Indoor Air in Healing Environments: definition of a monitoring activity in inpatient wards for design and management strategies in healthcare facilities.

Introduction. Several countries are carried out air quality monitoring in professional work-places of hard areas of hospitals. Currently the main investigations are about biological and physical risks, otherwise chemical ones are less investigated. Therefore it determinated the definition and adoption of specific legislation, guidelines and values, although Italian context lacks of specific norms. Methodology. A research group has launched an investigation of air quality in inpatient rooms. The analysis examines VOCs, and the relative influence of micro-climatic parameters, ventilation and concentration of pollutants’ parameters. Discussion. The paper reports the results of some hospitals obtained from the indoor air monitoring. Each survey, done every month, considers all the activities, users and processes that influence the in-door air. Conclusion. The analysis is work in progress on several inpatient rooms for control-ling the indoor air values during the year. Those data become useful for the definition of de-sign guidelines for healthy inpatient wards

L’INDOOR AIR QUALITY NELLE DEGENZE OSPEDALIERE campagne di monitoraggio di composti organici volatili (COV)

Introduzione - Gli studi inerenti i materiali di finitura e arredi, e i prodotti di pulizia hanno dato origine ad una crescente attenzione nei confronti dell’inquinamento dell’aria nelle strutture ospedaliere. A oggi, a livello legislativo sono stati individuati linee guida, protocolli e valori limite-VLEP (DLgs 81/08 smi), solo per il rischio professionale in cui sono utilizzate sostanze chimiche e per alcune specifiche aree dell’ospedale considerate ad alto rischio. Solo recentemente sono state messe in atto tutta una serie di attività di caratterizzazione del IAQ per comprendere il ruolo degli inquinanti chimici legate alle attività umane, alle sorgenti interne e alle diverse misure di risparmio energetico e per valutare le esposizioni indoor dei pazienti e del personale sanitario. Materiali e Metodi – Un Gruppo di Ricerca (PoliMI e ISS) ha attivato campagne di monitoraggio della qualità dell’aria indoor nelle camere di degenza di alcuni ospedali, con l’utilizzo di campionatori passivi per alcuni selezionati COV considerati di principale interesse dall’OMS, una settimana al mese per un anno, rilevando contemporaneamente i principali parametri microclimatici e mappando le attività quotidiane all’interno della camera. Le modalità operative fanno riferimento alle norme ISO 16000 sulla qualità dell’aria indoor e al rapporto ISTISAN 13/4 “Strategie di monitoraggio dei COV in ambiente indoor”. Risultati – I risultati rilevati confermano l’importanza della tematica negli spazi di cura in cui persistono utenti vulnerabili. Ad oggi i dati, per circa il 70% dei rilievi effettuati, rispettano i valori soglia emessi da OMS, sebbene l’intento sia quello di avere valori sempre più inferiori. L’analisi dei diversi materiali di finitura, arredo e delle modalità di ventilazione delle diverse camere di degenza, nonché dei prodotti di pulizia e disinfettanti, ha inoltre permesso di evidenziare alcuni importanti aspetti legati alle scelte progettuali, gestionali e manutentive delle strutture. Conclusione – Le prime campagne di indagine hanno permesso di implementare il protocollo di rilievo. Lo studio è in fase di applicazione su diversi ospedali per poter avere un quadro di riferimento a livello nazionale ampio e supportare i decisori nella definizione di riferimenti normativi per gli spazi di cura

VOC concentrations in hospital settings: definition of a protocol for monitoring activities in inpatient wards, its application and the first results

Introduction. Indoor Air Quality is one the main issue in which governments are focusing. In healing spaces, several researches are reporting a growing number of data analysis and research works in order to improve users’ health. Currently the main investigations are related to biological and physical risks, otherwise chemical ones are less investigated. Several countries are carried out air quality monitoring in those professional workplaces in which chemicals are used, but also in some typically indoor spaces for building hygiene assessment. Therefore it determinated the definition of guideline values for hospitals because the current scenario lacks of specific norms. Method. A research group has started a monitoring activity of air quality in inpatient rooms, giving rise to a protocol supported by ISO 16000 and guidelines by international institutions. The analysis examines VOCs -referring to WHO (2010) and ISO 16000- considered dangerous, and the influence of thermo-hygrometric, ventilation and concentration of pollutants’ conditions. The methodology with passive samplers requires the use of an activity log for registering all the activities during the day. Results. The application of the protocol on some inpatient rooms permitted to verify the feasibility of the monitoring. Each investigation (one week per month, per a year) considered all the activities, users and processes that influence the indoor air, as well as room configuration, furniture and finishing materials. Although data analysis reports quite adequate values, several inadequate design and management activities cause inadequate values, especially related to formaldehyde (values between 8 and 10,2/ 10 μg/m3), benzene (0,7 and 3,4/ 2 μg/m3) and carbon dioxide (914 and 1154/ 1000 ppm). Conclusion. The analysis is work in progress on some case studies for controlling the indoor air values even during the year, and it is expanding to several hospitals. Although the main goal is to reduce the concentration levels, the aim is to define limit values for VOCs, for guaranteeing healthy healing spaces. These data will support the definition of design and management guidelines for healthy inpatient wards

Assessment of Indoor Air Quality in Inpatient Wards

Introduction. The Indoor Air Quality is a topic that in recent years is obtaining great attention in healthcare facilities. Several studies are reporting a growing number of data and research works that allow to know all the possible indoor levels and the development of management procedures (such as materials’ choice, products for cleaning and disinfection, improvement of HVAC system, etc.) in order to improve the healing environments and health of medical and technical staffs, patients, ambulatory users and visitors. Ensuring a good IAQ in hospitals is fundamentally because there are the most vulnerable category of the population for their health conditions; although the assessment of IAQ results arduous.State of the Art. Currently in several countries are carried out air quality monitoring in those professional workplaces in which chemicals are used (i.e. operating rooms, sterilization, anticancer preparation, etc.), but also in some typically indoor spaces for the building hygiene evaluations. Therefore it determinated the definition and adoption of limits (occupational exposure limit values, threshold limit value of the Scientific Committee on Occupational Exposure Limits-VLEP or American Conference of Governmental Industrial Hygienists-TLV to be used exclusively in workplaces) or values and guidelines (such as in the case of indoor assessments, in particular the WHO’ indoor air quality guidelines). Methodology. Starting from these considerations, Istituto Superiore di Sanità and Politecnico di Milano have launched a research work for the evaluation and detection of air quality in inpatients rooms. The survey is examining formaldehyde and VOCs, and the relative influence of thermo-hygrometric, ventilation and concentration of pollutants’ parameters. Discussion. This paper reports the results obtained from the indoor air monitoring in inpatient rooms. Each survey, done every month, lasted between 5 and 7 days in relation to the real function use of the rooms. Conclusion. The analysis is continuing on the inpatient rooms for controlling the indoor air values even in summer season, and, in parallel, it is expanding to more health facilities in Lombardy and Latium regions