User-Centred Healing-Oriented Conditions in the Design of Hospital Environments

Postoperative hypothermia is associated with reduced length of stay in adult acute burn survivors

BACKGROUND

The hypermetabolic response after a burn predisposes patients to hypothermia due to dysfunction of thermoregulation. Traditionally, hypothermia is avoided actively in burn care due to reported complications associated with low body temperature. The likelihood of hypothermia with acute burn surgery is compounded by general anesthesia, exposure of wound areas and prolonged operation times. However, we find limited studies exploring the effects of perioperative hypothermia on length of stay in the adult burn population.

OBJECTIVE

To determine associations between postoperative hypothermia and hospital length of stay in adult burns patients.

METHOD

This retrospective cohort study involved patients admitted to the State Adult Burn Unit in Western Australia between 1st January 2015 to 28th February 2021. All adults who underwent surgery for acute burn, and had postoperative recovery room body temperature recorded, were included in the study. In this study, we defined normothermia as >36.5C and hypothermia as < 36.0 °C with mild, moderate, and severe hypothermia being 35.0-35.9 °C, 34.0-34.9 °C and < 34.0 °C, respectively. Patients with hyperthermia were excluded. Multivariable general linear models explored if hypothermia was independently associated with length of stay.

RESULTS

Among 1486 adult patients, 1338 (90%) were normothermic postoperatively, with temperatures >36.0C. We included 148 (10%) patients with hypothermia (temperature <36.0 °C) postoperatively. Most burns in the study population were minor: 96% had burns < 15% TBSA. Data modelling demonstrated that hypothermia was associated with a shorter length of hospital stay (coefficient = -0.129, p = 0.041).

CONCLUSION

In adult acute burn patients, postoperative hypothermia was associated with reduced length of stay after surgery. The positive results of this study indicate that a review of the core temperature targets with acute burn surgery, and timing of burn patient cooling practices in general is warranted.

Evaluation of Multisensory Interactions Between the Healing Built Environment and Nurses in Healthcare Nursing Stations: Case Study of Tehran Hospitals

BACKGROUND

Nursing stations are important features of medical centers that are constantly in use. As nursing is an inherently stressful occupation, nursing stations should be designed to minimize stress on those who must spend time there.

AIM

This study evaluated the effect of environmental design factors on mitigating the stress levels on nurses in nursing stations by determining the environmental factors that most influence the perceptual senses that affect physical and psychological comfort.

METHODS

A quantitative approach was used to evaluate the parameters that affect the sensory perceptions of nurses in nursing stations at four hospitals in Tehran. A survey was conducted to identify environmental design parameters that affect the visual, auditory, tactile, kinesthetic, and olfactory senses.

RESULTS

The results revealed that the olfactory category scored highest, followed by the auditory, visual and tactile categories, which had similar scores, and kinesthetic was ranked last.

CONCLUSION

A connection was revealed between the educational level of the nurses and environmental factors affecting their sensory perception in terms of materials, aesthetics and the appropriate number of windows as a visual sense, and ergonomics as a kinesthetic sense. Significantly, the gender variable differed in the Furniture variable based on comfort of seating with respect structure. Based on the results of this study, a combination of olfactory, visual, and auditory factors should be required at the nursing stations to decrease the stress level of nurses.

Ecological Study of Sick Building Syndrome among Healthcare Workers at Johor Primary Care Facilities

INTRODUCTION

Persistent exposure to indoor hazards in a healthcare setting poses a risk of SBS. This study determines the prevalence of and risk factors for SBS among healthcare workers in health clinics.

METHODS

A cross-sectional study was conducted across four health clinics from February 2022 to May 2022. As part of the study, self-administered questionnaires were completed to determine symptoms related to SBS. An indoor air quality (IAQ) assessment was conducted four times daily for fifteen minutes at five areas in each clinic (laboratory, lobby, emergency room, pharmacy, and examination room).

