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Better air, better care: Why indoor air quality in health care facilities is vital

Marie Bannister
September 30, 2021

Hospitals, clinics, care homes and other health facilities have important indoor air quality issues to control for an optimal environment.

In this blog:

  • Introduction
  • Indoor air quality for health care: the current issues and trends
  • Airborne chemicals (VOCs) and carbon dioxide (CO2)
  • Temperature and humidity
  • Radon and particulate matter (PM)
  • Regulators are moving fast
  • How can health care facilities ensure optimal indoor air quality?
  • Key takeaways

Introduction

The quality of the air we breathe is critical to our health and well-being. In recent decades, the attention of public health bodies has switched increasingly from the effects of poor quality air outdoors to focus on the impact of pollutants indoors.

According to the US Environmental Protection Agency (EPA), many common pollutants exist indoors in concentrations 2 to 5 times higher than typical outdoor levels1. Many of the people who are most susceptible to the adverse effects of pollution, like older adults, the very young and those with cardiovascular or respiratory diseases, are particularly likely to visit health care facilities.

As a result, the emphasis on indoor air quality in hospitals, clinics, and similar settings is intensifying. What challenges does this pose for health care settings and how are they responding? We’ll explain how monitoring indoor air quality and addressing any problems is becoming vitally important, both from a clinical and a compliance point of view.virus_closeup

Indoor air quality for health care: the current issues and trends

 

Infection control is always a key issue in hospitals and other health care facilities, given the risk of hospital-acquired infections and the often increased vulnerability of those who are already ill. 

The Covid-19 pandemic added a new dimension, highlighting concerns around airborne transmission of viruses through droplets generated through coughing, breathing, or talking. However, there is also increased awareness of diseases spreading through finer particles - or aerosols2. These pose a particular problem in health care facilities, where aerosol-generating equipment and procedures are often used3.

Indoor air quality and ventilation are clearly critical to dealing with these issues. But there are also other, less obvious, air quality problems that affect the health and well-being of patients and the workforce. 

Particulate matter (PM)

Contaminant illustrations_PM 1Particulate matter (PM), on the other hand, refers to tiny particles in the air that adversely affect health when they are breathed into the respiratory passages. Exposure to high levels is linked to a greater risk of being admitted to hospital4.

PM is made up of a mixture of solids and liquids, both organic and inorganic, including dust, pollen, soot, smoke, complex chemicals, sulphates, mineral dust, and water. The sources of external PM include road traffic, construction work, and industry.

Care must be taken to protect the clinical or care environment from PM, especially where institutions are located in or near urban centers. In the UK for example, more than 2,000 health centers are located in areas where levels of fine particulate matter exceed the recommended limit of the World Health Organization (WHO)6

With this in mind, it’s important for health care facilities to monitor PM levels in their surrounding environment and ensure that indoor air quality is not negatively impacted. Not only can inhaling PM damage the health of potentially already vulnerable patients, but it also impacts the comfort and environment of the health care facility for staff and visitors.

Airborne chemicals (VOCs) and carbon dioxide

Contaminant illustrations_CO2Airborne chemicals (VOCs) are toxic substances used to manufacture a range of common solid or liquid goods7. These chemicals, found in cleaning products, paints, ceiling tiles, building materials, office equipment, furniture, and many other items, are emitted as gases or odors and build up indoors.

VOCs can irritate the eyes, nose, and throat, trigger allergies, inflame the lungs, and aggravate asthma8. Environmental health research shows that wards and  pharmacy departments in hospitals are likely to have higher levels of both VOCs and CO29.   

Because we all breathe out carbon dioxide, it tends to build up indoors, particularly in busy, warm, airtight environments. High levels of CO2 are associated with restlessness, drowsiness, and headaches10, while the highest concentrations cause symptoms like increased heart rate, and breathing difficulties11

Studies show that carbon dioxide levels in health care facilities are most difficult to control during the colder months, when heating is most necessary12. Monitoring levels of the gas is a first step to identifying any influence it may be having on health, concentration, or comfort.

Temperature and humidity

Reduce PM Illustrations_Air purifiers-People’s perception of temperature varies wildly, and that effect can be particularly pronounced in health care facilities. Case in point: a health care professional moving quickly around the building will feel warmer than an older patient lying on a hospital cart wearing only a hospital gown.

The US Centers for Disease Control and Prevention (CDC) issues guidelines for environmental infection control in health care settings. They note, “cool temperature standards (68°F-73°F [20°C-23°C]) usually are associated with operating rooms, clean workrooms, and endoscopy suites. A warmer temperature (75°F [24°C]) is needed in areas requiring greater degrees of patient comfort. Most other zones use a temperature range of 70°F-75°F (21°C-24°C).”13

It can be a tricky balancing act to get humidity right. Existing recommendations from the US EPA recommends keeping levels between 30%-50%14. Recent research suggests that low relative humidity (RH) may be a risk factor for aerial transmission of viruses, with an RH of 40-60% suggested to reduce transmission15

Radon

Contaminant illustrations_RadonRadon is a naturally occurring radioactive gas that seeps into buildings from rocks and soil and can build up to dangerous levels indoors. 

