ventilation of multiple-bed hospital wards in the tropics

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Theventilationofmultiple-bedhospitalwardsinthetropics:AreviewY.H.Yau*,D.Chandrasegaran,A.BadarudinDepartmentofMechanicalEngineering,UniversityofMalaya,50603KualaLumpur,Malaysia

articleinfoArticlehistory:Received31August2010Receivedinrevisedform5November2010Accepted19November2010Availableonline27November2010Keywords:HospitalwardsIndoorairqualityEngineeringcontrolNumericalmethodTropicalclimatesabstractHospitalandhealthcarefacilitieshavediverseindoorenvironmentduetothedifferentcomfortandhealthneedsofitsoccupants.Currently,mostventilationstudiesrevolvearoundspecialisedareassuchasoperatingroomsandisolationrooms.Thispaperfocusesontheventilationofmultiple-bedhospitalwardsinthetropicalclimate,takingintoaccountthedesign,indoorconditionsandengineeringcontrols.Generalwardlayoutsaredescribedbriefly.Therequiredindoorconditionssuchastemperature,humidity,airmovementsandindoorairqualityinthewardspacesaresummarizedbasedonthecurrentguidelinesandpractices.Also,recentstudiesandengineeringpracticesinthehospitalindoorenviron-mentareelaborated.Usageofcomputationalfluiddynamicstoolsfortheventilationstudiesisdiscussedaswell.Asidentifiedduringthereview,thereisanapparentknowledgegapforventilationstudiesinthetropicscomparedwithtemperateclimates,asfactstudieshaveonlybeenpublishedforhospitalwardsincountrieswithatemperateclimate.Therefore,itishighlightedthatspecifictropicalstudiesalongwithnovelengineeringcontrolsarerequiredinaddressingtheventilationrequirementsforthetropics.Ó2010ElsevierLtd.Allrightsreserved.

1.IntroductionHospitalandhealthcarefacilitieshavediverseindoorenvi-ronmentsduetothevaryingneedsofpatientsandhealthcareworkers.Theindoorenvironmentsrangefromasimplegeneralpractitioners’roomtoanoperatingroom.Furthermore,there-centpandemicofinfluenzacreatesthemaximumlikelihoodforairbornetransmissionbycongregatingcommunicableandvul-nerableindividualsinhealthcarefacilities.Atthistime,ventilationinhealthcarefacilitiesisimportantasitprovidesthermalcomfortandprotectionfromharmfulemissionsorairbornepathogenicmaterialstobothpatientsandhealthcareworkers[1].Typically,theventilationrequirementsforspacesaregovernedbybuildingcodes,regulationsandspecificguidelinesfurnishedbythelocalhealthauthoritiesandothers[2e5].Theserequirementsvarybycountry,dependingonthegeographicloca-tion,economicbackgroundandthecountry’sspecificneeds.

Thebenefitsofenvironmentalcontrolforisolationwardsandoperatingroomtheatreshavebeenrecordedandanalysedthor-oughly.However,thereisalackofventilationstudiesonopenwardfacilities,whichiswheremostpatientsareplaced,especiallyinthetropics.Recentoutbreaksofpandemicdiseaseshaveheightenedtherisksassociatedwiththesefacilities.Thus,inthispaper,thecurrentstateofknowledgeoftheventilationofmultiple-bedhospitalwardsisreviewed.

2.VentilationinhealthcarefacilitiesByandlarge,thepurposeofventilationinanyoccupiedspaceistoprovidefreshairtotheoccupantsandremoveheatgeneratedwithinaconfinedspace.Inhealthcarefacilities,theventilationsystemshouldalsohelppreventdiseasesandtreatpatients.Researchhasshownthatthedesigncharacteristicsofahealth-carefacility,whichincludeventilationandlayoutimprovements,canenhancethehealthoutcomeofthepatientsandprovideabetterworkingenvironmentforemployees[6].Therefore,overallhealth-carequalitycanbepartlyenhancedbyimprovingtheventilation.Manyreportshaveshownthatinfectiousdiseasesoccurduetoairbornetransmissionandsurfacecontaminationsbydropletnuclei.ThistopicisfurtherelaboratedinSection6.TransmissionofSevereAcuteRespiratorySyndrome(SARS)hasbeendocumentedindifferentcircumstancesandlocationsworldwideandisfoundtobehighlycommunicableinhealthcaresettings[7,8].AirbornetransmissionsarenotonlylimitedtotheSARSepisodebutalsoextendtonosocomialinfections,whicharemoreprevalentin

Abbreviations:ACH,airchangesperhour;ASHRAE,Americansocietyofheating,refrigeratingandair-conditioningengineers;CDC,centersfordiseasecontrol;CFD,computationalfluiddynamic;HCW,healthcareworkers;HEPA,highefficiencyparticulateair;HICPAC,healthcareinfectioncontrolpracticesadvisorycommittee;IAQ,indoorairquality;MRSA,methicillin-resistantStaphylococcusaureus;RANS,ReynoldsaveragedNaviereStokes;RNG,re-normalisationgroup;SARS,severeacuterespiratorysyndrome;SBS,sickbuildingsyndrome;UV,ultraviolet;UVGI,ultravioletgermicidalirradiation;WHO,WorldHealthOrganization.*Correspondingauthor.Tel.:þ60379675210;fax:þ60379675317.

E-mailaddress:yhyau@um.edu.my(Y.H.Yau).

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