RESULT

Most of the areas illustrated poor air movement (<0.15 m/s), except for the laboratory. The total bacterial count (TBC) was above the standard limit in both the lobby and emergency room (>500 CFU/m³). The prevalence of SBS was 24.84% (77) among the healthcare workers at the health clinics. A significant association with SBS was noted for those working in the examination room (COR = 2.86; 95% CI = 1.31; 6.27) and those experiencing high temperature sometimes (COR = 0.25; 95% CI = 0.11; 0.55), varying temperature sometimes (COR = 0.31; 95% CI = 0.003), stuffy air sometimes (COR = 0.17; 95% CI = 0.005; 0.64), dry air sometimes (COR = 0.20; 95% CI = 0.007; 0.64), and dust sometimes (COR = 0.25; 95% CI = 0.11; 0.60) and everyday (COR = 0.34; 95% CI = 0.14; 0.81). Only healthcare workers in the examination room (AOR = 3.17; 95% CI = 1.35; 7.41) were found to have a significant risk of SBS when controlling for other variables.

CONCLUSION

SBS is prevalent among healthcare workers at health clinics.

A Conceptual Framework for Blockchain Enhanced Information Modeling for Healing and Therapeutic Design

In the face of the health challenges caused by the COVID-19 pandemic, healing and therapeutic design (HTD) as interventions can help with improving people’s health. It is considered to have great potential to promote health in the forms of art, architecture, landscape, space, and environment. However, there are insufficient design approaches to address the challenges during the HTD process. An increased number of studies have shown that emerging information modeling (IM) such as building information modeling (BIM), landscape information modeling (LIM), and city information modeling (CIM) coupled with blockchain (BC) functionalities have the potential to enhance designers’ HTD by considering important design elements, namely design variables, design knowledge, and design decision. It can also address challenges during the design process, such as design changes, conflicts in design requirements, the lack of design evaluation tools and frameworks, and incomplete design information. Therefore, this paper aims to develop a conceptual BC enhanced IM for HTD (BC-HTD) framework that addresses the challenges in the HTD and promotes health and well-being. The structure of BC-HTD framework is twofold: (1) a conceptual high-level framework comprising three levels: user; system; and information, (2) a conceptual low-level framework of detailed content at the system level, which has been constructed using a mixed quantitative and qualitative method of literature analysis, and validated via a pre-interview questionnaire survey and follow-up interviews with industry experts and academics. This paper analyzes the process of BC enhanced HTD and the knowledge management of HTD to aid design decisions in managing design information. This paper is the first attempt to apply the advantages of BC enabled IM to enhance the HTD process. The results of this study can foster and propel new research pathways and knowledge on the value of design in the form of non-fungible token (NFT) based on the extended advantages of BC in the field of design, which can fully mobilize the healing and therapeutic behaviors of designers and the advantage potential of HTD to promote health, and realize the vision of Health Metaverse in the context of sustainable development.

Heat Strain Evaluation of Power Grid Outdoor Workers Based on a Human Bioheat Model

Power grid outdoor workers are usually exposed to hot environments and could suffer the threats to occupational health and safety like heat strain and injury. In order to predict and assess the thermophysiological responses of grid workers in the heat, the clothing thermal insulation of grid worker ensembles was measured by a thermal manikin and a multi-segment human bioheat model was employed to evaluate the thermophysiological response parameters of grid workers such as core temperature, skin temperature and sweat loss. The results show that working in a hot environment can cause a obvious increase in core temperature and skin temperature of grid workers, and the acceptable maximum working time of grid workers varies greatly in different hot environments. A reasonable work organization strategy can effectively decrease the core temperature and sweat loss, increasing the duration of acceptable maximum working time for grid workers. This study is helpful to assess heat-related risks of grid workers and support power grid companies to rationalize work organization strategies and personal protection guidelines.

