Chemical Pollution in Healing Spaces: The Decalogue of the Best Practices for Adequate Indoor Air Quality in Inpatient Rooms

Indoor Carbon Dioxide, Fine Particulate Matter and Total Volatile Organic Compounds in Private Healthcare and Elderly Care Facilities

Poor indoor air quality can have adverse effects on human health, especially in susceptible populations. The aim of this study was to measure the concentrations of dioxide carbon (CO₂), fine particulate matter (PM_2.5) and total volatile organic compounds (TVOCs) in situ in private healthcare and elderly care facilities. These pollutants were continuously measured in two rooms of six private healthcare facilities (general practitioner’s offices, dental offices and pharmacies) and four elderly care facilities (nursing homes) in two French urban areas during two seasons: summer and winter. The mean CO₂ concentrations ranged from 764 ± 443 ppm in dental offices to 624 ± 198 ppm in elderly care facilities. The mean PM_2.5 concentrations ranged from 13.4 ± 14.4 µg/m³ in dental offices to 5.7 ± 4.8 µg/m³ in general practitioner offices. The mean TVOC concentrations ranged from 700 ± 641 ppb in dental offices to 143 ± 239 ppb in general practitioner offices. Dental offices presented higher levels of indoor air pollutants, associated with the dental activities. Increasing the ventilation of these facilities by opening a window is probably an appropriate method for reducing pollutant concentrations and maintaining good indoor air quality.

Indoor Air Quality in Healthcare Units—A Systematic Literature Review Focusing Recent Research

The adequate assessment and management of indoor air quality in healthcare facilities is of utmost importance for patient safety and occupational health purposes. This study aims to identify the recent trends of research on the topic through a systematic literature review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. A total of 171 articles published in the period 2015–2020 were selected and analyzed. Results show that there is a worldwide growing research interest in this subject, dispersed in a wide variety of scientific journals. A textometric analysis using the IRaMuTeQ software revealed four clusters of topics in the sampled articles: physicochemical pollutants, design and management of infrastructures, environmental control measures, and microbiological contamination. The studies focus mainly on hospital facilities, but there is also research interest in primary care centers and dental clinics. The majority of the analyzed articles (85%) report experimental data, with the most frequently measured parameters being related to environmental quality (temperature and relative humidity), microbiological load, CO2 and particulate matter. Non-compliance with the WHO guidelines for indoor air quality is frequently reported. This study provides an overview of the recent literature on this topic, identifying promising lines of research to improve indoor air quality in healthcare facilities.

How Can Design Features and Other Factors Affect the Indoor Air Quality in Inpatient Rooms? Check-Lists for the Design Phase, Daily Procedures and Maintenance Activities for Reducing the Air Concentrations of Chemical Pollution

Indoor Air Quality (IAQ) is one of main topics of Public Health on which international institutions and countries are taking action. With regards to healing architectures, several studies have reported data analysis and case studies to improve users' health (patients, and medical and administrative staffs), but there are not enough regarding volatile organic compounds (VOCs). Regarding chemical pollution of indoor air, the Scientific Community has highlighted that there are several factors that affect the IAQ, in particular the design and management, and energetic efficiency, of inpatient wards. Several stakeholders, from the designers to the managers, are responsible for the indoor air in healing environments. Supported by analysis of the State of the Art and the main factors that influence the heterogeneous scenario of inpatient wards, the paper presents three check-lists, designed for supporting the stakeholders during the design phase, or for the daily procedures and maintenance activities, for pre-assessment of factors that affect chemical pollution, and for the definition of strategies to be applied. In fact, in such environments IAQ assumes a particular meaning and importance, both for the vulnerability of the patients and for the long time spent by the sanitary staff. The multidisciplinary approach emphasizes the continuous need for interdisciplinary knowledge and skills aimed at finding solutions able to protect users' health status (including patients, workers and visitors), especially in the field of the indoor air issue.

