According to many published studies, ‘ducting in ventilation and air-conditioning are largely overlooked and ignored, as they are out of sight and out of mind’, despite mounting evidence indicating a higher risk in spreading airborne infections’.1-6
So says Ghasson Shabha BSc (Arch) MSc, PhD (Arch), MBIFM, Associate CIBSE, PG Cert Ed, of the Faculty of Technology, Engineering and the Environment (TEE), at the Birmingham School of the Built Environment (BSBE) at Birmingham City University, who adds that CIBSE estimates that fewer than 5% of buildings with air-conditioning systems above 12 kW have been inspected so far. Here he argues that incorporating 3D building information modelling software into existing computer-aided facilities management software systems will enable hospitals’ ‘infection hotspots’ to be far more quickly identified, and subsequently monitored, to prevent future problems.
The healthcare environment can be described as a reservoir for potentially infective agents which can spread unpredictably in a whole array of ways, making it difficult to effectively control and manage, particularly for those seeking timely information about the patterns of cross-infection. Airborne transmission extends over a wide spectrum, and includes many prevalent agents, inter alia Mycobacterium tuberculosis (TB), nosocomial MRSA, Aspergillus fumigatus, Serratia marcescens, norovirus, and other airborne HCAIs.7 The severity of the problem has been highlighted extensively over the past decade, as part of wider umbrella of what have become known as healthcareacquired infections (HCAIs). Several influential design factors for the outbreak of HCAIs have been identified in literature, including hospital and ward design, bed occupancy,8 and intensity of use of the hospital area.9,10 Environmental factors including indoor relative humidity (RH), air temperature, air velocity, surface humidity, surface porosity, and dust accumulation, were also identified as triggers for colonisation and the spread of infection.11,12,13,14 There is growing recognition that RH level and air temperature in particular are more pertinent for the growth and spread of airborne infection. Both act as triggers facilitated by air circulation, and both might be critical to colonisation, and can affect the survival and persistence of microorganisms on surfaces of the indoor environment, leading to airborne infection spread.
An uncomfortable environment
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