VENTILATION
pressure relations between various critical/non-critical spaces are maintained by the HVAC system, reducing contamination risks.
4 Implement smart HVAC solutions where system automation can respond to any variations in IAQ through data-driven decisions enabled by air quality sensors, aiming to optimise air quality management and reduce manual monitoring efforts.
5 Provide staff training on IAQ, proper HVAC operation, and best practices, to reduce pollutant transmissions. Training endeavours should also include orienting patients during admission about the essence of infection control protocols that hospitals implement to manage air quality assiduously.
Addressing the imperative steps Addressing the imperative steps toward enhancing IAQ is crucial, especially in the light of the ongoing challenges that facility management encounters in managing engineering-related air quality issues. A significant concern lies with many hospitals and healthcare facilities, which often operate with ageing infrastructures. These outdated systems, and specifically their heating, ventilation, and air-conditioning components, regularly fall short of meeting contemporary IAQ standards, raising profound implications for the wellbeing of patients and healthcare personnel. Retrofitting these antiquated HVAC systems is not only
complex, but also expensive. Upgrading to advanced filtration solutions – integrating state-of-the-art filter media and sophisticated IAQ monitoring technologies – requires significant technical expertise and financial investment. Unfortunately, many stakeholders view these necessary enhancements as costs rather than critical investments in health, safety, and operational efficiency, which can hinder essential upgrades and ongoing system maintenance. Furthermore, conventional HVAC systems often struggle
to provide the thermal comfort required while adapting to the ebb and flow of human occupancy and unpredictable changes in air quality. With HVAC systems running continuously – 24 hours a day, seven days a week – these facilities experience considerable energy consumption. This reality highlights the pressing need for energy-efficient solutions that effectively balance operational efficiency with the imperative of maintaining superior IAQ. The concepts of energy recovery ventilation for outdoor air admitted in large capacities – often in healthcare facilities – and demand-controlled ventilation (DCV) to serve highly variant occupied patient and non-patient spaces present promising ways to improve energy efficiency while maintaining air quality via upgraded advanced filtration systems. However, there are challenges to consider. The limited spaces where these advanced filtration and energy efficiency systems need to be installed, and the system/control sophistication associated with retrofitting existing HVAC systems with systems like demand-controlled ventilation, can limit options for achieving the optimal intersection point of improved energy efficiency with enhanced filtration efficiency. A design- focused approach indicates that many filtration challenges arise from the common ‘one-size-fits-all’ method. These issues can be addressed by integrating filtration early in the HVAC design process, ensuring balanced ventilation, energy use, and maintenance efficiency.
Modern HVAC units’ compact design The compact design of modern HVAC units adds another layer of complexity, making it increasingly challenging to accommodate the high-performance filters needed to
improve IAQ to desirable levels. However, the argument could be thrown at the filtration technologies demanding optimal filter performance with massive occupancy space in HVAC units. Ultimately, filtration innovations in filter design, filter media innovations, and aerodynamic and sustainable filter performance, are certainly the order of the day for creating healthier indoor environments for all. That would require addressing challenges such as the increased costs associated with implementing advanced filtration technologies, which might outweigh the benefits of improved air quality? Existing HVAC systems may not be readily compatible with new filtration innovations, limiting their practical application in many buildings. Finally, overemphasising air filtration may overshadow the role of other factors affecting IAQ, such as ventilation rates, leaky envelopes, and patients’ indoor behaviour and emissions.
Airborne pathogen control Other challenges include airborne pathogen control – particularly during pandemics such as COVID-19. During the recent pandemic, HVAC systems faced increased demands for controlling airborne transmission and excessive patient occupancy beyond the designed capacity of the facilities. Hospitals must adapt by upgrading appropriate and engineered filtration selections and technologies, looking beyond particle capture – including gas-phase and bioaerosol technologies in the filtration plan, ensuring appropriate air changes per hour, and implementing emergency IAQ protocols. Eventually, healthcare facilities must comply with stringent IAQ regulations and guidelines for infection control from organisations such as the ANSI/ASHRAE/ASHE Standard 170 in the US, which provides minimum design standards for healthcare facilities, including specific temperature, humidity, and ventilation for infection control and patient comfort. Among other local and national environmental quality standards that set the stage of what is expected of IAQ, filtration, and HVAC system performance in healthcare facilities are ISO 16000 (IAQ), ISO 7740 (Ergonomics of the thermal environment), ISO 14644 (Cleanrooms and associated controlled environments), and ISO 16890 (Air filters for general ventilation). In evaluating the overarching hospital environment, it is
imperative to extend the focus beyond IAQ considerations to encompass Indoor Environmental Quality (IEQ), as well as the factors of noise, lighting, thermal comfort,
September 2025 Health Estate Journal 69
Figure 3. A layer of nanofibres coating a micron media substrate.
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