Particulate pollution in healthcare facilities is a potential threat to healthcare workers, patients and visitors. A study was carried out to monitor particulate levels in and outside of five wards of Sheikh Zayed Hospital, a tertiary healthcare facility of Lahore. Measurements indicated that the hourly mean concentrations of PM2.5 in a medical, pulmonology (chest), surgical, pediatric and nephrology ward were 78 ± 37, 86 ± 46, 94 ± 48, 169 ± 122 and 488 ± 314 µg m-3 respectively. The outside levels of PM2.5 of the same wards were 69 ± 27, 81 ± 49, 178 ± 85, 282 ± 164 and 421 ± 240 µg m-3. Indoor levels were higher than outdoors in all the wards except surgical and pediatric ward. Such elevated levels of PM can result in aggravation of the poor health status of the patients as well as affecting the hospital staff and visitors

Ahmad, M

Ali, Z

Ansari, B

Colbeck, I

Gulshan, T

Nasir, ZA

Zainab, I

Zona, Z

The Journal of Animal and Plant Sciences

Particulate pollution in healthcare facilities is a potential threat to healthcare workers, patients and visitors. A study was
carried out to monitor particulate levels in and outside of five wards of Sheikh Zayed Hospital, a tertiary healthcare
facility of Lahore. Measurements indicated that the hourly mean concentrations of PM2.5 in a medical, pulmonology
(chest), surgical, pediatric and nephrology ward were 78 ± 37, 86 ± 46, 94 ± 48, 169 ± 122 and 488 ± 314 µg m-
3
respectively. The outside levels of PM2.5 of the same wards were 69 ± 27, 81 ± 49, 178 ± 85, 282 ± 164 and 421 ± 240
µg m-
3
. Indoor levels were higher than outdoors in all the wards except surgical and pediatric ward. Such elevated levels
of PM can result in aggravation of the poor health status of the patients as well as affecting the hospital staff and visitors

Gulshan, T.

Ali, Z.

Zona, Z.

Ansari, B.

Ahmad, M.

Zainab, M.

Nasir, Zaheer A.

Colbeck, I.

