Air Date: 7-31-2020|Episode 594
This week we welcome Stephanie Taylor, MD, M Architecture, CIC the CEO of Taylor Healthcare Commissioning, Inc. After working as a physician for many decades, Dr. Taylor obtained a Masters in Architecture as well as Infection Control certification. Her lifelong commitment to patient care includes focusing on improving the healthcare physical environment and clinical work processes to help patients heal quickly and save hospitals valuable dollars. Dr. Taylor is a graduate of Harvard Medical School (MD), and Norwich University (Masters Architecture). She has numerous research publications in “Nature and is also a member of the ASHRAE Epidemic Task Force. We look forward to a fascinating discussion about buildings and their role in infection control.
Z-Man’s Blog:
Appropriate Moisture
After working for decades as a physician, Dr. Stephanie Taylor, MD decided to obtain her Masters Degree in Architecture and an Infection Control Certification. Dr. Taylor is the CEO of Taylor Healthcare Commissioning, Inc. where her lifelong commitment to patient care focuses on improving the physical healthcare environment and clinical work practices to protect and help heal patients.
Nuggets mined from today’s episode:
From a young age, Dr. Taylor was interested in looking at the little things underneath. Like the human interaction between: cells, tissues and organs. She has done cell biology research, pediatric oncology, psychiatry and family medicine. Dr. Taylor observed that patients practicing hand hygiene and modified behavior were still getting sick and sensed that the building was involved.
When she tried discussing issues with facility managers she struggled with communications because clinicians and facility managers had different beliefs and lexicon.
After receiving her Masters in Architecture in 2005, she began to design hospitals. Her focus was decreasing infections in hospitals. Hospital patients have increased vulnerability. She found the same infection trends in all types of buildings. She opined that hospital related infections are underreported at 5%-10% and that a rate of 15% is more realistic. Pneumonia and pressure sores are common problems.
According to Dr. Taylor, humidity plays a big role in infection control. Maintaining RH at 40%-60% improves patient health and outcomes.
In 2014 she began tracking microbiome in a new hospital. Looking at patients she monitored 11 factors. She compared 8 million data points to patient outcomes and found an association between low RH and higher infection rates. This finding broadened her perspective. Holistically, the indoor environment affects the mind, human comfort, human energy and immunity.
She learned that after becoming knowledgeable in one field that it is hard to start as a novice in another field. She was uncomfortable as a beginner. She wondered why the medical profession and building professionals don’t communicate effectively.
In operating rooms (ORs) doctors and nurses wear multiple layers of garments and PPE. Cooler, lower humidity air is preferred in ORs for doctor and nurse comfort. Lower humidity in the OR comes at the cost of more surgical site infections due to condensation.
Stephanie consults with hospitals, nursing homes, schools and hotels. She suggests that hospitals may begin to be used differently. While building codes may require patient rooms have windows and views, she offered the example of a beehive hierarchy where the vulnerable queen is kept in the middle,
A universal finding is that most buildings lack adequate moisture. Dry air impairs the immune system. We’ve all experienced: chapped lips, dry eyes and dry skin during air travel.
When our mucous lining becomes thick effective,particle capture is reduced. Particle capture becomes ineffective at as little as a 6% increase in mucous viscosity. Cystic fibrosis patients experience more infections because infectious particles settle and macrophages and dendritic cells don’t secrete needed proteins.
“Low ambient humidity impairs barrier function and innate resistance against influenza infection.” https://www.pnas.org/content/116/22/10905 Akiko Iwasaki study found that the mammalian immune system is impaired at 10%-20% RH –
The comfort zone is 40%-60%. Staying within the comfort zone is the goal. Staying within the comfort zone reduces infectivity.
“The only good humidifier, is one that isn’t working.” Humidifiers undeservingly have a bad reputation due to the perceived costs of: investment, cleaning and maintenance.
Positive or negative pressure, it depends. So as not to infect others by pushing bacteria into hallways, drug resistant TB patients should be kept in a negative pressure environment. Conversely, operating rooms and immune compromised patients should be positively pressurized.
Dr. Taylor’s lives in fear. Her son is an ER room physician in a Boston hospital where a makeshift isolation room houses 25 COVID-19 patient beds and a physician station. The HVAC exhaust grilles are near the physician’s station.
Dr. Taylor is OKAY with schools reopening when distancing and masks are implemented. She warns that if humidity is not maintained between 40%-60% RH that infections will spike. Any humidifier would provide value and MERV 13 air-filters are recommended. She advises that vulnerable children should not attend school during the dry season.
Stephanie acknowledges that maintaining adequate moisture in the winter is challenging and points to a museum in Alaska which houses artifacts and is able to maintain 40%-60% RH in the winter. It isn’t inexpensive but it can be done.
Focus is changing. No longer are real estate values and energy efficiency the only considerations, shelters for humans has been added. How much are we willing to pay for healthy occupants?
Final comments:
“Appropriate moisture.”
Perfect is the enemy of good. Trying to make something perfect can prevent us from making it just good.
RH outdoors and RH indoors are two different considerations, there is one we can’t control and one we can control.
[Z-Man US EPA Air Sanitizer Link https://www.epa.gov/pesticide-registration/efficacy-data-and-labeling-requirements-air-sanitizers ]
Z-Man signing off
Trivia question
What are the 5 main routes of disease transmission?
Answer: Aerosol, direct contact, fomite, oral and vector
Answered by: Doug Kohnen, ERAtechEnvironmental Dayton Ohio