Revisiting Healing Environments: Islamic Interior Elements in Hospital Rooms in North Africa

BACKGROUND

A predominant notion among researchers is that hospital room design and decor are subject to the designer's expression of self, which is contrary to evidence-based studies showing that design and decor can impact patient health. The aim of this study was to examine whether improvement in quality of healthcare provided in hospitals could be achieved through the convergence of expertise of healthcare professionals and hospital room designers.

METHODS

This was a prospective study to identify the impact of hospital interior design features with a focus on single occupancy rooms. Volunteers were recruited through advertisements and the study was conducted at the Tripoli Medical Center. Responses were analyzed using a three-dimensional computer-aided design software to help respondents accurately map their preferences and visualize outcomes.

RESULTS

Participants preferred an aesthetically pleasing hospital room environment that included art and bright colors, window views, and the need for personalization, technology, mobility, and flexibility, all of which improved satisfaction and happiness. Of these, participants' preference for technology as a cause for satisfaction and happiness was a novel finding.

CONCLUSION

Designers of hospital room interiors should plan and create an appealing single occupancy room for increasing user satisfaction and patient wellness.

The Impact of Ambient Temperature Control Across Various Care Settings on Outcomes in Burn Patients: A Review Article

Ambient/room temperature settings in burn treatment areas vary greatly due to a lack of evidence-based guidelines to direct care. While it is generally understood that ambient/room temperature impacts patient body temperature and metabolism, the ideal settings for optimizing patient outcomes are unclear. The literature assessing this topic is scarce, with many of the articles having significant limitations. We aim to summarize the current evidence for ambient/room temperature control, to address gaps in current reviews addressing this topic, and to elucidate topics requiring further research. PubMed and Google Scholar databases were queried for studies which evaluated the effect of the ambient/room temperature on burn patient core body temperature, patient metabolism, and outcomes among those treated in trauma bays, burn ICUs, and operating rooms. Although existing literature lacks sufficient patient outcome data regarding specific ambient/room temperatures, we highlight physiological processes that are impacted by changes in room temperatures in an effort to describe strategies that can allow for improved patient core body temperature control and outcomes in burn care settings.

Sick building syndrome among healthcare workers and healthcare associates at observed general hospital in Slovenia

OBJECTIVE

The aim of this study was to assess the possible associations between self-perceived sick building syndrome (SBS) symptoms among healthcare workers and healthcare associates and self-perceived parameters of indoor work environment quality.

METHODS

The cross-sectional study was conducted from February to April 2019. Validated standardized evaluation tools (MM 040 NA Hospital 2007 and MM 040 NA Office 2007) were used for estimating the prevalence of SBS among observed populations. Chi-square and Mann-Whitney U tests for assessing possible associations in SBS symptoms between healthcare workers and associates were used.

RESULTS

The response rate was 69.8%. The results showed a lower prevalence of six or more SBS symptoms in healthcare associates (6.4%) compared to healthcare workers (12.0%). Healthcare workers perceived the most frequent risk factors for SBS to be poor air quality, an inappropriate level of relative humidity, and inappropriate room temperature, while the least frequently self-perceived risk factors were inappropriate lighting and noise levels.

CONCLUSIONS

This study represents a platform for further analyses - the identification of health risk factors with environmental monitoring.

Phenomenological and Thermodynamic Model of Gas Exchanges in the Placenta during Pregnancy: A Case Study of Intoxication of Carbon Monoxide

The present work simulates the transport of oxygen, carbon dioxide, and carbon monoxide between a fetus's circulatory system and the mother's. The organ responsible for this exchange is the placenta. Carbon monoxide is a common air pollutant, and it impacts the physiological conditions even in low concentration. The impacts of carbon monoxide are especially dangerous for pregnant women, fetuses, and newborn babies. A model of carbon monoxide transport, from the literature, is modified to simulate a pregnant woman (original model was a male), therefore changing some parameters to express the adjusted respiratory system. It was considered the gas exchange in the placenta, to evaluate the concentration of these different gases in the fetus arterial and venous blood. Three methods of the exergy analysis are implemented for both mother and fetus respiratory systems, aiming at the comparison with the respiratory system of a male adult. The destroyed exergy of the literature did not have the same trend as the models proposed in this article, taking into consideration the hemoglobin reactions. In contrast, the entropy generation associated only with the diffusion transport phenomena was one order of magnitude lower than the other methods. The placenta destroyed exergy rate is significantly higher compared to the irreversibilities of the mother's respiratory system. One possible explanation is the fact that the placenta has other physiological functions than gas transportation.

