Indoor air quality (IAQ) is one of the main topics in which governments are focusing. In healthcare facilities, several studies have reported data analysis and case studies to improve users' health. Nowadays, although many studies have been conducted related to the biological and physical risks, the chemical risks have been less investigated and only in some specific functional areas of the hospitals. Starting from some systematic reviews and research works, this paper aims to list the best healthy practices for an adequate IAQ in inpatient wards. In particular, the decalogue lists the strategies related to chemical pollution, starting from design and management, with a focus on (a) localization of hospitals and inpatient rooms, (b) hospital room, (c) microclimatic parameters, (d) ventilation systems, (e) materials and finishing, (f) furniture and equipment, (g) cleaning products and activities, (h) maintenance and (i) management activities, and (l) users and workers. The multidisciplinary approach emphasizes the need for interdisciplinary knowledge and skills aimed to find solutions able to protect users' health status. The design and management decision-making, ranging from the adequate choices of construction site and hospital exposure, finishing materials, cleaning and maintenance activities, etc., which can affect the IAQ must be carried out based on scientific research and data analysis.

https://www.mdpi.com/1660-4601/16/22/4388/pdf

Chemical Pollution in Healing Spaces: The Decalogue of the Best Practices for Adequate Indoor Air Quality in Inpatient Rooms

Aerobiology is the interdisciplinary science focused on the study of airborne organisms and biological materials, like pollen grains, fungal spores, bacteria, viruses, mycotoxins. The results of the aerobiological monitoring are practically employed in medicine, agriculture, beekeeping, meteorology, monument protection. The information of the current and predicted exposure is transmitted to patients and physicians through the electronic tools, applications, media, to compile the optimal therapy of respiratory diseases, especially pollen allergy. It is worth taking into account some confirmed phenomena to interpret the aerobiological data correctly: (i) many airborne particles occur seasonally and their amount and seasonal dynamics are more or less variable; (ii) threshold values for the airborne particles causing the threat for humans (e.g. for allergic individuals) are important, but the personal sensitivity must be also included; (iii) overlapping occurrence of different airborne particles, like pollen, spores, pollution makes clinical symptoms worsening; (iv) modern pollen and spores fall is affected in direct and indirect way by the climate changes, anthropogenic pollution, long range transport and the specific local environmental conditions. Currently the implementation of the automatic measurement systems and the analyses of allergen particles in the air are the main challenges for aerobiologists. Joined activity of this group of enthusiastic specialists of different interests is performed in frame of the multi centre networks and supported by the International Association for Aerobiology together with the regional.

/pdf/aerobiological-studies-current-state-and-future-challenges-5aohmm4mqn.pdf

Aerobiological studies – current state and future challenges:

Aim: Determine the utility of the Periodic Environmental Biosecurity Assessment Program (PEBAP) in achieving clean air as measured by the number of colony-forming units (CFU) of fungi and bacteria in the air. Background: There is no international consensus on the sampling frequency, the recommended limits for microorganisms in the air nor on the usefulness of routine microbiological air monitoring of hospitals. Methods: During the PEBAP, data were recollected between 2010 and 2017 in eight hospitals in southeast Spain. Air samples were collected in very high risk rooms (VHRRs) and high risk rooms (HRRs), unoccupied, using active sampling methods. Temperature, relative humidity, air changes per hour (ACH), and differential pressure were measured. When limits of CFU of opportunistic fungi and bacteria established in the PEBAP were exceeded, corrective measures were adopted. Results: We found a reduction (p < .01) of percentage of air samples with fungi growth throughout the years of PEBAP in all rooms. Aspergillus was the most frequent opportunistic fungus. We found a high compliance of the standards of CFU of bacteria in HRR, and the percentage of compliance in VHRR was lower than in HRR in all years. Differences in environmental and design parameters were statistically significant (p < .05) between rooms, except for ACH. Conclusions: PEBAP resulted in a useful tool to maintain and improve air quality in hospitals. The control of environmental biosecurity requires a multidisciplinary approach from preventive medicine, engineering, and cleaning services. Aspergillus is the most frequent opportunistic fungus in southeast Spain.