Indoor Air Quality: A Focus on the European Legislation and State-of-the-Art Research in Italy

The World Health Organization (WHO) has always stressed the importance of indoor air quality (IAQ) and the potential danger of pollutants emitted from indoor sources; thus, it has become one of the main determinants for health. In recent years, reference documents and guidelines have been produced on many pollutants in order to: i) decrease their impact on human health (as well as the number of pollutants present in indoor environments), and ii) regulate the relevant levels of chemicals that can be emitted from the various materials. The aim of this paper is to discuss and compare the different legislations present in the European Union (EU). Furthermore, a focus of this paper will be dedicated at Italian legislation, where there is currently no specific reference to IAQ. Although initiatives in the pre-regulatory sector have multiplied, a comprehensive and integrated policy on the issue is lacking. Pending framework law for indoor air quality, which takes into account WHO indications, the National Study Group (GdS) on Indoor Air Pollution by the Italian Institute of Health (IIS) is committed to providing shared technical-scientific documents in order to allow actions harmonized at a national level. An outlook of the main Italian papers published during these last five years will be reported and discussed.

The Relevance of Indoor Air Quality in Hospital Settings: From an Exclusively Biological Issue to a Global Approach in the Italian Context

In the context of the architectures for health, it is an utmost priority to operate a regular and continuous updating of quality, efficacy, and efficiency’s processes. In fact, health promotion and prevention take place through a proper management and design of healing spaces, in particular with regard to the most sensitive users. In recent decades, there has been increasing attention to indoor air quality in healthcare facilities. Nowadays, this issue must involve the implementation of a series of appropriate interventions, with a global approach of prevention and reduction of risk factors on users’ health, which allows, in addition to a correct management of hospital settings, the realization of concrete actions. To date, in Italy, despite the indoor air being taken in consideration in numerous activities and studies aimed at understanding both building hygiene and environmental aspects, the greatest difficulty is strongly related to the absence of an integrated national policy. The scope of the paper is to underline the relevance of indoor air quality in hospital settings, highlighting the need of procedures, protocols, and tools for strengthening and improving interventions for health prevention, protection, and promotion of users.

Assessment of Indoor Air Quality and Users Perception of a Renovated Office Building in Manchester

Building renovations can adversely affect building occupants through the release of biological contaminants, gases and particulates. In this study, the research aim was to monitor the air quality of a renovated building and assess the impact of sick building syndrome (SBS) on the occupants. Post occupancy monitoring of the building was carried out after two months occupancy for the following environmental parameters: airborne microflora using an air sampler (SAS super 180) and a hand-held monitoring device (Graywolf advance sense IQ-610) to measure total volatile organic compounds (TVOC), CO₂, CO and temperature and relative humidity in each office environment. In addition, an online (Qualtrics) structured questionnaire was used to assess occupants’ perceptions of the indoor environment. Results of the airborne flora showed 833 cfu/m³ recovered on a Malt Extract Agar (MEA) plate in the morning and 1213 cfu/m³ in the afternoon. A similar result was noticed on a Plate Count Agar (PCA) plate during the morning period (731 cfu/m³) and afternoon (1358 cfu/m³). Results of TVOC monitored over one week showed that the first two days of monitoring had a high reading that peaked at 10,837 ppb and that the CO₂ concentration during that period was 1163 ppm. Online questionnaire analysis indicates that a majority of the staff who took part in the survey experienced some form of health abnormality, including headache, shortness of breath, itchy eyes/ears, loss of concentration and so on, especially in the first few weeks of returning to the office. The results from the study indicate that a large proportion (41%) of the respondents experienced thermal discomfort as a result of varying room temperature during their working hours. A high number of female participants experienced some form of SBS as compared to their male counterparts. The study findings show a direct relationship between high airborne mold counts, TVOC and adverse staff health perception of the building. The study raised a number of opportunities for estate managers to improve building performance based on occupants’ preferences.