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COMBATING INFECTION

Opening windows? Not an open-and-shut decision

AVALOS-BOCK, STEVEN RN, CIC; BARR, BRENDA MADDEN RN, CIC, MS

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In Brief

IN SOME FACILITIES, it's easy to open a window. But before you throw one open, carefully review your facility's policies and ask yourself the following questions:

Will an open window endanger my patient? Make safety your first concern. For example, consider whether an open window will present a fall or escape hazard to a patient or visitor, particularly a child. If so, don't open it.

What's my patient's susceptibility to infection? If your patient received a transplant, is severely immunocompromised, or has open wounds or burns, don't expose him to unfiltered outside air during the acute phase of his illness.

Will I affect the heating, ventilation, and air conditioning (HVAC) system? Depending on the design of the HVAC system, an open window may cause heating and cooling problems. If you open a window during cool weather to cool the room off, the incoming cool air may cause a nearby thermostat to compensate by pouring more heat into the room.

Most facilities have a centralized HVAC system that draws in outside air, adjusts its temperature and humidity, and then filters the air before circulating it. Most general patient-care areas have filters, which operate at 90% to 95% efficiency and remove particles such as bacteria or mold spores that can trigger allergies. In areas with surgical suites, special procedure rooms, transplant or oncology wards, or some critical care areas, additional filtration may achieve 99% efficiency. An open window compromises this filtration system.

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Figure:
Before you throw that window open, stop and weigh the potential hazards.

What's the air quality outside? Don't open a window that's close to an HVAC air exhaust outlet or downwind from a construction or demolition site. Although building codes require exhaust systems to vent above the roof line to prevent exhaust air from reentering the building, your patient's window may be outside of a different part of your facility or another building. Opening a window may allow this exhaust to enter your patient's room. If you're unsure about the location of nearby exhaust systems, consult your facility's engineering or maintenance staff.

Will I affect the air balance in the room? Airflow standards mandate a certain number of air changes per hour: the amount of air supplied versus the amount exhausted from the room. If your patient's room is neutrally balanced and you open a window, you probably won't alter this air balance.

However, if you open a window in a room with negative or positive air pressure, you can create an infection risk for your patient. Examples of positive areas, which have more air supply than exhaust, are surgical suites and rooms with immunocompromised patients. An example of a negative area, which has more exhaust than air supply, is an airborne precaution room used to isolate a patient with an airborne transmissible disease, such as active tuberculosis. If you open a window in either type of room, you'll alter the air balance.

Not all patients require a constant supply of filtered air. If you've checked out and eliminated potential hazards, your patient may benefit from a breath of fresh air. Just make sure any window you open has a tight-fitting, small-mesh, and hole-free screen to prevent insects from entering the building.

SELECTED REFERENCE

Healthcare Infection Control Practices Advisory Committee (HICPAC), Centers for Disease Control and Prevention: Draft Guideline for Environmental Infection Control in Healthcare Facilities. March 6, 2001.
    © 2002 Lippincott Williams & Wilkins, Inc.