Cranfield CERES

Lahore, Pakistan7, 2015-held on February 6The National Conference and Training Workshop “Wildlife and Aerobiology”Proceedings of666STATE OF AIR QUALITY IN AND OUTSIDE OF HOSPITAL WARDS IN URBANCENTRES – A CASE STUDY IN LAHORE, PAKISTANT. Gulshan1, Z. Ali1*, Z. Zona1, B. Ansari1, M. Ahmad1, I. Zainab1, Z. A. Nasir2,3 and I. Colbeck3Environmental Health and Wildlife, Department of Zoology, University of the Punjab, Lahore, Pakistan12School of Energy, Environment and Agrifood, Cranfield University, Cranfield, Bedfordshire MK43 0AL, UK3School of Biological Sciences, University of Essex, Colchester, Essex, CO4 3SQ, UKzali.zool@pu.edu.pk*Corresponding Author’s Email:ABSTRACTParticulate pollution in healthcare facilities is a potential threat to healthcare workers, patients and visitors. A study wascarried out to monitor particulate levels in and outside of five wards of Sheikh Zayed Hospital, a tertiary healthcarefacility of Lahore. Measurements indicated that the hourly mean concentrations of PM2.5 in a medical, pulmonology(chest), surgical, pediatric and nephrology ward were 78 ± 37, 86 ± 46, 94 ± 48, 169 ± 122 and 488 ± 314 µg m-3respectively. The outside levels of PM2.5 of the same wards were 69 ± 27, 81 ± 49, 178 ± 85, 282 ± 164 and 421 ± 240µg m-3. Indoor levels were higher than outdoors in all the wards except surgical and pediatric ward. Such elevated levelsof PM can result in aggravation of the poor health status of the patients as well as affecting the hospital staff and visitors.Keywords: Particulate matter,hospital, wards, outdoor, Pakistan.INTRODUCTIONNosocomial outbreaks have been associatedwith airborne transmission and role of microorganisms inaerosolized form in hospital acquired infection is thoughtto be much greater than is up to now recognized.Immuno-compromised patients have also higher risk ofbecoming infected. Furthermore, epidemiological studiesdemonstrate associations between particulate matter (PM)concentrations and increased morbidity and mortality;while toxicological studies have begun to providepotential biological explanations for these observedassociations. Previous studies have revealed thesignificance of indoor air quality and of the contributionof indoor sources to particle concentrations. The qualityof air in the indoor hospital environment is of increasingconcern both for patients and healthcare personnel whoare exposed to infectious microorganisms and particulatematter. Additionally, healthcare staff are also prone tohealthcare associated infections (HCAIs) due to theirinteraction and proximity to infectious sources. Theproblem regards not only medical equipment and thecleanliness of the staff but also surfaces in rooms andindoor air. (Charkowska, 2008).In general, HCA Is are spread by contact,however, there is growing evidence that an airborne routehas played a major role in nosocomial outbreaks of manypathogens e.g. Staphylococcus aureus, Acinetobacter sppand Serratia marcescens (Uduman et al. 2002; Kumari etal. 1998; Bernards et al. 1998). Additionally, infectiontransmission by deposition and/or resuspension is also animportant pathways. It can be argued that the state of airquality in hospitals, particularly with reference toparticulate matter, is likely to impact on HCAIs.Many air pollutants are present in the air butmost important is particulate matter which is responsiblefor cardio-vascular ailments (Pope et al. 1995).Concentrations of particulate matter indoors depend uponthe various indoor sources/activities (e.g. cleaning,dusting and sweeping and poor ventilation) and also onoutdoor sources and seasonal variations (Nitta et al.1994; Abt et al. 2000).Air borne particles in hospitals areof vital concern for infection control to protect hospitalworkforces and patients. Infectious agents in aerosolsmay be spread by droplet nuclei, aerial and uncleansurfaces. Prospective health effects of particulate matterin hospital air are many including toxic, allergenic andinfectious. In fact, every hospital has an inherent risk ofHCAIs, however, the burden is higher in developingcountries in comparison to developed with a prevalenceof 10% (WHO 2011). Furthermore, developing countriesare facing excessive levels of particulate matter,especially, in urban centres and these are very likely tocontribute to indoor level of particulate matter inhospitals in these areas. Additionally, administrative,engineering and personal control measures to reduce therisk of exposure to airborne hazards in hospitals are oftenminimal in these countries.The current research was undertaken to monitorambient and indoor PM2.5 levels, simultaneously, in fivedifferent wards of Sheikh Zayed Hospital in Lahore,Pakistan as a case study to comprehend the impact ofambient PM on indoors as well as to gauge theeffectiveness of existing protection measures.Gulshanet al., J. Anim. Plant Sci. 25 (3 Supp. 2) 2015Lahore, Pakistan7, 2015-held on February 6The National Conference and Training Workshop “Wildlife and Aerobiology”Proceedings of667MATERIALS AND METHODSStudy site:Sheikh Zayed Hospital is a tertiary carehospital located in Lahore (31º 30'N and 74º 18'E),Punjab Pakistan (Figure 1). It was established in 1986and is consisting of 99 wards and 713 beds. About 50,000patients visit the hospital annually. Table 1 provides asummary of the selected wards in the Sheikh ZayedHospital.Figure 1: Location of Sheikh Zayed Hospital, LahoreTable 1. Characteristics of the selected wardsParameters Medical ward PulmonarywardSurgical ward Pediatrics ward NephrologywardWard size 39m2 39m2 39m2 39m2 39m2Number of beds 6 6 6 8 8Beds occupied 4 6 5 8 7Number ofwindows2 2 2 2 3Windowsclosed/openClosed Closed Closed Closed ClosedNumber ofvisitors9 10 9 14 17Activities in thewardMonitoring ofvitals, runningmedication,peoplemovement,dinningpractices, doctor’svisitMonitoring