Healthcare Buildings Research Articles

Determining the Essential Criteria for Choosing Appropriate Methods for Maintenance and Repair of Iraqi Healthcare Building Facilities

Today, building maintenance and repair (M&R) is a neglected aspect of the construction business throughout a building’s entire life cycle. Selecting appropriate M&R strategies is crucial, particularly for emerging economies like Iraq with severely constrained resources. This study seeks to identify the primary selection criteria for M&R methods of healthcare building facilities (HBFs) in Iraq. A comprehensive desktop literature analysis was undertaken to extract and determine the essential selection criteria for the most suited M&R approaches to buildings in general. Then, two rounds of the Delphi survey were conducted to consolidate the specific selection criteria to suit the circumstances of Iraq and HBFs. A total of 21 sub-criteria were identified and divided into six main groups. The main criteria and the associated sub-criteria were then analyzed and ranked using the fuzzy analytic hierarchy process (FAHP) technique. The ranking of the various main criteria revealed that the “cost” criterion was ranked first in terms of importance, followed by the “human resources” and “quality” criteria. The fourth, fifth, and sixth main criteria are “reliability/flexibility”, “safety/risk/environment”, and “facilities/technology”, respectively. The overall ranking of the sub-criteria placed “optimization and cost reduction” in the first position and “extending the life of the equipment and preserving their initial quality” in the bottom place. It is anticipated that the key findings and effective recommendations of this study will considerably contribute to the improvement of building maintenance and repair management practices in developing nations while enhancing different stakeholders’ understanding of the most important selection criteria for M&R methods, particularly with regard to healthcare building facilities in Iraq.

Particulate Matter Concentration in Healthcare Facilities: The Influence of Natural Ventilation

Particulate Matter (PM) is an air pollutant that harms human health. Therefore, there is a particular concern about reducing indoor air pollutants. Natural ventilation supplies clean air into the room to reduce indoor pollutants and create good air quality. This research aims to determine the influence of natural ventilation on the particulate matter’s concentration in the room. First, the physical indoor air quality, including particulate matter, was measured using research instruments to obtain the primary data in healthcare facility buildings. Quantitative analysis is then carried out following the applicable recommended standards. The results indicate that natural ventilation can affect particulate matter concentration in the room and play an essential role in reducing it. Therefore, a building must consider good ventilation design to create better indoor air quality.

High-Performance Glazing for Enhancing Sustainable Environment in Arid Region’s Healthcare Projects

The integration of sustainability rating systems in healthcare projects and healthcare building envelope specifications is a growing concern in the construction industry, especially in the arid region. The external facade of healthcare buildings is one of the most significant contributors to the energy cost and comfort level of healthcare buildings in such a region. This study undertook a comprehensive comparison analysis of an adaptive model of high-performance glazing (HPG) specifications for patient rooms in a case study inside Saudi Arabia based on multi-criteria, including the LEED Healthcare rating system. The study used a technical comparative analysis for three onsite glazing models with HAB software v6.0 based on specifications of specialist manufacturer organizations for glazing window performance, climatic conditions, and the region’s culture. Significant results in the case study project were achieved in energy saving and sustainability ranking in the healthcare rating system, providing new specification guidelines for HPG applications in healthcare buildings located in an arid region, and cultural environment considerations.

Discussion of digital transition impact on the facility management sector applied to healthcare buildings.

