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ESL-IC-10-10-88

IAQ in Hospitals – Better Health through Indoor Air Quality Awareness

M. Ramaswamy Farooq Al-Jahwari Saif M. Masoud Al-Rajhi

PhD Technical Expert, Royal Court College of Engineering, Sultan Royal Flight Area Eng., Royal
Affairs Qaboos University Estates, Royal Court Affairs
Sultanate of Oman

Abstract
Quality air is fundamental to people’s health and well-being. Indoor air quality is an important issue from both a
social and economic point of view. Continual advances in medicine and technology necessitate constant reevaluation
of the air-conditioning needs of hospital and medical facilities. The application of air conditioning to health facilities
presents many problems not encountered in the usual comfort air conditioning design. Hospital air conditioning
assumes a more important role than just the promotion of comfort. Studies show that patients in controlled
environment generally have more rapid physical improvement than do those in uncontrolled environment. Air
quality at hospitals needs special precautions during design and maintenance stage to prevent infections from
spreading. 50% of all illnesses are either caused by, or aggravated by, polluted indoor air. The main objective of this
paper is to critically review and summarize the available information about IAQ particularly in health care
industries. Symptoms of poor IAQ in a building, contaminants causing poor IAQ, features of HVAC systems for a
hospital for better IAQ are briefly discussed in this paper. Strategies to improve indoor air quality in hospitals and
the current international research to improve indoor air quality are reported in this paper. Based on the extensive
interactions with different stake holders of a hospital it is concluded that maintenance of proper indoor quality in a
hospital needs meticulous team work among the various members of the hospital at various stages .

Key Words: - HVAC system, infection control, ventilation, clean room, hospital, AHU, Filters, pollutants,

INTRODUCTION show remarkable consistency in the relationship

Most of us spend major portion of our time observed between changes in daily ambient
indoors in homes, schools, the workplace, shopping suspended particulate levels and changes in mortality.
malls or hospitals. The average person will use In developing countries the problem of indoor air
typically 15kg of air a day through breathing pollution far outweighs the ambient air pollution. In
compared with 1kg of food and 2kg of water, yet the minds of many people, air pollution is usually
there are no clear guidelines to ensure good air associated with the contamination of urban air from
quality in buildings available. automobile exhausts and industrial effluents. But the
The successful monitoring and control of the fact of the matter is that indoor air quality creates
quality of room air is becoming increasingly serious problems if not understood properly. As we
important – particularly as the application of novel breathe, we use up available oxygen and replace it
building techniques and materials coincide with with carbon dioxide, which is a simple asphyxiant. A
improved awareness of their effects on comfort and poorly ventilated room or a building, especially a
health. Air quality within a building is influenced by crowded one, sometimes lacks enough proper fresh
many external and internal factors. The air we supply air to keep carbon dioxide concentrations at
breathe can be degraded by a wide variety of low levels. This sometimes results in drowsiness or
contaminants, natural, synthetic, biological and discomfort.
inorganic. The major sources of contaminants in any The US Environmental Protection Agency (EPA)
building are occupants, office furnishings and concedes that about 30% of new or renovated
equipments etc. Occupants generate odours, skin buildings have serious indoor air quality problems,
flakes, bacteria and other bio- effluents. Office and ranks IAQ as the most prominent environmental
furnishings release solvent vapours including volatile problem (Roodman, 1995). It is reported in the report
organic compounds, such as formaldehyde, as does titled “Causes of Indoor Air Quality Problems in
office equipments such as copiers which also release Schools“(ASHRAE Journal, P16, 1999) that as many
ozone. as 20% of U.S. Schools have indoor air quality
In recent years a large number of studies of health problems. ASHRAE standard 62.2 P, Ventilation and
impact of suspended particulate air pollution have Acceptable Indoor Air quality in Low – Rise
been under taken in developing countries (Air Residential Buildings defines the roles of and
Quality Guidelines for Europe, 1997).These studies minimum requirements for mechanical and natural

