May 16, 2022

Monitoring as an Essential Part of Hospital Indoor Air Quality

Healthcare Facilities

While the pandemic has made indoor air quality a primary concern for anyone with facility-management responsibilities, those entrusted with medical HVAC systems have long known about, and focused on, the importance of maintaining the healthiest hospital air quality possible.

The reasons are not surprising, just by the nature and purpose of the facility, the ventilation system in a hospital must contend with more airborne contaminants than one in an average commercial or residential building. This article focuses on the challenges of maintaining optimal indoor air quality and the role of air quality monitors in healthcare facilities.

How does air quality in hospitals differ from other facilities?

HVAC design for hospitals and healthcare facilities also must contend with a variety other of indoor air pollutants particles and airborne contaminants, listed in a recent study in the National Center for Biotechnology Information, such as carbon dioxide, carbon monoxide, formaldehyde, total VOCs, respirable suspended particulates, radon, glutaraldehyde, nitrous oxide, latex allergens, and total bacterial count.

In addition, a hospital environment also includes a much higher presence of cleaning chemicals than the average home or office building, its own unique odors, and the challenges brought by the need for higher traffic levels through its patient rooms, laboratories, corridors and common areas. 

While patients may be the source of many airborne contaminants, because of their often- vulnerable conditions, they are also at a greater risk for their effects. Staphylococcus aureus (MRSA), which can be transmitted through the air, has become one of the most common causes of hospital infections. More recently, the COVID-19 virus also demonstrated the importance of maintaining effective, efficient healthcare HVAC systems and the growing need for air quality monitors for hospitals.

What are the environmental challenges for a healthcare HVAC system?

So, there are several factors in hospital settings that negatively affect indoor air quality (IAQ):

  • Cleaning products and detergents increase TVOCs;
  • High-frequency cleaning of walls, floors, and disinfection of equipment increases humidity and potentially leads to mold growth;
  • Improper filtration of outdoor air  leads to PM2.5 exposure;
  • Improper maintenance of HVAC systems contributes to the development of bacterial and mold spores in air filters;
  • Health status of patients;
  • Furniture and finishes might contain formaldehyde and other TVOCs.
  • Polymer materials used in plastic infusion bags, injectors, blood bags, and rubber tubes emit phthalates, etc.

While many of these elements are a product of the activity inside the hospital, HVAC design for healthcare facilities must also deal with the air coming in from the outside. According to the American Society for Health Care Engineering (ASHE), if incoming air is not properly filtered, dust is drawn into the building.

How does indoor air quality and environmental comfort affect hospital occupants?

A hospital, for instance, can be caring for a patient population with dozens of different ailments at any one time. So, the HVAC system in a hospital is designed and maintained to support the staff’s efforts to return these patients to health — while at the same time keeping the staff members’ wellness in mind.

Hospital air quality concerns go beyond the presence of airborne germs and chemicals, but also focus on the circulation, filtration, temperature and humidity levels of the air, all of which can either limit or accelerate the spread of pathogens. According to guidance from the Centers for Disease Control and Prevention published on the OSHA website, decreased performance of healthcare facility HVAC systems, including filter inefficiencies, installation issues and poor maintenance can contribute to the spread of airborne infections. 

Ineffective air conditioning in hospital laboratories can allow chemicals to leak into nonlaboratory or patient spaces. Mercury from a number of critical healthcare devices can emit toxic vapors. Temperature can affect patient and staff comfort and wellness and excessive relative humidity may support microbial growth. And if patient isolation rooms are not properly pressurized, airborne bacteria may be transmitted to surrounding areas. 

Maintaining optimal air quality in operating rooms is particularly important. Just as with other areas of the hospital, keeping the right temperature, humidity and air quality is critical to support infection control, but the HVAC standards for hospital operating rooms differ from those of other parts of the hospital and need additional attention and monitoring.

Healthcare HVAC systems aren’t designed just for the specific hospital HVAC requirements. Long-term care facilities have their own challenges. The HVAC in these specialized healthcare facilities must address potential odor issues and help safeguard an often older, even more vulnerable population.

How does optimizing hospital HVAC support green building programs?

No matter the type of facility, many healthcare organizations, when building or renovating, are choosing to participate in green building programs and work toward certifications, such as WELL or LEED. In order to achieve LEED certification, for instance, buildings are rated in five areas: sustainable site development, water savings, energy efficiency, materials selection and indoor environmental quality. 

These certifications are scored on a point system and are not “won and done.” The five LEED areas are confirmed, monitored and periodically checked.

For example, NYU Langone Health achieved Double Platinum LEED certification for The Helen L. and Martin S. Kimmel Pavilion and its Science Building. The Kimmel Pavilion, was designed to maintain high levels of filtration, and part of the hospital’s HVAC system design included sensors that monitor fresh air and carbon dioxide levels to maintain comfort.

NYU Langone chose materials with fewer VOCs. The facility also uses cleaning products free of antimicrobials, bleach and unnecessary chemicals.

Source: NYU Langone Health

How air quality monitors can be an integral part of HVAC systems in healthcare facilities?

With the COVID-19 pandemic, tracking pollutants has become common to safeguard any people in the home or office who may be vulnerable — someone with asthma, other cardio/pulmonary issues, or compromised immune systems. 

Because this perfectly describes a hospital population, air quality monitoring is even before pandemic concerns, air quality monitors for hospitals are becoming even more crucial and common. 

The EPA’s Clean Air in Buildings Challenge has established guidelines to help facility managers in all types of buildings determine a space’s air quality needs. The agency’s guidelines encourage using monitoring techniques to determine how clean the outdoor air that is coming inside and how well the HVAC systems are working. 

Air quality monitors not only can provide a general awareness of air pollution inside the building but also validate the efficiency of HVAC system upgrades. 

A more recent healthcare facility project, Dubai’s Clemenceau Medical Center, opened in 2020.  In 2021, to achieve optimal air quality, the hospital’s HVAC design was updated to add an Airlife Swiss air purification duct system designed to increase the mechanical filtration efficiency by 99.7 %.

Before the system was installed, eight Atmocube air quality monitoring devices were added in “reference rooms” to determine an indoor air quality baseline of elements including particulate matter and total VOCs. 

Source: Airlife Swiss

With this baseline in hand, it was determined that reference rooms have shown a significant reduction of particulate matters of more than 50%. It was also confirmed that the TVOC levels decreased by more than 50% without increasing energy consumption.

Despite the different ages, purposes and locations of the facilities mentioned above, the air conditioning system in the hospitals deal with the same principal air pollutants affecting their indoor air quality. 

***

If knowledge is power, then monitoring indoor air quality (IAQ) gives facility managers the power to keep their buildings’ occupants comfortable — and more importantly, especially when it comes to hospitals and other healthcare facilities — safe and healthy. An indoor air quality monitor gives facility managers the real-time information they need.

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