Since 2020, the rapid global spread of the COVID-19 pandemic has generated unprecedented impacts on the management of hospital buildings, namely: (i) providing space for patients, medical staff, and equipment storage, (ii) imposition of limitations on access by the teams responsible for managing the building, (iii) adapting the space and its functionality quickly, (iv) ensuring continuous control of air quality and adequate ventilation of spaces, (v) development of digital tools for management, and (vi) assets monitoring in real-time. In addition, hospital buildings facilities’ deterioration rate is typically higher than in other buildings, enhanced by the fact that these facilities are open 24 hours a day, year-round. Thus, facilities management (FM) assumes a vital role in the future of healthcare facilities. FM is expected to grow at a 5% annual rate for 2021-2028, representing an acceleration of the industry at a global level. Furthermore, Industry 4.0 may positively impact the FM processes. As a new industrial revolution, providing a set of new approaches and tools will increase the efficiency of operations, significantly impacting the potential of optimization. These trends can improve planning and management of scope, costs, environment, and safety in the value chain of projects and assets, thus creating a more resilient and sustainable industry. Based on a literature review, this paper contributes to the discussion of the questions: How can the digital transition improve the management of the operation and maintenance of infrastructure in healthcare facilities? What is the legacy for FM teams in this post-COVID-19 management of hospital buildings?

Analyzing Temporal Changes in Initial and Recurrent Embodied Energy Using an Input-Output-based Hybrid method

Buildings consume over 40% of global energy annually in their initial construction and operation as embodied and operational energy, contributing to over 39% of global carbon emissions. Embodied energy (EE) is consumed directly in construction processes and indirectly using construction materials, each of which uses energy during its manufacturing. All direct and indirect embodied energies used in maintenance, repair, and replacement processes of buildings is termed recurrent embodied energy (REE). Because REE accrues over 50-100-year life cycle of buildings, it may be equal to, or more than the initial embodied energy (IEE) used during buildings’ construction. Both REE and IEE must be optimized to help effectively reduce the environmental burdens of buildings. However, calculating IEE and REE is a data-intensive process requiring temporally representative data that may not be readily available. Consequently, studies may use older data. This paper offers a temporal analysis of the IEE and REE of healthcare buildings to demonstrate how energy source-specific EE values may change over time and introduce errors in IEE and REE calculations if old data is used. Using macroeconomic modeling, the IEE and REE intensities of healthcare building sector are computed. The results indicate that using 5-year and 10-year-old data may underestimate IEE by 5% and overestimate it by 26%, respectively, whereas the REE may be overestimated by 20% and 33%, respectively. The results also show that the share of electricity in EE may be increasing over time. The findings underscore the importance of using temporally representative EE data for energy analysis.

Evaluation of Temporary COVID-19 Testing Sites at Brussels Airport, Belgium: Users’ Comfort and Privacy

This paper explored the temporary facilities created during the pandemic for use as COVID-19 test centers at Zaventem Airport, the main airport for the city of Brussels, Belgium. The possibilities of modular construction technology and the impact of the building envelope on users’ perception of indoor space comfort and privacy were closely observed. The three main problem statements were as follows: (1) the COVID-19 crisis indirectly influenced the creation of temporary modular buildings with glass envelopes; (2) the modular envelope is adaptable to the existing context; and (3) the envelope meets the needs of the users. This study’s objectives were to identify the critical factors for users’ well-being in temporary modular buildings, and to conduct factor comparisons among different users and between different building-enclosure systems. The study data were collected through a subjective assessment using a SWOT analysis and a survey questionnaire. The glass facade affected the users’ acceptance levels of comfort and privacy. The main results show that the users were satisfied with the level of comfort and dissatisfied with the level of privacy. This information can be used to identify areas for improvement and provide useful feedback to designers and engineers about specific design features and operating strategies for temporary modular emergency healthcare buildings.

The Development of a Life-Cycle-Based Sustainability Index That Incorporates Patient-Centredness for Assessing and Reporting the Sustainability of Healthcare Buildings in Saudi Arabia

