Lessons learned from using high efficiency particulate air (HEPA) filtration units in care homes: interviews with care home staff, residents and relatives from the AFRI-c trial

Background Respiratory infections are a leading cause of mortality and morbidity among older adults in residential care homes. We conducted a qualitative study within the ‘Air Filtration to prevent symptomatic winter Respiratory Infections (including COVID-19) in care homes (AFRI-c)’ pragmatic cluster randomised controlled trial. This paper reports the lessons learned from using high-efficiency particulate air (HEPA) filtration units in a care home setting. Methods Interviews with care home staff (n=25), residents (n=20), and relatives (n=12) who participated in the AFRI-c trial were analysed using reflexive thematic analysis. Results Preventing respiratory infections was a high priority for staff. Although using HEPA filters became normalised during the intervention period, they were not considered suitable for all residents. The ability to lock settings or fix them to walls was identified as a potential way to improve them in this setting. Participants felt that the care home sector would be unable to afford the cost of HEPA filters for all residents and that their use would be prioritised for those with the greatest need. However, without financial support, HEPA filters may only be used by residents who can afford them. Staff felt that HEPA filters might be attractive to potential residents and their families, but consultees and residents were both more focused on overall quality of care and life. Maintenance of the HEPA filters had a minor impact on staff workload. Conclusions Although the AFRI-c trial found that HEPA filters did not reduce respiratory infections in residents, these insights could be valuable for care homes wishing to use HEPA filters for other reasons, such as reducing airborne pollutants and allergens. With some adaptions, portable HEPA filters could be made more suitable for use in care home settings. There were concerns that without financial support, inequalities could deepen.