Sains Malaysiana 50(6)(2021): 1609-1620
http://doi.org/10.17576/jsm-2021-5006-09
Characterization of Indoor Air Quality in Relation
to Ventilation Practices in Hospitals of Lahore, Pakistan
(Pencirian Kualiti Udara Dalam Ruang dengan Hubungan kepada Amalan Ventilasi di Hospital Lahore, Pakistan)
AFZAL NIMRA1*, ZULFIQAR ALI1,
ZAHEER AHMAD NASIR2, SEAN TYRREL2 & SAFDAR SIDRA3
1Environmental Health and Wildlife, Department of Zoology, University of
the Punjab, Lahore, Pakistan
2School of Water, Energy and Environment, Cranfield University, Cranfield,
Bedfordshire, MK43 0AL, United Kingdom
3Department of Wildlife and Ecology, University of Veterinary and Animal
Sciences, Lahore, Pakistan
Received: 26 May 2020/Accepted: 6 November 2020
ABSTRACT
Temporal variations of particulate
matter (PM) and carbon dioxide (CO2 ) in orthopedic wards and
emergency rooms of different hospitals of Lahore, Pakistan were investigated.
Hospitals were classified into two groups, I (centrally air-conditioned) and II
(non-central air-conditioned) based on the ventilation system. Statistical
analysis indicated significantly lower PM and CO2 levels in
centrally air-conditioned hospitals in comparison to non-central
air-conditioned. The low indoor-outdoor (I/O) ratio of PM2.5 in the ward and emergency rooms of group I (0.62, 0.45) as
compared to group II (0.70, 0.83), respectively, suggested that indoor spaces
equipped with central air-conditioning systems efficiently filter particulates
as compared to non- central air conditioning systems. Apart from the ventilation type,
increased visitor and doctors’ activities, and cleaning sessions were observed
to contribute significantly to indoor air quality. This study adds up to the
understanding of temporal variations in PM emissions and the role of
ventilation systems in context of hospitals in the urban centers in Pakistan.
The findings can inform the development of intervention strategies to
maintain the appropriate air quality in health care built environment in
developing countries.
Keywords: Central air
conditioning systems; CO2; HVAC; indoor air; particulate matter;
split air conditioning systems
ABSTRAK
Variasi temporal jirim zarah (PM) dan karbon dioksida (CO2 )
di wad ortopedik dan bilik kecemasan daripada hospital yang berbeza di Lahore, Pakistan telah dikaji. Hospital telah dikelaskan kepada dua kumpulan, I (hawa dingin berpusat)
dan II (hawa dingin tidak berpusat) berdasarkan daripada sistem ventilasi. Analisis statistik menunjukkan tahap PM dan CO2 adalah ketara rendah dalam hawa dingin berpusat jika dibandingkan dengan hawa dingin tidak berpusat. Nisbah dalaman-luaran (I/O) masing-masing daripada PM2.5 di dalam wad dan bilik kecemasan daripada kumpulan I (0.62, 0.45) dan kumpulan II (0.70, 0.83), menunjukkan bahawa ruang dalam yang dilengkapi dengan sistem hawa dingin berpusat menapis zarah secara cekap jika dibandingkan dengan sistem hawa dingin tidak berpusat. Selain daripada jenis ventilasi, peningkatan pelawat dan aktiviti para doktor serta sesi pembersihan telah diperhati memberi sumbangan besar terhadap kualiti udara ruang dalam.
Kajian ini menambah pemahaman terhadap variasi temporal pengeluaran PM
dan peranan sistem ventilasi dalam konteks hospital di kawasan pusat bandar Pakistan. Penemuan ini dapat memaklumkan pembangunan strategi intervensi untuk menjaga kualiti udara yang sesuai bagi pusat penjagaan kesihatan di negara yang membangun.
Kata kunci: Bahan zarah; CO2; HVAC; sistem hawa dingin berpusat; sistem udara hawa dingin terpisah; udara dalam ruang
REFERENCES
Ahmad, H.R., Mehmood, K., Sardar,
M.F., Maqsood, M.A., Rehman, M.Z.U., Zhu, C. & Li, H. 2019. Integrated risk
assessment of potentially toxic elements and particle pollution in urban road
dust of megacity of Pakistan. Human and Ecological
Risk Assessment: An International Journal 26(7): 1810-1831.
