Background
Many Irish healthcare buildings are quite old and are poorly equipped to cope with rising temperatures. The heat wave experienced in Ireland and the EU during the summer of 2018 caused unacceptably high environmental temperatures in some healthcare settings, placing already vulnerable people under additional heat stresses. This has resulted in some facilities resorting to the use of portable fans. Extreme weather events such as this recent heat wave may become more common and this must be considered when refurbishing old hospitals and designing new facilities.
In Ireland, very few hospitals have air-conditioning. In conditions of extreme heat, fans may be useful to assist in patient and staff comfort and regulation of body temperature. They achieve this through circulating airflow to create a breeze. Although there is no published evidence that electric fans spread infection, they may pose a risk through dispersal of airborne microorganisms, debris and dust, or through disturbing the normal or expected airflow in a clinical setting.
It is the responsibility of hospital management to try to provide the best possible temperature controlled environment for patients and staff. If this cannot be achieved after all other measures have been investigated, the use of a portable electric fan may be considered. For each patient/scenario, the safety of implementing fan use should be decided upon by the medical/nursing team in conjunction with the infection control team. A common sense approach is required that balances the risk of infection with patient and staff comfort and safety. In cases where a fan is sanctioned for use by a healthcare facility, these guidelines aim to assist in the proper use of that fan.
Portable fans should NOT be used in the following situations:
- In high-risk areas including operating rooms, critical care units, transplant units, dialysis units
- In areas where immunocompromised patients receive care, for example, oncology units
- In rooms where a patient is on airborne precautions
- In rooms where a patient is on droplet or contact precautions, for example, Clostridium difficile, MRSA, norovirus
- In rooms with directed airflow e.g. positive or negative pressure rooms
- In areas where sterile supplies are stored or where medical device reprocessing occurs, for example, hospital sterile services department, endoscopy units
Prior to commencing use of a portable fan, confirm:
- The use of fans is not prohibited by the healthcare facility
- Alternative cooling methods have been attempted with no success
- The patient is in a non-restricted use location (see above)
- The use of a fan is determined to be of benefit to the patient’s clinical condition or comfort
- A risk assessment has been performed
If a portable fan is sanctioned for use the following tips may be used:
Position
- Position the fan so airflow is directed at the patient
- Position fan on a clean surface at the patient’s bed level or higher
- Ensure airflow is not directed towards the door of the room or across environmental surfaces. The direction of flow should be upwards toward the ceiling, avoiding smoke detectors
- Ensure airflow is not blowing directly on burned skin, burn dressings, open wounds or directly into the patient’s face
- In non-patient areas, such as healthcare staff stations, ensure airflow is directed within the area
Cleaning
- Determine who will be responsible for cleaning and disinfecting the fan
- Follow the manufacturer’s instructions to clean, disinfect and maintain the fan on a scheduled basis and whenever it becomes visibly soiled
- Perform hand hygiene before handling fan
Turn the fan off before the following:
- Any sterile or aseptic procedure e.g. intravenous cannulation, catheterisation, dressing change
- Any procedure that may result in sprays or splashes of body fluids e.g. lumbar puncture, chest drain
Adapted from advice from HPSC
References:
Gupta S, Carmichael C, Simpson C, Clarke MJ, Allen C, Gao Y, et al. Electric fans for reducing adverse health impacts in heatwaves. The Cochrane database of systematic reviews. 2012;7:CD009888
World Health Organization. 2004. Practical Guidelines for Infection Control in Health Care Facilities. Accessed 25/07/18. Available at http://www.wpro.who.int/publications/docs/practical_guidelines_infection_control.pdf
Covenant Health. Infection Prevention and Control - The Use of Portable Oscillating Blade Fans for use in Healthcare Facilities. Accessed 25/07/18.
Winnipeg Regional Health Authority. Acute Care Infection Prevention and Control Manual – Portable Fans Cleaning and Use Restrictions. Accessed 25/07/18. Available at http://www.wrha.mb.ca/extranet/ipc/files/manuals/acutecare/Portable_Fans_Restrictions.pdf
Alberta Health Services. Infection Prevention and Control Guidance – Use of portable fans in healthcare. Accessed 25/07/18. Available at: https://www.albertahealthservices.ca/assets/healthinfo/ipc/if-hp-ipc-info-sheet-portable-fans.pdf
