These pages are to be used by long-term care facilities in Tennessee to interpret their assessment data report and to help provide suggestions for mitigation if needed.

Choose from one of the parameter sections below to review its data properties information.

C. AIR DATA PROPERTIES

Below are descriptions of each of the air properties that were measured and what each means. Further, if your facility had any samples that were not within the healthy ranges, we have suggested various ways of improving the air quality as indicated.

PM 2.5

PM 2.5 refers to particulate matter that is 2.5 micrometers in diameter or smaller. To put that into perspective, a human hair is about 70 micrometers in diameter, making PM 2.5 particles about 30 times smaller than a single hair on your head. These tiny particles are so small that they can be inhaled deep into the lungs and may even enter the bloodstream. Because of their size, PM 2.5 particles can bypass the nose and throat’s natural defenses, making them particularly dangerous.

Sources and Composition: PM 2.5 can come from various sources, including vehicle emissions, industrial processes, forest fires, and even some natural sources. The composition of these particles can vary greatly, containing a mix of chemicals such as organic compounds, metals, and soil or dust particles.

Health and Environmental Impact: The health impacts of inhaling PM 2.5 can be significant. They are linked to a range of problems, from minor irritations like coughing or sore throat to more serious conditions such as heart disease, lung cancer, and respiratory infections. Children, the elderly, and those with pre-existing health conditions like asthma or heart disease are particularly at risk. Environmentally, PM 2.5 can reduce visibility (contributing to haze) and affect the health of animals and ecosystems. The index we used is divided into categories that correspond to different health risks and is measured in (µg/m³):

≤12: (Good)
12.1~35.4 (Moderate)
35.6~55.4 (Unhealthy for Sensitive Groups)
55.5~150.4 (Unhealthy)
150.5~250.4 (Very Unhealthy)
≥250.5 (Hazardous)

PM 10

PM 10 refers to particulate matter that is 10 micrometers in diameter or smaller. These particles are larger than PM 2.5 but still small enough to be inhaled into the lungs. While they are less likely to penetrate as deeply into the lung’s air sacs as PM 2.5, they can still cause respiratory issues and other health problems.

Sources and Composition: PM 10 particles originate from a variety of sources, both natural and human made. Common sources include dust from roads, fields, construction sites, and mining operations, as well as smoke from wildfires and industrial emissions. The composition of PM 10 can vary widely, including dust particles, pollen, mold spores, and metal particles.

Health and Environmental Impact: The health impacts of PM 10 are significant, particularly for individuals with pre-existing respiratory conditions such as asthma or chronic bronchitis. Inhalation of these particles can aggravate these conditions, leading to symptoms like coughing, throat irritation, and shortness of breath. Long-term exposure can contribute to cardiovascular and respiratory diseases. Environmentally, PM 10 can affect visibility and harm wildlife and ecosystems by depositing pollutants over large areas. The index we used is divided into categories that correspond to different health risks and is measured in (µg/m³):

≤54: (Good)
55~154 (Moderate):
155~254 (Unhealthy for Sensitive Groups)
255~354 (Unhealthy):
355~424 (Very Unhealthy)
≥425 (Hazardous)

Number of Particles

Number of Particles refers to the total count of individual particles in a specific volume of air. This measure gives an overall picture of the particulate load in the air, encompassing a wide range of particle sizes, from very fine to coarse. It’s a broad indicator of air quality, especially in environments where particulate pollution is a concern.

Sources and Composition: The sources of airborne particles are varied and include both natural processes, such as dust storms, sea spray, and pollen release, and human activities, such as vehicle emissions, industrial processes, and combustion of fossil fuels. The composition of these particles can be just as varied, including everything from organic compounds and metals to soil and biological materials.

Health and Environmental Impact: The number of particles in the air can have diverse impacts on health, depending on the size, composition, and concentration of the particles. High concentrations of airborne particles can reduce air quality and visibility, contributing to respiratory and cardiovascular issues in humans. People with pre-existing health conditions, the elderly, and children are particularly vulnerable to high particulate environments. Environmentally, high particle counts can affect plant life, water quality, and animal health, disrupting ecosystems and contributing to the degradation of natural habitats.

HCHO – formaldehyde

HCHO, or formaldehyde, is a colorless gas with a pungent smell, known for its widespread use in building materials, household products, and as a preservative in laboratories and mortuaries. It is also produced naturally in small amounts by most living organisms as part of cell metabolism.

