with a severe lung disease. It most often causes infections in people with cystic fibrosis (CF). P. aeruginosa infections in non-CF patients are most common in those with chronic obstructive pulmonary disease (COPD).9
  • MDR tuberculosis (TB): MDR-TB is a TB infection by tuberculosis-causing bacteria that are resistant to treatment with at least isoniazid and rifampicin, two of the most powerful anti-TB drugs.10
  • MDR Acinetobacter baumannii: A. baumannii has become a leading cause of HAIs in the U.S. and around the world. There are an increase of strains that are drug-resistant, particularly resistant to carbapenem antibiotics.11
  • MDR Clostridium difficile: Hospital-acquired Clostridium difficile infections are a growing problem in hospitals in the U.S. and many other countries.12

Other airborne pathogens causing HAIs 

The increasing number of healthcare-associated infections has received significant attention in recent decades, especially opportunistic fungal infections. These include:

  • Varicella-Zoster Virus (VZV): Virus that causes chickenpox and shingles13 
  • Measles (rubeola): Caused by a single-stranded RNA virus14
  • Smallpox: Caused by the variola virus15
  • Avian influenza (bird flu): Avian viruses occur naturally in bird aquatic birds around the world. They can infect poultry products and other animal species. Avian flu viruses have sporadically infected humans.16
  • Severe Acute Respiratory Syndrome (SARS): Remember SARS? It was a flu virus causing panic in the early 2000s.17 IQAir is proud to have helped slow the pandemic, having been chosen by the Hong Kong Hospital Authority (HHKA) as the only air cleaning technology capable of removing the SARS virus from the air

How are airborne HAIs spreading?

Airborne pathogens and particles are carried by air currents and circulated through the ventilation systems of healthcare facilities. Airborne particles can be and inhaled by, or deposited on, the mucous membranes. Key points about airborne transmission include:

  • The amount of airborne infectious agents is directly related to people’s activities

  • Humans are the source of drug-resistant microorganisms that affect humans

  • Airborne transmission of infectious agents may be more prevalent than realized18

Precautions healthcare facilities can take

Addressing infection control in hospitals requires integrating HVAC and air-pressure-control with dedicated infection-control systems, and minimizing unplanned airflows through building envelopes and interior spaces.

The combination of filtration equipment and airflow rates are often misunderstood or underappreciated for the effect they have on the concentration of infectious agents in any conditioned space. Filtration should be considered healthcare’s first line of defense against infectious agents as it removes a large percentage of them with every complete air change through an air handler. If the filter efficiency and/or air change rate is increased, a larger number of infectious agents would be removed per pass.

Filtration should be considered healthcare’s first line of defense against infectious agents.

IQAir stand-alone air cleaners have been shown to cut hospital aspergillosis infections by more than 50%. Also, IQAir's Cleanroom H13 air cleaner has been shown to reduce Methicillin-resistant Staphylococcus aureus (MRSA) contamination.

IQAir President Frank Hammes states, “We feel the most relevant protocols should involve HEPA filtration. However, we also feel that negative pressure should be mandatory for known cases. This is because patients in the nearby hall (who are not wearing personal protective equipment) should also be protected from cross contamination. We ventilate contaminated air out of the building through negative pressure. Negative pressure is maintained by keep double doors closed at the entrance of the room.”19

IQAir stand-alone air cleaners have been shown to cut hospital aspergillosis infections by more than 50%.

IQAir also offers environmental control of chemical compounds and odors through filtration of ambient air, creation of pressure differentials (containment of chemical compounds and unpleasant odors through negative pressure areas) and through source capture (capture and filtration of chemical compounds and unpleasant odors at their source).

To prevent transmission of pathogens that may be spread by both routes varicella, disseminated herpes zoster, and SARS, for example it may be necessary to use a combination of airborne and contact isolation precautions. Airborne transmission isolation procedure specifications require:

  • A single-patient room with negative air pressure ventilation and outside exhaust

  • That the door to the room be kept closed except for entry and exit

An IQAir Cleanroom H13 air purifier can significantly reduce MRSA contamination in patient isolation rooms, according to a study conducted by the Department of Biology at Nottingham City Hospital (UK).

How to protect yourself from HAIs

Choose the cleanest hospital

Do some research to choose the best hospital for you, especially for long-term stays. Learn what you can about a hospital's infection track record and choose the one that has the lowest infection rate. You may want to discuss this with your doctor, too.

Learn what you can about a hospital's infection track record and choose the one that has the lowest infection rate.

If your insurance allows it, or if you can afford it, ask for a private room. Having a room to yourself will reduce the chance you will be infected by another patient. There are certain times of the year that are more dangerous than others, increasing the opportunities for patients to acquire infections.

