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Environmental Comfort in Hospitals

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A special issue of Buildings (ISSN 2075-5309). This special issue belongs to the section "Building Energy, Physics, Environment, and Systems".

Deadline for manuscript submissions: closed (31 August 2023) | Viewed by 29627

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Dr. Simone Secchi

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Guest Editor

Department of Architecture, Università di Firenze, 50125 Firenze, Italy
Interests: building physics; acoustic comfort; architecture technology
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Nicoletta Setola

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Guest Editor

Department of Architecture, University of Florence, 50121 Firenze, Italy
Interests: hospital design; healthy spaces; layout configuration analysis

Prof. Dr. Luca Marzi

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Guest Editor

Department of Architecture, University of Florence, 50121 Firenze, Italy
Interests: healthy spaces; tools and methods for hospital management; accessibility and design for all

Special Issue Information

Dear Colleagues,

Hospitals include a variety of different spaces with different sensitivity and environmental requirements both for patients and for personnel. Thermal, lighting, and acoustic comfort is very important for patients as well as visual comfort and humanized environment: they can facilitate or make patients’ rehabilitation more complex. Hospital staff, who often spend many hours continuously in closed hospital environments, is usually very sensitive to environmental conditions.

The layout configuration inside a hospital must be planned with regard to the potential conflict between different requirements. Indeed, environmental requirements can be very different in indoor spaces close to each other. The need for doctors and nurses to monitor patients’ health often conflicts with patients’ need for rest. The use of medical equipment often requires conditions that cannot be waived but which are not comfortable for the patients. For example, concerning acoustic comfort, in hospitals, there are different activities and equipment that can cause high noise levels.

Aspects relating to the relationship between space design and work activities also contribute to increasing the level of environmental comfort. In this context, ergonomics and environmental control and management methods can be examined in relation to both the design and the space management phases.

Despite the number of regulations that refer to hospitals, environmental comfort for patients and medical staff is not an easy task.

The need to create healthy spaces suitable for various types of use entails difficulties in identifying where and how to apply the limits set by the legislation while there are situations in which, regardless of the legislation, it would be opportune to consider a more adequate environmental control.

Sensory environments, where light and sound can be controlled, help to reduce stress in patients and staff.

In this Special Issue, articles are expected on environmental design, sensory environment, layout configuration, management parameters and methods, aspects related to human factors and legislation, and the results of physical parameter measurements in hospitals.

Prof. Dr. Simone Secchi
Prof. Dr. Nicoletta Setola
Prof. Dr. Luca Marzi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

hospitals
environmental comfort
acoustic quality
lighting
thermal comfort
digital space control
digital healthcare systems (DHS)
human factors
ergonomics
path

Published Papers (11 papers)

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Research

24 pages, 6335 KiB

Open AccessArticle

Exploring the Use of the AEDET Hospital Evaluation Toolkit to Create a Better Healing Environment for Cancer Patients beyond the Global North

by Bedia Tekbiyik Tekin and Ozgur Dincyurek

Buildings 2023, 13(10), 2588; https://doi.org/10.3390/buildings13102588 - 13 Oct 2023

Viewed by 1178

Abstract

Today, numerous studies have shown that the physical environment in hospitals can significantly influence patients’ well-being, comfort, and recovery. However, this is currently neglected in hospitals in the Global South. Therefore, there is an urgent need to increase awareness to make it more applicable worldwide. Thus, this study focuses on improving the healing environment standards by exploring the impact of evidence-based design and patient-centered care in hospitals for cancer patients, particularly the architectural space quality, on patient health outcomes as well as hospital staff health and well-being. In Global North countries such as the UK, the achieving excellence design evaluation toolkit (AEDET) is used by their National Health Services to assess the effectiveness of various environmental attributes. However, these toolkits have not been designed for and do not work well within Global South countries, such as Northern Cyprus. To examine and compare the effectiveness of different physical environmental attributes and to evaluate user responses, the post-occupancy evaluation method and the AEDET toolkit were used in this study. These were applied to both public and private hospitals in Northern Cyprus, involving cancer patients, staff, and professionals (n = 220). The findings reveal the strengths and weaknesses in terms of environmental comfort based on the aspects of the evidence-based design of the hospitals such as natural light, air quality, noise, view, infection control, etc., to create a more optimal physical environment for better psychological outcomes. They also reveal that these toolkits are not fit for purpose for Global South contexts and require adaptations. This is the first study to propose an adaptation of the AEDET toolkit to assist architects in designing healthcare facilities that are responsive to the requirements of hospital patients and staff and to promote the quality of a healing environment for improved health and well-being outcomes. Full article