Proceedings of the Tenth International Conference Enhanced Building Operations, Kuwait, October 26-28, 2010
 ESL-IC-10-10-88

ventilation systems and building envelope intended to Air conditioning, as common man knows, is the
provide acceptable indoor air quality. It applies to control of temperature, humidity and quality of air
spaces intended for human occupancy within single – simultaneously. IAQ is defined as the process of
family houses and low – rise multifamily structures. providing air which is comfortable in every way and
Max Sherman reviewed this draft standard in his does not cause negative health effects, disease or
article “Indoor Air Quality for Residential Buildings sickness in humans and is devoid of dust, smells,
“(ASHRAE Journal, P26, 1999). He has recreated draughts and noise as much as possible. Air doesn't
important question about this standard and its answer just get cleaned up by itself. We need special
were also given in this paper. The demand on equipment to monitor and control the quality of air.
designers to provide comfortable buildings are The capital costs as well as running cost of the
increasingly balanced with the demands of low- HVAC plants are the deciding factors to maintain the
carbon economy, greater environmental concern etc. required quality of air for different applications. The
Studies reporting perceived air quality (PAQ) and more stringent requirement of quality of air the more
performance (Bako, 2004) have indicated a capital cost & running cost. Indoor air quality is a
relationship between changes in PAQ and change in prime factor, during the design stage and critical
work performance (Figure 1). Researchers have factor during the maintenance stage of HVAC
suggested that when people feel good about the air systems. Governments across the world have begun
they breathe, they are more productive and happier. to address IAQ problems through various measures.
Work collated by a team of researchers from the IAQ in hospital is more critical as the patients have
University of Technology, Finland, has shown that less immunity. Hospital buildings involve complex
there is a likely link between the rate of ventilation installations. It is a known fact that in a typical
and sickness in offices (Figure 2). hospital the level of airborne infectious contaminant
(CIBSE,2006).Recent estimates place the direct increases proportionately with the increased
health care costs of poor IAQ in the US at $30 population density of infected individuals. Therefore
billion, with sick leave and productivity losses adding IAQ concept in hospital is emerging as a modern
another almost $100 billion annually (Fisk, 1997). field of specialization among engineers and health
care professionals. The importance of IAQ in
hospitals is discussed with the theme better health
through IAQ awareness in this paper.

LITERATURE REVIEW ON IAQ WORKS IN

HOSPITALS
Hospitals being the major segment of the total
health care system, where most resources are
allocated, are expected to function efficiently and
effectively to achieve “Health for All” mission.
Modern hospital is no more considered a place for the
diagnostic and treatment of a patient’s disease.
Figure1. Relative performance of typing depending Broadly speaking, it is a place for the diagnostic and
on perceived air quality expressed as % of treatment of human sickness, where health education,
dissatisfied with air quality by non-adapted persons. training, research activities and many more activities
are undertaken. It is functionally a complex
organization having multi faceted developments in
the society. Therefore healthcare facilities have to
pay particular care to indoor air concerns. The basic
difference between air conditioning for hospitals (and
related health facilities) and that for other building
types stem from

• The need to restrict air movement in and between

the various departments;
• The specific requirements for ventilation and
filtration to dilute and remove contamination in
Figure 2. Relative short –term sick leave or illness Vs the form of odor, air-born microorganisms and
Ventilation rate viruses, and hazardous chemical and radioactive
substances;

Proceedings of the Tenth International Conference Enhanced Building Operations, Kuwait, October 26-28, 2010
 ESL-IC-10-10-88