Sources and Composition: Formaldehyde is released into the air from a variety of sources. In homes and buildings, sources include pressed-wood products (like particleboard, plywood, and fiberboard), glues, adhesives, paints, varnishes and some insulation materials. It is also emitted by combustion processes, including cigarette smoke, vehicle exhaust, and the burning of wood, coal, or natural gas. Additionally, formaldehyde can off-gas from products such as cosmetics, detergents, fabric softeners, cleaning supplies and the preservatives used in some medicines and foods.

Health and Environmental Impact: Exposure to formaldehyde can cause a range of health effects. Short-term exposure, even at low levels, can irritate the eyes, nose, throat, and skin, leading to symptoms like coughing, nausea, and skin rashes. Long-term or high-level exposure has been associated with more serious health issues, including respiratory problems, and is classified as a known human carcinogen, linked to certain types of throat and nose cancers. The environmental impact of formaldehyde is less pronounced, as it breaks down quickly in the air; however, its contribution to indoor air pollution is a significant concern, especially in poorly ventilated environments. The index is divided into two categories that correspond to different health risks:

≤0.1 Healthy
>0.1 Unhealthy

In summary, HCHO or formaldehyde is a volatile organic compound with widespread use and presence in indoor environments, posing health risks ranging from minor irritations to serious diseases upon prolonged exposure. Understanding and controlling indoor levels of formaldehyde are crucial for maintaining healthy living and working environments.

TVOC (Total Volatile Organic Compounds)

TVOC (Total Volatile Organic Compounds) refers to the total concentration of multiple volatile organic compounds (VOCs) present in the air, typically within indoor environments. VOCs are a large group of chemicals that can easily evaporate at room temperature and enter the air we breathe. The term “total” in TVOC represents the combined amount of these compounds rather than the concentration of any specific one. Measuring TVOC levels is a way to assess the overall quality of indoor air and identify potential health risks associated with chemical exposure.

Sources and Composition: VOCs are emitted from a wide range of products and processes. Common indoor sources include paints, varnishes, cleaning supplies, air fresheners, office equipment such as printers and copiers, building materials, and furnishings. Outdoor sources like vehicle exhaust can also contribute to indoor TVOC levels, especially in buildings with poor ventilation.

Health and Environmental Impact:

Health Effects: Exposure to high levels of VOCs can lead to a variety of health issues, ranging from short-term effects such as eye, nose, and throat irritation, headaches, dizziness, and fatigue, to long-term effects including respiratory diseases, heart disease, and cancer. The severity of the health impact depends on the type of VOC, concentration, and duration of exposure. Sensitive individuals, such as children, the elderly, and those with pre-existing health conditions, may experience effects at lower levels of exposure. The index we use is divided into two categories that correspond to different health risks:

≤0.5 Healthy
>0.5 Unhealthy

Comfort and Well-being: Beyond health impacts, high levels of VOCs can decrease overall comfort and well-being. Odors and air irritancy can make indoor environments unpleasant and reduce the quality of life. In workplaces, high levels of VOCs can decrease productivity and increase absenteeism.

In summary, TVOC represents a critical indicator of indoor air quality, reflecting the presence and concentration of various volatile organic compounds. Monitoring and controlling TVOC levels are essential for maintaining healthy indoor environments, minimizing health risks, and ensuring the comfort and well-being of occupants. Strategies to reduce TVOC levels include improving ventilation, using low-VOC cleaning products (check your cleaning supplies chemicals), and regular monitoring of indoor air quality.

AQI – Air Quality Index

AQI, or the Air Quality Index is a system used to measure and report the quality of the air in a simple, understandable way. It quantifies the levels of air pollution on a scale typically ranging from 0 to 500. The AQI is calculated for different pollutants, including particulate matter (PM2.5 and PM10), ground-level ozone, sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO). Each of these pollutants can affect health, and the AQI provides a way to communicate the risk associated with the current air pollution levels to the public.

Sources and Composition: The AQI is derived from the concentration levels of key air pollutants, which come from a variety of sources such as vehicle emissions, industrial activities, natural events like wildfires and dust storms, and chemical reactions between pollutants in the atmosphere.

Health and Environmental Impact: The AQI is designed to provide information on how the current air quality affects one’s health within a short time period, typically the same day or the next. The index is divided into categories that correspond to different health risks:

0 to 50 (Good): Air quality is considered satisfactory, and air pollution poses little or no risk.
51 to 100 (Moderate): Air quality is acceptable; however, there may be a risk for some people, particularly those who are unusually sensitive to air pollution.
101 to 150 (Unhealthy for Sensitive Groups): Members of sensitive groups may experience health effects. The general public is not likely to be affected.
151 to 200 (Unhealthy): Everyone may begin to experience health effects; members of sensitive groups may experience more serious health effects.
201 to 300 (Very Unhealthy): Health warnings of emergency conditions. The entire population is more likely to be affected.
≥301 (Hazardous): Health alert: everyone may experience more serious health effects.