Ahwah, T.F., Yuan-Gao, W., Ansah,
O. & Menu, E.O.E. 2015. Assessment of indoor particulate matter in hospital
environment a case study in China. International
Journal of Modern Engineering Research 5(12) Version 1: 1-9.
Ali, M.Y., Hanafiah, M.M., Khan,
M.F. & Latif, M.T. 2017a. Quantitative source apportionment and human
toxicity of indoor trace metals at university buildings. Building and Environment 121:
238-246.
Ali, M.U., Rashid, A., Yousaf, B.
& Kamal, A. 2017b. Health outcomes of road-traffic pollution among exposed
roadside workers in Rawalpindi City, Pakistan. Human and Ecological Risk Assessment: An International Journal 23(6):
1330-1339.
Armadans-Gil, L.,
Rodríguez-Garrido, V., Campins-Martí, M., Gil-Cuesta, J. & Vaqué-Rafart, J.
2013. Particle counting and microbiological air sampling: Results of the
simultaneous use of both procedures in different types of hospital rooms. Enfermedades Infecciosasy Microbiologia
Clinica 31(4): 217-221.
ASHRAE. 2017. Ventilation of Health Care Facilities. American Society of Heating,
Refrigerating and Air-Conditioning Engineers (ASHRAE) Customer Service.
Asif, A., Zeeshan, M., Hashmi, I.,
Zahid, U. & Bhatti, M.F. 2018. Microbial quality assessment of indoor air
in a large hospital building during winter and spring seasons. Building and Environment 135: 68-73.
Baurès, E., Blanchard, O., Mercier,
F., Surget, E., Le Cann, P., Rivier, A. & Florentin, A. 2018. Indoor air quality in two French hospitals:
Measurement of chemical and microbiological contaminants. Science of The Total Environment 642: 168-179.
Beggs, C.B., Kerr, K.G., Noakes,
C.J., Hathway, E.A. & Sleigh, P.A. 2008. The ventilation of multiple-bed
hospital wards: Review and analysis. American
Journal of Infection Control 36(4): 250-259.
Bessonneau, V., Mosqueron, L.,
Berrubé, A., Mukensturm, G., Buffet-Bataillon, S., Gangneux, J.P. & Thomas,
O. 2013. VOC contamination in hospital, from stationary sampling of a large
panel of compounds, in view of healthcare workers and patients exposure
assessment. PloS ONE 8(2): e55535.
Bucur, E. & Danet, A. 2019.
Indoor/outdoor correlations regarding indoor air pollution with particulate
matter. Environmental Engineering &
Management Journal 18(2): 425-432.
Capolongo, S. 2016. Social aspects
and wellbeing for improving healing processes’ effectiveness. Ann. Ist Super Sanita 52(1): 11-44.
Cavallo, D., Alcini, D., De
Bortoli, M., Carrettoni, D., Carrer, P., Bersani, M. & Maroni, M. 1993.
Chemical contamination of indoor air in schools and office buildings in Milan,
Italy. Proceedings of Indoor Air 93:
45-49.
Chamseddine, A., Alameddine, I.,
Hatzopoulou, M. & El-Fadel, M. 2019. Seasonal variation of air quality in
hospitals with indoor-outdoor correlations. Building
and Environment 148: 689-700.
Chen, C. & Zhao, B. 2011.
Review of relationship between indoor and outdoor particles: I/O ratio,
infiltration factor and penetration factor. Atmospheric
Environment 45(2): 275-288.
Diapouli, E., Chaloulakou, A. &
Koutrakis, P. 2013. Estimating the concentration of indoor particles of outdoor
origin: a review. Journal of the Air
& Waste Management Association 63(10): 1113-1129.
Doğan, T.R. 2019.
Investigation of indoor air quality in a hospital: A case study from
Şanlıurfa, Turkey. Doğal
Afetler ve Çevre Dergisi 5(1): 101-109.
Ediagbonya, T.F., Tobin, A.E. &
Legemah, M. 2013. Indoor and outdoor air quality in hospital environment. Chemistry and Materials Research 3(10):
72-78.
El-Sharkawy, F.M. & Noweir,
M.E. 2014. Indoor air quality levels in a University Hospital in the Eastern
Province of Saudi Arabia. Journal of
Family & Community Medicine 21(1): 39-47.
