VENTILATION


Addressing the quest for clean indoor air


Dr Iyad Al-Attar, a mechanical engineer, air quality consultant, and a Visiting Academic Fellow in the School of Aerospace, Transport, and Manufacturing at Cranfield University, considers what he dubs the Indoor Air Quality (IAQ) ‘gaps’ in healthcare facilities, and explores the potential for attaining and maintaining clean, fresh air for patients, staff, and visitors.


The quest for clean air dates back to Hippocrates (c. 460 – 377 BC), often considered the ‘Father of Medicine’. He emphasised the effects of environmental factors, including air quality, on human health. He linked the characteristics of the air in a region to the prevalence of certain diseases. He believed that understanding the winds, seasons, and the quality of air and water was crucial for a physician to understand the health of a community. Throughout history, philosophers were influenced by the Miasma Theory, which posited that diseases were caused by ‘miasma’ – bad air from decaying organic matter. While there is no demand for ‘clean’ air in the modern sense, it highlights the perceived danger of ‘foul’ air, and implicitly suggests the need to avoid such conditions to prevent illness. Later thinkers, such as the jurist, Sir Edward Coke, in


the early 1500s, argued that ‘lights and sweet air were as necessary as pure and wholesome water’. In his letter to King Charles II in 1661, John Evelyn expressed grave concerns about the poor air quality in London, attributing it to the burning of coal, and highlighting its detrimental effects on public health – including coughs, low birth rates, and high mortality. Later, in the 19th century, public health reformers like John H. Griscom in New York actively campaigned for improved living conditions, including better ventilation and cleaner environments, to improve public health. While not strictly philosophers in the traditional sense, their work was driven by a philosophical concern for the well-being of the population.


The early hospital design Most hospitals’ early purpose was to house – not cure – the sick, in tightly packed rows of beds in dark open wards. Florence Nightingale, known as the ‘Lady with the Lamp’, decided to fundamentally change healthcare forever with her insights into patient recovery and environmental factors like air quality and ventilation. During the Crimean War, she observed the dire sanitary conditions in military hospitals, and identified the link between the environment and patient mortality. Her detailed data collection revealed that preventable diseases were the primary killers, prompting her to implement vital reforms in hospital management. Nightingale emphasised the importance of fresh air and proper ventilation, advocating open windows and cleanliness as key infection control measures. Her innovative statistical analysis, including famous Coxcomb charts, provided compelling evidence for the effectiveness of her sanitary reforms, convincing sceptical medical authorities. Her influence reached beyond her wartime efforts, shaping hospital design and public health


practices. Nightingale’s writings, particularly Notes on Nursing, became essential for nursing education, highlighting the significance of observation and hygiene. By fostering a culture of continuous improvement and empowering nurses to participate actively in patient care, she elevated the profession to one requiring specialised knowledge.


The later acceptance of germ theory Florence Nightingale’s focus on air quality also anticipated the later acceptance of germ theory, laying the groundwork for understanding airborne pathogens in disease transmission. In summary, her leadership and commitment to evidence-based care transformed nursing and modern healthcare, establishing her as a pioneer in the field. In the early 1900s, hospitals shifted gears. They started focusing on curing patients and utilising technologies such as X-rays and cardiographs, which undoubtedly revolutionised patient care and saved the lives of millions. However, keeping the machines needed for treatment near patients represented a significant challenge for the staff, and fundamentally changed how designers approached hospital layouts. Today, staying overnight in a hospital could mean experiencing a shared room poorly lit by flickering fluorescent light with no windows. Furthermore, the persistent odour might keep the patient up all night if the cacophony of beeping from various old machines does not. Likewise, research has correlated fluctuating temperatures and poor IAQ to ‘Hospital-related illness and Infection’, ‘cross-contamination’, and ‘sick building syndrome’, which can actually deteriorate patients’ health conditions.1-3


So,


today, raising the bar of air quality through multi-


September 2025 Health Estate Journal 67


Florence Nightingale, known as the ‘Lady with the Lamp’, decided to fundamentally change healthcare forever with her insights into patient recovery and environmental factors like air quality and ventilation.


Henry Hering (1814-1893) Public domain via Wikimedia Commons


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132