ofvitals, runningmedication,peoplemovement,dinningpractices,doctor’s visitPreoperative andpost-operative care,Administeringmedication bynurses, peoplemovement, dinningpractices,doctor’svisitAdministeringmedication bynurses, peoplemovement,dinning practices,doctor’s visitAdministeringmedication bynurses, peoplemovement,dinning practices,doctor’s visitVentilation By door By door By door By door By doorGulshanet al., J. Anim. Plant Sci. 25 (3 Supp. 2) 2015Lahore, Pakistan7, 2015-held on February 6The National Conference and Training Workshop “Wildlife and Aerobiology”Proceedings of668Monitoring of ambient and indoor PM2.5 levels:PM2.5was sampled by using a real time aerosol monitoringinstrument, DustTrak (TSI Model 8520). Two DustTrakmonitors were run in parallel, one inside the ward and theother running simultaneously just outside the hospital.The sampling duration for each ward (indoorand ambient) was 24 hours.  Ambient air was sampledrelative to each ward and the sampler was placed on theroof of the ward. Average concentrations of all thesampling sites were obtained. Different activities in thewards were also noted. The association between indoor(ward) air and ambient air was statistically tested byapplying correlation bivariate analysis using SPSSversion (17) with a significance level of 0.01.RESULTS AND DISCUSSIONThe latitude of this work was to characterizePM2.5 in different wards (Medical, Pulmonology,Surgical,Pediatrics and Nephrology) of patients inhospital microenvironment and to examine the relativecontribution of indoor and outdoor sources to PM2.5 indifferent wards (Table -2).Table 2. Summary of PM2.5 concentration in different wardsPM2.5 hourly mean and standard deviation  at the study siteWards Hourly Mean SD I/O ratioMedical ward 78 ±37 1.130Medical  ward outdoor 69 ±27Pulmonary ward 86 ±46 1.061Pulmonary  ward outdoor 81 ±49Surgical  ward 94 ±48 0.528Surgical  ward out door 178 ±85Pediatrics ward 169 ±122 0.600Pediatrics ward outdoor 282 ±164Nephrology ward 488 ±314 1.159Nephrology ward outdoor 421 ±240The indoor to outdoor PM ratio of five differentwards i.e. medical, pulmonology, surgical, pediatrics andnephrology was observed to be 1.13, 1.06, 0.53, 0.60 and1.16 respectively. The highest I/O ratio was found in thenephrology ward. This has the largest number of visitors,along with varied activities. The differences among thewards results from the geometry of the cracks inbuildings, indoor particle sources, outdoor environmentsand ventilation patterns.Different indoor activities largelyinfluence the levels of indoor PM. It was noted thatalthough peaks were recorded in the ambient air duringhigh vehicular activity, in most cases the levels weregenerally lower than those recorded in the indoorenvironment. The impact of ambient PM2.5 levels on theindoor air quality is also clearly indicated in thecomparative graphs given. It is evident that although thehospital is centrally air conditioned, the wards are not air-tight thereby allowing infiltration from the outside mainlyby doors. Such infiltration is an important contributingfactor in defining the indoor air quality and this situationcan cause multiple health effects.With reference to medical ward the highestlevels of PM2.5 occurred during the hours when there wasa doctor’s visit, dinner time and prayer time as shown inFigure 2. For the pulmonology ward (Figure 3) thehighest levels of PM2.5 occurred during the hours whenthere was heavy traffic load. As the hospital is situated inan urban area on a busy road, traffic emission are majorsource of PM2.5. Other activities including a doctor’s visitand dining times show increases in PMconcentrations.Peak concentrations of PM2.5 were seenduring heavy traffic which indicates the infiltration ofparticulate matter from outside. Different indooractivities and outdoor sources were main contributor toincreased PM concentrations in the surgical wards as well(Figure 4).Gulshanet al., J. Anim. Plant Sci. 25 (3 Supp. 2) 2015Lahore, Pakistan7, 2015-held on February 6The National Conference and Training Workshop “Wildlife and Aerobiology”Proceedings of669Figure 2: PM2.5levels in Medical ward and outdoor resulting from various activitiesFigure: 3 PM2.5levels in pulmonary ward and outdoor resulting from various activitiesFigure 4: PM2.5levels in surgical ward and outdoor resulting from various activitiesFigure 5: PM2.5levels in Pediatric ward and outdoor resulting from various activities0.0020.0040.0060.0080.00100.00120.00140.000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 AvgPM mass concentrationsµg/m³HoursMedical Ward Outdoor Medical wardPrayerBreakfastDinner timeDoctor's visitIncreased traffic load0.0020.0040.0060.0080.00100.00120.00140.00160.00180.00PM mass concentrations µg/m³HoursPulmonology Ward Outdoor Pulmonology wardTraffic loadPrayer timeDoctor's visitTraffic loadMovement of people0.0050.00100.00150.00200.00250.00300.00350.00PM mass concentrationsµg/m³HoursSurgical Ward Outdoor Surgical wardTraffic loadBreakfast time, Smoking activity,0.00100.00200.00300.00400.00500.00600.00700.00PM mass concentrationsµg/m³HoursPediatrics Ward Outdoor Pediatrics wardTraffic loadIncreasedmovement ofpeopleGulshanet al., J. Anim. Plant Sci. 25 (3 Supp. 2) 2015Lahore, Pakistan7, 2015-held on February 6The National Conference and Training Workshop “Wildlife and Aerobiology”Proceedings of670Increased levels of PM2.5 were observed in thepediatrics ward during visiting hours where themovement of people causes re-suspension of the pollutantas shown in Figure 5. In addition this ward is not airconditioned and is equipped with 8 fans which, when on,cause high rates of particulate matter re-suspension.Figure 6: PM2.5 levels in and out of Nephrology ward resulting from various activitiesSimilar results were obtained in the nephrologyward as