• The different temperature and humidity standards 62.1 and 62.2 for ventilation and acceptable
requirements for various areas ; indoor-air quality, European standards 13779 and
• The design sophistication needed to permit 15251 for building design and ventilation
accurate control of environmental conditions. performance , the International Society of Indoor Air
Quality and Climate’s guidelines for biological
Air quality at hospitals needs special precautions indoor-air quality , the Finnish Society of Indoor Air
during design and maintenance stage to prevent Quality and Climate’s classifications for indoor
infections from spreading. It is reported that 5% of all climate and the Federation for European Heating and
patients who go to hospitals for treatment will Air-Conditioning Association’s guidelines for
develop an infection while they are there (O'Neal C, ventilation and hygiene. These few cited literatures
2000). The levels of some hazardous pollutants in clearly indicate that in order to create a healthy
indoor air at some places have been found to be up to environment for patient recovery and safe working
70 times greater than in outdoor air. Besides the environment for staffs IAQ is an important issue for
complex hospital environment requires special the smooth functioning of a hospital.
attention to ensure healthful indoor air quality to
protect patients and health care workers against SYMPTOMS CAUSES & CONSEQUENCES OF
nosocomial infections and occupational diseases. POOR IAQ
According to WHO, bad indoor air quality is a real Following are some of the symptoms of poor IAQ in
health hazard and can have significant impact on the a building;
shortening of life expectancy. Children and the
elderly are especially affected by polluted indoor air. • Limited fresh air.
Researchers from Hong Kong university carried • Temperature & humidity outside comfort zone.
out a detail study about the role of ventilation in • Eye, nose, throat irritation.
airborne transmission of infectious agent in health • Dry facial skin.
care units and concluded that there is a strong and • Respiratory infections, asthma.
sufficient evidence to demonstrate the association • Fatigue, Headaches.
between ventilation, air movements in buildings and • Increased allergic reactions.
the transmission spread of infectious diseases such as • Sick building syndrome – SBS.
measles, tuberculosis, chickenpox, influenza, and sars
etc. (Ignatius T.S, 2004). Nordstrom and his team Potential Causes of Poor Air Quality
from Sweden investigated IAQ in hospitals in
• Reduced Ventilation.
relation to building dampness and type of
• Building Materials and furnishings.
construction. They analyzed four hospital buildings
of different age and design and concluded that • Deferred Maintenance to Save Money.
building dampness in the floor construction may • Pesticides, Housekeeping Supplies, Office
increase the sensation of air dryness and stuffy air Supplies, and Chemicals in Personal Care
(Nordstrom, 1998). An interesting study was carried Products.
out by researchers from Greece about the indoor air
conditions in 20 numbers of hospital operating rooms Consequences of Poor IAQ
in major hospitals in Greece and listed out the • Health Problems
commonly encountered problems such as insufficient • Reduced productivity
indoor air change, bad space ergonomics, poor • Higher Costs to Fix
maintenance etc. (Balaras, 2007). Studies show a • Problems than to Prevent
direct relationship between certain concentrations of • Poor Public Relations
air pollutants with internal health problems, such as: • Liability Issues
allergies, asthma, bronchitis, pneumonia, lung cancer
etc. [(Deloach, 2004), (Craig, 2003), (Health Canada
Indoor air quality, 2005), (Hoskins, 2003)]. Modern FRESH AIR- VENTILATION ITS
methods for the management of indoor-air problems IMPORTANCE TO IAQ AND ENERGY COST
have been outlined in numerous publications, with OF THE HVAC PLANT
some examples including the World Health Ambient air contains nearly constant amount of
Organization’s air-quality guidelines, Health Nitrogen (78% by volume), Oxygen (21%) and
Canada’s exposure guidelines for residential indoor- Organ (0.9%) with varying amount of carbon dioxide
air quality, The American National Standard (about 0.3%) and water vapour. Gases other than
Institute’s and the American Society of Heating, listed above are usually considered as contaminants.
Refrigerating and Air-Conditioning Engineer’s They have serious effect on occupant’s health. To

Proceedings of the Tenth International Conference Enhanced Building Operations, Kuwait, October 26-28, 2010
 ESL-IC-10-10-88