The AQI serves as a guide for people to understand the quality of the air around them and make informed decisions about their outdoor activities, especially those who are vulnerable or have pre-existing health conditions. It also helps in raising awareness about air pollution and the importance of clean air for health and the environment.

In summary, AQI is a tool used to communicate the level of air pollution and its potential health impacts to the public. It is an essential resource for individuals to protect their health during periods of poor air quality and for policymakers to implement measures aimed at reducing air pollution.

Temperature

Temperature in the context of air quality refers to the measure of how hot or cold the air is at a given time and location. It is a fundamental environmental parameter that affects both the quality of the air and the comfort and health of individuals exposed to it. Temperature is usually measured in degrees Celsius (°C) or Fahrenheit (°F).

Sources and Composition: While temperature itself is not emitted from a source like pollutants, it is influenced by various factors including geographical location, time of year (season), time of day, and local weather patterns. Urban areas often experience higher temperatures compared to rural surroundings due to the “urban heat island” effect, where buildings, roads, and other infrastructure absorb and re-radiate the sun’s heat more than natural landscapes.

Health and Environmental Impact: The temperature of the air can significantly impact air quality and health:

Heat and Air Quality: High temperatures can increase the rate of chemical reactions in the atmosphere, leading to higher concentrations of some pollutants, such as ozone. Hot weather can also lead to stagnant air conditions, trapping pollutants near the ground and exacerbating air quality issues.

Health Effects: Extreme temperatures, both hot and cold, can have direct health impacts. High temperatures can lead to heat exhaustion, heatstroke, and exacerbate chronic health conditions such as cardiovascular and respiratory diseases. Cold temperatures can increase the risk of hypothermia, frostbite, and also worsen chronic respiratory and cardiovascular diseases.

Comfort and Productivity: Temperature affects human comfort and productivity. Optimal temperature ranges are essential for comfortable living and working environments. Extreme temperatures can lead to discomfort, decreased productivity, and increased energy consumption for heating or cooling.

For assisted living and nursing home facilities, maintaining a comfortable and safe indoor temperature is crucial for the health and well-being of residents, who are often more vulnerable to temperature extremes due to age, medications, or health conditions. The ideal indoor temperature range in these settings tends to be slightly warmer than might be recommended for the general population, to accommodate the decreased thermoregulation capabilities and increased sensitivity to cold that can come with age.

While guidelines can vary by region and specific health requirements of the residents, a common recommendation is to keep indoor temperatures between 71°F to 81°F (21.5°C to 27°C). This range helps ensure comfort, prevents hypothermia, and addresses the reduced ability of older adults to regulate body temperature effectively. Facilities should also consider individual preferences and health conditions, ensuring that residents can adjust their immediate environment to suit their comfort levels, within safe limits.

To provide the best care, facilities should regularly monitor indoor temperatures, especially during extreme weather conditions, and adjust heating and cooling systems accordingly. They should also consider humidity levels, as both too high and too low humidity can affect health and comfort, with ideal relative humidity levels generally ranging from 30% to 60%.

In summary, temperature plays a crucial role in determining air quality and has direct and indirect effects on human health and comfort. Understanding and managing the impacts of temperature are important for public health, especially in the face of changing global climates and increasing urban heat island effects. Monitoring and adapting to temperature variations are essential for creating resilient communities and ensuring the well-being of individuals.

Relative Humidity

Relative Humidity refers to the amount of water vapor present in the air inside a building or room, expressed as a percentage of the amount of water vapor the air can hold at that specific temperature. Relative humidity (RH) is a crucial factor in determining indoor air quality and comfort, as it affects both the health of the occupants and the condition of the building itself.

Sources and Composition: Indoor humidity levels can be influenced by various factors, including outdoor humidity, indoor water sources (like plants, aquariums, and cooking without proper ventilation), human activities (such as bathing and breathing), and the operation of heating, ventilation, and air conditioning (HVAC) systems. The materials used in construction and furnishings can also absorb and release moisture, further affecting indoor humidity levels.

Health and Environmental Impact:

Health Effects: The ideal indoor relative humidity level is generally considered to be between 30% and 60%. Humidity levels outside this range can lead to a variety of health issues:

Low Humidity (<30% RH): Can cause skin irritation, dry eyes, and respiratory discomfort. Viruses and some bacteria can survive longer in low humidity, potentially increasing the risk of respiratory infections.

High Humidity (>60% RH): Can contribute to the growth of mold, mildew, and dust mites, leading to allergic reactions, asthma attacks, and other respiratory issues. High humidity can also make the air feel uncomfortably warm, contributing to heat stress.

