Integral Control of Health Hazards in Hospital Environment

Hospitals present complex indoor environment with various users, health hazards and specific activities. This paper classifies health hazards specific to the hospital environment (HE), defines their interactions and possible impacts on human health and summarizes recommendations for biological and chemical hazards. A detailed literature review clearly shows that there is no developed system or method for integral control of health hazards in HE. There is no appropriate technology available that would allow development of optimal thermal comfort conditions for individual users in HE. For integral control of physical hazards, an innovative low exergy (LowEx) system was designed and tested. The system enables individual control of thermal comfort parameters to meet the needs of various users in the same room. It enables the design of optional conditions for healthcare and treatment considering the different requirements of individual patients and thermally neutral zones for other users. The system application is presented in a model room for burns patient. The measured energy use was lower by 11–27% for space heating and by 32–73% for cooling, when using LowEx system as compared to the conventional system. Owning to its flexibility, the system can also be used for other potential users.

[1]  R. Barrow,et al.  Inhalation injury in burned patients: effects and treatment. , 1988, Burns, including thermal injury.

[2]  J. Madsen,et al.  Residential exposure to plasticizers and its possible role in the pathogenesis of asthma. , 1997, Environmental health perspectives.

[3]  R. Doty,et al.  Biochemical profile or uremic breath. , 1977, The New England journal of medicine.

[4]  A. Mason,et al.  Catecholamines: Znediator of the Hypermetabolic Response to Thermal Injury , 1974, Annals of surgery.

[5]  A. Melikov,et al.  Personalized ventilation: evaluation of different air terminal devices , 2002 .

[6]  D. Pittet,et al.  Infectious Risk Factors Related to Operating Rooms , 1994, Infection Control & Hospital Epidemiology.

[7]  V. Wedler,et al.  Care of burns victims in Europe. , 1999, Burns : journal of the International Society for Burn Injuries.

[8]  R. Weinstein,et al.  Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  D. Pittet,et al.  Environmental controls in operating theatres. , 2002, The Journal of hospital infection.

[10]  J. Wagenvoort,et al.  Long-term in-vitro survival of an epidemic MRSA phage-group III-29 strain. , 1997, The Journal of hospital infection.

[11]  Constantinos A. Balaras,et al.  Air quality in hospital operating rooms , 2008 .

[12]  T. Horan,et al.  Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. , 1999, American journal of infection control.

[13]  B. Zawacki,et al.  Does Increased Evaporative Water Loss Cause Hypermetabolism in Burned Patients? , 1970, Annals of surgery.

[14]  Nobuo Hamada,et al.  Effect of air-conditioner on fungal contamination ☆ , 2002 .

[15]  R Akselsson,et al.  Effect of air humidification on the sick building syndrome and perceived indoor air quality in hospitals: a four month longitudinal study. , 1994, Occupational and environmental medicine.

[16]  J. Rodríguez-Tudela,et al.  Airborne outbreak of nosocomial Scedosporium prolificans infection , 2001, The Lancet.

[17]  W. Silverman,et al.  The influence of the thermal environment upon the survival of newly born premature infants. , 1958, Pediatrics.

[18]  T. Kondo,et al.  Clinical application of breath analysis for dimethyl sulfide following ingestion of DL-methionine. , 1979, Clinica chimica acta; international journal of clinical chemistry.

[19]  Proctor Ea.  The Operating Room , 1981, International anesthesiology clinics.

[20]  T. Eckmanns,et al.  The burden of MRSA in four German university hospitals. , 2005, International journal of hygiene and environmental health.

[21]  K. Brück,et al.  Temperature Regulation in the Newborn Infant (Part 1 of 3) , 1961 .

[22]  Yat Huang Yau,et al.  The ventilation of multiple-bed hospital wards in the tropics: A review , 2010, Building and Environment.

[23]  J. Skoog.  Relative Air Humidity in Hospital Wards – User Perception and Technical Consequences , 2006 .

[24]  T. Udaka,et al.  Evaluation of bedmaking-related airborne and surface methicillin-resistant Staphylococcus aureus contamination. , 2002, The Journal of hospital infection.

[25]  K. Bergh,et al.  Spread of methicillin-resistant Staphylococcus aureus in a neonatal intensive unit associated with understaffing, overcrowding and mixing of patients. , 2002, The Journal of hospital infection.

[26]  T. Rebmann.  Management of patients infected with airborne-spread diseases: An algorithm for infection control professionals , 2005, American Journal of Infection Control.