Escombe, A.R., Oeser, C.C., Gilman,
R.H., Navincopa, M., Ticona, E., Pan, W. & Moore, D.A. 2007. Natural
ventilation for the prevention of airborne contagion. PLoS Medicine 4(2): e68.
Ferro, A.R., Kopperud, R.J. &
Hildemann, L.M. 2004. Source strengths for indoor human activities that
resuspend particulate matter. Environmental
Science & Technology 38(6): 1759-1764.
Fonseca, A., Abreu, I., Guerreiro,
M., Abreu, C., Silva, R. & Barros, N. 2019. Indoor air quality and
sustainability management - Case study in three portuguese healthcare units. Sustainability 11(1): 101.
Gaidajis, G. & Angelakoglou, K.
2014. Indoor mass concentrations of particulate matter in hospital environment. Global Nest Journal 16(5): 832-839.
Ghio, A. 2014. Particle exposures
and infections. Infection 42(3):
459-467.
Gilkeson, C., Camargo-Valero, M.,
Pickin, L. & Noakes, C. 2013. Measurement of ventilation and airborne
infection risk in large naturally ventilated hospital wards. Building and Environment 65: 35-48.
Gola, M., Settimo, G. &
Capolongo, S. 2019. Indoor air quality in inpatient environments: A systematic
review on factors that influence chemical pollution in inpatient wards. Journal of Healthcare Engineering 2019: 8358306.
Gulshan,
T., Ali, Z., Zona, Z., Ansari, B., Ahmad, M., Zainab, M. & Colbeck, I.
2015. State of air quality in and outside of hospital wards in urban centres - A case study in Lahore, Pakistan. Journal of Animal and Plant Sciences 25(3):
666-671.
Health
Effects Institute. 2019. State of Global
Air 2019. Special Report.
He,
K.Q., Yuan, C.G., Yin, L.Q., Zhang, K.G., Xu, P.Y., Xie,
J.J. & Shen, Y.W. 2019. A comparative study on arsenic fractions in
indoor/outdoor particulate matters: A case in Baoding, China. Environmental Monitoring and Assessment 191(8):
528.
Idris, S.A.A., Hanafiah, M.M.,
Khan, M.F. & Abd Hamid, H.H. 2020. Indoor generated PM2.5 compositions and volatile organic compounds: Potential sources and health risk
implications. Chemosphere 255:
126932.
Jung, C.C., Wu, P.C., Tseng, C.H.,
Chou, C.C. & Su, H.J. 2018. Contribution of indoor-and outdoor-generated
fine and coarse particles to indoor air in Taiwanese hospitals. Aerosol and Air Quality Research 18(12):
3234-3242.
Jung, C.C., Wu, P.C., Tseng, C.H.
& Su, H.J. 2015. Indoor air quality varies with ventilation types and
working areas in hospitals. Building and
Environment 85: 190-195.
Jurado, S.R., Bankoff, A.D. &
Sanchez, A. 2014. Indoor air quality in Brazilian universities. International Journal of Environmental
Research and Public Health 11(7): 7081-7093.
Kressel, A., Linnenmann, C. &
Mayhall, C. 2004. Nosocomial infection in obstetrical patients. In Hospital Epidemiology and Infection Control, edited by Mayhall, C.G. Philadelphia: Lippincott Wiilliams & Wilkins. pp. 927-935.
Ling, S. & Hui, L. 2019. Evaluation
of the complexity of indoor air in hospital wards based on PM2.5,
real-time PCR, adenosine triphosphate bioluminescence assay, microbial culture
and mass spectrometry. BMC Infectious
Diseases 19(1): 646.
Lomboy, M.F.T.C., Quirit, L.L.,
Molina, V.B., Dalmacion, G.V., Schwartz, J.D., Suh, H.H. & Baja, E.S. 2015.
Characterization of particulate matter 2.5 in an urban tertiary care hospital
in the Philippines. Building and
Environment 92: 432-439.
Luksamijarulkul, P., Somjai, N.,
Nankongnap, N., Pataitiemthong, A., Kongtip, P. & Woskie, S. 2019. Indoor
air quality at different sites of a governmental hospital. Nursing and Palliative Care 4: 1-5.
Macher, J.M., Gold, D., Cruz, P.,
Kyle, J.L., Durrani, T.S. & Shusterman, D. 2019. Evaluation and management
of exposure to infectious agents. Handbook
of Occupational Safety and Health 3: 147-197.