delete/ remove the contaminants from the enclosed CONTAMINANTS CAUSING POOR IAQ IN
space fresh air is to be injected in to the area through HOSPITALS
the air conditioning system. This is known as Contaminants causing poor IAQ can be broadly
ventilation. Assessment of indoor air quality relies on classified as outdoor and indoor contaminants. Later
the experience of engineers, building managers and one plays a vital role in IAQ of hospitals. Indoor
air quality consultants to determine whether contaminants can be further classified as Chemical
satisfactory ventilation rates are maintained, contaminants and Biological contaminants. Tobacco
occupancy levels are within guidelines and smoke, Volatile Organic Compounds (VOC), Radon,
housekeeping practices are effective. To maintain Inorganic gases, Carbon dioxide, and Nitrogen oxides
proper air quality ASHRAE has created new are some sources of chemical contaminants.
standards. The new standards require more fresh air Chemical compounds that have a carbon basis and
and exhaust large volumes of conditioned air which evaporate easily into the air are known as Volatile
in turn raises energy cost. Engineers and owners of Organic Compounds .VOC cover a wide range of
health care units are facing a major challenge to find compounds having boiling points in the range of 50 –
solution without tripling the cost of building 260 OC and hence existing in vapour form at room
operation and maintenance system. Installation of temperature. ASHRAE Standard 62 (1999) suggests
suitable heat exchangers used to recycle the energy that complaints are unlikely to arise for total VOC
from the exhaust to the supply air stream, is one concentrations below 3000 mg/m3, whereas above
option to reduce the energy cost. During recent years 3000 mg/m3 complaints are likely. Radon is a
Demand Controlled Ventilation (DCV) concept is colorless and odourless radioactive gas. It comes
being used in hospital HVAC system design.DCV is from radioactive decay of radium, which in turn
a strategy that attempts to reduce the energy used by comes from the decay of uranium. Radon is
ventilation systems while maintaining required levels implicated in the cause of lung cancer. Respirable
of indoor air quality (IAQ). During the last few particles are those constituents of the air that are not
decades variable air volume (VAV) systems that in purely gaseous form. They can be ingested into the
were conceived to alter the volume flow rate to match lungs while breathing and cause a wide range of
thermal demand has became popular among air health problems. The most potentially dangerous
conditioning engineers. By regulating the flow rate of particulates are asbestos fibers but there are concerns
air through a properly designed system, significant about other ‘man made mineral fibers’ (MMMF),
energy savings could be achieved with the help of which are widely used for insulation with in
VAV systems. The concept has been developed and buildings. Carbon monoxide (CO) is odourless and
refined to produce the modern DCV systems that colourless gas. Its presence in air more than 1500ppm
frequently not only control temperature (and leads to death. Carbon dioxide (CO2) is also a
humidity) but also optimize the supply of air colourless and odourless gas. It forms from burning
volumes, and particularly outdoor air, so that carbon-based material and also from human
appropriate levels of IAQ are maintained whilst respiration (200 ml/min). Its presence in air less than
minimizing energy costs. 5000ppm does not cause much problem but more
than that creates metabolic stress and respiratory
SICK BUILDING SYNDROME (SBS) problems. Nitrogen oxide usually from combustion
The issue of improving air quality in buildings has and vehicles, react with air to produce nitrates. It
previously been mainly related to SBS. It is a causes lung damage. Its presence more than 150ppm
situation in which occupants of a building experience is lethal.
linked to time spent in the building with no specific Air borne micro-organism may be sampled by
illness. Symptoms of SBS are acute discomfort, drawing air across a growth medium followed by
headaches, dizziness, eye, nose, throat irritation, dry laboratory incubation and analysis to allow
cough, itchy skin, nausea etc. Recently many enumeration and species identification. Bacterial and
researchers have worked on SBS issue and its effect fungi are always present in the indoor environment
on office workers and noticed that SBS is not linked but, in most cases, not at levels to significantly
to the type of ventilation or air conditioning system detrimental to healthy adults .Biological
used but it is more likely to be a function of how well contaminants such as bacteria, mold, and viruses can
system are installed, managed and operated. breed in stagnant water that has gradually
Therefore Operation & Maintenance of HVAC accumulated in ducts, humidifiers and drain pans of
systems in hospitals are more critical than other the ventilation system; or water that has collected on
buildings. ceiling tiles, carpeting, or insulation. Moulds
reproduce by releasing tiny spores which when they
land on a damp spot begin to grow. Above 60% RH

Proceedings of the Tenth International Conference Enhanced Building Operations, Kuwait, October 26-28, 2010
 ESL-IC-10-10-88