Choose a doctor with a low infection rate

Once you know which hospital is the cleanest, then ask which doctors of the specialty you need, have admitting privileges at that hospital. Do some background research to choose the right doctor for you.

Prior to your hospital admission, work with your doctor to set the stage for reducing your risk of infection.

Prior to your hospital admission, work with your doctor to set the stage for reducing your risk of infection. Recommendations may include:

  • Using chlorhexidine soap when you shower for a week before admission 
  • Begin taking antibiotics a day or two prior to your surgery
  • Stop smoking: there is a correlation between smoking and higher infection rates

Prepare your hospital stay

By understanding how infections spread, you can prepare ahead of time by packing some items that will help you fend off those germs. Must-have items include:

  1. Antiseptic wipes and sprays will help you kill germs on surfaces.
  2. Make a sign that says "PLEASE WASH YOUR HANDS before touching me." Hang it in a someplace in your hospital room that can’t be missed, such as above your head so every caregiver will see it.
  3. A germ-filtering mask might come in handy if your roommate begins coughing. Find masks at your local pharmacy. Be sure they are the germ-filtering kind and don't let someone else open the package if they haven't already washed their hands.
  4. Bring a high-performance air purifier that can create medical-grade air, such as the IQAir HealthPro Plus or an Atem personal air purifier. This will help remove particles of all sizes, as well as mold spores, airborne bacteria, and airborne viruses from the indoor air.


Healthcare-acquired infections are preventable, and seeking care should not be avoided out of fear. However, awareness empowers you to protect yourself and those you care about.

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REFERENCES:

[1] World Health Organization. (2010).
https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf 

[2] U.S. Centers for Disease Control and Prevention. (2018).
https://www.cdc.gov/hai/data/portal/index.html

[3] Canadian Patient Safety Institute. (2016).
http://www.patientsafetyinstitute.ca/en/Topic/Pages/Healthcare-Associated-Infections-(HAI).aspx

[4] European Centre for Disease Prevention and Control. (2018).
https://ecdc.europa.eu/en/healthcare-associated-infections 

[5] Wang, J. et. al.(2017).
Burden of healthcare-associated infections in China: results of the 2015 point prevalence survey in Dong Guan City.

[6] Cerqueira, G. et al. (2017).
Multi-institute analysis of carbapenem resistance reveals remarkable diversity, unexplained mechanisms, and limited clonal outbreaks. DOI: 10.1073/pnas.1616248114

[7] U.S. Centers for Disease Control and Prevention. (2018).
https://www.cdc.gov/mrsa/index.html

[8] Wang, Z. et al.(2018).
MDR Clostridium difficile: Hospital-acquired Clostridium difficile infections are a growing problem in hospitals in the U.S. and many other countries. DOI: 10.4103/0366-6999.221267

[9] Holm, J.P. et al. (2013).Pseudomonas aeruginosa in patients without cystic fibrosis is strongly associated with chronic obstructive lung disease.
https://www.ncbi.nlm.nih.gov/pubmed/23743112

[10] U.S. Centers for Disease Control and Prevention. (2016).
https://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm

[11] Spellberg, B. et al. (2013).
“Airborne Assault”: A New Dimension in Acinetobacter baumannii Transmission. DOI: 10.1097/CCM.0b013e31829136c3 

[12] Adalja, A.A. (2010). Airborne Spread of Clostridium difficile.
http://www.centerforhealthsecurity.org/resources/cbn/articles/2010/cbnreport_05142010.html

[13] U.S. Centers for Disease Control and Prevention. (2016).
https://www.cdc.gov/chickenpox/hcp/healthcare-setting.html

[14] U.S. Centers for Disease Control and Prevention. (2016).
https://www.cdc.gov/measles/hcp/index.html

[15] U.S. Centers for Disease Control and Prevention. (2016).
https://www.cdc.gov/smallpox/bioterrorism-response-planning/healthcare-facility/prevent-spread-disease.html

[16]  U.S. Centers for Disease Control and Prevention. (2017).
https://www.cdc.gov/flu/avianflu/infection-control.htm

[17] U.S. Centers for Disease Control and Prevention. (2017).
https://www.cdc.gov/sars/index.html

[18] Kutter, S.K. (2018). Transmission routes of respiratory viruses among humans. 
https://www.sciencedirect.com/science/article/pii/S1879625717301773

[19] Dix, K. (2005). Infection Control Today: Clinical Update.
https://www.infectioncontroltoday.com/personal-protective-equipment/infection-control-today-clinical-update

Air Quality Life is brought to you by The IQAir Group, the world’s leading innovator of Indoor Air Quality solutions since 1963. This online publication is designed to educate and inform the public about the latest research and news affecting indoor and outdoor air quality.

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