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BUILDING DESIGN ELEONORA C. ZIONI – CHIEF EXECUTIVE, ASCLEPIO CONSULTORIA, BRAZIL


Indoor environment’s role in hospital health


Eleonora C. Zioni of Asclepio Consultoria, a specialist in ‘healthy’ hospital design, takes a look at the role of indoor environment quality on the impact on human health and finds that COVID-19 offers an opportunity to raise the standards of healthcare buildings.


Hospitals need to work 24 hours per day, seven days a week. Understanding indoor environmental aspects is essential to design, build and maintain a building to improve human health and enhance comfort. At the beginning of the 21st century, Kepleis et al found people spend 87 per cent of their lives indoors.1 As a result of the COVID-19 pandemic,


people are spending even more time indoors. The pandemic is likely to prove revolutionary for 21st-century-built environment design, including healthcare facilities. Isolation rooms inside intensive care units (ICU) of hospitals for infectious cases will increasingly need to be able to isolate these epidemics cases and treat people suffering from climate emergencies and future pandemics. Brazil already lacked hospital ICU beds


in all regions of the country. In order to attend to the tens of thousands of people infected with COVID-19, several temporary hospitals were built, in addition to adaptations to existing hospitals to minimise contamination. Figure 1 shows a Brazilian map of


all regions. Highlighted in brown are the number of hospital beds to treat COVID-19 per 100,000 people. In general, the distribution of hospital beds per population is uniform, although the absolute numbers are quite different.


Figure 1. Hospital beds to treat Covid-19 per 100,000 Brazilian population.


Indoor environmental quality of hospitals differs depending on building functional sector: assistance environments (care rooms), social (public and convenience) and support (technical, logistical and administrative areas).2 Assistance indoor environments to treat very critically ill patients need ICUs with specific aspects.


ICU beds with air filtration have an efficiency of at least 85 per cent. The high efficiency HEPA filters used in ICU


Eleonora C. Zioni


Eleonora C. Zioni is chief executive of Sao Paulo consultancy Asclepio Consultoria and a consultant for the United Nations Office for Project Services. Eleonora is a master’s graduate of the University of Sao Paulo (FAU USP) with an MBA from Getulio Vargas (FGV EAESP). She is also an executive


specialised in healthy Buildings at Harvard’s T.H. Chan School of Public Health. With advanced green building knowledge and


expertise having earned LEED BD+C credentials in 2007, Eleonora is also a certified member of the WELL faculty, an accredited DGNB consultant, a Green Building Council Brazil consultant, ABDEH


member, and healthcare design post-graduate course teacher and advisor at Albert Einstein Hospital in Sao Paulo.


IFHE DIGEST 2021


isolation beds for bone marrow transplant, for example, have a particulate filtration efficiency of 99.97 per cent. ICU indoor temperature should be


between 21-24 degrees Celsius and humidity should be between 40-60 per cent. This range mitigates contamination from virus, bacteria and microorganisms. Temperature and humidity could have


influenced COVID-19 mortality rates in the hot and humid Brazilian North, Centre and East regions. At the beginning of August 2020, Brazil had recorded 100,000 deaths caused by COVID-19 and more than three million confirmed cases, in a country with a population of 209 million.3


From Figure 2 it is possible to


observe via the dark purple area the high mortality rate of the Amazon, Centre-West, North-west and North-east regions of Brazil. In August 2020, many building


environment experts and influential international associations pledged support for a petition to World Health Organization (WHO) to work on integrated design and operation solutions as a critical part of the defence path for mitigating indoor COVID-19 exposure.4


57


Source: Brazilian Health Ministry.


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