This study aims to develop and test a life-cycle-based sustainability index that incorporates patient-centredness for assessing and reporting the sustainability of healthcare buildings in Saudi Arabia. The research strategy follows a triangulation method approach to meet the objective of this research. Semi-structured interviews were initially employed in developing sustainable healthcare building indicators based on a previously conducted literature review that explored sustainable building in Saudi Arabia. Then, a scoping review protocol including the Delphi technique was used to develop patient-centredness care, PCC, indicators. Questionnaire surveys were also employed in data collection for industry investigation and patient involvement. Lastly, case study practice tests were conducted involving a specialised hospital and a pre-occupant hospital for indicator verification. A set of sustainability indicators were developed to assess and report the sustainability performance of healthcare buildings. Patient-centredness indicators were also developed and incorporated into the resulting index. A case study practice test was conducted to confirm the feasibility of all final resulting indicators. The research study contributes towards a holistic approach to assess and report sustainability in healthcare buildings incorporating patient-centredness. The objectives of the research include (1) the development of sustainable healthcare indicators (primary indicators); (2) the development of patient-centredness indicators (secondary indicators); and (3) indicator practice tests for validation. The resulting index could be implemented to assess and report sustainability in healthcare buildings, and it could be a pivotal step to shift to sustainable patient-centred healthcare buildings in Saudi Arabia.

Methodology to Identify and Prioritise the Sustainability Aspects to Be Considered in the Design of Brazilian Healthcare Buildings

The evidence of climate change has increased the necessity for actions to avoid severe consequences for future generations. Recognising the benefits of sustainable and energy-efficient buildings has led to the development of several methods to estimate and rate the performance of building. Healthcare buildings are functional and dynamic structures that support their occupants’ healing processes and comfort. They have a significant role in society and specific goals in merging their strategic planning requirements (cost reduction, regulatory compliance, social responsibility, and performance improvement) with Sustainable Development Goals. Therefore, this paper addresses critical issues regarding the sustainability of the Brazilian healthcare sector by analysing the suitability of the most common international healthcare building sustainability assessment methods to the specific social, economic, and environmental contexts of the Brazilian healthcare sector. The paper analyses the HBSAtool-PT, a sustainability assessment method developed for this type of building, and identifies the possibilities for adapting to the Brazilian context. As a result, this research proposes a framework to assess the sustainability of healthcare buildings in Brazil. In the framework’s definition, a survey was conducted to determine the opinion of building stakeholders regarding the importance of indicators. A weighing system for the proposed sustainability indicators was developed using the AHP method.

Flanking noise transmission in a healthcare facility

Healthcare building constructions have some similarities and some differences compared with those of other building types. This presentation will examine door gasketing problems and perimeter sound isolation leaks found at an outpatient healthcare facility. The observations and test results for the problem conditions will be discussed along with our recommended solutions. Anecdotal feedback from the facility may be available by the time of the presentation.

Life cycle analysis methodology for heating, ventilation and air conditioning ductwork in healthcare buildings

The design, modelling and construction of heating, ventilation and air conditioning (HVAC) facilities in healthcare buildings must aim for the users’ maximum comfort and meet sanitary criteria for indoor air quality. The environmental impact of 12 HVAC duct types was subjected to life cycle assessment, with a single-score damage category analysis carried out for the midpoint and endpoint levels. The two most favourable duct types for the different impact categories were aluminium with helical steel wire reinforcement and fibreglass insulation, and also copper sheeting with rock wool and polyurethane insulation. However, although the former presented the best environmental impact values, this type is inadvisable for healthcare buildings. This is due to its nature and the subsequent tendency of the system to lose pressure and efficiency, as well as the difficulty of cleaning this type of ductwork and its predisposition to bacterial proliferation. Thus, the copper duct type with rock wool insulation is the most suitable type for healthcare buildings. This came second overall environmentally (1.06 pt/m2), with values 2.83 times more favourable than the polyisocyanurate solution. Finally, the application of the life cycle assessment (LCA) methodology to HVAC ductwork was demonstrated to reduce the impact by up to 39.88%.