(This article belongs to the Special Issue Environmental Comfort in Hospitals)

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25 pages, 6470 KiB

Open AccessArticle

Analysis and Evaluation of Indoor Environment, Occupant Satisfaction, and Energy Consumption in General Hospital in China

by Yukai Sun, Shoichi Kojima, Kazuaki Nakaohkubo, Jingqi Zhao and Shenbo Ni

Buildings 2023, 13(7), 1675; https://doi.org/10.3390/buildings13071675 - 29 Jun 2023

Cited by 4 | Viewed by 1303

Abstract

Different functional areas within general hospitals have varying environmental requirements, with relatively high energy consumption. A comprehensive evaluation of the operational performance’s rationality is of great significance in hospitals’ energy conservation efforts. This study conducted an annual post-occupancy evaluation of a general hospital located in a hot summer and cold winter area in east of China. Two hundred and seventy-eight valid online satisfaction questionnaires, sixty valid point-to-point questionnaires, indoor environment data of each typical season, and energy consumption data were obtained. The overall indoor environment of the selected hospital met the standard requirements. The results showed that occupant satisfaction was influenced by gender, working hours, and length of stay. The annual energy consumption level of this building was 84.7 kWh/m², which is significantly lower than that of other public general hospitals in China and general hospitals in developed countries. The energy consumption of the inpatient department was directly related to the hospital days, with an increase of 12.2 kWh/m² for every 1000 additional hospital days. A new indoor environment quality (IEQ) model and a new comprehensive evaluation model for energy efficiency were established. Overall, the outpatient department exhibited superior performance compared to the inpatient department. These evaluation models can help owners and decision-makers in the identification of environmental performance in hospitals. Full article

(This article belongs to the Special Issue Environmental Comfort in Hospitals)

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18 pages, 22608 KiB

Open AccessArticle

A Study on the Layout of Hospital Ward Buildings in Cold Regions of China Based on the Efficiency of Nurse Rounds

by Qingtan Deng, Chenxia Jiao, Guangbin Wang, Xiaoyi Song and Jiayao Zang

Buildings 2023, 13(6), 1399; https://doi.org/10.3390/buildings13061399 - 29 May 2023

Viewed by 2164

Abstract

As an important public facility, the number, area, and scale of hospital buildings are growing rapidly. The efficiency of nurses’ rounds to beds is an important indicator of the efficiency of nursing units in ward buildings. Ward buildings occupy a very important position in the overall energy consumption of hospital building complexes. The type and scale of nursing unit floorplans are some of the key factors affecting the energy consumption of ward buildings. In this paper, three typical floorplan layout types of hospital ward buildings in cold regions of China are selected. The relationships between rounding efficiency, building energy consumption, floorplan layout, and building size were quantified using Origin based on linear regression and non-linear regression. The study showed that at 60 beds, the efficiency of nurse rounds was 35.68% higher in the double-corridor layout compared to the single-corridor. At 44 beds, the difference in average bed energy consumption between the double-corridor type and the single-corridor type is the greatest, with a 9.02% saving in energy consumption. This result confirms that the layout and scale of the ward building has a significant impact on the efficiency of nursing unit rounds and building energy efficiency. Full article

(This article belongs to the Special Issue Environmental Comfort in Hospitals)

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28 pages, 1676 KiB

Open AccessFeature PaperArticle

Sensory Design in the Birth Environment: Learning from Existing Case Studies

by Elena Bellini, Alessia Macchi, Nicoletta Setola and Göran Lindahl

Buildings 2023, 13(3), 604; https://doi.org/10.3390/buildings13030604 - 24 Feb 2023