Radon is the biggest cause of lung cancer in non-smokers, killing 21,000 people each year in the US16, and 20,000 in the EU17. It exists in higher concentrations in certain localities, with the result that health authorities in areas with particularly high levels have unveiled testing and mitigation plans18.

By continuously monitoring indoor air quality in nursing homes, hospitals, and other settings, it’s possible to identify problem concentrations of the gas and put them right with ventilation or building works.

Increasing compliance and regulatory guidelines

Policy makers now have a keen appreciation of the importance of indoor air quality for health and, for that reason, it’s an area where regulations are developing fast. In the US, for example, health insurance schemes require hospitals and health care facilities to comply with ASHRAE standards, which govern ventilation system design and indoor air quality19

WHO is among the international bodies that has urged states to regulate indoor air quality in line with its recommendations. The EU’s Scientific Committee on Health and Environmental Risks (SCHER), advocates policing indoor air pollution just as rigorously as outdoor air20.

In most jurisdictions, there are already a range of rules governing temperature, carbon dioxide levels, radon, and humidity in workplaces. The clear direction of travel is towards increasing regulation of indoor air quality.

How can health care facilities ensure optimal indoor air quality?

The first step to taking charge of indoor air quality in hospitals, health centers, care homes and other health facilities, is to understand the air in your facilities and identify any problems.

Airthings for Business offers a complete indoor air quality monitoring system that measures the important metrics for health care, including PM, VOCs, radon, carbon dioxide, temperature, humidity, and air pressure. A central hub makes it easy to access data from across your site, which is collated in a user-friendly dashboard, complete with useful insights and alert options for when problems arise.

With this information, it’s possible to identify air quality issues and act on them immediately, making the maintenance of an optimal environment more achievable. The solution can even integrate with heating, ventilation, and air conditioning (HVAC) systems, to trigger them automatically when required for indoor air quality purposes.

If you know where and why problems are arising, you can quickly begin to put them right. Many issues are solved with more effective ventilation. This could mean replacing your existing system, or opening windows more regularly. A lack of up-to-date maintenance and servicing can sometimes explain issues with CO2 or VOCs. 

Airthings recently introduced the virus risk indicator, which analyzes four key factors and ranks the building’s airborne virus risk level on a scale of 1-10.Know what to do and where using virus risk insights and risk analysis reports in the Dashboard. With continuous monitoring you can check that your methods are working, and receive alerts when your virus risk creeps up.

Maximising indoor air quality in health care facilities relies on the right information. Indoor air quality monitoring provides accurate real-time and historic data, so you can identify issues, make the changes needed, and provide the best possible environment for patients and staff.       

Virus_factors_transparent-4

[KEY TAKEAWAYS]

  • Many of the people who are most vulnerable to the effects of bad indoor air quality are also more likely to visit health care facilities.
  • Care must be taken to protect the clinical or care environment from particulate matter (PM), which can damage respiratory health.
  • Infection control is a key issue in health care, and is affected by indoor air quality factors, including relative humidity.
  • Environmental health research shows that hospital wards and pharmacy departments in hospitals are likely to have higher levels of both VOCs and CO2.
  • There is a growing regulatory focus on indoor air quality in several jurisdictions. Health care facilities in the US must conform to ASHRAE standards for ventilation design and indoor air quality.
  • Improving indoor air quality starts with obtaining accurate, relevant data to help identify issues and take action.

 

Sources:

1. https://www.epa.gov/report-environment/indoor-air-quality
2 ttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293495/

3. https://www.uhb.nhs.uk/coronavirus-staff/aerosol-generating-procedures.htm

4. https://www.bmj.com/content/367/bmj.l6258

5. https://www.greenfacts.org/en/particulate-matter-pm/level-3/01-presentation.htm#0p0

6. https://www.blf.org.uk/take-action/campaign/nhs-toxic-air-report

7. https://www.epa.gov/indoor-air-quality-iaq/what-are-volatile-organic-compounds-vocs

8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363895/

9. https://doi.org/10.1016/j.buildenv.2014.11.026

10. https://www.jacionline.org/article/S0091-6749(54)00063-2/fulltext#section.0070

11. https://www.airthings.com/en-gb/what-is-carbon-dioxide

12. https://www.sciencedirect.com/science/article/pii/S1877705815027460

13. https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/air.html

14. https://www.epa.gov/mold/mold-course-chapter-2#:~:text=Indoor%20relative%20humidity%20(RH)%20should,Humidifiers

15. https://oem.bmj.com/content/77/7/508

16. https://www.epa.gov/radon/health-risk-radon

7. https://ec.europa.eu/commission/presscorner/detail/en/IP_04_1539

18 https://www.plymouthhospitals.nhs.uk/download.cfm?doc=docm93jijm4n6359.pdf&ver=8698

19 https://www.ashrae.org/about/news/2017/cms-issues-directive-requiring-medicare-certified-healthcare-facilities-to-implement-and-maintain-legionella-prevention-policies

20https://ec.europa.eu/health/ph_risk/committees/04_scher/docs/scher_o_055.pdf