A Qualitative Study Exploring Perceptions of Pakistani Nurses about Nursing Workforce Migration: Analysis and Policy Implications

Background: The interaction of numerous factors leads to nurse migration. The poor national nurse production rate and the high incidence of migration of Pakistani-Educated nurses are the two main causes of Pakistan's extremely low nurse-to-patient ratio. Objective: This study intends to explore the perceptions of Pakistani nurses about the migration of the nursing workforce. Methods: This qualitative descriptive exploratory study used purposive sampling to conduct semi-structured interviews with three groups of Pakistani-educated nurses: those who have migrated, those who are working professionally and have established their careers in Pakistan, and those who are student nurses pursuing nursing education in Pakistan from January to April 2019. The interviews explored the nurses' perceptions of migration as a nursing workforce. Six analytical methodologies were used to analyse the forty-one IDIs that were performed. Results: Inductive analysis of qualitative data resulted in three main themes and nine sub-themes i.e. motivation for migration, contextual transition, and adaptation to the new environment. These themes were constructed from the image of nursing, work environment, scope of nursing, quality of life, beginning again, obscured individual identity, contrasting healthcare system, capacity building, acclimatization, and settling. Conclusion: We found that Pakistani-educated nurses are highly motivated to migrate. The most frequent causes of nurses' intention to migrate were wage disparities, political upheaval in Pakistan, working circumstances, lack of opportunities for professional development, active recruitment, and personal safety. The findings can inform the policy of professional organizations and government agencies to decrease the brain drain.

CONSTRUCTION SYSTEM SELECTION IN LOW-BED CAPACITY HEALTH BUILDINGS WITH FUZZY AHP IN EARTHQUAKE ZONES

Purpose: Reconstruction of health buildings that were heavily damaged after the earthquake has become an important issue in Turkey. The negative performance of the construction systems of health buildings after major earthquakes necessitates the evaluation of the building system (CS) options, which can create an alternative to the market, according to various criteria. The main purpose of the study is to develop a systematic basis for the CS of 1816 health institutions to be rebuilt within the scope of the UDSEP 2023 project and to decide between alternatives in Turkey. In this study, the example of a hospital with a low bed capacity (20 beds) was discussed. Method: In the application of the Methodology-Fuzzy Analytical Hierarchy Process (FAHP) method of the research, 40 expert opinions were taken at the stages of planning, construction and inspection of health buildings. Findings: Experts in various fields of the construction industry have determined that CS performance is the primary criterion and cost is the secondary criterion for healthcare buildings in high seismic hazard areas. Conclusion: Among the CS alternatives, Structural Steel Frame (SSF) was determined as the most suitable structural system for earthquake zones.

Effects of devolution on healthcare system performance in Machakos County Level 5 Hospital, Kenya

Background: Globally, there has been a trend of devolving services from the National governments to local governments in order to enhance efficiency, effectiveness, equity, responsiveness, and community participation at the grass root levels. This study evaluated the effects of devolution on healthcare system performance in Machakos Level 5 Hospital in Machakos County. Specifically, it evaluated the effects of devolution on healthcare systems performance on healthcare infrastructure, workforce adequacy and workforce satisfaction.Methods: Descriptive cross-sectional study design was used, with mixed methods of data collection of data collection (quantitative and qualitative).Results: The analyzed results revealed that healthcare infrastructure, workforce adequacy and workforce satisfaction improved post devolution period to a great extent. From the inferential statistics analysis, there was a significant improvement in all the three objectives post devolution i.e., p<0.05.Conclusions: Devolution of healthcare system improved the performance of Machakos County Level 5 Hospital. Recommendations were made to roll out the UHC program countrywide, equip all departments, employ more staff, enforce the referral system, similar study be conducted in other county referral hospitals, and similar study be conducted with a focus on other healthcare building blocks.

