VOC concentrations in healing environments. A protocol for monitoring activities in inpatient wards and its application on some case studies.

Introduction In recent years, IAQ becomes a primary issue that needs more and more to focus because of the increasing number of exposed population due to lifestyles and the permanence in confined environments. Hospitals are supposed to preserve Public Health, but they are also highly energy-demanding and socially impact on communities and they can determinate negative effects on quality of health of users and performances of environments. Although nowadays there are many evaluation systems that assess building's performance and its sustainability, among the criteria the evaluation of IAQ is postponed to the regulations into punctual hospital areas. Starting from the definition that health promotion is also due to environmental factors, the medical activities carried out, the design features, etc., the research work has the aim to provide an analysis on the State of the Art of indoor air in healing environments, in particular related to chemical pollution, highlighting and verifying all the factors that affect the air quality and, supported by an investigation on the current state of inpatient ward, giving rise a protocol. The purpose of the protocol is to determine the levels of indoor concentrations of specific and selected chemical pollutants and the physical parameters responsible for thermo-hygrometric comfort in inpatient wards. These environments must ensure an adequate indoor air quality with particular attention due to the presence of vulnerable subjects with precarious health status, but also to safeguard healthcare professionals who are subject to a longer period of time (years) to VOCs. Materials and methods The research team investigates inpatient rooms analysing VOCs, and the relative influence of thermo-hygrometric, ventilation and concentration of pollutants’ parameters, for giving rise to new strategies on the design of inpatient room for healthier hospital settings. It is of primary importance to investigate selected VOCs for obtaining guideline values on concentration levels. The selection of operative strategies has been made with some expertise on the field, considering the specific indoor air standards ISO 16000. In order to define the monitoring activity and identify the appropriate monitoring and analysis techniques, the scope of the monitoring activity, the pollutants to be analysed and the duration of monitoring activity have been defined: VOCs selected are the most dangerous air pollutants listed by WHO. In addition, it is necessary to introduce a microclimatic control unit for measuring the following parameters: temperature, relative humidity and air velocity, CO and CO2. Moreover for understanding the indoor pollution values, it must also be provided with an outdoor location that is closer to the room analysed. The protocol defines that the investigation is carried out during a year, divided into summer and winter sessions. The duration of each sampling is 7 days. It allows to evaluate a long period of time and take into account possible changes due to health activities, seasonal microclimate, the variability of natural/mechanical ventilation system, etc. The purpose of the investigation is to define the annual value of concentrations, therefore the research group opts for passive samplers (Radiello). The data processing is carried out by the laboratories of Italian Institute of Health Results For the reliability and validation of the protocol, it has been tested on some case studies, in particular on three inpatient rooms in three hospitals in Lombardy (Italy) between 2017-2018. The analysis of each case studies was conducted for 1 year. For each pollutant, several analysis have been developed for analysing the trends during the year, the relationship with temperature and relative humidity, etc. and the correlation of events and medical activities during the weeks. Although data analysis reports quite adequate values, several design and management activities affect the performances and VOC values, especially related to Benzene (with values between 0,7 and 3,4 μg/m3 compared to 2 μg/m3 (1 year) – ANSES), Carbon Dioxide (with values between 914 and 1154 ppm compared to 1000 ppm (week) –ISTISAN report), and Formaldehyde (with values between 8,4 and 12,4 μg/m3 compared to 10 μg/m3 (1 year) – ANSES). Conclusions The data collected permit to understand VOC concentrations. Although the data respect the guidelines values, new frontiers should suggest to reduce their presence in hospital settings. In general, the air monitoring demonstrate that a deepen knowledge on IAQ issue can be strategic in order to continuous improvement of indoor environmental quality. For managers and hospital planners, it is essential to pay attention to the design approach, the choice of specific materials, the periodic maintenance of AHUs and post maintenance assessment, the choice of cleaning and disinfection products compatible with finishing materials and adequate operational, etc.