shown in Figure6. A statistically significantpositive correlation was observed between the wards(indoor air) and ambient air with an alpha value of 0.01being used. The obtained p values were 0.00, 0.001, 0.00,0.006, 0.000 for medical, pulmonary, surgical, andpaediatric and nephrology ward respectively.Apart from outdoor air influencing the indoorair, multiple indoor sources are also important toconsider. Movement of people re-suspends the dustsettled on the surface and thereby increases the PMlevels. In our case, it has to be mentioned that due tostrike of janitorial staff, cleaning activities were quiteirregular and not up to the normal standards. A visibleimpact of the strike was recorded in our results as theaverage levels of PM2.5 are observed to increase fromward to ward. The medical ward was monitored first andthe PM levels are lower as compared to the nephrologyward (78 vs 488 µg/m³). Although cleaning activities resuspend the settled particles, it is a temporary process asmost of the particles are swept away in the cleaningactivity. On the other hand, irregular cleaning and floorsweeping results in more deposition of particles than arecleared. As observed in this research, as the cleaningactivities decreased over time, PM levels increasedconsiderably. The deposited dust was re-suspended againand again due to movement of people as there was noremoval process.In addition the results show that outdoorconcentrations of PM2.5 were above accepted air qualitystandards and indicate that site is highly affected byheavy traffic. Indoor levels were generally higher thanthe corresponding outdoor, bar surgical and paediatricwards. This is most probably due to presence of indooraerosol sources such as people movement/activities,sweeping,and poor ventilation. In the urban environmentthere are many sources for particulate matter such astraffic and industry (Wehner et al. 2002, Hussein et al.2005, and Arnold et al. 2006). These may lead toelevated indoor concentrations by ambient air penetrationin the indoor microenvironments (Diapouli et al. 2011).Conclusion:The study demonstrated that aerosolparticles are frequently liberated within the wards.The high I/O ratios observed in the wards andambient air reveals greater contribution from indoorsources to PM. Pakistan, being a developingcountry, is confronting serious problems in thehealth sector and lacks strategies to maintain airquality in the healthcare environments .Theoutcomes of the study illustrates that the particulatematter levels imparted by various indoor activitiesand infiltration from outdoor can be used as a tool indetermining air quality of the healthcareenvironments.REFERENCESAbt, E., H. S. Helen, A. George and K. Petros (2000).Characterization of Indoor Particle Sources: AStudy Conducted in the Metropolitan BostonArea. Envirn. Health Persp 108: 35-44Arnold F., I. Irjola, H. Aufmhoff, T. Schuck, T. Lahdeand K. Hameri (2006). First gaseous sulfuricacid measurements in automobile exhaust:Implications for volatile nanoparticle formation.Atmos. Environ. 40: 7097-7105Bernards, A. T., H. M. Frénay, B.T. Lim, W.D. Hendriks,L. Dijkshoorn and C.P. Van Boven (1998).Methicillin-resistant Staphylococcus aureus andAcinetobacterbaumannii: an unexpected0.00200.00400.00600.00800.001000.001200.00PM mass concentrationsµg/m³HoursNephrology Ward Outdoor Nephrology wardPrayer timeBreakfast timeDoctor's visit VisitorsGulshanet al., J. Anim. Plant Sci. 25 (3 Supp. 2) 2015Lahore, Pakistan7, 2015-held on February 6The National Conference and Training Workshop “Wildlife and Aerobiology”Proceedings of671difference in epidemiologic behavior. AmericanJ. Infection Control. 26(6): 544-551.Charkowska, A. (2008). Ensuring Cleanliness inOperating Theatres. (JOSE) 14(4): 447–453.Diapouli, E., K. Eleftheriadis, A.A. Karanasiou, S.Vratolis, O. Hermansen, I. Colbeck and M.Lazaridis (2011). Indoor and Outdoor ParticleNumber and Mass Concentrations in Athens.Sources, Sinks and Variability of AerosolParameters Aerosol and Air Quality Research,11: 632–642Hussein T., K. Hameri, P. Aalto, A. Asmi, I. Kakko andM. Kulmala (2004). Particle sizecharacterization and the indoor-to-outdoorrelationship of atmospheric aerosols in Helsinki.J. Work environ. Health 30: 54-62.Kumari, D. N. P., T.C. Haji,  V. Keer, P.M. Hawkey, V.Duncanson and E. Flower(1998). Ventilationgrilles as a potential source of methicillin-resistant Staphylococcus aureus causing anoutbreak in an orthopaedic ward at a districtgeneral hospital. J. Hospital Infection, 39(2):127-133.Nitta H., M. Ichikawa, M. Sato, S. Konishi and M. Ono(1994). A new approach based on a covariancestructure model to source apportionment ofindoor fine particles in Tokyo, atmos. Res., 28:631–636.Pope, C.A., D.V. Bates, and M.E. Raizenne (1995).Health effects of particulate air pollution: timefor reassessment? Environ. Hlth. Perspect. 103:472-480.Saksena,S and R.Uma (2008). Longitudinal study ofindoor particulate matter and its relationship tooutdoor concentrations in New Delhi, India.Indoor and built environment. 17 (6): 543-551.Uduman, S. A., A.S. Farrukh, K.N.R. Nath, M.Y.H.Zuhair, A. Ifrah, A.D. Khawla and P. Sunita(2002). An outbreak of Serratia marcescensinfection in a special-care baby unit of acommunity hospital in United Arab Emirates:the importance of the air conditioner duct as anosocomial reservoir. J. Hospital Infection.52(3): 175-180.Wehner B., W. Birmili, T. Gnack and A. Wiedensohler(2002). Particles number size distribution in astreet canyon and their transformation into theurban air background: measurements and asimple model study. Amos. Environ. 36:2215-2223.WHO. (2011). Report on the burden of endemichealthcare-associated infection worldwide,Clean Care is Safer Care, A systematic reviewof the literature, World Health Organization, 20Avenue Appia, 1211Geneva 27, Switzerland.