moulds grows rapidly. For example, certain However with due care during the design and
respiratory care equipment produces a lot of mist, maintenance of HVAC systems in hospitals
which can increase the humidity levels in a room. contaminants can be minimized as per the required
These rooms need to be cleaned regularly to prevent standards. Proper maintenance of Air handling units
the growth of mold. Allergic reactions and asthma and regular cleaning of ducts and its accessories is
are few symptoms associated with mould. Fungi are one of the important strategies to ensure a better IAQ
another biological contaminant, which needs special in a hospital.
attention. One researcher calculated that about 9% of
reported hospital infections between 1986 and 1990 FEATURES OF HVAC SYSTEMS FOR A
were caused by fungi. (Martone, 1992). Sarah et al HOSPITAL FOR BETTER IAQ
reviewed the health effects of fungi and concluded Various studies have shown that two out of three
that despite intense public interest in the subject indoor air quality problems involve the HVAC
science is not yet developed to answer many basic system. Therefore it is very important to determine
questions about the potential health threat posed by the ventilation strategy at an early stage of design to
indoor fungi and no standards for exposure to molds ensure that the systems are tailored to the
have been promulgated (Sarah, 2002). requirements of each area of a hospital. In general,
separate ventilation systems should be provided for
IMPORTANCE OF AIR FILTERS & DUCTS each department or group of similar departments
IN HVAC SYSTEMS provided that they are closely grouped together. It is
It is very important that the air filters in the a general requirement for health care buildings that
ventilation system be changed often. That is because the building has an overall positive or neutral
filters are an ideal location for fungus to grow. pressure and the extracted air replaced by treated
Bacteria are microorganisms, which are less than 1 make-up air supplied to, for example, internal areas,
micron. They reproduce and develop to resist anti- staff base, etc. in ward areas. Air handling plant for
biotic. One out of six people who suffer from all medical areas should be of the ‘blow-through’
allergies do so because of the direct relationship to type with only the frost coil and pre-filter upstream of
fungi and bacteria in air duct systems .All parts of the the fan to ensure that there is no inward leakage of air
humidification and dehumidification systems must be downstream of the coils and main filter. In general,
kept clean and dry to prevent growth of bacteria. outlets supplying air to ultra-clean areas such as
Viruses is an another infection mechanism found in operation theaters, ICUs should be located on the
almost every living organism, divided into 70 ceiling, and perimeter, or many exhaust outlets
families over 4100 known types, 30-450nm, 95 times should be near the floor. This arrangement provides a
smaller than bacteria. Viruses do not reproduce but downward movement of clean air through the
replicate by injecting their genetic information into a breathing and working zones to the floor area for
cell, which acts as a host. It damages or destroys host exhaust.
cell e.g. Cancer. Many diseases are the result of viral Surgery & Critical Care areas of a hospital such as
infection e.g. cold, flu, rubella, measles, chickenpox obstetrical area, delivery rooms, recovery rooms etc
and shingles. Bacteria or viruses spread so easily need more careful control. The temperature set point
through air. When someone sneezes, coughs, laughs should be adjustable by staff over a range of 17 to 27
o
or exhales air, respiratory droplets can become C. Relative humidity should be kept between 45 and
aerosolized and can stay airborne for hours. Tests 55%. Air pressure should be maintained positive with
show it takes 4.5 hours for an aerosolized droplet to respect to adjoining rooms by supplying 15% excess
reach the ground in a room with no air current. air. Differential pressure indicating device should be
Complete removal of indoor contaminants is not installed to permit air pressure reading in the rooms.
easily possible due to the following reasons: Thorough sealing of all wall, ceiling, and floor
penetrations and tight-fitting doors is essential.
• Poor design and / or material selection of Humidity indicator and thermometers should be
HVAC system and building materials. located at the correct locations for easy observation.
• Air is recycled for energy efficiency. Filter efficiencies should be as per ASHRAE
• No / low efficiency internal filtration. recommendation. Bad filtration does not control
• Physical constraints--not easy to check or outdoor contaminants. Recycled air allows fine dust
clean the filters regularly. particles to accumulate in the air ducts. Figure 3
• Un-identified sources of pollutants, and no shows the condition of A.C duct in one of the
regular testing. hospitals in Oman.

Proceedings of the Tenth International Conference Enhanced Building Operations, Kuwait, October 26-28, 2010
 ESL-IC-10-10-88

size with efficiency of 99.9%. Pressure drop is 15

mm of W.G. High Efficiency Particulate Air (HEPA)
filters down to 0.3-micron size. Pressure drop is in
these type of filters is 50 mm of W.G. Use of
appropriate filters and its regular maintenance is
strongly recommended in all IAQ standards.

