Most long term care (LTC) administrators have optimized staffing, supply chains, and clinical resource allocation. But until recently, few fully appreciated the importance of indoor air quality not just for patient health, but for the facility’s financial well-being.
Historically, airborne disease transmission in LTC facilities has been treated as an uncontrollable background variable. However, scientific literature increasingly points to airborne transmission as a documented, persistent driver of infections in LTC facilities. A recently published peer-reviewed study in the Journal of the American Medical Directors Association offers clinical evidence that facilities can reduce infection incidence by nearly 50 percent through an approach known as continuous active air disinfection.
The upshot for LTC leaders is clear. No longer restricted to specialized sterile environments like operating theaters, continuous air disinfection is now a practical tool that can reduce the medical, operational, and financial burdens of airborne infections in LTC facilities.
What Airborne Infections Cost Your Facility
One direct way airborne infections cost LTC facilities is through the Skilled Nursing Facility Value-Based Purchasing (VBP) program. The VBP program withholds 2 percent of all Medicare Part A payments to create a pool of funds that it redistributes to facilities based on their scores on various measures.
Each fiscal year, facilities receive a payment adjustment ranging from a 1.5 percent increase to a 2 percent cut based on, among other measures, their rehospitalization rates in the previous year. This means an airborne infection-driven hospitalization in an LTC facility is not just a clinical event. It also feeds directly into a scored, payment-adjusted federal quality measure.
It is not just patient infections LTC facilities worry about. Airborne disease transmission can also contribute to staffing strains. When nursing staff are absent due to respiratory infections, LTC facilities are often forced to bring in agency staff at premium rates, which contributes to cost pressures. The relative cost of contract nursing staff has also ballooned since the COVID-19 pandemic. The Department of Health and Human Services reports in a recent issue brief that labor costs were 75 percent higher for contract nursing staff than for permanentemployees in 2021.
Infections are also a financial risk to LTC facilities in the form of occupancy and retention. Outbreak-driven cohort restrictions can interrupt admissions and force bed-holds. Meanwhile, well-publicized outbreaks can erode family confidence and interrupt the referral pipeline. Infection-related quality measures are also a component of a facility’s CMS Star Rating.
There is also the cost of the response itself. Following updated ventilation guidance after 2020, many facilities increased airflow and fresh air intake to dilute airborne pathogens. The intent was sound, but the approach carries an ongoing operational burden. Conditioning more outside air raises energy costs and accelerates wear on HVAC equipment, and adding higher-efficiency filtration on top increases the strain further, since denser filter media restricts airflow and forces the system to work harder for a partial result. Facilities can find themselves paying more on both ends and still managing infection risk only indirectly.
What the Study Say
Recognizing that airborne transmission is an important driver of health care-associated infections, a team led by Israeli epidemiologist Itamar Grotto conducted a controlled study into the impact of continuous air disinfection at the Golden Care Geriatric Center in Ness Ziona, Israel.
In their research letter to JAMDA, “Continuous Hydroxyl Radical Air Disinfection and Infection Outcomes in a Geriatric Long Term Care Department: A Prospective Cohort Study,” the authors describe how they evaluated 242 resident-years across two comparable LTC units for two consecutive years. Residents who were present in both years count as two resident years.
At the start of Year 2, induct-mounted hydroxyl radical generators, which disperse hydroxyls radicals that replicate the effects of the sun’s ultraviolet energy and sanitize indoor air, were installed in the intervention unit and operated continuously throughout the year. The control unit received standard care with no additional air disinfection.
The results show a dramatic 48 percent reduction in respiratory infections in the intervention group during Year 2.
Infection incidence in the intervention unit decreased from 1.88 to 0.98 events per resident-year, while remaining unchanged in the control unit (1.61 to 1.57).
Overall infections declined from 51.6 to 26.8 per 10,000 resident days in the treated unit, compared to minimal change in the control unit.
Hospitalization rates between the two units remained comparable, indicating that the primary benefit was reducing infection burden within the facility.
Doing the Math
While the reduction in infections with continuous air disinfection is measurable, existing studies do not discuss the potential economic impact. The cost per infection varies widely from facility to facility, and so will the return on investment.
Nevertheless, administrators can estimate the potential savings by leveraging this simple framework.
- Take your facility’s current annual infection event rate or use the study’s pre-intervention benchmark of 1.88 events per resident-year as a reference.
- Apply a conservative 40 percent reduction scenario, which is below the study’s observed 48 percent.
- Multiply avoided events by your facility’s estimated cost per infection event. These costs may include staffing up with agency nurses, lost bed space due to quarantines, and the VBP payment exposure related to health care-associated infections that require hospitalization.
- Compare these savings against device installation and operating costs. These vary widely by facility size, layout, and vendor. Factors such as installation, maintenance, and energy costs can make or break the ROI. Legitimate vendors will have robust figures ready to present during the ROI conversation. Administrators should always request a transparent cost breakdown from any vendor they speak to.
What Operators Can Do Now
Being just one study, the JAMDA study has its limitations. The authors acknowledge the limited, single-center implementation and potential variations between care units, as well as reliance on electronic medical records, as potential confounding factors. But it contributes to a growing body of research that highlights the impact of indoor air quality on resident health. The JAMDA paper itself cites a systematic review showing that air filtration and decontamination can reduce respiratory infections in congregate care environments.
Some administrators worry that installing new air filtration appliances will be intrusive. But one of the best parts about continuous air disinfection is that it operates completely autonomously. Once installed, it does not require vacancy periods, staff compliance, or behavior changes from patients. Furthermore, induct hydroxyl radical generators like those used in the JAMDA study operate out of the way of patients and staff, keeping critical floor space clear.
LTC administrators tend to be cautious, and rightly so. To ease into the continuous air disinfection conversation, administrators can take these three practical steps.
- Audit your infection data. Before any conversations with vendors, pull your infection event logs and hospitalization transfer rates so you know your baseline.
- Ask the right vendor questions. Is the system designed for continuous operation in occupied spaces? What purification technology does it use? Is there peer-reviewed, LTC-specific evidence for it? What is the installation, maintenance, and ongoing monitoring requirements?
- Consider a phased pilot. The JAMDA study validated the efficacy of continuous air disinfection at the unit level. A pilot in one wing would generate internal data before committing to a facility-wide upgrade.
No Going Back
Air quality is no longer just an infection control issue. It is a financial performance issue, a workforce stability issue, and a regulatory risk issue. Administrators now have peer-reviewed, real-world evidence that continuous air disinfection in LTC facilities correlates with a clinically and operationally meaningful reduction in infection burden.
Air quality is emerging as a strategic lever for LTC facilities to potentially improve their cost structure and staffing stability. Administrators owe it to their facility’s patients and staff to start a conversation about this promising new direction for infectious disease control in LTC settings.
Mahyar Khosravi, P.Eng., is the chief executive officer and a member of the board at Pyure Company, Inc. Mahyar brings over two decades of experience in strategy, technology, and operations and holds a Bachelor of Science in Computer Engineering from the University of Calgary.
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