English

State of air quality in and outside of hospital wards in urban centres – a case study in Lahore, Pakistan

University of Essex Research Repository

Gulshanet al., J. Anim. Plant Sci. 25 (3 Supp. 2) 2015Lahore, Pakistan7, 2015-held on February 6The National Conference and Training Workshop “Wildlife and Aerobiology”Proceedings of666STATE OF AIR QUALITY IN AND OUTSIDE OF HOSPITAL WARDS IN URBANCENTRES – A CASE STUDY IN LAHORE, PAKISTANT. Gulshan1, Z. Ali1*, Z. Zona1, B. Ansari1, M. Ahmad1, I. Zainab1, Z. A. Nasir2,3 and I. Colbeck3Environmental Health and Wildlife, Department of Zoology, University of the Punjab, Lahore, Pakistan12School of Energy, Environment and Agrifood, Cranfield University, Cranfield, Bedfordshire MK43 0AL, UK3School of Biological Sciences, University of Essex, Colchester, Essex, CO4 3SQ, UKzali.zool@pu.edu.pk*Corresponding Author’s Email:ABSTRACTParticulate pollution in healthcare facilities is a potential threat to healthcare workers, patients and visitors. A study wascarried out to monitor particulate levels in and outside of five wards of Sheikh Zayed Hospital, a tertiary healthcarefacility of Lahore. Measurements indicated that the hourly mean concentrations of PM2.5 in a medical, pulmonology(chest), surgical, pediatric and nephrology ward were 78 ± 37, 86 ± 46, 94 ± 48, 169 ± 122 and 488 ± 314 µg m-3respectively. The outside levels of PM2.5 of the same wards were 69 ± 27, 81 ± 49, 178 ± 85, 282 ± 164 and 421 ± 240µg m-3. Indoor levels were higher than outdoors in all the wards except surgical and pediatric ward. Such elevated levelsof PM can result in aggravation of the poor health status of the patients as well as affecting the hospital staff and visitors.Keywords: Particulate matter,hospital, wards, outdoor, Pakistan.INTRODUCTIONNosocomial outbreaks have been associatedwith airborne transmission and role of microorganisms inaerosolized form in hospital acquired infection is thoughtto be much greater than is up to now recognized.Immuno-compromised patients have also higher risk ofbecoming infected. Furthermore, epidemiological studiesdemonstrate associations between particulate matter (PM)concentrations and increased morbidity and mortality;while toxicological studies have begun to providepotential biological explanations for these observedassociations. Previous studies have revealed thesignificance of indoor air quality and of the contributionof indoor sources to particle concentrations. The qualityof air in the indoor hospital environment is of increasingconcern both for patients and healthcare personnel whoare exposed to infectious microorganisms and particulatematter. Additionally, healthcare staff are also prone tohealthcare associated infections (HCAIs) due to theirinteraction and proximity to infectious sources. Theproblem regards not only medical equipment and thecleanliness of the staff but also surfaces in rooms andindoor air. (Charkowska, 2008).In general, HCA Is are spread by contact,however, there is growing evidence that an airborne routehas played a major role in nosocomial outbreaks of manypathogens e.g. Staphylococcus aureus, Acinetobacter sppand Serratia marcescens (Uduman et al. 2002; Kumari etal. 1998; Bernards et al. 1998). Additionally, infectiontransmission by deposition and/or resuspension is also animportant pathways. It can be argued that the state of airquality in hospitals, particularly with reference toparticulate matter, is likely to impact on HCAIs.Many air pollutants are present in the air butmost important is particulate matter which is responsiblefor cardio-vascular ailments (Pope et al. 1995).Concentrations of particulate matter indoors depend uponthe various indoor sources/activities (e.g. cleaning,dusting and sweeping and poor ventilation) and also onoutdoor sources and seasonal variations (Nitta et al.1994; Abt et al. 2000).Air borne particles in hospitals areof vital concern for infection control to protect hospitalworkforces and patients. Infectious agents in aerosolsmay be spread by droplet nuclei, aerial and uncleansurfaces. Prospective health effects of particulate matterin hospital air are many including toxic, allergenic andinfectious. In fact, every hospital has an inherent risk ofHCAIs, however, the burden is higher in developingcountries in comparison to developed with a prevalenceof 10% (WHO 2011). Furthermore, developing countriesare facing excessive levels of particulate matter,especially, in urban centres and these are very likely tocontribute to indoor level of particulate matter inhospitals in these areas. Additionally, administrative,engineering and personal control measures to reduce therisk of exposure to airborne hazards in hospitals are oftenminimal in these countries.The current research was undertaken to monitorambient and indoor PM2.5 levels, simultaneously, in fivedifferent wards of Sheikh Zayed Hospital in Lahore,Pakistan as a case study to comprehend the impact ofambient PM on indoors as well as to gauge theeffectiveness of existing protection measures.671-666Page:) 2015 Special IssueSupp. 