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Rapid Responses: Rapid Responses published:
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A breath of fresh air
- Michael Wiliams (27 June 2008)
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Windows again
- Elizabeth H Price (6 August 2008)
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Michael Wiliams, A patient patient Tokyo, 164-0001
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As Dr Smith correctly points out, hospital windows are often open even on "a particularly chilly day". He also cites some reasons as to why this may be, but omits one: which is that hospital wards - including shiny new PFI ones - tend to be poorly ventilated. It is not unusual to see an extract vent that would not be out of place in a small bathroom, serving a 6-bedded ward. This is "more than inadequate" to cope with the heat output of equipment, lights, and people, and solar heat gain. Likewise it provides very few air changes an hour to refresh the "breathable air". Whilst it is easy to use a blanket to keep warm, it is difficult to "cool off" - notice the number of patients who sleep under just a sheet, and the number of portable oscillating fans located in clinical and ward areas! Perhaps it is true that wards are kept so warm and soporific so that patients are more docile? Competing interests: None declared |
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Elizabeth H Price, retired microbiologist London
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Further to Dr Smith’s comments on hospital windows, there may also be problems from limited opening of windows. Health technical regulations have meant that windows in all NHS patient areas are restricted to an opening of 10cm.1 This has been put in place to prevent accidental falls or suicides (although there may be other ways of doing this such as decorative lattices, rails or slats). During summer months in particular a hot and moderately humid atmosphere could develop. Also, the resulting limitation on air changes may mean that the air is relatively still. Basic physiology teaches that this may cause temperature control problems, especially for sick patients. As hospitals designed for natural ventilation acquire more & more heat producing electrical equipment, they can become uncomfortably warm. Steam from bathrooms and kitchens may not escape & evaporate so easily with reduced window opening. Staff & patients may be less able to loose heat by sweating adequately if the atmosphere is more humid and some perspiration may remain on the skin. Theoretically at least, increased moisture on the skin, could result in a greater likelihood of acquiring and passing on infecting organisms.2 Bacteria and some respiratory viruses may survive better if the humidity increases. Adequate air changes and appropriate limits for temperature and humidity are advisable for all patient areas. Proper control of temperature and humidity in hospitals is long overdue! References 1. NHS Estates Health Technical Memorandum 55 Windows 98. 2. E.H. Price, G. Ayliffe Hot hospitals and what happened to wash, rinse and dry? Recent changes to cleaning, disinfection and environmental ventilation J Hosp Infect 2008 ; 69(1): 89-91 Competing interests: None declared |
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