[27]  D. Wong,et al.  Microbial flora on doctors' white coats. , 1991, BMJ.

[28]  U. Ransjö,et al.  Spread of coagulase-negative staphylococci during cardiac operations in a modern operating room. , 2000, The Annals of thoracic surgery.

[29]  N. Fox.  Space, sterility and surgery: circuits of hygiene in the operating theatre. , 1997, Social science & medicine.

[30]  P. Nafstad,et al.  Interior surface materials in the home and the development of bronchial obstruction in young children in Oslo, Norway. , 1999, American journal of public health.

[31]  Tadj Oreszczyn,et al.  Energy, energy efficiency, and the built environment , 2007, The Lancet.

[32]  M. Arturson.  Metabolic changes following thermal injury , 1978, World Journal of Surgery.

[33]  John M Boyce,et al.  Environmental contamination makes an important contribution to hospital infection. , 2007, The Journal of hospital infection.

[34]  Adopted August,et al.  Hazard Analysis and Critical Control Point Principles and Application Guidelines †. , 1998, Journal of food protection.

[35]  Y. Tochihara,et al.  Effects of setting up of humidifiers on thermal conditions and subjective responses of patients and staff in a hospital during winter. , 2008, Applied ergonomics.

[36]  M. Essex-Lopresti.  Operating theatre design , 1999, The Lancet.

[37]  F. Caldwell.  Energy metabolism following thermal burns. , 1976, Archives of surgery.

[38]  T. Walsh,et al.  How much time is needed for hand hygiene in intensive care? A prospective trained observer study of rates of contact between healthcare workers and intensive care patients. , 2006, The Journal of hospital infection.

[39]  C. O. Solberg.  Spread of Staphylococcus aureus in Hospitals: Causes and Prevention , 2000, Scandinavian journal of infectious diseases.

[40]  W C Noble,et al.  Dispersal of skin microorganisms * , 1975, The British journal of dermatology.

[41]  Klaus Westphal,et al.  Occupational exposure to inhalational anesthetics during cardiac surgery on cardiopulmonary bypass. , 2003, The Annals of thoracic surgery.

[42]  Jacob Stegenga,et al.  The Role of Nurse Understaffing in Nosocomial Viral Gastrointestinal Infections on a General Pediatrics Ward , 2002, Infection Control & Hospital Epidemiology.

[43]  J. Ojajärvi,et al.  The conventionally ventilated operating theatre and air contamination control during cardiac surgery--bacteriological and particulate matter control garment options for low level contamination. , 1998, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[44]  Brian Tomlinson,et al.  SARS: experience at Prince of Wales Hospital, Hong Kong , 2003, The Lancet.

[45]  Antony J. H. Goddard,et al.  Size specific indoor aerosol deposition measurements and derived I/O concentrations ratios , 1997 .

[46]  W. Silverman,et al.  Temperature regulation in the newborn infant. , 1966, The New England journal of medicine.

[47]  H. Rüdiger,et al.  Waste anaesthetic gases induce sister chromatid exchanges in lymphocytes of operating room personnel. , 1999, British journal of anaesthesia.

[48]  N. Shotts,et al.  Antibiotic-resistant streptococci in the mouths of children treated with penicillin. , 1967, Lancet.

[49]  G. Bannister,et al.  Clothing in laminar-flow operating theatres. , 1996, The Journal of hospital infection.

[50]  Mateja Dovjak,et al.  Alternative to the Conventional Heating and Cooling Systems in Public Buildings , 2010 .

[51]  P. Borm,et al.  Plasticisers, another burden for asthmatics? , 1990, Agents and actions. Supplements.

[52]  P. Carling,et al.  Intensive care unit environmental cleaning: an evaluation in sixteen hospitals using a novel assessment tool. , 2008, The Journal of hospital infection.

[53]  C. Pini,et al.  Exposure to indoor allergens and association with allergy symptoms of employees in a work environment. , 2009, Annali dell'Istituto superiore di sanita.

[54]  M. Panni,et al.  The use of a uniquely designed anesthetic scavenging hood to reduce operating room anesthetic gas contamination during general anesthesia. , 2002, Anesthesia and analgesia.

[55]  G. Kampf.  State-of-the-art hand hygiene in community medicine. , 2003, International journal of hygiene and environmental health.

[56]  P. Dineen,et al.  Epidemics of postoperative wound infections associated with hair carriers. , 1973, Lancet.

