Healthcare


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Hospitals need healthy air


Analysis by King’s College London and the UK Health Alliance on Climate Change released last year shows that more than half of London’s NHS facilities are blanketed by air pollution above legal limits, posing risks to both patients and staff. While little can be done in the short term to improve the air outside, ensuring Indoor Air Quality (IAQ) is safe and clean is essential. Steven Booth, managing director for Guardian Water Treatment, explains


and lung disease, cancers and even dementia; for patients who are already ill, exposure to poor indoor air will do more harm than good. For hospitals in our increasingly polluted cities, ensuring the inside of the building is a sanctuary of cleanliness and healing must be a priority. In the King’s College research, the air quality of 2,200 medical facilities, including London’s major hospitals, was examined; 74% of facilities in inner London and 41% in outer London are in areas where nitrogen dioxide levels are above the legal limit. So, what can be done? Ultimately the air outside needs to improve, through changes in transport routes and preventing cars near hospitals (as well as schools, care homes and any other building including vulnerable groups). These measures will take time, and for the people using these facilities now, be a case of too little too late.


P Extra care


All public buildings have a duty to keep occupants safe. For hospitals, additional requirements have been put in place, in the shape of HTM 03-01: Specialised Ventilation, which deals with both the design and maintenance of air ventilation systems. HTM 03-01 addresses specific issues relating to the hospital environment, such as patient comfort, the prevention and control of healthcare- associated infections. Specialised ventilation systems (Ultra-Clean Ventilation (UVC) are key to protect patients, but also staff who may be exposed to substances such as anaesthetics. The standard also sets out the minimum requirements for the design of air handling units with regard to the control of Legionella and safe access for routine inspection and maintenance.


Air quality essentials


System design: Air handling equipment must be appropriate for a building’s usage and the number of people using it. For hospitals, this needs careful consideration owing to the high volumes and specialist conditions. Extra care must be taken in operating theatres, for example. Air must be ‘Ultra Clean’ in order to minimise the risk of the further infection. In new buildings this can be factored in at the design and specification stage, but for older buildings where this is not possible, it’s important to review and modify air conditioning and ventilation in light of any changes in the building. When things do change, an air hygiene assessment will confirm the overall condition of the extract


20 May 2018


oor indoor air quality poses health risks to all of us, but for children, the elderly or unwell, its risks are dramatically exacerbated. Air pollutants have been linked to a whole host of medical complaints, including heart


ventilation, informing recommendations about system improvements. Outside air supply: While outdoor air supply is necessary, as mentioned, for


many hospitals, this air contains dangerous levels of pollutants. Properly installed and maintained filters are essential to collect airborne particles. Smaller particulates are the most damaging to health, so the highest grade filters should be used.


Airflow and space planning: Suitable airflow is essential. Vents and grilles shouldn’t be blocked by equipment or furniture. If heat generating equipment, such as patient monitoring systems, are placed under a HVAC thermostat it could confuse the system and lead to too much cold air being delivered. Maintenance: Manufacturers’ instructions should be a benchmark for good


system maintenance, but its good practice to take a bespoke approach, based on an individual product and its usage. Preventative maintenance along with regular monitoring will safeguard building occupants and protect against system breakdown. Maintenance should include regular ventilation and ductwork cleaning, which is not only important to ensure the removal of grime and dust, but is essential to comply with insurance, preventing fire, unnecessary breakdowns and protecting building interiors. Indoor Air Quality (IAQ) monitoring: To ensure indoor air quality remains clean,


IAQ must be monitored, including pollutants, such as carbon monoxide, dust, fungus, bacteria and pathogens, plus temperature and humidity. Water can create a hospitable environment for the growth of moulds, fungi and harmful bacteria like Legionella. Humidity levels that are too low may cause irritated mucous membranes, dry eyes and sinus discomfort. Through regular monitoring, issues can be caught early and root causes dealt


with, rather than a knee jerk reaction which may not be sufficient. IAQ monitoring will also help buildings comply with Control of Substances Hazardous to Health (COSHH) Regulations. Who is responsible? HTM 03-01 is aimed at healthcare, estates and operations managers, holding these groups responsible to ensure that the inspection, service and maintenance activity is carried out safely, without putting staff, patients or members of the public at risk. Good IAQ should be the responsibility of everyone working in a building, however, particularly where the stakes are so high. Educating staff about the factors that affect IAQ can have a significant impact on improving overall hygiene.


With air quality both outside and inside a building repeatedly hitting the headlines, everyone is becoming more aware of the potential dangers – hopefully this awareness will lead to the higher level action required to safeguard our cities. For now, building services engineers and building managers must do what they can to protect vulnerable patients.


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