Indoor air problems in Finnish hospitals : from the occupational health perspective

Indoor air in hospitals is important to both employees and patients. Complaints and problems concerning the quality of indoor air are posing an increasing challenge to occupational health and safety in hospitals. The aim of the present study was to assess the perceived indoor air quality and prevalence of indoor-air-related symptoms among hospital workers. We also determined the relationship between these factors and the condition of hospital buildings and ventilation systems. An additional aim was to find how the problem solution process functions in hospitals from the occupational health perspective. We also tested the usability of nasal lavage in patient examinations. A modified questionnaire was used to collect information on the complaints and indoor-air-related symptoms of hospital employees. Construction and ventilation professionals examined the hospitals. Semi-structured interviews concerning the processes aimed towards resolving indoor air problems were carried out among hospital personnel working in occupational health, occupational safety, and infection control. Nasal lavage was performed as part of the examinations of the employees working in a moisture-damaged hospital ward and a control group before and after the repair. Hospital employees experienced poor indoor air quality and symptoms related to indoor air more often than office workers. The workers in moisture-damaged departments had complaints and symptoms more often than the workers in departments that were in good condition. In hospitals where, for the most part, the ventilation systems were in need of repair, the workers experienced more inconvenience and symptoms than those in hospitals in which the ventilation systems were mostly in good condition. Workers in moisture-damaged departments showed signs of immune-suppression in their nasal lavage samples, and their inflammatory cell counts and cytokine levels were lower than those of the controls. Occupational health and safety personnel considered the indoor air problems difficult to tackle. The roles and responsibilities of occupational health professionals, the technical department, and the employer in solving the problems were not clear. The flow of information between the different parties clearly needed improvement. An indoor air group had been appointed in under half of the hospitals in which the interviews were carried out. These groups were considered good, especially in regard to the flow of information. In conclusion, an indoor air group should be established in every hospital. Indoor air quality should be monitored by conducting regular questionnaire surveys and walk-throughs of the buildings, and by evaluating ventilation systems. Nasal lavage needs further development before it can be applied in the occupational health tool kit for examining indoor-air-related symptoms.Sairaalarakennusten kunto ja sisäilman laadun parantaminen edellyttävät ripeitä toimia Suomessa. Tässä tutkimuksessa on arvioitu sairaaloiden henkilökunnan raportoimien sisäilmahaittojen ja niihin liittyvien oireiden yleisyyttä. Sisäilmastokyselyn tulokset yhdistettiin asiantuntijoiden tekemään kolmiportaiseen arvioon rakennuksen korjaustarpeesta ja ilmanvaihtojärjestelmien kunnosta. Sairaaloiden työterveyshuollon toimintatapoja, työkaluja, resursseja ja yhteistyötä muiden toimijoiden, erityisesti työsuojelusta vastaavien kanssa sisäilmaongelmien hoitamisessa arvioitiin teemahaastatteluilla. Nenähuuhtelun soveltuvuutta kosteus- ja homevauriorakennuksissa altistuneiden työntekijöiden tutkimuksiin arvioitiin määrittämällä nenähuuhtelunesteen soluja ja tulehduksen välittäjäaineita työterveyshuollossa tapaus-verrokkitutkimuksella. Sairaalatyöntekijät raportoivat sisäilmastokyselyssä työpaikan sisäilmaan liittyviä haittoja ja oireita enemmän kuin vertailuryhmänä olleet toimistotyöntekijät. Sekä tiloissa todettu tai epäilty kosteusvaurio että puutteet ilmanvaihtojärjestelmissä lisäsivät henkilökunnan sisäilmaan liittämien valitusten ja oireiden määrää. Työterveyslaitoksen sisäilmastokysely näytti tämän tutkimuksen mukaan toimivan hyvin sairaalaympäristössä. Tutkimuksen tuloksena saatiin sairaalatyyppisille työympäristöille sisäilmastokyselyn vertailuaineisto. Nenähuuhtelusta saadut löydökset viittasivat ryhmätasolla immuunivasteen heikkenemiseen niillä työntekijöillä, jotka todennäköisesti olivat altistuneet sairaalassa toksiineja tuottavalle mikrobikasvustolle. Seurantatutkimuksessa kosteusvauriokorjauksen jälkeen ryhmätason nenähuuhtelulöydökset eivät poikenneet oireilevien työntekijöiden ja vertailuryhmän välillä. Yksilötason tutkimuksiin työterveyshuollossa nenähuuhtelua ei tämän tutkimuksen perusteella voi vielä suositella. Sisäilmaongelmien hallinta koettiin sairaaloiden työterveyshuolloissa vaikeaksi erityisesti sen vuoksi, että nämä ongelmat tulivat yleensä yllättäen ja edellyttivät poikkeuksetta moniammatillista työotetta. Yhteistyö sujui paremmin niissä sairaaloissa, joissa oli perustettu toimiva sisäilmaryhmä. Sisäilmastokyselyä oli hyödynnetty sairaaloissa sisäilmaongelmien tutkimisessa vain satunnaisesti. Sisäilmaryhmä tulisi perustaa jokaiseen sairaalaan. Tutkimuksessa sovellettu walk-through (läpikävely) -tyyppinen rakennusten ja ilmanvaihdon katselmointi ja koetun sisäilman laadun selvittäminen sisäilmastokyselyillä säännöllisin väliajoin parantaisi sairaaloiden sisäilman laadunhallintaa ja ehkäisisi ongelmien syntyä