225(3The Journal of Animal & Plant Sciences,ISSN: 1018-7081Gulshanet al., J. Anim. Plant Sci. 25 (3 Supp. 2) 2015Lahore, Pakistan7, 2015-held on February 6The National Conference and Training Workshop “Wildlife and Aerobiology”Proceedings of667MATERIALS AND METHODSStudy site:Sheikh Zayed Hospital is a tertiary carehospital located in Lahore (31º 30'N and 74º 18'E),Punjab Pakistan (Figure 1). It was established in 1986and is consisting of 99 wards and 713 beds. About 50,000patients visit the hospital annually. Table 1 provides asummary of the selected wards in the Sheikh ZayedHospital.Figure 1: Location of Sheikh Zayed Hospital, LahoreTable 1. Characteristics of the selected wardsParameters Medical ward PulmonarywardSurgical ward Pediatrics ward NephrologywardWard size 39m2 39m2 39m2 39m2 39m2Number of beds 6 6 6 8 8Beds occupied 4 6 5 8 7Number ofwindows2 2 2 2 3Windowsclosed/openClosed Closed Closed Closed ClosedNumber ofvisitors9 10 9 14 17Activities in thewardMonitoring ofvitals, runningmedication,peoplemovement,dinningpractices, doctor’svisitMonitoring ofvitals, runningmedication,peoplemovement,dinningpractices,doctor’s visitPreoperative andpost-operative care,Administeringmedication bynurses, peoplemovement, dinningpractices,doctor’svisitAdministeringmedication bynurses, peoplemovement,dinning practices,doctor’s visitAdministeringmedication bynurses, peoplemovement,dinning practices,doctor’s visitVentilation By door By door By door By door By doorGulshanet al., J. Anim. Plant Sci. 25 (3 Supp. 2) 2015Lahore, Pakistan7, 2015-held on February 6The National Conference and Training Workshop “Wildlife and Aerobiology”Proceedings of668Monitoring of ambient and indoor PM2.5 levels:PM2.5was sampled by using a real time aerosol monitoringinstrument, DustTrak (TSI Model 8520). Two DustTrakmonitors were run in parallel, one inside the ward and theother running simultaneously just outside the hospital.The sampling duration for each ward (indoorand ambient) was 24 hours.  Ambient air was sampledrelative to each ward and the sampler was placed on theroof of the ward. Average concentrations of all thesampling sites were obtained. Different activities in thewards were also noted. The association between indoor(ward) air and ambient air was statistically tested byapplying correlation bivariate analysis using SPSSversion (17) with a significance level of 0.01.RESULTS AND DISCUSSIONThe latitude of this work was to characterizePM2.5 in different wards (Medical, Pulmonology,Surgical,Pediatrics and Nephrology) of patients inhospital microenvironment and to examine the relativecontribution of indoor and outdoor sources to PM2.5 indifferent wards (Table -2).Table 2. Summary of PM2.5 concentration in different wardsPM2.5 hourly mean and standard deviation  at the study siteWards Hourly Mean SD I/O ratioMedical ward 78 ±37 1.130Medical  ward outdoor 69 ±27Pulmonary ward 86 ±46 1.061Pulmonary  ward outdoor 81 ±49Surgical  ward 94 ±48 0.528Surgical  ward out door 178 ±85Pediatrics ward 169 ±122 0.600Pediatrics ward outdoor 282 ±164Nephrology ward 488 ±314 1.159Nephrology ward outdoor 421 ±240The indoor to outdoor PM ratio of five differentwards i.e. medical, pulmonology, surgical, pediatrics andnephrology was observed to be 1.13, 1.06, 0.53, 0.60 and1.16 respectively. The highest I/O ratio was found in thenephrology ward. This has the largest number of visitors,along with varied activities. The differences among thewards results from the geometry of the cracks inbuildings, indoor particle sources, outdoor environmentsand ventilation patterns.Different indoor activities largelyinfluence the levels of indoor PM. It was noted thatalthough peaks were recorded in the ambient air duringhigh vehicular activity, in most cases the levels weregenerally lower than those recorded in the indoorenvironment. The impact of ambient PM2.5 levels on theindoor air quality is also clearly indicated in thecomparative graphs given. It is evident that although thehospital is centrally air conditioned, the wards are not air-tight