Fluke 985 Application Note 2412973

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Airborne particle counters
provide vital information for
maintaining indoor air quality
in healthcare facilities

Technology
at Work

In the highly sensitive environment of a healthcare facility,
where both infectious patients and those highly susceptible
to infection receive treatment, it is essential to minimize the
possibility of infection and disease transmission.

One potential vector of infection
that must be managed is the air
circulating within the building.
Failure to correctly monitor and
manage indoor air quality can
add cost due to increased lengths
of stay, expose the institution to
liability and, more importantly,
expose patients and staff to
unnecessary risk.
In an effective indoor air quality (IAQ) program, a handheld
airborne particle counter such as
the Fluke 983 is an important
tool. Used in conjunction with
pressure and airflow testers, particle traps and laboratory
analysis, the particle counter can
provide facilities managers with
the data they need to detect IAQ
problems, identify and address
root causes and verify when conditions have returned to
acceptable levels.
Specifically, a particle counter
enables the healthcare facility
manager to:
• Document baseline particle
counts within a specific space
• Detect when airborne particulate levels diverge from
baseline or “normal” levels

•

Gain early warning of underlying issues, such as changes
in operating procedures,
equipment malfunctions,
maintenance shortcomings or
failure to separate construction
zones from patient areas
• Test particle levels after
changes have been made, to
ensure that remedies have
been effective
The use of handheld test instruments has received endorsement
at the highest levels. According
to infection control guidelines
published by the U.S. Centers for
Disease Control in 2003, “the use
of handheld, calibrated equipment
that can provide a numerical
reading on a daily basis is preferred for engineering purposes”
in ensuring the proper and safe
operation of HVAC systems.i
It must be clearly stated, however, that the particle counter is
not designed to determine what
particles consist of or whether
the particles counted pose a
threat of infection. Those judgments must be based on
laboratory analysis of particle
samples collected in the healthcare facility and cultured in a
laboratory setting.

From the Fluke Digital Library @ www.fluke.com/library

Sources of IAQ Problems in Healthcare Facilities

The spread of infection through the indoor air is a serious
potential problem in healthcare facilities. Such infections
can stem from two sources:
• Infectious agents produced by people inside the facility,
such as Tuberculosis, Rubella (measles) and influenza
• Agents normally present in the human environment that
can endanger patients who have compromised
immune systems. Such organisms include Aspergillus
fumigatus, a common species of mold, and others.
Other airborne particulates, such
as inorganic materials and allergens, while capable of causing
health problems, pose a lesser
threat to patients. These contaminants will not be addressed in
this document, though the air filtration and air pressure balancing
techniques that help control biological pathogens can also control
odors, dust and other non-viable
air pollutants.
To control the movement and
spread of infectious agents, facility designers and managers
establish special purpose spaces
called Airborne Infection Isolation
(AII) or patient isolation room,
and Protective Environment (PE)
facilities. In both of these special
ventilation spaces, air pressures
are regulated to move air from
clean to dirty areas.
The AII room would house a
patient judged to be a source of
airborne infection, such as
Mycobacterium tuberculosis or
measles virus. Vents draw air
from the room and exhaust it outside the building. High efficiency
particulate air (HEPA) filters may

be used to help remove particles
from the air. Makeup air flowing
into the room is balanced so that
the room remains under negative
air pressure. Thus the direction of
airflow under the door or when
the door is opened is into the
space, rather than out, helping
contain infectious particles.
The Protective Environment
facility is designed to keep infectious agents out and protect
immuno-suppressed patients and
others, such as bone-marrow and
organ-transplant patients and
premature infants, who are especially vulnerable to opportunistic
infectious agents. The CDCii recommends that PE facilities be
maintained under positive air
pressure, with directional airflow
(from one side of the room, across
the patient to the exhaust) and
twelve or more air changes per
hour. Clean air is supplied
through HEPA filters, and pointof-use HEPA filters may also be
used. Air flowing through an
open door or leak moves out of
the space, not in.

