Health and Care Innovation Expo 2017 returns to Manchester Central on 11th and 12th September 2017.
Calling for greater focus on indoor air quality
Thousands of premature deaths could be avoided and millions of pounds in running costs saved if ventilation and air conditioning systems were properly maintained, according to Giuseppe Borgese, chairman of the Building Engineering Services Association
More than 25 per cent of all child deaths globally are attributable to unhealthy environments including indoor and outdoor air pollution, according to the World Health Organisation (WHO). Its latest research shows that 1.7 million children under five years of age die every year as a result of the poor state of their living environment with air pollution a major contributor. Infants and pre-schoolers exposed to indoor and outdoor air pollution have an increased risk of pneumonia in childhood, and a lifelong increased risk of chronic respiratory diseases, such as asthma.
Exposure to air pollution may also increase their lifelong risk of heart disease, stroke and cancer. Dr Penny Woods, chief executive of the British Lung Foundation, explains that air pollution is now a full-blown ‘public health crisis’. Urban populations across the planet face growing risks from air contamination, which increases the severity of asthma attacks, instances of heart failure and certain cancers. It reduces lung capacity so upsetting the balance of nutrients and oxygen in the blood.
There are few more serious issues out there, but cleaning up the air is proving a seemingly intractable political problem and the government has admitted that the UK will remain in breach of its obligations under EU clean air regulations until at least 2025. The government has also lost two court cases over its plans to tackle the key pollutant nitrogen dioxide (NO2) and has been ordered by the High Court to publish a draft new clean air plan to tackle NO2 by 31 July this year.
Sarah Wollaston, chair of the All Party Parliamentary Health Committee says poor air quality is affecting ‘the health of millions of people across the UK because of the impact of invisible particulates and other pollutants’. Reducing air pollution inside and outside buildings and protecting pregnant women from second-hand tobacco smoke can prevent children’s deaths and diseases, according to the WHO, which also estimates there are 360,000 premature deaths in the EU every year as a result of worsening air pollution – around 40,000 of which are in the UK.
It also estimates that between 11-14 per cent of children aged five years and older worldwide display asthma symptoms and an estimated 44 per cent of these are related to environmental exposures including air pollution, second-hand tobacco smoke, and indoor mould and dampness. In central London the concentration of diesel and nitrogen dioxide (NO2) is about three times the level recommended by the WHO with Londoners suffering a 20 per cent increase in mortality rates as a result.
Therefore, the more alarming pollution becomes outside, the more desirable and valuable it is for buildings to be turned into ‘safe havens’ that protect their occupants from the worst effects. We do, after all, spend up to 90 per cent of our time inside – and by addressing the ventilation solutions available it is possible to create indoor ‘clean air zones’.
We are all familiar with the principle of controlling temperature inside buildings to improve comfort and health. When it is too hot or cold outside, people expect to be able to step into comfortable conditions inside. The same principle should apply to air pollution – with people expecting a similar protection from outside conditions. Unfortunately, in many buildings, the opposite is the case with indoor conditions having a very negative impact on human health.
At the Building Engineering Services Association (BESA), we are campaigning hard for any legislation covering air pollution, in general, to take account of the importance of indoor air quality (IAQ) alongside the more high profile issue of transport and industrial emissions. This is timely because, to mark the 60th anniversary of the UK’s first Clean Air Act, a powerful coalition of environmental campaigners, health bodies and industry groups is pressing the UK government to update clean air legislation.
Air quality ambitions
The group, which includes Greenpeace, Friends of the Earth, the Royal College of Physicians, the British Lung Foundation and environmental lawyers ClientEarth, wants the UK to give the UK the most ambitious air quality legislation in Europe.
Paul McLaughlin, BESA chief executive, said: “People spend more than 80 per cent of their time indoors and there is still a lot more we can do to improve IAQ. A series of low cost, maintenance measures to ensure ventilation systems work properly and incoming air is filtered and cleaned would make a major difference to the health and well-being of building occupants.
“Reducing toxic emissions from vehicles and industrial processes is vital, but will take many years to produce results and involve major long-term investment. Improving building ventilation is a quick and relatively painless process that can be tackled today to help protect people in the meantime. Building owners also have a legal duty of care to protect the health of their tenants and employees.”
