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Development of Predictive Maintenance
Management System for tackling air-borne infection in Healthcare Facilities
Dr Ghasson Shabha ,BSc MSc (Arch Eng) PhD (Arch), Associate CIBSE, MBIFM, PG Cert Ed., IOSH
Email: [email protected], [email protected] Mobile: 07854763536 Skype: Ghasson.Shabha
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How can the spread of air -borne infection in health care facilit ies be effectively monitored and managed on a day-to-day basis to reduce fatalit ies?
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Setting the Scene Health Facilities are very complex organisations.
Technologically-led.
Highly-serviced.
24/7 management input to ensure effective functionality.
Difficult and costly to manage.
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Type (A)
Effective with greater functionality but often
costly
Type ( C)
Risky with performance penalties
Type (B)
Effective and can be low impact but often small
scale
Type (D)
Can be thoughtful and imaginative, but
sometimes less user-friendly
Management More Less
More Cost
Cost Less Cost
Technological Complexity of Buildings based on (Bordas & Leman 2001) model
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The spread of infection relies on trio of factors: Source. Mode(s) of transmission. Susceptible recipient(s).
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Source • A person. • An Object. • Environment. • Substance from which the infectious.
agent is transmitted to the host.
When host- the primary source of cross-infection are factored into any equation the laws which represent logic are constantly being moved
and become more difficult to predict and manage.
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Direct contact leading to cross-infection through Touch. Cross-contamination. Air-borne through mechanical ventilation and air-conditioning systems. a combination of one or more …
Mode(s) of transmission
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Environmental Factors
• Humidity level (RH). • Temperature. • Surface material and texture. • Availability of nutrients and
food particles.
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Ventilation and Air-conditioning
“Health care environment is a secondary reservoir for organisms with the potential for infecting patients.”
• Environmental conditions can affect the survival and persistence of
hazardous micro organism on surfaces or indoor environment. • Indoor air quality (patients spend 90% of their time indoor). • Air-tightness (to comply with Part L of Building Regulations which
might compromise environmental qualities) air permeability down to 3m³/h m2 at 50 Pa.
• Indoor Relative Humidity (RH) (keeping the relative humidity below
60%). “Humidity levels are known to influence microbial survival and growth
such as mould, mildew and bacteria inside ductwork and ventilation diffusers leading to high concentration of the production of allergens, odours and toxins in the ambient environment.”
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Air-borne transmission is more likely to spread via ventilation and air-conditioning
systems, internal surfaces of ducts and diffusers as much as cross-contamination via
hard surfaces and floors.
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Controlling the spread of infection through
ventilation & AC systems
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Filtration
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Air Purification
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Anti-bacterial filters
Filters based on silver nano-particles held in plasma
A multi-stage filtration air-conditioning system by Toshiba
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www.tri-airdevelopments.com
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Ultraviolet catalysis
UVGI Technology
Under ceiling unit
UVG Heating Ventilation Unit
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What have we learnt so far? • Both hard surfaces and ventilation/AC systems might be influential to
transmission. • There seem to be several interrelated factors involved in the spread of
air-borne infection. • Lack of critical evaluation of the spread of air-borne infection
– Methods of interventions are quite limited in their scope and are mostly corrective.
– Highly fragmented (cleaning vs finishing specifications) . – Prescriptive in their scope ignoring the role of human factor in spreading
infection- might simultaneously act as a trigger for spreading the infection
Monitoring the efficacy of intervention is no-existent and
largely ad hoc.
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Aims and Objectives • To assess the commercial viability of integrating
intelligent predicative management system in monitoring air-borne infection in health care facilities
• To develop an early alert system to monitor the
spread of air-borne infection in health care facilities incorporating purpose built 3-D building Information modelling software for mechanical ventilation and air-conditioning system.
• To generate a web-based knowledge management system
easily accessible by maintenance and facilities managers (FM) to address infection control in the light of the wealth of knowledge-base generated over the past few years.
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Anticipated Benefits and Outcomes?
To empower NHS decision makers, stakeholders and facilities managers (FMs) in proactively addressing the problem of duct cleaning.
Better understanding of the mechanism of how air-borne infection is spreading in health care facilities.
Predicative Infection Criticality Model (PICM) for
monitoring and managing the spread of air-borne infection in critical hotspots of mechanical and air-conditioning systems including in particular air-handling units (AHU), supply and return ductwork, T- junctions, connectors, diffusers and fire dampers.
Robust Infection monitoring management system with the potential of being fully integrated into the building management system (BMS).
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Slightly Harmful
Moderately Harmful
Extremely Harmful
Temperature <16 c 22-24 c >24 c
Humidity <40 % 40-60 % <60%
Dust Accumulation <0.05 mm minor accumulation
0.05 – 1.00 mm >1.00 mm major accumulation
Air Velocity >20 20-5 <5
Very Unlikely 1 2 3
Unlikely 4 5 6
Likely 7 8 9
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Environmental parameters level of risks based on NHS risk model Failure risk and the strategy for managing the risk is determined using the model developed by NHS Estates. It uses a 3 x 3 matrix to determine the level of risk with regard to failure of items or elements of an installation
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Sensor type Green status
Yellow alert status
Orange alert status
Red alert status
Violet status
Acceptable
risk
Moderate
risk
Substantial
risk
Intolerable
risk
Extreme risk
Temperature <16 c
(1)
16-21 c
(2)
21-24 c
(3)
24-26 c
(4)
>26 c
(5)
Humidity <30%
(2)
30% -45%
(4)
45%-60%
(6)
55-60
(8)
>60
(10)
Dust (µm)(applies to extract ducting)
Dust (µm) (applies to supply ducting)
15-30
<30
(3)
30-60
30-90
(6)
60-90
90-180
(9)
120-150
180-240
(12)
>150
>240
(15)
Air Velocity m/s
>20
(4)
20-15
(8)
15-8
(12)
8-3
(16)
<3
(20)
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1-10 Insignificant
Acceptable/Tolerable 11-15 Low
15-29 Medium Tolerable
30-35 High
Unacceptable/Intolerable >35 Critical
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Traffic Light model based on grand total weighting score o f the risk associated with environmental parameters.
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Action Plan
• An intelligent “safety by design” management
system for tackling the spread of air-borne infection in health care facilities.
• A real-time predicative intelligent system for
managing the spread of air-borne infection in ventilation and air-conditioning systems.
• An integrated web-based knowledge management system to enable maintenance and facilities managers to access the latest state of affair and know-how about the best way for tackling the spread of air-borne infection
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Thank You
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