Evaluation of the Results of a Periodic Environmental Biosecurity Assessment Program on Air Quality in Controlled Environment Rooms of Hospitals

Background: Healthcare-associated infections (HAIs) constitute a significant financial strain on healthcare systems across the world, with surgical site infections (SSIs) being the costliest form. Despite the existence of diverse sources of infection in the operating room (OR), current literature focuses on human and procedural sources of contamination that could lead to an infection. Comparatively, the OR built environment is understudied as a potential disease transmission interface between the environment, patients, and surgical staff. This systematic literature review aims to investigate how the physical characteristics and components of the built environment impact airflow, infection risk, aerosols, particle counts, contamination, and pathogens in operating rooms. Methods and Findings: Literature searches were conducted in the PubMed and Web of Science Core Collection databases on December 21, 2020, ultimately retrieving 2,965 articles after duplicates were removed. During abstract screening, all abstracts were independently reviewed by two authors and conflicts were resolved by a third author. All articles published since January 1, 2010, that reported primary data investigating an aspect of the built environment inside an OR in relation to airflow, contamination, and/or infection for which the full text in English was available were included. This resulted in the inclusion of 138 articles, which includes studies conducted in ORs during active surgeries, computer modeling studies, and simulations in which a real OR was used for a mock surgical procedure. Six major built environment categories were identified based on the collected literature: OR layout, disinfection systems, surgical lights, doors, ventilation, and portable airflow devices. A survey created on Qualtrics software was used to record the aspect of the built environment and the outcome of each study, as well as the relationship between the two. Conclusions: While OR ventilation has been studied extensively, the OR built environment as a whole is understudied in relation to airflow, contamination, and infection. The current literature is inconsistent in both its findings and subsequent recommendations, making it difficult to inform hospital design in the context of SSIs. No articles were identified that discussed respiratory infection transmission in the OR, and very few addressed healthcare worker (HCW) safety in relation to the OR built environment. The significant discrepancies in the literature identified in this review highlight the need for future studies that assess the quality and bias of these studies before firm recommendations can be made. Future work should also focus on addressing the lack information regarding respiratory infection transmission in the OR, especially in the context of HCW safety.

Influence of the Built Environment on Airflow, Contamination, and Infection in the Operating Room: A Systematic Literature Review

Surgical staff behavior in operating theatres is one of the factors associated with indoor air quality and surgical site infection risk. The aim of this study was to apply an approach including microbiological, particle, and microclimate parameters during two simulated surgical hip arthroplasties to evaluate the influence of staff behavior on indoor air quality. During the first hip arthroplasty, the surgical team behaved correctly, but in the second operation, behavioral recommendations were not respected. Microbiological contamination was evaluated by active and passive methods. The air velocity, humidity, temperature, and CO2 concentration were also monitored. The highest levels of microbial and particle contamination, as well as the highest variation in the microclimate parameter, were recorded during the surgical operation where the surgical team behaved "incorrectly". Turbulent air flow ventilation systems appeared more efficient than in the past and very low air microbial contamination was reached when behavior was correct. Therefore, adherence to behavioral recommendations in operating theatres is essential to not undermine the effectiveness of the heating, ventilation, and air conditioning systems and employed resources.

The Influence of Surgical Staff Behavior on Air Quality in a Conventionally Ventilated Operating Theatre during a Simulated Arthroplasty: A Case Study at the University Hospital of Parma

As part of the overall management of a Hospital, the Hygiene Unit has specific tasks including the improvement in the levels of hospital safety by air quality monitoring in hospital environments to control the sources of infection and assessing the healthiness of hospital facilities. Operating theaters (OTs) and cleanrooms air quality control can represent a focal point considering that environmental contamination depends on not only factors such as characteristics and level of maintenance of Heating, Ventilation and Air Conditioning systems (HVAC), but it also depends on the number of people present, their behavioral habits, sanitation and disinfection procedures adopted. Several studies demonstrate a high variability in microbial air contamination in different OTs with similar HVAC, suggesting the need for achieving strict control over the factors affecting air quality. The control of air contamination, as an indicator of the quality care provided, therefore sets precise objectives, accuracy from a scientific point of view including planning, analysis and interpretation of results to propose corrective actions. However, there are no generally accepted standards for sampling nor threshold values on microbial air contamination. Aerobiology skills can improve the approach to involved issues. The monitoring plan of air quality assessment at the Parma University Hospital, by the Laboratory of Aerobiology, involves approximately 80 environments equipped with turbulent or mixed air flow. This paper describes the practical approach to air contamination control of the Hospital Hygiene Department at the Parma University Hospital as an example of how Health Departments can improve safety standards for patients and operators.

The management of air contamination control in operating theaters: the experience of the Parma University Hospital (IT)

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The management of air contamination control in operating theaters: the experience of the Parma University Hospital (IT)