A well-sealed building envelope combined with effective filtration of the air supply can reduce the amount of harmful particles coming in by 78 per cent. Considerable investment has already been made in improving the airtightness of buildings to reduce heat loss and, therefore, energy consumption and that same process can be used to manage air quality, but it requires a clear focus on the effectiveness of ventilation systems.
BESA’s own Guide to Good Practice – Internal Cleanliness of Ventilation Systems (TR/19) includes step-by-step guidance and references UK and international standards on maintaining ventilation systems to a level essential for good IAQ. Detailed service and maintenance schedules can also be set up by using the Association’s widely adopted SFG20 online tool, which includes targeted tasks related to air quality in specific building types.
This approach has been saving businesses money in a wide range of sectors for a number of years by optimising maintenance, avoiding over-spend, ensuring efficient running of plant and maintaining compliance. It now includes an HTM (Health Technical Memorandum) module designed specifically for healthcare buildings. This Healthcare Functional Set, developed in collaboration with healthcare professionals, aligns SFG20 with the requirements of the HTMs for hospitals, NHS trusts, dentists, as well as vets and doctors’ surgeries.
The new schedules display how often tasks need to be carried out to avoid over or under maintaining assets and what skill set should be used to perform the tasks. This has been shown to save estates managers as much as 20 per cent on their maintenance budgets as well as ensuring buildings perform better in terms of occupant health and productivity.
SFG20 is a dynamic online tool so makes best practice widely available and easy to access. As well as featuring over 500 core maintenance schedules, covering more than 60 equipment types, SFG20 also gives users the opportunity to customise maintenance schedules, including service times, frequency and criticality ratings. SFG20 is also aligned with rapidly emerging digital working methods and is constantly updated to capture evolving service and maintenance techniques.
Planned service and maintenance programmes play an increasingly important role in helping facilities managers maintain comfort levels; identify areas requiring improvement; and meet energy efficiency goals. With the NHS spending £8.3 billion on estate costs in 2015, according to the NHS Estates Review carried out by the consultant Arcadis, focusing on building engineering maintenance issues has the potential to make a significant difference to the bottom line of most NHS operations.
Brian Dunne, PPM Manager at St George’s Hospitals University NHS Foundation Trust says: “SFG20 saves a lot of time that we previously had to spend making contact with equipment manufacturers regarding routine maintenance. SFG20 has simplified the task of setting specifications for our maintenance contractors at the same time as making sure we’re following all correct procedures. I also like the fact it’s speedy, making essential information readily available.”
Maintaining good air purity in clinical and general healthcare facilities remains a major priority, but many facilities managers are missing the growing threat from increased outside air pollution. Current NHS technical design guidance is largely focused on managing the risk posed by the transmission of infections from sources inside a building.
However, the building engineering services industry has a wide range of solutions to offer including different levels of filtration, but also other (mainly low cost) improvements, such as upgrading fans; servicing air conditioning and simple maintenance that, not only reduces health risks to building occupants, but also does it in a way that improves the overall efficiency of the ventilation and so significantly cuts running costs.
Optimising the way air is supplied to just one operating theatre could save a hospital £5,000 in annual running costs – or £10 million a year if replicated right across the whole of the NHS and would also avoid 80 tonnes of carbon emissions, according to recent estimates. Any ventilation fan that is over five years old is almost certainly inefficient and a replacement would pay for itself in less than three years. Healthcare facilities managers could cut running costs by 29 per cent by replacing the fans in their air handling units and the addition of heat recovery to ventilation systems can reduce costs in non-clinical areas by up to 30 per cent. Even more basic, low cost measures like having grilles and filters cleaned regularly can save thousands of pounds a year.
Persuading NHS trust boards to spend money on remedial measures is not easy because they are fully focused on frontline patient care. However, most of these changes pay for themselves through energy efficiency improvements, but even more importantly; they represent a worthwhile investment in protecting vulnerable patients from the potential impact of external pollution.
The whole principle of a ‘safe haven’ is of particular relevance to healthcare facilities housing people with reduced immunity, who are therefore, more vulnerable to the worst effects of airborne pollutants. While critical care areas already achieve high standards of air cleanliness; NHS managers should also consider the significant benefits of putting in place relatively low cost maintenance regimes that can transform general areas around their buildings into internal clean air zones for the benefit of both patients and staff.