Construction of Healthcare Facilities Using Energy Efficient Technologies

Introduction. According to the Low-Carbon Development Strategy of the Russian Federation 2050, the special attention is allocated to cities, to evaluation of the quality and comfort of population life-activity, taking into account the implementation of energy-saving measures and other technological solutions, as well as to design and construction ensuring zero carbon dioxide emissions. The quality of people’s life is characterized by the availability of social infrastructure and adjacent spaces including: educational and healthcare institutions, as well as sports, recreation and cultural facilities. Planning the optimal development of healthcare institutions network with respect to the energy efficient measures, requires the integral system of urban territory evaluation, which is the main aim of the present study.Materials and methods. A complex task requires a multifaceted approach to systematizing the information about the state of urban territory in the following spheres: energy efficiency, green technologies, healthcare facilities network and its condition, development and character of the urban territory, environmental stability etc. In the context of low-carbon development the optimization of the healthcare network provided the use of energy-saving technologies becomes possible thanks to the use of the geographic information system.Results. As a result of the study held with application of the systemic approach to the phased planning of the healthcare institutions network optimization and using the geographic information system as a tool for territorial and spatial analysis, there were identified the main districts that require expansion and development of social infrastructure, namely healthcare institutions, and the urban territory features — infrastructure indicators (transport) and comfort of living indicators (urban greening evaluation). The basic opportunities and ways to improve energy efficiency of healthcare buildings were determined.Discussion and Conclusions. The long-term development of the healthcare institutions network in the city is fulfilled by means of the phased planning method implicating the differentiated normative-target approach, multi-criteria evaluation, which allows to organise sufficient medical care under conditions of the specific residing system. The implementation of the information modeling technologies, green and energy saving technologies will ensure improvement of the comfort of staying level, reduce energy consumption and ease the load on the municipal infrastructure of the city.

Control measure implications of COVID-19 infection in healthcare facilities reconsidered from human physiological and engineering aspects.

The Wells-Riley model invokes human physiological and engineering parameters to successfully treat airborne transmission of infectious diseases. Applications of this model would have high potentiality on evaluating policy actions and interventions intended to improve public safety efforts on preventing the spread of COVID-19 in an enclosed space. Here, we constructed the interaction relationships among basic reproduction number (R0) - exposure time - indoor population number by using the Wells-Riley model to provide a robust means to assist in planning containment efforts. We quantified SARS-CoV-2 changes in a case study of two Wuhan (Fangcang and Renmin) hospitals. We conducted similar approach to develop control measures in various hospital functional units by taking all accountable factors. We showed that inhalation rates of individuals proved crucial for influencing the transmissibility of SARS-CoV-2, followed by air supply rate and exposure time. We suggest a minimum air change per hour (ACH) of 7h-1 would be at least appropriate with current room volume requirements in healthcare buildings when indoor population number is < 10 and exposure time is < 1h with one infector and low activity levels being considered. However, higher ACH (> 16h-1) with optimal arranged-exposure time/people and high-efficiency air filters would be suggested if more infectors or higher activity levels are presented. Our models lay out a practical metric for evaluating the efficacy of control measures on COVID-19 infection in built environments. Our case studies further indicate that the Wells-Riley model provides a predictive and mechanistic basis for empirical COVID-19 impact reduction planning and gives a framework to treat highly transmissible but mechanically heterogeneous airborne SARS-CoV-2.

Energy Saving Opportunities through Glazing and Shading Alternatives

Windows are the weakest elements due to their high heat transfer coefficient and are responsible for 60% energy heat/gain loss. Healthcare buildings are one of the biggest consumers of energy due to continuous occupation hours and medical requirements, providing comfortable conditions for people in need of care and staff; yet recently less attention was given to healthcare buildings due to their unique operational requirements and advanced medical equipment. Thus, the main purpose of this study was to evaluate energy saving potentials of windows through glazing and shading alternatives over a case study. Within this study, a single patient room in Izmir Turkey has been chosen as a case study, and the room was simulated for sixteen scenarios generated by using four different glazing and shading systems. Each design scenario was simulated using DALEC for their lighting, heating, cooling, and total energy consumption. Results showed that lighting energy consumption constitutes the highest energy demand (up to 52%) and high transmitting glazing usage can reduce lighting loads. Finally, up to 16.3%, energy saving is possible only by changing shading and glazing types. Though there is a great diversity of glazing and shading types, this study’s outputs only reflect the selected four glazing and four shading system types that are offered by DALEC. Healthcare buildings spend a vast amount of energy to provide thermal and visual comfort for various user profiles. Considering the large number of patient rooms in healthcare facilities, only careful consideration of glazing or shadings can significantly contribute to energy savings. This study focuses on shading and glazing alternatives as an energy-saving strategy. For simulation, an underrecognized BES tool DALEC was hyped to show integrated thermal and visual energy consumption. The findings highlight that energy savings of up to 16.3% is possible.

