Published White Paper

Practical Standards for Ceiling Access Carts & Room Isolation

Over the last ten years, it has become well documented that poorly contained construction,
renovation and maintenance projects in high risk areas can be fatal to healthcare patients
with compromised immune systems. These fatalities along with non-fatal secondary
infections occur when infected dust is disturbed by the air flow in the affected area. The
infected dust particles are dispersed into the air and carried where they are more likely to
enter or infect the patient.

Within those infected airborne dust particles, there exist many common harmful
components (known as bioaerosols) including mold spores like Aspergillus, bacterium like
Streptococci, Diptheria and Tuberculosis, construction debris, viruses, rodent waste, dust
mites, dust mite feces, insects, toxins and chemicals like PCBs. Patients (cancer, HIV, organ
transplant, stem-cell transplant, congential deficiencies, neurological and others) who are
immunocompromised from treatment or illness are at risk from these contaminates.

An especially high risk exists among mold spores like aspergillus furmigatus. Aspergillus
furmigatus can cause Aspergillosis, a disease that can lead to a serious and sometimes
fatal infection in the lungs and other organs. This is especially serious with cancer patients,
transplant patients and HIV patients who have significantly weakened immune systems.
Fatal outbreaks of Aspergillosis have been linked back to unsafe construction practices.

A best practice in construction, renovation and maintenance in healthcare facilities is to

assume all dust contains the Aspergillus mold spores along with other mold and
contaminates and the air disturbed by the project should be contained and thoroughly
cleaned. In order to have the air thoroughly cleaned, there are three basic standards
recommended: Negative Air, Filtering and Certificate.

Negative Air

Negative Air is a term used to identify an area or chamber where the air pressure is less
than that on the outside of the area or chamber. It is important to remember that air in its
natural state moves from a high pressure area to a lower pressure area (known as positive
pressure). Negative air pressure alters flow of naturally moving air and prevents it from
escaping to the lower pressure area. The air is seeking equilibrium.

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Negative room pressure is one isolation technique employed by infection control
personnel in healthcare facilities to prevent cross-contamination. It is achieved by using a
fan system to generate air flow out of one isolated area where it is kept from escaping in in
its natural state. The air flow is often HEPA-filtered and then exhausted into another area.

The negative pressure is achieved when more air is taken out (exhausted) compared to
what is allowed in (supplied).

Air pressure can best be measured with a manometer or magnahelic in water-columns in

centimeters and inches. These measurements are often converted to the international
measurement for pressure: the pascal (or newton per square meter). How much
negative air pressure is enough? The American Institute of Architects recommends 0.01"
water gauge (w.g.) or 2.5 Pacals(Pa) for all patient rooms and 0.03" w.g. or 8 Pascals(Pa) for
rooms that require an advanced protected environment.

To provide protection from contamination, air and contaminants must flow into the
negative pressure area. The fan component providing this function is normally called a
negative air machine or NAM. A product that dust not have a negative or machine is simply
for containment.

Air flow is generally measured by cubic feet per minute or how much air in feet is flowing
through the filter and exhausting in one minute of time. CFM is an air volume
measurement and requirements depend upon the opening and air flow volume coming
into the contained area and negative air machine. In hospitals with large interstitial space,
the CFM requirement is as high as 600 to 750 CFM. Requirements for higher CFM come as
facilities look for a minimum number of air changes per hour (ACH). General guidelines are
that spaces with immunocompromised patients have 15 ACH or more. If there are not
immunocompromised patients then many facilities accept 12 ACH. Operating and delivery
rooms usually have recirculating air systems that provide 25 ACH.

Vacuum cleaners and components will not meet these requirements for CFM and ACH in
most interstitial areas as airflow maybe as low as 100-150 CFM. Industrial NAM systems
are needed to provide the CFM to ensure negative air. Higher quality negative air machine
components have variable speed control so the user can select the CFM to meet each
situation. While filtering affects air flow, only when you have negative air does filtering
become a valid consideration.

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Filtration

Filtering is the second area that has standardization. All filters have specific characteristics
with the most common healthcare filtering standard being a generic term, HEPA, which
stands for High Efficiency Particle Air. Even within HEPA, there are different standards from
95% at the low-end (which is not ‘true’ HEPA) to the hospital standard of 99.97% or 0.3
microns.