thereby allowing infiltration from the outside mainlyby doors. Such infiltration is an important contributingfactor in defining the indoor air quality and this situationcan cause multiple health effects.With reference to medical ward the highestlevels of PM2.5 occurred during the hours when there wasa doctor’s visit, dinner time and prayer time as shown inFigure 2. For the pulmonology ward (Figure 3) thehighest levels of PM2.5 occurred during the hours whenthere was heavy traffic load. As the hospital is situated inan urban area on a busy road, traffic emission are majorsource of PM2.5. Other activities including a doctor’s visitand dining times show increases in PMconcentrations.Peak concentrations of PM2.5 were seenduring heavy traffic which indicates the infiltration ofparticulate matter from outside. Different indooractivities and outdoor sources were main contributor toincreased PM concentrations in the surgical wards as well(Figure 4).Gulshanet al., J. Anim. Plant Sci. 25 (3 Supp. 2) 2015Lahore, Pakistan7, 2015-held on February 6The National Conference and Training Workshop “Wildlife and Aerobiology”Proceedings of669Figure 2: PM2.5levels in Medical ward and outdoor resulting from various activitiesFigure: 3 PM2.5levels in pulmonary ward and outdoor resulting from various activitiesFigure 4: PM2.5levels in surgical ward and outdoor resulting from various activitiesFigure 5: PM2.5levels in Pediatric ward and outdoor resulting from various activities0.0020.0040.0060.0080.00100.00120.00140.000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 AvgPM mass concentrationsµg/m³HoursMedical Ward Outdoor Medical wardPrayerBreakfastDinner timeDoctor's visitIncreased traffic load0.0020.0040.0060.0080.00100.00120.00140.00160.00180.00PM mass concentrations µg/m³HoursPulmonology Ward Outdoor Pulmonology wardTraffic loadPrayer timeDoctor's visitTraffic loadMovement of people0.0050.00100.00150.00200.00250.00300.00350.00PM mass concentrationsµg/m³HoursSurgical Ward Outdoor Surgical wardTraffic loadBreakfast time, Smoking activity,0.00100.00200.00300.00400.00500.00600.00700.00PM mass concentrationsµg/m³HoursPediatrics Ward Outdoor Pediatrics wardTraffic loadIncreasedmovement ofpeopleGulshanet al., J. Anim. Plant Sci. 25 (3 Supp. 2) 2015Lahore, Pakistan7, 2015-held on February 6The National Conference and Training Workshop “Wildlife and Aerobiology”Proceedings of670Increased levels of PM2.5 were observed in thepediatrics ward during visiting hours where themovement of people causes re-suspension of the pollutantas shown in Figure 5. In addition this ward is not airconditioned and is equipped with 8 fans which, when on,cause high rates of particulate matter re-suspension.Figure 6: PM2.5 levels in and out of Nephrology ward resulting from various activitiesSimilar results were obtained in the nephrologyward as shown in Figure6. A statistically significantpositive correlation was observed between the wards(indoor air) and ambient air with an alpha value of 0.01being used. The obtained p values were 0.00, 0.001, 0.00,0.006, 0.000 for medical, pulmonary, surgical, andpaediatric and nephrology ward respectively.Apart from outdoor air influencing the indoorair, multiple indoor sources are also important toconsider. Movement of people re-suspends the dustsettled on the surface and thereby increases the PMlevels. In our case, it has to be mentioned that due tostrike of janitorial staff, cleaning activities were quiteirregular and not up to the normal standards. A visibleimpact of the strike was recorded in our results as theaverage levels of PM2.5 are observed to increase fromward to ward. The medical ward was monitored first andthe PM levels are lower as compared to the nephrologyward (78 vs 488 µg/m³). Although cleaning activities resuspend the settled particles, it is a temporary process asmost of the particles are swept away in the cleaningactivity. On the other hand, irregular cleaning and floorsweeping results in more deposition of particles than arecleared. As observed in this research, as the cleaningactivities decreased over time, PM levels increasedconsiderably. The deposited dust was re-suspended againand again due to movement of people as there was noremoval process.In addition the results show that outdoorconcentrations of PM2.5 were above accepted air qualitystandards and indicate that site is highly affected byheavy traffic. Indoor levels were generally higher thanthe corresponding outdoor, bar surgical and paediatricwards. This is most probably due to presence of indooraerosol sources such