Cited by 1 | Viewed by 4509

Abstract

Studies have shown how built environments for hospitals can influence psychological and physiological conditions and status for childbearing women. Sensory attributes of birth spaces can enhance comfort, feelings of wellbeing, and, to some extent, clinical outcomes. Recently, some case studies of multisensory rooms for the birth environment have been developed based on, e.g., Snoezelen room examples. The aim of this research is to develop an overview of how sensory aspects for birth environments are designed, used, and tested in current and recent studies. Case studies were selected according to sensory aspect significance, observing space factors, and relationship with the experience and comfort of users (women, partners, midwives). All case studies were analysed to collect information about the design and validation process. The collected data were organised in categories and compared for the selected case studies. Main findings were summarised in tables with the aim of underlining how sensory design processes and projects can positively influence comfort for birthing. Conclusions about how to bring forward the issue of sensory design so that it can be used and applied to support childbearing women is discussed. Full article

(This article belongs to the Special Issue Environmental Comfort in Hospitals)

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22 pages, 2117 KiB

Open AccessArticle

A Comparative Study of Acoustic Regulations for Hospital Bedrooms in Selected Countries in Europe

by Birgit Rasmussen, Teresa Carrascal and Simone Secchi

Buildings 2023, 13(3), 578; https://doi.org/10.3390/buildings13030578 - 21 Feb 2023

Cited by 1 | Viewed by 2292

Abstract

Regulatory acoustic requirements for hospitals exist in several countries in Europe, but many countries have either no or few regulatory limits or only recommendations. The purpose of limit values is to ensure optimal acoustic conditions for the patients under treatment and for the personnel for the various tasks taking place in many different rooms, e.g., bedrooms, examination and treatment rooms, corridors, stairwells, waiting and reception areas, canteens, offices, all with different acoustic needs. In addition, some rooms require special considerations such as psychiatric rooms and noisy MR-scanning rooms. The extent of limit values varies considerably between countries. Some specify few, others specify several criteria. The findings from a comparative study carried out by the authors in selected countries in various geographical parts of Europe show a diversity of acoustic descriptors and limit values. This paper includes updated criteria for reverberation time, airborne and impact sound insulation, noise from traffic and from service equipment for hospital bedrooms. The discrepancies between countries are discussed, aiming at potential learning and implementation of improved limits. In addition to regulations or guidelines, some countries have hospitals included in national acoustic classification schemes with different acoustic quality levels. Indications of such class criteria are included in the paper. Full article

(This article belongs to the Special Issue Environmental Comfort in Hospitals)

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17 pages, 2807 KiB

Open AccessArticle

Evaluation of Noise Level in Intensive Care Units of Hospitals and Noise Mitigation Strategies, Case Study: Democratic Republic of Congo

by Jean-Paul Kapuya Bulaba Nyembwe, John Omomoluwa Ogundiran, Manuel Gameiro da Silva and Nuno Albino Vieira Simões

Buildings 2023, 13(2), 278; https://doi.org/10.3390/buildings13020278 - 18 Jan 2023

Cited by 6 | Viewed by 4268

Abstract

High noise levels in hospitals can affect patients’ well-being, staff productivity, and medical error rates. This study measured noise in two intensive care units (ICUs) in the Democratic Republic of Congo (DRC). An occupant’s survey and a continuous field sampling were conducted in May and June 2021 in each ICU, using a T Tocas SL 1361 digital sound level meter and an online questionnaire. In GH-ICU, variations in the noise levels for the day, evening, and night-time were recorded as measuring 60.5–94.6 dBA, 61.9–90.0 dBA and 33.3–80.2 dBA respectively, while respective values of 58.8–75.5 dBA, 57–75 dBA, and 33.9–74.8 dBA were recorded for CH-ICU. The weekly noise equivalent level (L_eq) of 82.8 dBA and L_den of 83.8 dBA for GH-ICU was computed, and 68.6 dBA and L_den 72.1 dBA for CH-ICU. This study found that the noise levels in both ICUs exceeded the recommended limits of the World Health Organization (WHO) for hospitals, while three-quarters of occupants expressed dissatisfaction with the acoustic environment. The results suggest the need for immediate intervention, including implementing suitable noise mitigation measures since hospital workers and patients are prone to long-term exposure to high noise, which can decrease working performance and health problems. Full article

