As children, we are often reminded that we are “unique” either to dissuade us from jealousy or simply to help us develop self-esteem. Similarly, building professionals committed to sustainable design see uniqueness amongst diverse building types. Perhaps more than any other building type, healthcare facilities are unique.

Consistent throughout building sectors is the increasing importance of indoor air quality. With the green building movement serving as the engine, environments in which building occupants breathe are inexorably improving with the USGBC’s LEED program and other initiatives serving as fuel. Yet, focus on specific indoor air issues often varies based on building type. For instance, the harmful growth of mold tends to dominate residential indoor air discussions while ventilation and emissions from volatile organic compounds (VOCs) are often more visible for commercial buildings.

Hospitals Lead the Way

Hospitals are often at the vanguard in addressing the health-related consequences of bad air. The phenomenon has many examples. The Joint Commission on the Accreditation of Healthcare Organizations, which accredits most U.S. hospitals, enacted a standard that prohibited smoking in hospitals, requiring institutions to be smoke free by the end 1993. The reality is that indoor air in hospitals is unique for multiple reasons: 1) the presence, including in the air, of microbes, viruses and bacteria that are associated with illness and can lead to serious infections and disease; 2) the controlled ventilation environment, including temperature, humidity and air change; and 3) the volume and diversity of people — visitors, patients, employees, medical staff, etc. — going in and out of a hospital every day.

The primary building occupants — sick patients — are more vulnerable to disease and infection than the general population. Plus, hospital “occupants” are often more at risk to exposure to illness and irritation. Additionally, the sheer magnitude of current hospital construction sets this building type apart. About $44 billion in hospital construction, including new facilities, renovation, and expansion, is in the design stage. In 2005 alone, over 139,000 patient beds were either in design or under construction.

Increasingly, those responsible for worrying about indoor air quality in hospitals have focused attention on nosocomial infection, which is an infection that is acquired in a hospital that was not present or incubating at the time of admission of a patient. It is more commonly known as “hospital-acquired infection.” Airborne transmission is one of the causes for spreading this infection, which has further highlighted the importance of air quality and effective ventilation in hospitals.

In an article published in July 1998 issue of HPAC Engineering, the issue of airborne respiratory disease control of microbes in the mechanical systems in hospital was reviewed. The authors concluded that many respiratory pathogens have adapted to the comfortable indoor environments of hospitals and are able to move around the building through airflow movement, whether natural – due to temperature gradients or pressure differences — or mechanical — forced airflow through ductwork.

In the U.S. alone, it has been estimated that as many as one hospital patient in 10 acquires a nosocomial infection, or 2 million patients a year. Estimates of the annual cost range from $4.5 billion to $11 billion and up. Nosocomial infections contributed to 88,000 deaths in the U.S. in 1995. One third of nosocomial infections are considered preventable.

The possible spread of infection is an important function in every hospital. “Infection Control Departments” typically play the lead in ensuring that bacteria normally found in hospitals. Disinfecting hospitals is often closely tied with cleaning surfaces, instruments, linens and other articles that have been in contact with sick patients; however, infection control experts are increasingly undertaking strategies that manage airborne risks. While surface contact with some of these bacteria may cause harm, controlling its rapid dispersal via the ventilation system is essential.

Cleaning: A Delicate Balance

The vigor with which hospitals attack the spread of disease and infection can potentially have negative side effects on a hospital’s indoor air. A delicate balance must be reached between the frequency of cleaning, the characteristics of the cleaning products and the impact that the chemicals from the cleaning/disinfectant products might have on the health and well being of patients. Cleaning products often emit VOCs that are associated with a range of potential health risks; for highly sensitive people, even small levels of VOCs can potentially cause reactions.

Organizations Embrace Green Practices

Organizations including Green Guide for Health Care (GGHC) and Hospitals for a Healthy Environment (H2E), have embraced products and processes that reflect best practices in green cleaning, attempting to address the seemingly contradictory goals of controlling infection and disease and minimizing the impact of harmful chemicals. For example, GGHC (v. 2.2) seeks to “limit exposure of building occupants and maintenance personnel to potentially hazardous chemical, biological and particulate contaminants through the implementation of an environmentally preferable cleaning policy.” While, to some in the healthcare field, “green” building rating programs and product certifications have made their challenges in managing indoor air risks even more complex, a well-known consultant in the field, Steve Ashkin of the Ashkin Group describes these efforts as essential.

“If anything, we need to be cleaning buildings, including hospitals, more and not less,” explains Ashkin. “There are a breadth of cleaning solutions increasingly available to hospitals that minimize any impact on indoor air.”

While some might be tempted to treat hospitals like any other building type, its important to note that they are a special breed.