VENTILATION
Dr Iyad Al-Attar
Dr Iyad Al-Attar is a mechanical engineer, air quality consultant, and a Visiting Academic Fellow in the School of Aerospace, Transport, and Manufacturing at Cranfield University for air quality and filter performance relevant to land-based gas turbines. The first associated air filtration consultant for Eurovent Middle East, most recently, he became the Indoor Air Quality (IAQ) patron for Eurovent – ‘the voice of the European HVACR industry with global reach’. Dr Al-Attar received his engineering degrees (BSc, MSc, Ph.D.) from the University of Toronto (Canada), Kuwait University, and Loughborough University (UK), respectively. His current research at the University of Oxford addresses the importance of air quality inclusion as a rudiment of sustainable urban development. His research is expected to provide a comprehensive ecosystem for engaging HVAC systems to enhance IAQ through appropriate filtration, the deployment of air quality sensing infrastructure, and data sharing with key stakeholders, ‘enabling a human-centred approach and design to understand the air quality they are exposed to and have agency in their overall wellbeing’.
and ergonomics. Contemporary healthcare settings increasingly integrate ergonomic principles, which play a crucial role in public health by preventing musculoskeletal disorders and promoting overall wellbeing. Effective ergonomic design in workplaces and communal areas mitigates physical strain, thereby enhancing comfort and productivity. Furthermore, sub-optimal posture may exacerbate the adverse effects of inadequate IAQ, rendering individuals more vulnerable to respiratory complications. Conversely, well-designed workspaces facilitate comfort and concentration, fostering improved respiratory habits. Consequently, the amalgamation of ergonomic principles with IAQ considerations is vital for cultivating healthy and sustainable environments. In addition to air quality, creating a therapeutic
environment necessitates carefully examining various physical factors within the hospital setting. Implementing window and door treatments is instrumental in influencing noise levels, privacy, light exposure, temperature regulation, and hygiene. Innovative solutions, such as integrated louvres between glass, present significant potential to address multiple needs more effectively than conventional alternatives. A comprehensive strategy combining robust IAQ management with astute architectural design and operational practices is essential for establishing safer, healthier, and more supportive hospital environments for patients, staff, and visitors alike.
The art of healing Additional studies have suggested that balancing natural and artificial lighting through windows and lamps, respectively, can impact patients’ healing process.11,12 However, avoiding temperature fluctuations from external sources through exterior windows is critical to the indoor environment. The appropriateness of HVAC system selection and performance is thus paramount in controlling the climate in terms of temperature and moisture. Climate control encompasses more than just ensuring thermal comfort for human occupants; in a hospital setting, it specifically refers to maintaining the ideal temperature and humidity levels that promote optimal wound healing. These conditions engage chemical reactions and enzymatic processes crucial for effective cell and tissue metabolism during healing. Furthermore, despite efforts to attain the best air quality, the contaminants carried indoors from outdoors represent a risk for infection, even after the treated patient has left the hospital.13-15
The evolving nature of hospital design The design of hospitals significantly impacts how they are perceived and experienced by patients. Modern hospital environments should not only focus on medical expertise, but also on creating pleasant, healing spaces free of contamination. The evolving nature of hospital design aims to revolutionise healthcare delivery, incorporating elements like tree planting for a calming ambiance. Architects also consider geographical location, topography, weather, and aerosol data in their designs. There is a vision for sustainable hospitals that generate their own power, and use waste as a resource, ultimately striving for a minimal environmental footprint. The challenge of managing the hospital-built
environment lies in engineering and interfacing several parameters in complex building settings. Indoors, healthcare facility design is more complicated than with other building types, and influences HVAC, air quality, and filtration requirements. For example, HVAC requirements for the design of operating theatres range from regulating temperature and moisture to appropriate
70 Health Estate Journal September 2025
space pressurisation between adjacent zones. In addition, operating theatres require cleanroom applications, mandating advanced air filtration systems to yield acceptable air quality. Laminar air diffusion represents the final critical step towards achieving thermal comfort by utilising equal clean air distribution in individual zones. Today, technology facilitates testing airflow patterns to minimise the mixing of clean and contaminated air, mainly because airflow can be influenced by various factors. Appropriate air filter selection and regular maintenance of filtration systems are critical, as the consequential pressure rise of HEPA due to particle loading can impede the volumetric flow rates required for healthcare facilities, and specifically operating theatres. Airborne particles from patients can spread infections and deteriorate IAQ. Visitors’ health also impacts patient and staff well-being. Identifying health issues linked to specific pollutants is challenging, especially with multiple contaminants. Modern hospitals should adopt advanced technologies beyond standard HVAC systems to maintain a sterile environment. A comprehensive strategy for air quality is essential, as neglecting ventilation and maintenance can elevate pandemic risks. Simply changing filters is insufficient; there is a need for research into sustainable air filter options and HVAC performance. Proper disposal of used air filters, and especially HEPA
types, is critical due to the contaminants they contain. Maintenance teams must be trained to handle these filters safely, ensuring hygiene in HVAC systems. Furthermore, continuous air quality monitoring devices are crucial for facility management, allowing data-driven decisions to uphold air quality standards. Investing in these systems is essential for saving lives, and facility directors should prioritise sustainable maintenance over cost-cutting measures.
Conclusions A comprehensive approach incorporating design, technology, maintenance, and education, underscores the necessity to advance beyond the mere treatment of symptoms associated with inadequate IAQ to rectify the fundamental deficiencies within systems. It is imperative to raise the bar of IAQ, and provide sufficient fresh and clean air to patients, staff, and visitors. These elements are foundational to the future of healthcare, and require addressing the existing gaps in current practices through the integration of advanced technologies, meticulous maintenance, adherence to regulatory standards, and a holistic perspective on the broader indoor environment. Healthcare facilities possess the capability to foster safer, healthier, and more supportive conditions for all occupants. This, in turn, contributes to enhanced health outcomes and operational efficiency. The article serves as a call to action for stakeholders to acknowledge IAQ as a critical strategic priority rather than merely a regulatory obligation.
References 1 Jung CC, Wu PC, Tseng CH, Su HJ. 2015. Indoor air quality varies with ventilation types and working areas in hospitals. Building and Environment. February 2015; 85: 190-195.
2 Ibrahim F, Samsudin EZ, Ishak AR, and Sathasivam J. 2022. Hospital indoor air quality and its relationships with building design, building operation, and occupant-related factors: A mini-review. Frontiers in Public Health. 2022; 10: 1067764.
3 Nimlyat PS, Kandar, MZ, 2015. Appraisal of indoor environmental quality (IEQ) in healthcare facilities: A literature review. Sustainable Cities and Society. 2015; 17: 61-68.
4 Ackley A., Olanrewaju OI, Oyefusi ON, Enegbuma WI, Olaoye T.S, Ehimatie AE et al. Indoor environmental quality
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