as people movement/activities,sweeping,and poor ventilation. In the urban environmentthere are many sources for particulate matter such astraffic and industry (Wehner et al. 2002, Hussein et al.2005, and Arnold et al. 2006). These may lead toelevated indoor concentrations by ambient air penetrationin the indoor microenvironments (Diapouli et al. 2011).Conclusion:The study demonstrated that aerosolparticles are frequently liberated within the wards.The high I/O ratios observed in the wards andambient air reveals greater contribution from indoorsources to PM. Pakistan, being a developingcountry, is confronting serious problems in thehealth sector and lacks strategies to maintain airquality in the healthcare environments .Theoutcomes of the study illustrates that the particulatematter levels imparted by various indoor activitiesand infiltration from outdoor can be used as a tool indetermining air quality of the healthcareenvironments.REFERENCESAbt, E., H. S. Helen, A. George and K. Petros (2000).Characterization of Indoor Particle Sources: AStudy Conducted in the Metropolitan BostonArea. Envirn. Health Persp 108: 35-44Arnold F., I. Irjola, H. Aufmhoff, T. Schuck, T. Lahdeand K. Hameri (2006). First gaseous sulfuricacid measurements in automobile exhaust:Implications for volatile nanoparticle formation.Atmos. Environ. 40: 7097-7105Bernards, A. T., H. M. Frénay, B.T. Lim, W.D. Hendriks,L. Dijkshoorn and C.P. Van Boven (1998).Methicillin-resistant Staphylococcus aureus andAcinetobacterbaumannii: an unexpected0.00200.00400.00600.00800.001000.001200.00PM mass concentrationsµg/m³HoursNephrology Ward Outdoor Nephrology wardPrayer timeBreakfast timeDoctor's visit VisitorsGulshanet al., J. Anim. Plant Sci. 25 (3 Supp. 2) 2015Lahore, Pakistan7, 2015-held on February 6The National Conference and Training Workshop “Wildlife and Aerobiology”Proceedings of671difference in epidemiologic behavior. AmericanJ. Infection Control. 26(6): 544-551.Charkowska, A. (2008). Ensuring Cleanliness inOperating Theatres. (JOSE) 14(4): 447–453.Diapouli, E., K. Eleftheriadis, A.A. Karanasiou, S.Vratolis, O. Hermansen, I. Colbeck and M.Lazaridis (2011). Indoor and Outdoor ParticleNumber and Mass Concentrations in Athens.Sources, Sinks and Variability of AerosolParameters Aerosol and Air Quality Research,11: 632–642Hussein T., K. Hameri, P. Aalto, A. Asmi, I. Kakko andM. Kulmala (2004). Particle sizecharacterization and the indoor-to-outdoorrelationship of atmospheric aerosols in Helsinki.J. Work environ. Health 30: 54-62.Kumari, D. N. P., T.C. Haji,  V. Keer, P.M. Hawkey, V.Duncanson and E. Flower(1998). Ventilationgrilles as a potential source of methicillin-resistant Staphylococcus aureus causing anoutbreak in an orthopaedic ward at a districtgeneral hospital. J. Hospital Infection, 39(2):127-133.Nitta H., M. Ichikawa, M. Sato, S. Konishi and M. Ono(1994). A new approach based on a covariancestructure model to source apportionment ofindoor fine particles in Tokyo, atmos. Res., 28:631–636.Pope, C.A., D.V. Bates, and M.E. Raizenne (1995).Health effects of particulate air pollution: timefor reassessment? Environ. Hlth. Perspect. 103:472-480.Saksena,S and R.Uma (2008). Longitudinal study ofindoor particulate matter and its relationship tooutdoor concentrations in New Delhi, India.Indoor and built environment. 17 (6): 543-551.Uduman, S. A., A.S. Farrukh, K.N.R. Nath, M.Y.H.Zuhair, A. Ifrah, A.D. Khawla and P. Sunita(2002). An outbreak of Serratia marcescensinfection in a special-care baby unit of acommunity hospital in United Arab Emirates:the importance of the air conditioner duct as anosocomial reservoir. J. Hospital Infection.52(3): 175-180.Wehner B., W. Birmili, T. Gnack and A. Wiedensohler(2002). Particles number size distribution in astreet canyon and their transformation into theurban air background: measurements and asimple model study. Amos. Environ. 36:2215-2223.WHO. (2011). Report on the burden of endemichealthcare-associated infection worldwide,Clean Care is Safer Care, A systematic reviewof the literature, World Health Organization, 20Avenue Appia, 1211Geneva 27, Switzerland.

State of air quality in and outside of hospital wards in urban centres – A case study in Lahore, Pakistan

http://dspace.lib.cranfield.ac.uk/bitstream/1826/10663/3/air_quality_in_and_outside-hospital_wards-Lahore-2015.pdf

State of air quality in and outside of hospital wards in urban centres – A case study in Lahore, Pakistan

Abstract

Similar works

Full text

Available Versions

Cranfield CERES

University of Essex Research Repository