(This article belongs to the Special Issue Environmental Comfort in Hospitals)

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10 pages, 1608 KiB

Open AccessArticle

Perceived Hospital Environment Quality Indicators: The Case of Healthcare Places for Terminal Patients

by Sara Manca, Marino Bonaiuto and Ferdinando Fornara

Buildings 2023, 13(1), 57; https://doi.org/10.3390/buildings13010057 - 27 Dec 2022

Cited by 3 | Viewed by 2453

Abstract

The “user-centered” design perspective (Gifford, 2002) suggests that healthcare places should improve their environmental quality in order to both meet the users’ needs and become “more humane” care environments, facilitating a higher level of patients’ satisfaction, wellbeing, and quality of life. The hospice is a specific category of healthcare, given the specificity of its target population, i.e., the terminal patients. This research aimed (i) to verify the factorial structure of an adapted version of the Perceived Hospital Environment Quality Indicators (PHEQIs, Fornara et al., 2006) for the hospice environment; (ii) to test the reliability of such indicators; and (iii) to detect the association between each indicator and the global satisfaction toward the hospice. Participants (N = 135) were patients, their relatives, and staff of eleven Italian hospices. They had to fill in a questionnaire including items tapping three diverse hospice settings (i.e., external spaces, interior common spaces, and interior private spaces). The confirmatory factor analysis run for each scale produced six reliable Hospice PHEQIs. As expected, significant relationships between most of them and the overall users’ satisfaction toward the hospice environment emerged. Full article

(This article belongs to the Special Issue Environmental Comfort in Hospitals)

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18 pages, 7739 KiB

Open AccessArticle

Pre-Occupancy Evaluation in Hospital Rooms for Efficient Use of Natural Light—Improved Proposals

by Tiziana Ferrante and Teresa Villani

Buildings 2022, 12(12), 2145; https://doi.org/10.3390/buildings12122145 - 06 Dec 2022

Cited by 5 | Viewed by 2174

Abstract

This paper aims to contribute to the formulation of criteria for the design of inpatient spaces through the efficient use of natural light as a factor that greatly influences human health. Specifically, it concerns the development of a methodology to assess the quality of natural light in the operating phase and demonstrate how the morphological and material characteristics of the hospital rooms can affect natural lighting. All variables affecting light in indoor spaces have been evaluated, with a focus on the photometric characteristics of finishing materials and furnishings, aimed at determining their contribution in terms of reflectance. This evaluation was based on pre-occupancy evaluation methodologies, which allow comparing actual and simulated natural light conditions, and was tested on a sample of inpatient rooms located in a hospital in Rome. Improvement design solutions were proposed and simulated through the evaluation of physical variables including daylight factor, illuminance, color rendering index, etc., selecting the ones with appreciable improvements over ante operam natural light conditions. The methodology allows control over the effects of individual interventions, specific to each variable, highlighting their impact on visual comfort and their feasibility from an economic and operational point of view. Full article

(This article belongs to the Special Issue Environmental Comfort in Hospitals)

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15 pages, 1759 KiB

Open AccessArticle

Surveys on Noise in Some Hospital Wards and Self-Reported Reactions from Staff: A Case Study

by Fabio Lo Castro, Sergio Iarossi, Giovanni Brambilla, Raffaele Mariconte, Maurizio Diano, Vicente Bruzzaniti, Lidia Strigari, Giorgio Raffaele and Claudia Giliberti

Buildings 2022, 12(12), 2077; https://doi.org/10.3390/buildings12122077 - 27 Nov 2022

