The Role of Green Hospitals in Improving Indoor Environment Quality (IEQ) and Abolition of HAI
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The COVID-19 pandemic and other recent large disease outbreaks have highlighted the extent to which healthcare settings can contribute to the spread of infections, harming patients, health workers and visitors; if insufficient attention is paid to infection prevention and control, it may help in many ways to have resilient green healthcare. A Hospital-Acquired Infection (HAI) is defined by WHO as ‘an infection acquired in hospital by a patient who was admitted for a reason other than that infection’. They are transmitted by a variety of vectors, including person-to-person, through injection/insertion of medical devices, airborne contact of open wounds, and by respiration of airborne particles. Because of increased invasive procedures and growing antibiotic resistance, HAIs have increased by 36% in the last 20 years and consume more healthcare resources yearly [1]. Today, out of every 100 patients in acute-care hospitals, seven in high-income countries and 15 in low- and middle-income countries will acquire at least one healthcare-associated infection (HAI) during their hospital stay[2]. On average, 1 in every 10 affected patients will die from their HAI. [1] C J Uneke and P A Ijeoma, The potential for transmission of hospital-acquired infections by non-critical medical devices: the role of thermometers and blood pressure cuffs (World Health & Population, 2011) [2] Global report on infection prevention and control (WHO, 2022).
Introduction
The healthcare sector in India is growing at a rapid pace and contributing immensely to the growth of the quality of services. The industry is expected to grow several-fold in the next decade.
While this augurs well for the country, there is an imminent need to introduce green concepts and techniques in this sector, which can sustainably aid growth.
CII established the Indian Green Building Council (IGBC) 2001 to facilitate Green Building Movement. Since then, the Green building movement has gained tremendous momentum, and today, India has the second-largest registered green building in the world.
Indian Green Building Council, with the support of all the stakeholders associated with the healthcare industry, launched the ‘Green Healthcare Facilities Rating System’ to facilitate the adoption of green measures in hospitals. The rating system is a holistic framework that enables a hospital to measure the present green performance and guides them to improve further continuously.
A Green Building uses less water, optimizes energy efficiency, conserves natural resources, generates less waste, and provides healthier spaces for occupants than a conventional building. A Green Hospital provides a healing environment for faster recovery and reduces hospital-acquired infections (HAI).
The Rating was launched on 6 October 2016 during IGBC’s annual flagship event, ‘Green Building Congress 2016’ in Mumbai. It was developed under the chairmanship of Dr R. Chandrashekhar, Former Chief Architect, Ministry of Health &FW, Govt. of India and distinguished Healthcare technical committee members.
Introducing green concepts in healthcare facilities can help address National issues like infection, epidemics, handling of bio-medical waste, water efficiency, energy efficiency, reduction in fossil fuel use for commuting, consumer waste and, generally, conservation of natural resources. Most importantly, these concepts can enhance patients’ health, recovery and well-being.
Infection Control in Green Hospitals
There is a need to focus on providing appropriate infection control parameters & systems in healthcare facilities, thereby reducing hospital-acquired infection. A ventilation system should be designed to prevent airborne transmission of pathogens causing HAI.
ASHRAE 170 prescribes the minimum ventilation rates for dilution of air through fresh air ventilation, minimum energy reporting values in all spaces for filtration and pressurisation methodology for all regularly occupied spaces. Purification technologies such as germicidal/ UV lamps in Air Handling Unit (AHU) cooling coils, Photo Hydro Ionization O+ (PHIO+) at duct level should be employed to prevent airborne transmission of HAIs. To prevent the transmission of HAI through touch, the high touch surfaces as defined by Centre for Disease Control & Prevention (CDC) can be treated with bacteriostatic coatings/ copper coating approved by International Copper Association India (ICAI). Cleaning Protocol should be in place to maintain cleanliness & hygiene as recommended by CDC. 1. Adequate sanitation facilities are to be provided as per National Building Code-Part 9, Table 13, 14 & 15 or Indian Public Health Standards (IPHS) to reduce cross infections. Segregating bio-medical waste at source as per Bio-Medical Waste (Management and Handling) Rules-2016 will prevent direct exposure to disease-causing pathogens. Automatic waste collection systems reduce human intervention & exposure in handling hospital waste, thereby improving sanitation & hygiene. A new report from the World Health Organization (WHO) shows that where good hygiene and other cost-effective practices are followed, 70% of HAI infections can be prevented.
Healing Architecture
IEQ (Indoor Environment Quality) in healthcare facilities is essential and concepts related to thermal comfort, visual comfort, acoustic comfort, indoor air quality and ergonomics should necessarily be integrated in design and looked after during operation of healthcare facilities. Poor Indoor Environmental Quality (IEQ) increases the risk of infections in patients, visitors and staff in hospitals. IEQ in hospitals can aid in patients’ speedy recovery and maintain the medical staff’s health.
Healing Architecture is the most effective and tested way to enhance Indoor Environmental Quality (IEQ). Healing through architecture aims to eliminate environmental stresses such as lack of privacy & inadequate daylight, poor indoor air quality etc by connecting patients to nature and enhancing the patients physical and spiritual well-being, rejuvenating hope. As a result, hospital buildings should be planned to ease the stress on patients and their families. Healing architecture has a direct relationship to psychological notions of patients’ rehabilitation and the optimistic outlook of medical professionals and visitors. Daylighting, connectivity to nature, green open spaces, color psychology and acoustical design are important elements of healing architecture.
Conclusion
As of today, IGBC is working with more than 60+ hospitals. IGBC has certified premiere hospitals including Apollo hospital Mumbai, several hospitals of Max Super Specialty, PGIMER Chandigarh, Aster Medcity Kochi, Railway hospitals in Ajmer, Jaipur and Delhi etc. some of the ongoing green hospitals are Medanta Medicity Gurgaon, Medanta Noida, Multi Super Specialty Hospital at Kings Institute Campus, Chennai etc.