2 Fluke Corporation Airborne particle counters provide vital information for maintaining indoor air quality in healthcare facilities

Sources of IAQ Problems

AII and PE facilities provide a framework for limiting the
spread of infectious agents, but they are not foolproof.
Building design, inconsistent or inadequate operating
procedures, poor maintenance and facilities construction
and renovation projects all have the potential to cause
problems. And in any case, protective facilities are not
used for all patients.

Even the best air filtration and
airflow design can be defeated
by inadequate maintenance or
incorrect operation. A slipping
fan belt on a ventilation supply
fan, for instance, could alter
the air balance in a protective
environment facility, allowing
particle-laden air from the hallway outside to flow in. Failure to
correctly seal off and ventilate a
construction area can send a
cloud of construction dust and
Aspergillus spores into areas
where patients are housed.
Failure to fix a leaking sink can
turn the cabinet below into a
nursery for potentially hazardous
mold.
Andrew Streifel, MPH, hospital
environment specialist at the
University of Minnesota, recalls
what happened when costconscious hospital administrators
turned off the fan ventilating the
space over a dropped ceiling in
an intensive care area. “That
allowed humidity to stagnate,” he
says. “When humidity reached
extremely high levels in the
Minnesota summer, it started
raining in the ICU. The water
was coming through the ceiling
grid and dripping on the patients.
They stopped using four or five of
the intensive care rooms, and
diverted patients.” The larger
concern, Streifel continues, was
the possibility that the high
humidity would permit mold
growth. Raising the room

temperature above the dewpoint
provided a temporary fix, and
stopped the “rain.”iii
Building construction and
renovation can pose particular
challenges. Disruption to the
building’s envelope, generation
of large amounts of construction
dust and debris and the movement of workers and equipment
in and out of containment zones
all present contamination threats
beyond the norm for a healthcare

facility. According to the CDC, “a
recent aspergillosis outbreak
among oncology patients was
attributed to depressurization of
the building housing the HSCT
unit while construction was
underway in an adjacent building. Unfiltered outdoor air flowed
into the building through doors
and windows, exposing patients
in the HSCT unit to fungal spores.iv

3 Fluke Corporation Airborne particle counters provide vital information for maintaining indoor air quality in healthcare facilities

Contamination Testing with Airborne Particle Counters

Writing in HPAC Engineering
magazine, Streifel said “when
dealing with filtration testing,
the verification data should
be reflected with objective
analysis by providing
airborne-particle comparison
with the specifications of filter
Baseline Testing. To know
efficiency for fan systems. The
when the “abnormal” occurs,
objective analysis available
it’s necessary to document
today should provide functionwhat are normal levels of paring pressure gauges,
ticles. According to Andrew
inspection information of the
Streifel, it’s not reasonable to
filter banks, and objective
expect “clean room” conditions
particle analysis of filters for
in a healthcare setting. When
filtration leaks. The particlestaff rush into a room to interanalysis procedures at this
vene in a patient emergency,
time are not standardized but
there’s no time to worry about
yet the comparison of before
air quality. Particle counts will
versus after filter tests with
soar with the presence of mulatmospheric dust particle
tiple people (human beings
sizing will help to assure that
shed some 500,000 particles
the 90-percent-efficient filter
each minute) and medical prois removing 90 percent of the
cedures too can contaminate
particles greater than 0.5 µm.”vi
the air. But later, counts should
• Locating Particle Sources.
return to normal or baseline
The Fluke 983 can help
levels. Best practice calls for
identify areas where particle
baseline particulate levels to
counts are elevated and,
be documented, both within
ultimately, lead the user to
spaces and in the supply air
the source. A leaking air duct
flowing into the space.
could be sending unfiltered
Maintenance Testing. Once
air into a room, for instance;
baseline or “normal” particle
work above a suspended
levels are determined,
ceiling could be disturbing
followup tests should be
accumulated dust.
performed and documented
• Verifying the Effectiveness
periodically. These followup
of Remediation. Once the
tests can provide early warncauses of higher particle
ing of developing anomalies
counts have been addressed,
and enable the facility
post-testing will show
manager to intervene before
whether the fixes employed
anyone gets sick.
have really worked at bringing
Filter Testing. Used to test for
particulate levels down.
particle levels in the air
upstream and downstream
Controlling airborne contaminafrom filter media, the Fluke
tion within healthcare facilities
983 can verify that filters are
poses a complex set of challenges
performing as they should.
far beyond the scope of this
Testing the level of particles
paper. Numerous additional
in incoming filtered air at the
resources are available to help
diffuser (air grate)—air that
the professional understand and
should be the cleanest in the
overcome those challenges.
room—provides an additional
Among those easiest to grasp is
check on the performance of
the Fluke 983 handheld airborne
filtration systems.
particle counter.