[57]  Shih-Ming Tsao,et al.  The Influence of Air Motion on Bacteria Removal in Negative Pressure Isolation Rooms , 2005 .

[58]  Michael J. Tortora,et al.  Comparison of waste anesthetic gas exposures to operating room staff during cases using LMAs and ETTs , 2003 .

[59]  J. Crabtree,et al.  The Effect of Occlusive Dressings on the Energy Metabolism of Severely Burned Children , 1981, Annals of surgery.

[60]  Volker Mersch-Sundermann,et al.  Phthalates: toxicology and exposure. , 2007, International journal of hygiene and environmental health.

[61]  Masanori Shukuya,et al.  HUMAN-BODY EXERGY CONSUMPTION VARYING WITH THE COMBINATION OF ROOM AIR AND MEAN RADIANT TEMPERATURES , 2003 .

[62]  J. Cone,et al.  The interrelationships between wound management, thermal stress, energy metabolism, and temperature profiles of patients with burns. , 1994, Journal of Burn Care and Rehabilitation.

[63]  F. Nicol.  Adaptive thermal comfort standards in the hot–humid tropics , 2004 .

[64]  T. Horan,et al.  Guideline for prevention of surgical site infection. , 2000, Bulletin of the American College of Surgeons.

[65]  M. Jackson,et al.  Nurse staffing and health care-associated infections: Proceedings from a working group meeting. , 2002, American journal of infection control.

[66]  J. Garner.  CDC Guideline for Prevention of Surgical Wound Infections, 1985 , 1986, Infection Control.

[67]  Bjarne W. Olesen,et al.  EXERGY ANALYSIS: THE EFFECT OF RELATIVE HUMIDITY, AIR TEMPERATURE AND EFFECTIVE CLOTHING INSULATION ON THERMAL COMFORT , 2011 .

[68]  M. D. Turner,et al.  Researches on the Cause of Burn Hypermetabolism , 1974, Annals of surgery.

[69]  Daniela Vecchio,et al.  Occupational risk in health care and research. , 2003, American journal of industrial medicine.

[70]  J. Lister.  The optimum thermal environment for naked babies , 1970 .

[71]  James P Rydock.  A simple method for tracer containment testing of hospital isolation rooms. , 2002, Applied occupational and environmental hygiene.

[72]  W R Jarvis,et al.  Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. , 1999, Infection control and hospital epidemiology.

[73]  R. Sherertz,et al.  A Cloud Adult: The Staphylococcus aureus-Virus Interaction Revisited , 1996, Annals of Internal Medicine.

[74]  H Humphreys,et al.  Operating theatre ventilation standards and the risk of postoperative infection. , 2002, The Journal of hospital infection.

[75]  G. Arturson,et al.  The elimination of hypermetabolism in burned patients , 1976 .

[76]  C. J. Martin,et al.  Environmental conditions for treatment of burned patients by the exposure method. , 1992, Burns : journal of the International Society for Burn Injuries.

[77]  M. Bilban,et al.  Cytogenetic tests performed on operating room personnel (the use of anaesthetic gases) , 2005, International archives of occupational and environmental health.

[78]  K.W.D. Cheong,et al.  Development and application of an indoor air quality audit to an air-conditioned building in Singapore , 2001 .

[79]  E. Leoni,et al.  Indoor air climate and microbiological airborne: contamination in various hospital areas. , 1993, Zentralblatt fur Hygiene und Umweltmedizin = International journal of hygiene and environmental medicine.

[80]  Aleš Krainer,et al.  Integral control system of indoor environment in continuously occupied spaces , 2012 .

[81]  B Friberg,et al.  Surgical area contamination--comparable bacterial counts using disposable head and mask and helmet aspirator system, but dramatic increase upon omission of head-gear: an experimental study in horizontal laminar air-flow. , 2001, The Journal of hospital infection.

[82]  F. Caldwell.  Etiology and control of postburn hypermetabolism: the 1991 presidential address to the American Burn Association. , 1991, The Journal of burn care & rehabilitation.

[83]  P Borella,et al.  Effects of chronic exposure to anaesthetic gases on some immune parameters. , 2001, The Science of the total environment.

[84]  L. Peterson,et al.  Recovery of Vancomycin-Resistant Enterococci on Fingertips and Environmental Surfaces , 1995, Infection Control & Hospital Epidemiology.

[85]  F S Violante,et al.  Biomonitoring of exposure to nitrous oxide, sevoflurane, isoflurane and halothane by automated GC/MS headspace urinalysis , 2001, International archives of occupational and environmental health.