BIM-based big data analytic system for healthcare facility management

Facility management (FM) is the costliest stage in the building lifecycle of healthcare buildings. Building Information Modeling (BIM) has potential solution to enable information management for healthcare FM. However, BIM is not used at FM due to its static nature, while healthcare FM requires dynamic information handling. The FM systems in practice and literature require either implementation of WebGL-HTML5 applications that necessitates coding knowledge for updates or data analysis. Therefore, this paper aims to develop a healthcare FM system based on Big Data Analytic (BDA), BIM and Not only SQL (NoSQL) database to enable FM information query and FM-KPI (Key Performance Indicator) visualization. The proposed system is developed through Design Science Research methodology. Findings show that the system is effective and practical to perform FM data retrival and analysis by practioners in healthcare facilities management effectively.

Analysis of Sustainability Assessment Rating Systems for Existing Healthcare Buildings

Sustainability is the goal pursued by societies worldwide. Existing buildings have had their share of those issues, specifically healthcare buildings, as most governments encourage green new construction and neglect existing buildings. Additionally, the benefits of existing buildings in preserving the environment, and its resources and reducing energy and global warming crises. The research objective is to achieve a high-level performance of existing healthcare buildings within a framework of evaluating the most important determinants affecting these buildings.The paper will focus on presenting the different rating systems such as LEED and BREEAM, by dividing and analyzing these systems, given that each system has its own standards and how it scores evaluation points. As the rating systems help in improving the existing healthcare buildings and get low-negative environmental impacts; they will reduce pollution, reduce carbon emissions, choose non-polluting and sustainable materials, encourage the use of recycled materials, and control waste management.The paper presents an approach to find out which rating system will evaluate green existing healthcare.

Capabilities of rule representations for automated compliance checking in healthcare buildings

A suitable rule representation is essential to enable automated compliance checking of building design. It encapsulates engineering knowledge and facilitates an adequate interpretation of design standards. However, existing methods have achieved limited capabilities to represent rules for automated compliance checking. Thus, they merely worked for limited types of rules. This paper aims to identify capabilities needed for rule representation by using healthcare design regulations as an example. It can serve as a foundation for developing rule engines and compliance-checking systems in the future. A four-step process was used to systematically analyse six healthcare building regulations in rule-oriented and implementation aspects. The results showed 18 capabilities for healthcare rule representation, where 16 are required, and two are desirable. This research is valuable to researchers and practitioners by providing a checklist for future representation development and criteria for assessing rule representation methods.

Life Cycle Assessment of Energy Retrofit Measures in Existing Healthcare Facility Buildings: The case of Developing Countries

Although retrofitting existing buildings is an important step toward sustainability, most research have concentrated on the sustainability of new structures. Existing buildings retrofit is being questioned, particularly in terms of selecting the optimal solution. Additionally, thermal comfort is crucial for patient satisfaction in healthcare facilities, but enhancing this factor increases energy use. However, envelope retrofitting of healthcare facilities buildings stock provides a high potential for energy savings. Consequently, this study aims to develop envelope retrofitting guidelines for uninsulated healthcare buildings in Jordan and to propose locally available retrofit measures. The difference in the building performance before and after retrofit is used to assess potential energy savings. Next, this outcome is used in a life cycle assessment (LCA) to examine the economic and environmental feasibility of the proposed retrofit measures using life cycle cost and life cycle CO2. This procedure combines the best economic and environmental measures available to create a comprehensive retrofit strategy. Thus, this study adopts a mixed-method design combining quantitative and qualitative methods, including physical analysis, national archives, and questionnaires. The results show that all proposed measures are economically and environmentally feasible, and the combination of two or more measures could produce up to 33% energy savings. Finally, the holistic approach strategy is investigated with various healthcare facilities’ life cycle.