Impact on Buildings: Apart from health concerns, improper indoor humidity levels can damage building materials. Low humidity can cause wood to shrink and crack, while high humidity can lead to condensation on walls and windows, peeling paint, and structural damage from mold growth.

Comfort and Well-being: Maintaining optimal indoor humidity levels is essential for creating a comfortable living and working environment. Low humidity can make the air feel cooler than it actually is, while high humidity can make it feel warmer. Proper humidity levels help to maintain a comfortable indoor climate, reduce health risks, and protect the building structure and furnishings.

Adequate Indoor Ventilation

Adequate indoor ventilation is crucial for maintaining healthy indoor air quality by ensuring a continuous supply of fresh outdoor air and the removal of stale indoor air, which may contain pollutants, excess moisture, and other harmful substances. Proper ventilation helps dilute and remove airborne contaminants, thus playing a significant role in reducing the risk of health issues related to poor indoor air quality.

Importance and Benefits:

Health: Adequate ventilation reduces the concentration of pollutants such as volatile organic compounds (VOCs), particulate matter (PM), carbon monoxide (CO), and other potentially harmful gases. This can significantly lower the risk of respiratory diseases, allergies, and other health problems associated with poor indoor air quality.

Comfort: Proper ventilation helps control humidity levels, odors, and temperature, making indoor environments more comfortable. It can prevent the buildup of unpleasant smells and excessive moisture, which are common issues in poorly ventilated spaces.

Building Integrity: Effective ventilation prevents the accumulation of excess moisture, which can lead to mold growth and damage to building materials. By maintaining appropriate humidity levels, ventilation helps preserve the structural integrity of buildings and prolongs the lifespan of materials and finishes.

Strategies for Achieving Adequate Ventilation:

1. Natural Ventilation: Utilizing windows, doors, and other openings to allow fresh air to flow naturally into and out of a building. This method is effective in Tennessee during our seasons when outdoor air conditions are favorable and can significantly improve indoor air quality without the need for mechanical systems.

2. Mechanical Ventilation: Employing fans and duct systems to bring fresh air into a building and exhaust stale air outside. Mechanical ventilation systems can be designed to provide consistent and controlled ventilation, making them suitable for all climates and particularly beneficial in buildings where natural ventilation is insufficient.

3. Hybrid Ventilation: Combining natural and mechanical ventilation methods to optimize air quality and energy efficiency. Hybrid systems can automatically switch between natural and mechanical modes based on indoor and outdoor air conditions, providing a flexible and effective ventilation solution.

4. Ventilation with Heat Recovery: Using advanced systems that recover heat from exhaust air to pre-warm incoming fresh air. This method is energy-efficient and particularly useful in our more mountainous and cooler climates, where it can significantly reduce heating costs while ensuring adequate ventilation.

Considerations for Effective Ventilation:

Air Quality: The quality of the incoming air should be considered, especially in areas in our cities that have higher outdoor pollution levels. In such cases, filtration of incoming air might be necessary to ensure that ventilation does not introduce additional pollutants.

Energy Efficiency: Ventilation systems, especially mechanical ones, should be designed to minimize energy consumption. This includes using energy-efficient fans, optimizing airflow rates, and incorporating heat recovery features where applicable.

Building Design and Use: The design of the ventilation system should be tailored to the specific needs of the building, considering factors such as occupancy, activities performed within the space, and the layout of rooms and spaces.

In summary, adequate indoor ventilation is essential for maintaining a healthy, comfortable, and safe indoor environment. By effectively removing pollutants and controlling indoor air conditions, proper ventilation supports the well-being of occupants and contributes to the structural durability of buildings.

Odors

Odors in a long-term care facility can significantly affect the quality of life and comfort of residents, staff, and visitors. These odors can arise from various sources, including medical treatments, incontinence, food preparation, waste, and the lack of fresh air. Addressing these odors is crucial for creating a pleasant and healthy living environment. Here are strategies to mitigate indoor odors in such settings:

Identify and Eliminate Sources

Regular Cleaning: Implement a strict cleaning schedule to ensure that all areas, especially those prone to developing odors (e.g., bathrooms, kitchens, and waste disposal areas), are regularly and thoroughly cleaned.

Incontinence Management: Promptly change incontinence products and use high-quality, odor-controlling products. Ensure proper disposal to minimize odors.

Waste Management: Ensure that waste is regularly collected and removed from the living areas. Use well-sealed containers for temporary storage to prevent odors from spreading.

