Air-conditioning for infection control.

I have read with interest the article “If air conditioning is not functioning …” Indian J Anaesth 2010; 54:580, by Dr. Medha Mohta. As an anaesthetist who also has an interest in the field of infection control, I would like to add to what Dr Mohta had to say.[1]

Worldwide, the “Centers of Disease Control and Prevention (CDC)" and "Healthcare Infection Control Practices Advisory Committee (HICPAC)” are considered to be the pioneers and leading authorities in the field of infection control. If we may remember, the CDC was one of the main organizations guiding us in the fight against the spread of the H1N1 virus and in its control.

The CDC and HICPAC have laid down “Guidelines for environmental infection control in health care facilities”[2] and “Guideline for Prevention of Surgical Site Infection.”[3] The former guidelines have been laid down with the aim to prevent adverse incidents in, and adverse outcomes for, the patients and health care workers due to exposure to infectious pathogens; while the latter guidelines, as the name suggests, have been laid out to prevent surgical site infections. This, I hope, may also be of interest to our surgeon friends. The guidelines state the following:

Maintain positive-pressure ventilation with respect to corridors and adjacent areas.

Maintain >15 ACH (air changes per hour), of which >3 ACH should be fresh air.

Filter all re-circulated and fresh air through appropriate filters, providing at least 90% efficiency (dust-spot testing).

In rooms not engineered for horizontal laminar airflow, introduce air at the ceiling and exhaust air near the floor.

In Indian hospitals, these guidelines can be met with a well-functioning air-conditioning system. Lack of air-conditioning means absence of positive-pressure ventilation, air changes and filtering. Hence air-conditioning should be viewed by us as an instrument to provide better health care to our patients and to protect us from exposure to infectious agents.