The HEPA standard of 0.3 microns is used because particles this size are most difficult to
capture and HEPA-filters are even more efficient in capturing both smaller and larger
particles. Products that label themselves as “HEPA-type” , “HEPA-style”, “99% HEPA” of just
mention they have a HEPA-filter should be investigated thoroughly for these applications.
Many of these will tout a 95% removal rate of particles 2 microns or greater. Two microns
may sound small but it is 550% larger than a particle measuring 0.3 microns.

A HEPA-filter alone does not guarantee HEPA-filtered air. As mentioned, a 99.97% filter that
is “sealed” is the minimum. The best HEPA-filters test even better at 99.995%. The filtering
provided needs to fit the application with other E, H, and U classifications on HEPA.
Filtering beyond the 99.97% 0.3 microns is available and may be applicable for specific
uses. Both ULPA (ultra-low penetration air; 99.999% 0.12 microns)

Another term often used in filtration is the MERV- minimum efficiency reporting value.
MERV is a ratio of particles trapped by a filter. A good MERV rating for hospital use is 16+
but some environments may need an even higher MERV rating.

Finally, you need to make sure you have enough negative (or positive) air flow to make sure
your HEPA filtration system is actively pulling the air and contaminated dust into the
filtration system.

Certification

The integrity of performance starts with factory testing of the HEPA filter itself.
Many filters are produced in large volume at the factory and then spot checked.
Filters are then transported to assembly shops for use in a many applications
including negative air machines. These negative air machines may be a stand-alone
unit or embedded into containment apparatus, ceiling access cart, and other tools.
Sometimes these units are again spot checked but more often than not, these

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assembled units are not checked for air-quality or air flow on an individual basis.
The only true method to insure integrity and performance is a documented certification
test for each product by serial number. This certifies the integrity of the entire product and
its filtration and air-flow rate. This certification can be repeated in the field to insure
continued performance and is recommended on an annual basis or if the one suspects the
filtration system has been compromised.. Accepting filter testing as a standard is not the
same as requiring certification. Only with proper certification can you be ensured that the
product performs in the field. The standard is Air Cleanliness Level 5, 99.97% with a MERV
rating of 18 and a HEPA filter integrity tests (IEST-RP-CC0034.2) as well as particulate tests
for ISO 14644 Class V air. Certification paperwork should be included with your unit.

Infection Control Future

Infection control requirements for construction, renovation, and maintenance now can be
met with dynamic tools that meet the medical center and medical center contractor’s noted
needs - protecting patients and maximizing productivity. This market segment has moved
forward significantly over the last few years and a simple web search of HEPACART,
infection control cart, and mobile dust containment will educate the user and let them
make the most informed decision. From these developments will come more tools that
focus on the need to protect both patients and productivity. Note that the enforcement of
infection control standards is increasing. The standards will become more strict. Infection
control tools will continue to improve to meet the needs of hospitals and hospital
contractors.

HEPACART Inc. based in Shawnee, Kansas (Kansas City metro area) is the leading
manufacturer of high quality dust containment solutions for hospital construction,
renovation, and maintenance. HEPACART offers multiple types of HEPACARTs with various
sizes and options. HEPACARTs that provide only containment without HEPA filtering
sometimes use the brand, Dust Buggy. All options developed by HEPACART were the direct
result of a user’s request to configure the cart that would make them most productive.
Recent custom request like pass thru slips and multiple tile adapters are now standard
options. Custom work is also available because productivity is one of our key goals.

HEPACART was developed from hospital work required by its sister company, TED Systems
LLC. TED Systems provides secu-rity, access, video, fire alarm, sound, and nurse call

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products and services. TED Systems searched for a product that would protect patients, be
efficient to reduce interruption to the hospital staff, and meet the labor schedule. All
market products were evaluated- none met the criteria.

The result was the manufacture of our initial HEPACART.

HEPACART has since grown to various types, sizes, and options to better support our
growing list of hospital clients nd hospital contractors. HEPACARTs are in use at
Massachusetts General Hospital, MD Anderson, children’s hospitals in Chicago, Wash-
ington DC, Ft. Worth , among other hospitals in the United States and Canada.

“HEPACARTs protect patients and productivity.” For more information about HEPACART Inc.

Visit www.HEPACART.com , call 913.789.9590, or fax 913.677.5772

mailto:info@hepcart.com

Please consult the Infection Control Program for each medical facility for their specific
infection control program, policies, and procedures.

Some generic terms are used that are actually brand names; called Generized Trademarks.
In this area HEPACART is a Trademark sometimes used generically. If it's not a HEPACART -
it's not a HEPACART.

January 2015