Cynthiana’s Harrison Memorial Hospital, a 61-bed community healthcare provider, is becoming the nation’s first “PurHospital,” implementing an entire-building air disinfection system that strategically deploys ultraviolet energy in its HVAC infrastructure to irradicate pathogens.
HMH administrators opted to spend a few million additional dollars for the system midway through a multimillion-dollar renovation and expansion, but are breathing easier in expectation of lower hospital-acquired infection rates for patients and staff along with extended life and curtailed maintenance costs for 14 HVAC air handlers.
Purgenix, a company founded in Lexington and now based primarily in Atlanta, created the disinfection solution.
An open house in Cynthiana in mid-May is celebrating both completion of the expansion and the PurHospital designation, which commits the entire campus HVAC system to the PurgenixMatrix, an ultraviolet-C (UVC) germicidal energy grid that kills airborne bacteria, mold and viruses using a patented design. It includes a service commitment assuring the UVC matrix will always perform as intended, said Sam
Perkins, Purgenix co-founder and CEO.
During the open house celebration, HMH visitors will marvel at the hospital’s conversion to all private rooms and 40,250 s.f. of new clinic space but have to shift senses to take in the significant upgrade to the air-handling system.
“Your nose tells you,” Perkins said in an interview that included Glen Allen, HMH director of environmental services. The PurgenixMatrix had been operating inside all 14 of the hospital’s air-handling units for roughly two months. There was a noticeable difference in the air quality, Perkins said.
The typical “hospital smell” people talk about is emitted by molds unique to the healthcare environment, said Perkins, walking down a basement hallway toward one of HMH’s main air-handling units (AHU). Many libraries have a similar problem because molds that feed on books release their own odors, he added before prompting the group with him to notice the crisp feel and lack of odor to the circulated air inside the hospital.
“We’re walking in a hospital that doesn’t have those odors,” Perkins said. “Something is different here. Something is better. Something is healthier.”
The AHU occupies a space as large as a surgical suite. The intake on one side draws in a mix of returned building and fresh outdoor air that passes through a complex cooling and filtration process. The supply on the other side sends treated air to circulate throughout the hospital.
Before entering the air-handling unit, Allen passes out UV-protective eyewear to avoid the risk of vision damage similar to staring too long at arc welding. The matrix inside is a grid of dozens of UVC lamps that engulf the air handler’s coils with mold-, bacteria- and virus-killing energy.
An observation window into the area housing the cooling coils emits an electric blue glow from the angled arrangement of lamps, creating a germicidal energy curtain through which intake air rushes. They illuminate wisps of mist that appear as the air passes into the cooling coils. A second, less intensive grid of UV lamps provides a further level of treatment as the airflow emerges from the chiller and HEPA filters.
Temperatures in the AHU room are cooler since the matrix was installed.
“It’s never been this cool in here,” Allen said. “When the molds build up heavy on the coils, it forces the machines to work harder to circulate the air. And then it would get warm and humid in here, which made the mold and mildew grow even faster.”
The metal coils that warm or cool the air depending on the season now again gleam brightly, their vents free of obstructing mold buildup, he points out.
“It’s cool in here because the machines are operating like they were meant to do,” Allen said. “In the long run, that will mean less money spent on maintenance crews cleaning these units, and they’re going to last longer, too.”
‘Alignment of the moment’ for HMH
Working with Purgenix was not a part of HMH’s original renovation plans, according to CEO Sheila Currans. The renovation and expansion approved in 2013 was well underway when she and Allen first met Perkins. John Roach, the hospital’s legal counsel, was familiar with Perkins’ company and arranged an introduction. Roach thought the parties had shared interests and would at least have a good conversation.
His initial contact with HMH, Perkins said, was a “wonderful alignment of the moment.” There was no need to sell Currans on the idea and science of using UVC as a germicide because she and Allen were quite familiar with a successful application of the technology.
“HMH had been using UV technology to treat our domestic water intake for years,” Currans said. The needs of newborns in the maternity ward as well as its elderly patients requires the hospital to provide water at lower temperatures that raise the risk of bacterial contamination, particularly for legionella. Since implementing UV treatment, Currans said, she has been “blown away” by water test results.
“We’ve never had the first hint of legionella or other bacterial growth in our water system since we started the UV treatment,” she said.
Numerous articles in peer-reviewed research journals document how UVC kills microbial organisms by destroying their DNA structure. Beyond water applications, studies show UVC room and surface disinfection eliminates MRSA, rhinovirus and other pneumococcal bacteria. Several companies have developed robotic UVC systems to enhance infection-control protocols in hospital patient rooms and surgical suites.
Only in recent years has attention focused on applying UVC to destroy penicillium and aspergillus molds, as well as staph, c. difficile, enterobacter, corona virus and other infectious pathogens that are enabled by humid conditions inside large-building AHUs. Maintaining air quality is a huge concern for anyone who manages office buildings, hospitals or any large commercial structure, Currans said.
An efficient and mold-free system is important in office buildings where it’s common for flu, colds and viruses to be shared among staff. It’s especially crucial in hospitals, where the hospital-acquired infections (HAIs) rate among inpatients is a common quality measure healthcare facilities track.
Airborne pathogens can make people suffering from serious illnesses worse, affect the recovery of surgical patients and impact family members with compromised immune systems, Currans said. They also affect staff, who often are exposed to an even wider range of airborne illnesses than patients.
Spikes in staff absenteeism tell Currans, who entered healthcare as a registered nurse, when a particularly virulent flu bug is being spread. Her nursing experience informs much of her executive decision-making, she said. If a technology will reduce risk to patients and staff, she thinks it’s worth making the investment.
