Yale New Haven Health harnessed the power of ventilation to fight COVID-19

A recent observational study looking at COVID-19 isolation dormitories showed opening a window could reduce the amount of coronavirus in a room by half. This study highlights the importance of fresh air changes within indoor environments, a core aspect of Yale New Haven Heath’s immediate pandemic response.  

Robert Schuerlein started his career as an HVAC technician, influenced by his older brother who owned a repair business. He worked as a technician at Yale New Haven Hospital for several years and in 2018 was promoted to coordinator for mechanical systems which involves everything from regulatory work to dealing with power outages. 

“I was coordinator of mechanical systems for two years, just getting my footing in this new position when 2020 hit and the stakes grew from there,” said Robert.  

Working with ventilation and air pressure, Robert knew something that has been lurking behind the scenes in infectious disease mitigation since right after the Civil War. At this time, when tuberculosis was a public health crisis, some believed rooms with closed windows created a poisonous environment.

Data has supported this theory. The world’s deadliest diseases, including tuberculosis, measles, influenza, smallpox and SARS have all been shown to spread more during times of enclosure through heating, ventilation and air conditioning systems. 

In 1970 a patient with smallpox being treated in a German hospital infected people on three separate floors throughout the building due to poor ventilation design, which tends to be a problem for older facilities not up to code.

Today, hospitals must follow strict regulation governed by agencies like the Department of Public Health, Centers for Medicare & Medicaid Services (CMS) which include ventilation mitigation measures.

“Negative air has always been important, but nothing stressed this like the air changes per hour that we were looking for when COVID hit,” said Robert. “We had the capability to switch additional patient rooms to negative pressure—this means air flows from the corridors into the patient room, reducing the amount of virus getting out to common areas.”

When he first started working at the hospital, Robert was on the team that regularly tested this capability and saw how the pieces came together.  

“We even figured out how to convert multiple floors at once by creating a positive pressure bubble below the COVID units with the push of a button.”  

That button was pushed March 2020. 

“As summer approached we had to figure out how we could cool those floors. It was only meant to be a short run for that scenario, not for 100 degree days. Working with Infection Prevention, we installed HEPA filtration systems to filter out viral particles within individual rooms to supplement the Air Changes Per Hour rate of the in-house HVAC Systems. The hardest part was changing the filters and ensuring we understood the supply chain enough to have new ones coming in on time.”

The Facilities team includes nearly 100 YNHH individuals in facilities/engineering HVAC, mechanics, tube station mechanics, electricians, carpenters, painters, plumbers, locksmiths and maintenance specialists all reporting for work on site every day to help; some of whom struggled with and lost their own battles with COVID-19. 

“In engineering, especially in the HVAC team we work side by side to keep morale high,” said Robert.  “I am not going to sit at my desk while people I work with are in patient rooms keeping everything running.”

Since March 2020, this team has been an instrumental part of infection control supporting YNHH’s fight against COVID-19 within the hospital including: 

  • Planning and facilitating outdoor testing sites
  • Converting three RVs into mobile COVID-19 testing sites 
  • Creating additional negative pressure rooms
  • Supporting Facilities Design & Construction with the creation of Vaccination Clinics 

Robert explained that HVAC technicians have always been behind the scenes measuring air flow and ensuring equipment is up to code. 

“For years we would take these measurements and we were often seen as a nuisance. Now we are a welcomed part of how we are fighting this virus and protecting against future threats to our patients’ safety.”