3a. STRATEGIES TO IMPROVE INDOOR AIR

QUALITY IN HOSPITALS
Always follow guidelines such as ASHRAE/,
WHO, NADCA etc during the design and
maintenance stages. Regularly check and correct
ventilation standards to dilute and remove impurities.
Consider use of air purifiers or other methods to
improve indoor air quality. Do regular inspection and
testing for gases, particles, microbiological etc and
3b. take immediate actions to rectify the problems if any.
Figure 3. The condition of A.C duct in one of the Provide local hooding with exhaust for bathrooms
hospitals in Oman. and kitchen. Proper space planning, routine
monitoring of various parameters of HVAC systems,
In case of airborne infectious diseases like TB, proper maintenance of all parts of the system and
patients are often kept in special isolation rooms that regular inspection and cleaning of a.c ducts are some
are under negative pressure so that contaminated air of the airborne infection control techniques. Apply
will not get out of the room. This type of isolation is techniques of elimination of contaminants at source
called infectious isolation. Such rooms should have itself. This is most effective and least expensive
all air exhausted directly outdoors. Winter design strategy. During the design stage use special care for
temperature of 24C with 30% RH is recommended; space design for infection control. Segregation of
24C with 50% RH is recommended for summer. sterile areas, separate path for dirty materials
Each patient room should have individual movement, provision of staff change / wash areas,
temperature control. sealed rooms are few important factors to be
Modern laboratories in a hospital require regulated considered during the space design as a strategy for
temperature, humidity, relative static pressure, air infection control. Examination of floor and wall
motion, air cleanliness, sound and exhaust. In surfaces for cleanability, regular “deep clean” after
biological labs chemical fume hoods and biological infectious patients left the site, measurement of air
safety cabinets are used. Operator protection may be quality periodically and regular microbiological
provided by fume cupboards, microbiological safety testing are some of routine monitoring strategies for
cabinets or other local exhaust ventilation systems. infection control. Monitor controls, indoor
Safety cabinets provide protection against dangerous conditions, and pressure devices, regular filter, coil &
pathogens. There are three classes of safety cabinets. drain cleaning, regular water testing, regular
Class 1 safety cabinets provide user protection. Class component replacement are the recommended
2 safety cabinets protect the operator and the work by maintenance strategy for infection control in a
recirculating some of the air through a HEPA filter to healthcare unit. Another important strategy is that
provide a down-flow over the working area. Class 3 the infection control team is involved at all stages
safety cabinets are totally enclosed units designed to from pre-design through to opening and that adequate
provide a high degree of user protection. time for commissioning is built-in to the schedule,
As mentioned above filters are one of the critical including an allowance of time for microbiological
parts of HVAC system to maintain the prescribed assessments particularly hospital operation theaters.
standards of IAQ. Air borne dust consists of Also operating theatres must be commissioned before
disbursed solids of varying sizes and numbers. These being used, after being built or modified
can be graded as coarse, fine and very fine, according substantially. Commissioning is a task for both the
to their sizes. Air borne particles are measured in Estates Department and the Infection Control Team,
microns (1 micron = 0.001 mm). The human hair is and co-operation and co-ordination between them is
75 to 100 micron in diameter. Pre-filters are capable important. Pressure differentials between rooms in
of filtering, particles of 15 to 20 microns in size with the theatre suite are given in Health Technical
90% efficiency. Pressure drop in these types of filters Memorandum 2025 (HTM 2025), volume b (Design
is 6mm WG.Fine filters can filter down to 5-micron considerations) and the same should be followed

Proceedings of the Tenth International Conference Enhanced Building Operations, Kuwait, October 26-28, 2010
 ESL-IC-10-10-88