Milton, D.K., Fabian, M.P.,
Cowling, B.J., Grantham, M.L. & McDevitt, J.J. 2013. Influenza virus
aerosols in human exhaled breath: Particle size, culturability, and effect of
surgical masks. PLoS Pathogens 9(3):
1-7.
Mohammadyan, M., Keyvani, S.,
Bahrami, A., Yetilmezsoy, K., Heibati, B. & Pollitt, K.J.G. 2019.
Assessment of indoor air pollution exposure in urban hospital
microenvironments. Air Quality,
Atmosphere & Health 12(2):
151-159.
Mohammadyan, Keyvani, S.,
Yazdani-Charati, J., Bahrami, A. & Yousefi-Nejad, R. 2017. Indoor and
ambient air concentrations of respirable particles between two hospitals in
Kashan (2014-2015). Feyz Journal of
Kashan University of Medical Sciences 21(1): 66-73.
Mohammadyan, M., Keyvani, S.,
Charati, J.Y., Bahrami, A. & Nejad, R.Y. 2016. An assessment of indoor and
outdoor particulate matters concentrations at two hospitals in Kashan, Iran. Journal of Disease and Global Health 8(2): 55-59.
Montgomery, J.F., Storey, S. &
Bartlett, K. 2015. Comparison of the indoor air quality in an office operating
with natural or mechanical ventilation using short-term intensive pollutant
monitoring. Indoor and Built Environment 24(6):
777-787.
Morawska, L. & He, C. 2014.
Indoor particles, combustion products and fibres. In Indoor Air Pollution, edited by Pluschke, P. & He, C. Germany: Springer. pp. 117-147.
Morakinyo, O.M., Mokgobu, M.I.,
Mukhola, M.S. & Godobedzha, T. 2019. Biological composition of respirable
particulate matter in an industrial vicinity in South Africa. International Journal of Environmental
Research and Public Health 16(4): 629.
Moscato, U., Borghini, A. &
Teleman, A.A. 2017. HVAC management in health facilities. In Indoor Air Quality in Healthcare Facilities, edited by Stefano, C., Gaetano, S.
& Gola, M. Germany: Springer. pp. 95-106.
Nimra, A., Ali, Z., Khan, M.N.,
Gulshan, T., Sidra, S., Gardezi, J.R. & Colbeck, I. 2015. Comparative
ambient and indoor particulate matter analysis of operation theatres of
government and private (trust) hospitals of Lahore, Pakistan. Journal of Animal and Plant Sciences 25(3):
628-635.
Pankhurst, L., Taylor, J.,
Cloutman-Green, E., Hartley, J. & Lai, K. 2012. Can clean-room particle
counters be used as an infection control tool in hospital operating theatres. Indoor and Built Environment 21(3):
381-391.
Peng, Z., Deng, W. & Tenorio,
R. 2017. Investigation of indoor air quality and the identification of
influential factors at primary schools in the North of China. Sustainability 9(7): 1180.
Pereira, M., Knibbs, L., He, C.,
Grzybowski, P., Johnson, G., Huffman, J. & Dominski, F. 2017. Sources and
dynamics of fluorescent particles in hospitals. Indoor Air 27(5): 988-1000.
Qian, J., Peccia, J. & Ferro,
A.R. 2014. Walking-induced particle resuspension in indoor environments. Atmospheric Environment 89: 464-481.
Radaideh, J.A., Alazba, A.A., Amin,
M.N., Shatnawi, Z.N. & Amin, M.T. 2016. Improvement of indoor air quality
using local fabricated activated carbon from date stones. Sains Malaysiana 45(1): 59-69.
Rasli, N.B.I., Ramli, N.A., Ismail,
M.R. & Shith, S. 2019. Dependency of biological contaminants on temperature
and relative humidity within praying halls of mosques. Sains Malaysiana 48(8): 1575-1581.
Rudnick, S. & Milton, D. 2003.
Risk of indoor airborne infection transmission estimated from carbon dioxide
concentration. Indoor Air 13(3):
237-245.
Sari, K.A.M., Mastaza, K.F.A.,
Rahman, M.A.A., Saji, N., Muslim, R., Mustafa, M.S.S. & Ghing, T.Y. 2019.