When such problems occur, an airborne particle counter
such as the Fluke 983 can help hospital staff and industrial
hygienists detect increased particle levels, identify the
sources and verify the effectiveness of remedial action.

The Fluke 983 Particle Counter
operates by pumping an air sample of known volume—generally
one liter—past a laser beam. As
dust particles in the air stream
pass through the beam, each one
reflects or “scatters” the laser
light. A photodetector senses the
scattered light and generates an
analog electrical signal. Larger
particles scatter more light and
create higher-voltage electronic
“hits.” Onboard electronics track
the hits and count the particles in
six size categories, ranging from
.3 microns to 10 microns.
Particles larger than 10 microns
generally settle out of the air.
The Fluke 983 can be programmed to take repeat counts
instantly, or delayed up to 24
hours between samples. It can
store 5000 records of date, time,
counts, relative humidity, temperature, sample volumes, alarms
and location label records in its
onboard memory. Stored readings
may then be downloaded to a
personal computer. As an alternative, the particle counter can be
connected directly to a PC for real
time downloads.
According to the CDC,
“Particulate sampling (i.e., total
numbers and size range of particulates) is a practical method for
evaluating the infection-control
performance of the HVAC system,
with an emphasis on filter efficiency in removing respirable
particles (< 5 µm in diameter) or
larger particles from the air.”v
The accuracy, speed and
compact size of the Fluke 983
make it useful for baseline particulate testing, problem detection
and remediation and system
maintenance.

•

•

•

4 Fluke Corporation Airborne particle counters provide vital information for maintaining indoor air quality in healthcare facilities

i Guidelines for Environmental Infection Control in Health-Care
Facilities, Recommendations of CDC and the Healthcare Infection
Control Practices Advisory Committee (HICPAC), U.S. Department of
Health and Human Services Centers for Disease Control and
Prevention (CDC), 2003, page 20.
ii Ibid, page 34
iii Interview with Andrew Streifel, April 22, 2005
iv Ibid, page 26
v Ibid, page 27
vi “Hospital Accreditation for Airborne Infection Control,” by Andrew
J. Streifel, MPH, HPAC Enginering, March 2003, page 49.

Fluke. Keeping your world
up and running.
Fluke Corporation
PO Box 9090, Everett, WA USA 98206
Fluke Europe B.V.
PO Box 1186, 5602 BD
Eindhoven, The Netherlands
For more information call:
In the U.S.A. (800) 443-5853 or Fax (425) 446-5116
In Europe/M-East/Africa (31 40) 2 675 200 or
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From other countries +1 (425) 446-5500 or
Fax +1 (425) 446-5116
Web access: http://www.fluke.com
©2005 Fluke Corporation. All rights reserved.
Printed in U.S.A. 5/2005 2461172 A-US-N Rev A

5 Fluke Corporation Airborne particle counters provide vital information for maintaining indoor air quality in healthcare facilities



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