Improve Ventilation

Increase Airflow: Enhance natural ventilation by opening windows whenever possible. Use mechanical ventilation systems to ensure continuous air exchange and filter out odors.

Air Purification Systems: Install air purifiers with HEPA filters and activated carbon to capture particulate matter and neutralize odors. Ensure these systems are regularly maintained for optimal performance.

Use Odor Control Products

Neutralizers and Absorbers: Use odor neutralizers and absorbers specifically designed for healthcare settings. These products can effectively eliminate rather than mask odors.

Essential Oils and Diffusers: Consider using essential oils and diffusers to introduce pleasant scents. However, be mindful of potential allergies and sensitivities among residents and staff.

Maintain Indoor Air Quality

Regular Maintenance: Ensure that HVAC systems are regularly inspected, and filters are changed to maintain optimal air quality and odor control.

Humidity Control: Maintain indoor humidity levels between 30% and 50% to prevent the growth of mold and mildew, which can contribute to unpleasant odors.

Address Moisture Issues

Promptly Address Spills: Quickly address any spills or leaks to prevent the growth of mold and mildew, which can cause musty odors.

Dehumidifiers: Use dehumidifiers in areas prone to high humidity to help control moisture and prevent odor-causing mold growth.

Engage Staff and Residents

Training: Train staff on the importance of odor control and the proper use of cleaning and odor-neutralizing products.

Feedback System: Implement a system for staff and residents to report odors promptly, allowing for quick identification and resolution of issues.

Regular Review and Adaptation

Odor Control Plan: Develop and regularly review an odor control plan tailored to the facility’s specific needs, considering the effectiveness of current practices, and exploring new solutions as needed.

Professional Assessment: Consider consulting with indoor air quality experts for a professional assessment and recommendations tailored to the facility’s unique challenges.

Mitigating indoor odors in a long-term care nursing facility requires a comprehensive approach that combines cleanliness, maintenance, and the use of appropriate products and technologies. By prioritizing the comfort and well-being of residents, facilities can create a more pleasant and healthy living environment.

ADDITIONAL SUGGESTIONS ON HOW TO IMPROVE INDOOR AIR QUALITY

Improving indoor air quality in long-term care facilities is crucial for the health and well-being of both residents and staff. Here are several cost-effective strategies to enhance air quality in both common areas and patient rooms:

1. Increase Ventilation:

– Open windows whenever weather and health conditions permit to allow fresh air circulation and reduce indoor pollutant levels.

– Use window fans in reverse (exhaust mode) in select windows to help pull fresh air through other open windows.

2. Enhance Air Filtration:

– Upgrade HVAC filters to higher efficiency particulate air (HEPA) filters, if compatible, to better capture airborne particles, including viruses, bacteria, and allergens.

– Install portable air purifiers with HEPA filters in high-traffic areas and individual rooms, focusing on spaces where vulnerable residents spend most of their time.

3. Maintain HVAC Systems:

– Regularly clean and maintain HVAC systems to ensure they are operating efficiently and effectively distributing clean air throughout the facility.

– Ensure that air ducts are inspected and cleaned as needed to prevent the circulation of dust and other contaminants.

4. Control Humidity:

– Use dehumidifiers in areas prone to high humidity to prevent mold growth. Aim to keep indoor humidity levels between 30% and 50%.

– Repair any water leaks promptly and address dampness to prevent mold and mildew development.

5. Reduce Indoor Pollutants:

– Use low-VOC (volatile organic compounds) paints, adhesives, and cleaning products to minimize residents’ and staff’s exposure to harmful chemicals.

– Implement a strict no-smoking policy inside and near the facility to prevent tobacco smoke from affecting indoor air quality.

6. Enhance Cleaning Practices:

– Use microfiber mops and cloths for cleaning surfaces as they are more effective at trapping dust and allergens.

– Vacuum regularly with vacuums equipped with HEPA filters to reduce the amount of dust and allergens in carpets and upholstery.

7. Introduce Indoor Plants:

– Place indoor plants in common areas and patient rooms to naturally purify the air. Certain plants, like spider plants and peace lilies, are known for their air-purifying abilities. However, be mindful of potential allergies and the need for regular maintenance.

8. Educate Staff and Residents:

– Conduct regular training sessions for staff on the importance of indoor air quality and how their actions can make a difference.

– Engage residents in maintaining air quality by encouraging them to report leaks, odors, or other issues promptly.

9. Monitor Air Quality:

– Consider investing in indoor air quality monitors to keep track of pollutants, humidity, and temperature in real-time, allowing for immediate adjustments.

By implementing these cost-effective measures, long-term care facilities can significantly improve indoor air quality, creating a healthier and more comfortable environment for everyone.