Assessment of indoor air quality parameters at Ambulatory Care Centre XYZ,
Malaysia. IOP Conference Series: Earth
and Environmental Science 373(1): 012013.
Seppänen, O. & Kurnitski, J.
2009. Moisture control and ventilation. In WHO
Guidelines for Indoor Air Quality: Dampness and Mould. World Health
Organization.
Shrestha, P.M., Humphrey, J.L.,
Carlton, E.J., Adgate, J.L., Barton, K.E., Root, E.D. & Miller, S.L. 2019.
Impact of outdoor air pollution on indoor air quality in low-income homes
during wildfire seasons. International
Journal of Environmental Research and Public Health 16(19): 3535.
Sidra, S., Ali, Z., Nasir, Z.A.
& Colbeck, I. 2015. Seasonal variation of fine particulate matter in
residential micro-environments of Lahore, Pakistan. Atmospheric Pollution Research 6(5): 797-804.
Śmiełowska, M.,
Marć, M. & Zabiegała, B. 2017. Indoor air quality in public
utility environments - A review. Environmental
Science and Pollution Research 24(12):
66-76.
Sribanurekha, V., Wijerathne, S.,
Wijepala, L. & Jayasinghe, C. 2016. Effect of different ventilation
conditions on indoor CO2 levels. International
Conference on Disaster Resilienence at Kandalama Sri Lanka.
Sturm, R. 2016. Local lung
deposition of ultrafine particles in healthy adults: Experimental results and
theoretical predictions. Annals of
Translational Medicine 4(21): 420-428.
Su, F.C., Friesen, M.C., Stefaniak,
A.B., Henneberger, P.K., LeBouf, R.F., Stanton, M.L. & Virji, M.A. 2018.
Exposures to volatile organic compounds among healthcare workers: Modeling the
effects of cleaning tasks and product use. Annals
of Work Exposures and Health 62(7): 852-870.
Tang, C.S., Chung, F.F., Lin, M.C.
& Wan, G.H. 2009. Impact of patient visiting activities on indoor climate
in a medical intensive care unit: A 1-year longitudinal study. American Journal of Infection Control 37(3):
183-188.
Tellier, R., Li, Y., Cowling, B.J.
& Tang, J.W. 2019. Recognition of aerosol transmission of infectious
agents: A commentary. BMC Infectious
Diseases 19(1): 101.
Verkkala, K., Eklund, A., Ojajärvi,
J., Tiittanen, L., Hoborn, J. & Mäkelä, P. 1998. The conventionally
ventilated operating theatre and air contamination control during cardiac
surgery-bacteriological and particulate matter control garment options for low
level contamination. European Journal of
Cardio-Thoracic Surgery 14(2): 206-210.
Verma, N. & Taneja, A. 2011.
Particulate matter exposure in hospitals of urban city located in northern
central India. The Indian Journal of
Environment 31(8): 624-634.
Wang, X., Bi, X., Chen, D., Sheng,
G. & Fu, J. 2006a. Hospital indoor respirable particles and carbonaceous
composition. Building and Environment 41(8): 992-1000.
Wang, X., Bi, X., Sheng, G. &
Fu, J. 2006b. Hospital indoor PM10/PM2.5 and associated
trace elements in Guangzhou, China. Science
of The Total Environment 366(1): 124-135.
WHO. 2016. Ambient air pollution: A
global assessment of exposure and burden of disease.
https://www.who.int/phe/publications/air-pollution-global-assessment/en/.
Yang, Z., Shen, J. & Gao, Z.
2018. Ventilation and air quality in student dormitories in China: A case study
during summer in Nanjing. International
Journal of Environmental Research and Public Health 15(7): 1328.
Yau, Y.H., Chandrasegaran, D. &
Badarudin, A. 2011. The ventilation of multiple-bed hospital wards in the
tropics: A review. Building and
Environment 46(5): 1125-1132.
Zhou, Q., Lyu, Z., Qian, H., Song,
J. & Möbs, V.C. 2015. Field-measurement of CO2 level in general
hospital wards in Nanjing. Procedia
Engineering 121: 52-58.
Zuraimi, M.S. & Tham, K.W.
2008. Effects of child care center ventilation strategies on volatile organic
compounds of indoor and outdoor origins. Environmental
Science & Technology 42(6): 2054-2059.
*Corresponding author; email: nimraafzal90@gmail.com
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