Cited by 3 | Viewed by 2204

Abstract

Noise in hospital wards adversely affects the physiological processes of both patients and staff and it is a potential risk for communication breakdowns and errors, causing discomfort and problems regarding the healing of patients, as well as stress, fatigue, and annoyance for staff. Several noise sources are present in the wards, such as HVAC systems, alarms, paging, speech, calls, diagnostic equipment, medical devices, and so forth. This paper describes two surveys carried out at an Italian hospital in Rome to investigate the noise in some wards and to collect self-reported assessments from staff about their working environments, even if such assessments were not required for occupational noise exposure evaluation. Self-reported staff evaluations of the working environment quality and the effects of noise on their performances should be investigated. For this purpose, in this study, questionnaires were designed and submitted to staff members. In addition, noise measurements were taken from short-, medium-, and long-term audio recordings processed to determine psychoacoustic parameters, e.g., loudness, sharpness, roughness, and fluctuation strength. Their applications in enclosed spaces can provide additional information on some features of the noise observed in hospital wards, which may influence the perceptions and relevant extra-auditory effects. Even though the results cannot be generalized, they encourage the development of a methodology for noise surveys in hospital wards, including noise measurements and “ad hoc” questionnaires to collect self-reported reactions from exposed staff members. Full article

(This article belongs to the Special Issue Environmental Comfort in Hospitals)

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15 pages, 4943 KiB

Open AccessArticle

Analysis of the Acoustic Comfort in Hospital: The Case of Maternity Rooms

by Simone Secchi, Nicoletta Setola, Luca Marzi and Veronica Amodeo

Buildings 2022, 12(8), 1117; https://doi.org/10.3390/buildings12081117 - 28 Jul 2022

Cited by 2 | Viewed by 2498

Abstract

Hospitals include a variety of different spaces with different requirements and levels of sensitivity to noise but also different activities and equipment that can cause high noise levels. In this article, noise disturbance in hospitals is studied with reference to a case study in a maternity ward. The analysis is carried out by means of sound insulation measurements between bedrooms and between bedroom and corridor. Equivalent sound pressure level measurements were carried out continuously for two days and nights. The number of awakening events is examined for each hour of the two nights. In addition, the results of a questionnaire conducted on more than 100 patients are reported. The results of the study show that the main cause of noise disturbance is activity in the corridors and that this kind of disturbance is usually repeated throughout the night. This is made more critical by the poor acoustic performance of the doors, but also by the habit of keeping doors open or half-open to allow doctors to always control patients. The article proposes some possible solutions to reduce noise intrusion from the corridor to the rooms. Full article

(This article belongs to the Special Issue Environmental Comfort in Hospitals)

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18 pages, 595 KiB

Open AccessArticle

Facilitating Patient-Centric Thinking in Hospital Facility Management: A Case of Pharmaceutical Inventory

by Xiang Xie, Zigeng Fang, Long Chen, Qiuchen Lu, Tan Tan, Zhen Ye and Michael Pitt

Buildings 2022, 12(7), 888; https://doi.org/10.3390/buildings12070888 - 23 Jun 2022

Cited by 1 | Viewed by 2402

Abstract

Conventional hospital facility management (FM) focuses on reasonably allocating various resources to support core healthcare services from the perspectives of the FM department and hospital. However, since patients are the main service targets of hospitals, the patients’ demographic and hospitalization information can be integrated to support the patient-centric facility management, aiming at a higher level of patient satisfaction with respect to the hospital environment and services. Taking the pharmaceutical services in hospital inpatient departments as the case, forecasting the pharmaceutical demands based on the admitted patients’ information contributes to not only better logistics management and cost containment, but also to securing the medical requirements of individual patients. In patient-centric facility management, the pharmacy inventory is regarded as the combination of medical resources that are reserved and allocated to each admitted patient. Two forecasting models are trained to predict the inpatients’ total medical requirement at the beginning of the hospitalization and rectify the patients’ length of stay after early treatment. Specifically, once a patient is admitted to the hospital, certain amounts of medical resources are reserved, according to the inpatient’s gender, age, diagnosis, and their preliminary expected days in the hospital. The allocated inventory is updated after the early treatment by rectifying the inpatient’s estimated length of stay. The proposed procedure is validated using medical data from eighteen hospitals in a Chinese city. This study facilitates the integration of patient-related information with the conventional FM processes and demonstrates the potential improvement in patients’ satisfaction with better hospital logistics and pharmaceutical services. Full article

(This article belongs to the Special Issue Environmental Comfort in Hospitals)

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