strictly. The lights in various areas of the hospital Procedure have concluded that in order for the IAQ
should ideally be of a type that offers minimal Procedure of ASHRAE 62.1 to be widely used, there
interruption to the airflow pattern. The humidifier needs to be a base contaminants of concern (CoC)
and cooling coil in air handling units be disinfected at set. They recommended that research is needed to
least six-monthly. It is to be confirmed that drainage establish a base CoC list for engineers using the IAQ
systems on the air-handling unit comply with HTM Procedure of ASHRAE 62.1. (W.Bread, 2009). In
2040. recent years use of UVC emitters find interesting
Effective functioning of infection control application in HVAC technology to improve the IAQ
committee in a hospital, in which pathologist, especially in hospitals. A seven and a half-year study
infection control officer, head of nursing affairs, conducted in the in vitro fertilization clean room
representative from surgery department, hospital laboratory of the Lehigh Valley Hospital and Health
engineer are the members, is one of the most Network in the US found that the use of ultraviolet C
important strategy to be adopted to monitor the IAQ or “UVC” lights installed in the HVAC system had a
in a hospital. The infection control committee has to clinically significant impact on clinical pregnancy
review the surveillance data routinely in order to rates. The study found that UVC energy will destroy
identify/detect problems with regard to inherent 90 – 99% of airborne microbial contaminants.
potentials for unusual epidemics, clusters of Some of the areas in which current research is
infections, infections due to unusual pathogens or any focused are given below:
occurrence of nosocomial infection that exceeds • Use of UV irradiation to kill bacteria.
baseline levels and also to ensure strict compliance • Physical re-modeling of theatre access.
by all departments with the hospital’s infection • Air purifiers.
control policies and procedures. Create awareness • Re-design of ducts systems and materials.
among the staffs, and publics about the importance of • Development of international standards.
IAQ and encourage them as not to do the following: • UV irradiation in ductwork.
• Air – Ceiling – unidirectional air distribution
• Bringing non-sterile objects into the room – system.
particularly in designated clean areas.
• Opening windows – Frequent opening of CONCLUSION
windows allows external pollutants in. A healthy solution should be able to be achieved if
• Not changing prescribed clothes before good standards of design, commissioning, operation
entering into the clean areas and avoids and maintenance are followed. The most obvious
washing hands after touching the infectious steps in the prevention of indoor-air pollution are to
items. ensure that (i) the design and the operation of the
• Allowing too many visitors around patients. building is according to the state of the art in relation
to building application and conducted activities, (ii)
Primary methods of controlling air quality are: building performance is according to the
specifications in relation to pollutant concentrations
• Elimination : removing potential and operating parameters, and (iii) steps i and ii are
contaminants from the workplace routinely monitored. Even if the aforementioned
• Substitution : replacing materials with preventive steps are taken, there is a potential for
alternatives that are less harmful indoor-air problems to still occur, due to the various
• Dilution: the reduction in concentration of reasons outlined in this paper. In such cases, it is
harmful contaminants through the important for HVAC engineers, hospital facility
introduction of less contaminated or managers and hospital infection control officers to be
uncontaminated air. aware that there could be still problems, and not to
ignore warnings or indications of problems,
CURRENT INTERNATIONAL RESEARCH TO particularly if related to symptoms of human ill
IMPROVE INDOOR AIR QUALITY health, and be innovative and open to novel methods
Improvement of IAQ is a continuous process. It of investigation. Maintaining clean heating,
needs meticulous coordination and cooperation ventilation and air-conditioning (HVAC) systems is
between the various departments of the health care an important part of sustaining acceptable indoor air
unit. Researchers throughout the world are working quality (IAQ).
hard to improve the IAQ in hospitals. W. Bread et al Based on the visual inspection of ducts at various
based on their review of three publications sites it has been observed that very few HVAC
referencing successful application of the IAQ systems are “spotlessly” clean. Therefore it is

Proceedings of the Tenth International Conference Enhanced Building Operations, Kuwait, October 26-28, 2010
 ESL-IC-10-10-88

suggested to make a statuary requirement to clean the • Fisk W. and Rosenfeld A., "Improved
ducts at constant interval as per the international Productivity and Health from Better Indoor
standards in all health care units. Regular cleaning of Environments", Center for Building Science
cooling coils of the air handling units is strongly Newsletter, Lawrence-Berkeley Labs,
recommended to minimize the air pollution in a.c Summer, 1997.
systems. In GCC countries health sector is one of the • Health Canada Indoor air quality.
major areas which is growing exponentially. During Disponível em: <http://www.hc-
recent years many private enterprises have started sc.gc.ca/ewhsemt/air/in/index_e.html>.
investing heavily on the infrastructure of health care Access in: 25 Oct. 2005.
units. Role of private sectors are different from • Hoskins, J. A. Health effects due to indoor
government sectors. Profit is the main motive for the air pollution. Indoor Built Environment.
private enterprises although many corporate invest on London, v. 12, n.6, p. 427-433, Dec. 2003.
this sector as a part of their social responsibility. • Ignatius T.S et al , “ Evidence of Airborne
Therefore a common strategy to maintain a proper Transmission Syndrome Virus “ The New
IAQ in heath care units in GCC countries is required England Journal of Medicine,Vol 350:1731-
urgently. The strategies it is ready can be enforced 1739 April 22,2004,Number 17.
through local government regulations. The strategies • Martone WJ, Jarvis WR, Culver DH, Haley
should include various codes, practices, documents, RW. Incidence and nature of endemic and
procedures, commissioning formats, etc as described epidemic nosocomial infections. In Hospital
in the above pargraphs.Together identify report, Infections, J.V. Bennett and P.S. Brachman,
rectify inferior conditions or potential problem areas editors, Boston: Little, Brown, and Co.
and take necessary steps as not to re occur the same 1992:577-596 .
type of problem again elsewhere in the health care • Nordstrom et el, “Subjective Indoor Air
facility. Quality in Geriatric Hospitals” Department
of Occupational and Environmental
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Proceedings of the Tenth International Conference Enhanced Building Operations, Kuwait, October 26-28, 2010