Assessment of ventilation in low-resource healthcare settings: Montserrado County, Liberia—2022−2023

Krithika Srinivasan, Ronan Arthur, Ashley Styczynski, Ethan Bell, Thomas Baer, Jorge Salinas
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Abstract

Background: Mitigating the risk of nosocomial respiratory disease transmission in the healthcare facilities of low- and middle−income countries (LMICs) poses unique challenges because mechanical ventilation and mixed−mode strategies are often unavailable. Carbon dioxide (CO 2 ) can serve as a proxy for ventilation and, hence, airborne infectious disease transmission risk in naturally ventilated spaces. We assessed the adequacy of ventilation in Liberian hospitals. Methods: We sampled 3 hospitals, both urban and rural, in Montserrado County, Liberia. Moreover, 3 CO 2 meters were concurrently utilized to measure CO 2 levels at a 1-meter height in every patient-care room in each facility. We recorded temperature, humidity, room dimensions, and number of people in the rooms. From these variables, we calculated absolute ventilation using the ASHRAE equation to determine areas with the highest risk of nosocomial respiratory disease transmission. We also recorded qualitative observations about the sampled spaces. Results: From August 2022 to February 2023, 39 rooms in 3 healthcare facilities were sampled. Initial quantitative findings show that only 8 rooms (21%) met the WHO-recommended ventilation rate of 60 L per second per person. The average ventilation rate per person in the adequately ventilated settings was 86 L per second per patient, compared to 19 liters per second per patient in inadequately ventilated rooms. Additionally, 467 ppm mean CO 2 was noted in well-ventilated rooms compared to 895 ppm mean CO 2 in inadequately ventilated rooms. Initial qualitative observations showed that facilities with lower CO 2 readings tended to be older constructions that likely had been constructed with airborne disease such as tuberculosis in mind. Willingness to open windows was limited by lack of window screens for malaria prevention, and there was a pervasive fallacy that air conditioning was a source of ventilation. Correspondingly, of the 31 inadequately ventilated rooms, 22 (71%) had operating air conditioning units compared with 4 (50%) of the 8 adequately ventilated rooms. Overall, of the 13 rooms without air conditioning, 7 (54%) were more frequently characterized by open windows compared to only 5 of 26 (28%) of rooms that did have air conditioners. Conclusions: Being prepared for the next respiratory disease outbreak and creating more resilient healthcare systems in LMICs requires a frameshift of prevention strategies. Measuring CO 2 provides a simple strategy for identifying areas at highest risk for nosocomial respiratory disease transmission, which can be prioritized for low-cost environmental interventions, such as provision of window screens, as part of routine infection prevention and control efforts. Disclosure: None
低资源医疗环境中通气评估:利比里亚蒙特塞拉多县- 2022 - 2023
背景:在低收入和中等收入国家(LMICs)的医疗机构中,降低医院内呼吸道疾病传播的风险面临着独特的挑战,因为机械通气和混合模式策略往往不可用。二氧化碳(CO 2)可以作为通风的代表,因此,在自然通风的空间中,空气传播的传染病的风险。我们评估了利比里亚医院的通风条件是否充足。方法:对利比里亚蒙特塞拉多县的3家城乡医院进行抽样调查。此外,同时利用3个co2米来测量每个设施中每个病房1米高度的co2水平。我们记录了温度、湿度、房间尺寸和房间里的人数。从这些变量中,我们使用ASHRAE方程计算绝对通气,以确定院内呼吸疾病传播风险最高的区域。我们还记录了对采样空间的定性观察。结果:从2022年8月至2023年2月,对3家医疗机构的39间病房进行了抽样调查。初步定量调查结果显示,只有8个房间(21%)达到世卫组织建议的每人每秒60升的通风量。在通风良好的环境中,每位患者的平均通风量为每秒86升,而在通风不良的房间中,每位患者的平均通风量为每秒19升。此外,在通风良好的房间中,二氧化碳的平均浓度为467 ppm,而在通风不良的房间中,二氧化碳的平均浓度为895 ppm。最初的定性观察表明,二氧化碳读数较低的设施往往是较旧的建筑,可能在建造时考虑到了肺结核等空气传播疾病。由于缺乏预防疟疾的纱窗,人们打开窗户的意愿受到限制,而且普遍存在一种谬论,认为空调是通风的来源。相应地,在31间通风不佳的房间中,22间(71%)有空调装置,而在8间通风良好的房间中,只有4间(50%)有空调装置。总体而言,在13个没有空调的房间中,有7个(54%)更频繁地打开窗户,而26个有空调的房间中只有5个(28%)更频繁地打开窗户。结论:为下一次呼吸道疾病暴发做好准备,并在中低收入国家建立更具弹性的卫生保健系统,需要转变预防战略。测量CO 2提供了一种简单的策略,用于确定院内呼吸疾病传播风险最高的地区,可优先采用低成本环境干预措施,例如提供纱窗,作为常规感染预防和控制工作的一部分。披露:没有
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