[86]  P. Hawkey,et al.  Ventilation grilles as a potential source of methicillin-resistant Staphylococcus aureus causing an outbreak in an orthopaedic ward at a district general hospital. , 1998, The Journal of hospital infection.

[87]  A. Mason,et al.  Effect of ambient temperature on heat production and heat loss in burn patients. , 1975, Journal of applied physiology.

[88]  M. van den Ende,et al.  Reduction of Dust-borne Bacteria in the Air of Hospital Wards by Liquid Paraffin Treatment of Bedclothes , 1941, British medical journal.

[89]  R. Cataneo,et al.  Volatile organic compounds in breath as markers of lung cancer: a cross-sectional study , 1999, The Lancet.

[90]  A. Rampling,et al.  Evidence that hospital hygiene is important in the control of methicillin-resistant Staphylococcus aureus. , 2001, The Journal of hospital infection.

[91]  G. Laurell,et al.  The relative importance of the routes and sources of wound contamination during general surgery. II. Airborne. , 1991, The Journal of hospital infection.

[92]  Masanori Shukuya,et al.  Exergy concept and its application to the built environment , 2009 .

[93]  K. Parsons.  The effects of gender, acclimation state, the opportunity to adjust clothing and physical disability on requirements for thermal comfort , 2002 .

[94]  D. Wilmore,et al.  Erythrocyte sodium transport and membrane adenosine triphosphatase in patients with thermal injury. , 1973, Clinica chimica acta; international journal of clinical chemistry.

[95]  M. Desai,et al.  Outbreak of Vancomycin-Resistant Enterococci in a Burn Unit , 2000, Infection Control & Hospital Epidemiology.

[96]  J. Cone,et al.  Control of the hypermetabolic response to burn injury using environmental factors. , 1992, Annals of surgery.

[97]  C. Schulman,et al.  Core warming of a burn patient during excision to prevent hypothermia. , 2008, Burns : journal of the International Society for Burn Injuries.

[98]  Anand A. Samuel,et al.  CO2-dispersion studies in an operation theatre under transient conditions , 2008 .

[99]  T. Guidotti,et al.  Basic Environmental Health , 2001 .

[100]  E. Overton.  The Journal of Infection Control Nursing. Bed-making and bacteria. , 1988, Nursing times.

[101]  D. Herndon.  Mediators of metabolism , 1981 .

[102]  Mateja Dovjak,et al.  Analysis on exergy consumption patterns for space heating in Slovenian buildings , 2010 .

[103]  M. Exner,et al.  Hospital-acquired legionellosis originating from a cooling tower during a period of thermal inversion. , 2008, International journal of hygiene and environmental health.

[104]  C. Schleyer,et al.  Recovery of microorganisms shed by humans into a sterilized environment. , 1967, Applied microbiology.

[105]  L. Jones.  Resting energy expenditure in patients with thermal injuries. , 1993, JPEN. Journal of parenteral and enteral nutrition.

[106]  A. Mason,et al.  Effect of ambient temperature on metabolic rate after thermal injury. , 1996, Annals of surgery.

[107]  G. Woods,et al.  Hospital-acquired Infection with Vancomycin-resistant Enterococcus faecium Transmitted by Electronic Thermometers , 1992, Annals of Internal Medicine.

[108]  F. Mallick.  Thermal comfort and building design in the tropical climates , 1996 .

[109]  R. Tompkins,et al.  Support of the metabolic response to burn injury , 2004, The Lancet.

[110]  D. Tyrrell,et al.  Quantitative studies on preventing the spread of micro-organisms in a hospital isolation unit. , 1981, The Journal of hospital infection.

[111]  Dennis Y.C. Leung,et al.  Reducing Risk of Airborne Transmitted Infection in Hospitals by Use of Hospital Curtains , 2008 .

[112]  J. Carlet,et al.  Bacterial Contamination of Hospital Physicians' Stethoscopes , 1999, Infection Control & Hospital Epidemiology.

[113]  J. E. Janssen,et al.  Ventilation for acceptable indoor air quality , 1989 .

[114]  Lennart Jagemar,et al.  Thermal environment in Swedish hospitals: Summer and winter measurements , 2005 .

[115]  Bjarne W. Olesen,et al.  A relation between calculated human body exergy consumption rate and subjectively assessed thermal sensation , 2011 .

[116]  B. Collins,et al.  Pseudomonas aeruginosa in hospital sinks. , 1974, Lancet.