Association between Sick Building Syndrome and Indoor Environmental Quality in Slovenian Hospitals: A Cross-Sectional Study

Increased exposure times to various health risk factors and the vulnerability of building users might result in significantly higher prevalence rates of sick building syndrome (SBS) in a hospital setting compared to other indoor environments. The purpose of our study was to assess the association between SBS symptoms and measured environmental parameters at a Slovenian general hospital. A combination of a self-assessment study and field measurements was conducted in order to estimate the health risk factors for SBS symptoms among the users of a Slovenian general hospital. The Chi-square test was used to analyse the association between observed health and environmental parameters. The response rate was 67.5%. A total of 12.0% of healthcare workers at hospital wards reported at least six SBS symptoms, 19.0% reported 2-3 SBS symptoms. At the observed hospital wards, the most deviations were recorded for the level of lighting (83.3%), noise level (73.6%), and room temperature (55.3%). A statistically significant association was found between indoor environmental quality and skin-related SBS symptoms (χ2 = 0.009; p = 0.006). This information will be of great value in defining an integral strategy of environmental health activities aimed at healthier indoor environmental quality in hospitals.

Exergy Analysis of the Heart with a Stenosis in the Arterial Valve

In the past decade, several articles have proposed the use of an exergy perspective to analyze physiological systems of the human body under different physical conditions. Such a perspective focuses on the exergy transformations and the efficiency of the biological processes. This may aid the medical field in assessments of a patient’s physical health by means of an index (exergy efficiency) based on the quality of the energy conversion in a given process within the human heart. As a follow-up, a model was developed to describe the evolution of the transvalvular pressure gradient in the aortic valve as a function of stenosis severity. This model was created using physiological data from 40 patients available in the literature, as well as 32 operating points from different bileaflet aortic valve prosthesis. A linear regression results in values around 14.0 kPa for the pressure gradient in the most severe case, evolving from 1.0 kPa for a healthy scenario. The thermodynamic model assesses the irreversibilities associated with energy conversion processes related to metabolism: exergy destroyed at the valves, exergy increased in the flow, and the power of the heart. Results indicate that destroyed exergy reaches values of 10 W (almost 10% of total basal metabolic rate of the whole body). Exergy efficiency is 15% for a healthy heart, decreasing as a function of the severity of the stenosis to values lower than 5%.

Comparison of Health and Well-Being Aspects in Building Certification Schemes

The quality of the indoor environment is becoming increasingly important because people are spending the majority of their time indoors. This has led to an increased interest in the field of health and well-being of users of buildings and to the development of various assessment schemes dealing with this issue. In this study, LEED O+M Building Operations and Maintenance (hereinafter LEED O+M), BREEAM In-Use and DGNB Buildings In-Use were compared with a specialized BCS WELL that is focused on the health and well-being of building occupants. The aim of the comparison was to evaluate to what extent the selected building certification schemes (BCSs) cover the aspects of health and well-being in buildings. Based on the analysis, it was found that the observed BCSs mostly pay attention to indoor air quality, light and thermal comfort. In other areas, only certain topics are covered or the topics have a different focus. Another important finding of the study was that certain aspects that are important for the health and well-being of the occupants are not dependent only on the building design but also on the management of the building and the services provided within the building. This kind of information is especially valuable for building developers, managers and owners so they know how to improve health and well-being in a building. The present study provides them with a comprehensive overview of the certification schemes that are widely used in current practice.