Ventilation requirements in general practice

Before you go spending money, please know that right now:

• we do not have specific advice from the Ministry about ventilation
• there is not enough evidence on ventilation to warrant investing heavily in one product or another.

Good ventilation is not the only measure to reduce the risk, but is part of a comprehensive package of protective measures, such as physical distancing, mask wearing, frequent hand washing, etc.

What can your practice do now?

It’s easy to get complacent about risk migration measures, so this is a great opportunity to refresh the infection, prevention control measures at your practice.

Many practices are part of a commercial buildings or old villa with no ventilation at all, relying only on open windows. The biggest issue with using natural ventilation is that you have no control over where the air goes.

The College recommends that each practice should start by undertaking a simple ventilation self-assessment to help inform the simple steps necessary to increase ventilation and lower carbon dioxide (CO2) in a practice. Although checking CO2 levels is not a direct measure of possible exposure to COVID-19, it can help identify poorly ventilated areas.

Simple steps that can help increase ventilation

• Do a practice ventilation risk assessment. (Each practice will have to assess their own way of ventilating the space, whether that’s natural ventilation (opening windows) or mechanical HVA systems where it produces both fresh air or recirculated air, which may or may not be filtered.)
• Review infection prevention protection measures and ensure staff comply with the measures.
• Stream patients - Higher risk patients ideally should be seen either outside or in a well ventilated area.
• Review patient flow in the practice. The use of streaming and managing at risk people outside may be possible, ideally a practice would have a separate red entrance coming into a separate red assessment room and maintain the air extraction from that room and maintain directional air flow within the clinic and the airflow is always toward the red area.
• Centralised air handling units should be switched to 100 percent outdoor air mode.
• Non-ducted heating and air conditioning units that recirculate air, such as fan-coil or split units, should be assessed, maintained, and cleaned according to manufacturer recommendations. Assess the unit’s filter and consider replacing the existing filter with MERV14/F8 or the highest compatible filter with the filter rack, in collaboration with an HVAC professional. The units and filters should be periodically cleaned and maintained according to manufacturer recommendations.
• Consider purchasing portable HEPA filter units to increase the number of air changes per hour.
• If COVID-19 is circulating in your community and the use of a table or pedestal fan is unavoidable, it is important to regularly bring in air from outside by opening windows or doors, while minimising how much air blows from one person (or group of people) to another person (or group of people).
• The use of ceiling fans can improve the circulation of air from outside and avoid pockets of stagnant air forming indoors. However, it is critical to bring in air from outside when using ceiling fans, such as by opening windows.
• Air extractor or exhaust fan, which should run at a high speed.