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Here, there, every air: allergens are everywhere in your facility.

Gary Warren has the routine down. When Encore Senior Living refurbishes or rebuilds one of its long term care facilities, Warren follows a mental checklist: HVAC system operating? Check Germicidal ultraviolet lamps in place? Check. HEPA-filtered vacuum cleaners ordered? Check. Mold-resistant carpet installed? Check.

While no long term care facility can be completely allergen-free, Warren, the vice president of facility development at Encore Senior Living in Portland, Ore., is giving it a go. But then, he realizes the truth: allergens are everywhere.

They're a problem for everyone, according to Chris Ward, president of the Asthma and Allergy Foundation of America (AAFA) in Washington, D.C. One in five Americans, or about 50 million people, suffer from one or more allergies. Allergies are the nation's fifth-leading chronic disease. And, according to AAFA, the problem has steadily increased among Americans since the 1980s.

This problem is due largely to what they're breathing. The U.S. Environmental Protection Agency lists indoor air quality as one of the nation's top five public health concerns and estimates that indoor levels are, on average, two to five times more polluted than outdoor air.

This is a major concern, the EPA notes, because people spend as much as 90 percent of their time indoors--especially during their older years when they aren't as mobile.

But while the culprits--allergens--can be found in everything from air vents to bed sheets to carpets, experts note they can be kept under control--and red eyes to a minimum--through a combination of common sense, elbow grease and technology.

"You can improve your odds quite a bit with one of these," said David Shagott, president of Abatement Technologies Inc., an air purifier manufacturer in Suwanee, Ga. "Nothing is perfect. Nothing is going to get everything. But what you're trying to do is minimize the problems that you have."

Allergens and dust that float through the air eventually land somewhere in the facility--on floors, shelves, windowsills or countertops. Make sure somebody cleans rooms daily and gets to those hard-to-reach places, as well as the obvious ones, according to Bengt Rittri, president of Blueair Inc., an air purifier maker in Chicago. That includes everything from window blinds to light bulbs.

"The most important thing is to try and find out what's polluting the air," Rittri said. "Go for the source of these problems: wall-to-wall carpet, dirty air ducts, dirty air coming in from the streets."

While people have long accepted that it's a good idea to clean regularly to keep dust and dirt from building up, a better idea is to catch the dust before it settles onto surfaces, Rittri said.

An indoor environment such as a long term care facility will have 2.5 million to 4 million airborne particles per cubic foot of air, Shagott explained. More than 99 percent of those particles are smaller than 1 micron--about a millionth of a meter in size- making them invisible to the human eye, he said.

"People may not realize how easy it is to send these particles airborne," Rittri said. "lf l rub my hair a bit, I send 10,000 particles in the air. These can be allergens like pollen, particles from human beings' bodies, textiles, bacteria or viruses. Clean the air and you keep these things from going into your lungs."

One recommended aid: an air purifier that circulates the air in a room and filters out particles. The best units have High Efficiency Particulate Air [HEPA] filters, capable of capturing 99.97 percent of foreign materials that are at least 0.3 microns in size--roughly 1/300th the thickness of a human hair, according to Shagott. For every 10,000 such particles that go into a HEPA filter, only 3 pass though, he said.

Choose an air purifier that's appropriate for the room size, Rittri recommended. The Association of Home Appliance Manufacturers' Clear Air Delivery Rate Web site at can help people determine effective models, as can operational ratings from the Environmental Protection Agency. Other considerations include energy cost--look for Energy Star certified items--and the unit's noise level when operating on high speed.

Air purifiers cost about $300 to $600 each and the operational cost is "pennies a day," Rittri said. "It's about as much as a light bulb," he said. Some manufacturers also rent units to customers.

While air purifiers are very effective, they're not perfect, warned Dr. Peter Boggs, medical director at The Allergy Asthma Clinic in Shreveport, La. For example, heavier allergens and particles, such as dust mite feces don't get in the air long enough to be drawn in by the filtering system. These instead settle onto the carpet, bedding or other surface and need to be removed in a more conventional manner, such as dusting or vacuuming, Boggs said.

I See the Light

Those concerned that HEPA filters might not be efficient enough to remove all airborne irritants can install germicidal ultraviolet lamps in residents' rooms, according to Shagott. The lamps' popularity has increased in recent years due to rising health concerns about diseases such as Severe Respiratory Syndrome [SARS], anthrax and the reemergence of tuberculosis, he noted.

Germicidal UV systems, which typically cost $1,000 to $1,500 each, are installed in ceiling air diffusers and irradiate from the room's heating, ventilating and air conditioning [HVAC] system, Shagott said. Air circulates into the lamp and is fed back out, with limited notice by the residents. "The lights are hidden from direct view--prolonged skin or eye contact would be like being out in the sun or looking at it too long," he said. "A reassuring blue glow tells you it's working."

The lamps are also useful in large areas where air filtering might be impractical, such as in a dining room or indoor recreation area, Shagott said. "You might put UV in those rooms because you have no way of isolating the patients or residents," he said. "By irradiating the air with germicidal UV, you have a chance to destroy some of the airborne microorganisms that may be generated in those rooms."

But UV only kills harmful airborne particles like molds and bacteria--it doesn't trap particles or allergens such as dead skin or animal hair, Shagott noted. Therefore, it's not intended to be a filtering system on its own but rather an augmentation device for HEPA filtering. "Still, a lot of facilities feel more at ease having the UV as well, because it provides a fail-safe situation," he said.

Experts note that the biggest attractor of allergens is also one of the biggest items in a resident's room: the bed. A storage place for dust, pollen, dead skin, hair and microscopic organisms, the sheets should be removed and washed in hot water at least once per week, according to Boggs.

Alan Naditz, Senior Editor
COPYRIGHT 2005 Non Profit Times Publishing Group
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Title Annotation:air quality in long term care facilities
Author:Naditz, Alan
Publication:Contemporary Long Term Care
Article Type:Cover Story
Geographic Code:1USA
Date:Sep 1, 2005
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