The effects of the thermal environment on occupants’ responses in health care facilities: A literature review

Understanding the environmental characteristics that affect health and well-being is a requirement for good indoor environment design. The thermal environment is one of the factors that may affect patients, staff, family, and visitors in health care facilities (HCFs), and perceptions of general thermal comfort and local thermal discomfort are affected by air temperature, radiant temperature, relative humidity, air velocity, turbulence intensity, activity, and clothing. This study reviewed the effects of the thermal environment on patient and staff responses in HCFs, especially in patient and operating rooms. The material in this literature review consists of peer-reviewed journal articles searched by using Google Scholar and PubMed. According to the literature, thermal environment is one of the fundamental characteristics of the indoor environment and the effects of temperature on the comfort, well-being, safety, and health of both the patients and the health care personnel are broadly recognized. Thermal comfort affects sleep quality and quantity in a patient room, and thermal comfort or discomfort during surgery has an effect on the patient’s overall satisfaction with surgical care. It also affects the comfort and performance of the health care personnel who work in these environments. In the future, finding adequate solutions to reconcile the different thermal comfort conditions required by different occupants in hospitals will be important. Both the needs of patients and the attending hospital workers in different hospital spaces should be taken into account. Possible solutions could be, for example, different thermal micro environments based on different temperature and air velocity for different thermal comfort requirements, appropriate clothing for patients and staff, or active warming devices above patients

Kuntoutuslaitokset muutoksessa – näkökulmia tilojen kehittämiseen

Kuntoutusala on murroksessa. Tässä raportissa kuvattu laaja, kansallinen KUNTO-projekti arvioi kuntoutuslaitosten toiminnan muutospaineita ja sitä, miten toimintojen muuttuminen tulisi ottaa huomioon tilasuunnittelussa.Hanke toteutettiin yhteistyössä Aalto-yliopiston ja siihen osallistuneiden kuntoutuslaitosten kanssa.1

Perceived indoor air quality, air-related symptoms and ventilation in Finnish hospitals

Objectives: Good ventilation is more important in hospitals than in many other buildings. The objective of this study was to evaluate the effect of the condition, performance and modernity of ventilation systems on the perceived indoor air quality (IAQ) and the indoor air-related symptoms of hospital personnel. Materials and Methods: An inspection and evaluation graded on a 1 to 3 scale of the condition, performance, and modernity of the ventilation systems was carried out in ten central hospitals in Finland. The perceived IAQ and the related symptoms were collected by means of an indoor air questionnaire survey among the workers in these hospitals. Results: The condition, performance and modernity of the ventilation systems were good in 40% of the hospitals included in the research and poor in another 40% of them. In hospitals where the majority of the ventilation systems were assessed to be good, the prevalence of the indoor air-related complaints and symptoms was lower than in hospitals where the majority of the ventilation systems were assessed as needing extensive repairs. Conclusions: The condition and performance of the ventilation systems in hospitals had a significant impact on the perceived IAQ and the symptoms observed among the employees in Finnish hospitals. Therefore, it is important that hospital ventilation systems are maintained properly and regularly. Furthermore, they should be renovated, at the latest when their technical lifespan expires