[117]  C. Donskey,et al.  Acquisition of Nosocomial Pathogens on Hands After Contact With Environmental Surfaces Near Hospitalized Patients , 2004, Infection Control & Hospital Epidemiology.

[118]  J. V. Lee,et al.  Health-care facilities. , 2007 .

[119]  Ruey Lung Hwang,et al.  Patient thermal comfort requirement for hospital environments in Taiwan , 2007 .

[120]  Jan Stetkiewicz,et al.  Occupational exposure to nitrous oxide - the role of scavenging and ventilation systems in reducing the exposure level in operating rooms. , 2007, International journal of hygiene and environmental health.

[121]  A. Nachemson,et al.  Patient draping and staff clothing in the operating theatre: a microbiological study. , 1985, Scandinavian journal of infectious diseases.

[122]  Jlm Jan Hensen,et al.  The thermal comfort, the indoor environment control, and the energy consumption in three types of operating rooms , 2005 .

[123]  B. Collins,et al.  Ward floors and other surfaces as reservoirs of hospital infection , 1967, Epidemiology and Infection.

[124]  R. Barrow,et al.  Treatment of burns. , 1987, Current problems in surgery.

[125]  M. Persson,et al.  Wound ventilation with carbon dioxide: a simple method to prevent direct airborne contamination during cardiac surgery? , 2004, The Journal of hospital infection.

[126]  L. Lambert,et al.  Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. , 2005, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[127]  Alesš Krainer,et al.  Retrofitting of the Slovene Ethnographic Museum , 2007 .

[128]  W. Noble,et al.  Studies on the dispersal of staphylococci , 1965, Journal of clinical pathology.

[129]  R. Zittoun,et al.  Efficacy of Prevention by High-Efficiency Particulate Air Filtration or Laminar Airflow Against Aspergillus Airborne Contamination During Hospital Renovation , 1999, Infection Control & Hospital Epidemiology.

[130]  Bjarne W. Olesen,et al.  Heat exchange coefficient between floor surface and space by floor cooling -- Theory or a question of definition , 2000 .

[131]  B. Simmons.  CDC guideline for prevention of surgical wound infections , 1983 .

[132]  市瀬 裕一,et al.  7) Phillips, Gleeson, Hughes, et al. Volatile organic compounds in breath as markers of lung cancer: a cross-sectional study. Lancet. 1999 5; 353 (9168): 1930-3 , 2001 .

[133]  A N Exton-Smith,et al.  Urban hypothermia: preferred temperature and thermal perception in old age. , 1981, British medical journal.

[134]  P V Nielsen,et al.  Role of ventilation in airborne transmission of infectious agents in the built environment - a multidisciplinary systematic review. , 2007, Indoor air.

[135]  June J. Pilcher,et al.  Effects of hot and cold temperature exposure on performance: a meta-analytic review , 2002, Ergonomics.

[136]  H. J. O’neill,et al.  A computerized classification technique for screening for the presence of breath biomarkers in lung cancer. , 1988, Clinical chemistry.

[137]  S. Cosgrove,et al.  Epidemiology of Community-Acquired Methicillin-Resistant Staphylococcus aures Skin Infections Among Healthcare Workers in an Outpatient Clinic , 2006, Infection Control & Hospital Epidemiology.

[138]  S. Levenson,et al.  Nosocomial infection: prevention by special clean-air, ultraviolet light, and barrier (isolator) techniques. , 1986, Current problems in surgery.

[139]  M. Shukuya,et al.  Individualisation of personal space in hospital environment , 2014 .

[140]  경대호,et al.  Radiant Floor Cooling Systems , 2008 .

[141]  T V Perneger,et al.  Bacterial contamination of the hands of hospital staff during routine patient care. , 1999, Archives of internal medicine.

[142]  Farhad Memarzadeh,et al.  Reducing risks of surgery , 2003 .

[143]  Jennifer Richmond-Bryant,et al.  Transport of exhaled particulate matter in airborne infection isolation rooms , 2008, Building and Environment.

[144]  G. Arturson,et al.  The effects on the metabolic rate and nutrition of patients with severe burns following treatment with infrared heat , 1978 .

[145]  Constantinos A. Balaras,et al.  HVAC and indoor thermal conditions in hospital operating rooms , 2007 .

[146]  Standard Ashrae.  Thermal Environmental Conditions for Human Occupancy , 1992 .

[147]  J T Walker,et al.  Hospital and community acquired infection and the built environment – design and testing of infection control rooms , 2007, Journal of Hospital Infection.