Pineville likes Purgenix impact
Research into UVC air treatment led Currans to another Purgenix client in Kentucky. In Bell County, former Pineville Community Hospital CEO Milton Brooks four years ago authorized nearly every AHU to be outfitted with the PurgenixMatrix.
“I was skeptical about how these UV lights were supposed to work,” said Robin Saylor, director of engineering for PCH. “I’ve been in environmental services with Pineville Hospital for almost 16 years, and a good deal of my time was spent cleaning mold growth off coils every six months and replacing the specialized HEPA filters every three months.”
Since they were installed, however, Saylor has been impressed. Complaints about odors in the hospital and surgical suites have dropped to nothing, he said, and maintenance has diminished dramatically.
PCH used to clean the cooling coils three to four times a year, but now it’s once a year and they “barely even need it,” Saylor said. HEPA air filters that cost $80-150 apiece need to be changed only once a year rather than four times.
Harrison Memorial’s first UVC systems were turned on in 2015. It hasn’t been long enough to confirm maintenance cost savings or conclusively track reductions in HAIs, Currans said, but there are signs HMH’s environment is healthier.
“There were two quarters in late 2015 and early 2016 in which we had no HAIs,” she said. “We were infection-free, which was quite an accomplishment for any hospital.”
When Mark Haney, president of the WellStar Paulding Hospital in Hiram, Ga., and another Purgenix client, introduced that then-new $92 million regional hospital to residents of its service area in 2014, he chose to do so from the building’s basement mechanical room rather than its visually stunning lobby. Among an impressive range of cutting-edge patient-centric technologies incorporated into its design, Haney thought it most important to draw attention to the UVC matrix at work to improve the building’s air quality.
“He said, ‘We still do the (anti-infection) basics, but we have the building working for us now,’ ” Perkins said. “And that’s the same as what HMH has done. By integrating our design into every AHU, the building is now working for them.”
The building is working for them
In essence, Perkins said, HMH is making air handling an essential part of the mix in its infection-control procedures, alongside its policies on surface disinfection and hand washing. It means more than just installing UVC lamps and flipping a switch, though.
“Design matters when one wants to make air-handling systems a solution to the control and transmission of airborne infections rather than the problem,” Perkins said.
Purgenix’ scientists must engineer UVC energy fields like artists work with paints and brushes, he said, and it varies from client to client. Their research suggests a specific grid design is the most important consideration to maximize the infection-control efficiency of the UVC energy field. They found that angling UVC lamps within the air flow creates a smooth energy curtain “with no gaps or holes,” he said.
The goal of UVC infection control is three-fold, Perkins said. The first step is to eliminate infection reservoirs – areas of the air-handling system where molds, bacteria and viruses thrive. Growth typically is most abundant on the cooling coils where humidity is high and air temperatures tend to fluctuate most.
Allen has photos of HMH’s cooling coils before the UVC matrix was installed and, as is common among most air handling units, there is a mixture of green and black molds around vents and openings. Spore and bacterial growth hinder the performance of equipment, so eliminating the reservoir not only kills the germs, it increases the lifespan of expensive HVAC equipment, Allen said.
The second step is blocking the transport of microbes through the air intake and supply.
“Even if you have controlled for the reservoir, there are still sick people with their personal infections in the rooms,” Perkins said. HMH reduced the risk of patient-to-patient infection spread by making all rooms private. Purgenix adds to that effort by controlling airborne microbe transport via internal air intakes.
The final step is controlling transmission.
“The idea is, if the reservoir is eliminated and microbes are killed rather than transported, then harmful contaminants can’t be transmitted. The results are dramatically fewer microbes in the recirculated air, creating a healthier environment for patients and staff,” Perkins said.
This can be accomplished not only with new AHUs but in older ones where mold colonies already exist.
“Our system can gradually heal established buildings until they are like new.”
Other clients and matrix applications
Harrison Memorial Hospital is the country’s first PurHospital, but it is not the first to recognize the system’s potential. Since Purgenix’ 2003 founding and 2010 acquisition of Atlanta-based EnviroMax Engineering, it has signed clients from across the Southeast. It has installations in Georgia, Kentucky, North and South Carolina, Tennessee and Virginia.
Purgenix has more than 575 installations in 50-plus customer settings, mostly in healthcare.
Within the commonwealth, clients include the University of Kentucky Chandler Medical Center, Frankfort Regional Medical Center and Baptist Health Paducah, which each have incorporated a PurgenixMatrix in their dedicated surgical suite AHUs.
There are client applications outside of healthcare, too. Emory University in Atlanta has 130-plus Purgenix installations in 36 buildings with more planned. Washington & Lee University in Virginia has multiple installations and plans more. Animal environments at the world’s largest aquarium, the Georgia Aquarium in Atlanta, are treated.
Targeted applications make an important difference, Perkins said, but committing an entire building to treatment provides the most comprehensive impact.
“It’s all well and good to ensure an antiseptic environment in a surgical suite, but that vulnerable patient will eventually join the general hospital environment and its associated higher risks,” Perkins said.
Purgenix’ adjusted fee was about $5,000 per bed, which is not unusual for a hospital with 61 licensed beds, said Perkins. The hospital uses 13 major AHUs and a smaller side unit for its climate control, while a metropolitan hospital would use about two very large units to cover the same square footage.
“Small hospitals work off narrow margins. If at the end of a fiscal year I have a 1 percent margin, I’m over the moon,” Currans said. “But if I can take that 1 percent and reinvest it in a system that makes a healthier environment in this hospital, it’s worth every bit of the expense.” ■
Josh Shepherd is a correspondent for The Lane Report. He can be reached at [email protected]