Identification of hazards for human health under chemical pollution in air inside in-patient hospitals
A.G. Malysheva, N.V. Kalinina
Centre for Strategic Planning and Management of Biomedical Health Risks, 10 Pogodinskaya St., build. 1, Moscow, 119121, Russian Federation
Use of various physical and chemical research techniques, including chromato-mass-spectrometry, made it possible to identify and quantify more than 40 organic compounds in air inside healthcare organizations, including saturated, unsaturated, cyclic, and aromatic hydrocarbons; terpenes, alcohols, aldehydes, esters, ketones, halogen-containing compounds, and organic acids. Levels of ethanol, dichloromethane, carbon tetrachloride, ethyl acetate, propyl acetate, acetone, terpene hydrocarbons, and acetic acid made the main contribution to the total content of all identified compounds. Most detected substances were present in concentrations not exceeding hygienic standards, except for chloroform and iodoform, the levels of which were up to 2 times higher than average daily MPL in intensive care wards and a bronchoscopy room. Organic acids and chlorinated organic compounds were found in elevated concentrations compared with insides of non-medical public buildings. Among the wide list of identified substances, hygienic standards have not been established for more than 70% of compounds and it is not possible to give a hygienic assessment of hazards or safety of their presence in air inside healthcare facilities. Despite that, the information obtained in this study is extremely useful for accomplishing an important stage in health risk analysis, which is identification of hazards for health of patients and healthcare workers posed by chemical air pollution inside healthcare organizations when using the risk analysis methodology.
In this study, we assessed effects produced by operations of UV recirculator irradiators for air disinfection on its chemical composition inside healthcare institutions. The assessment showed that when such devices worked in the presence of patients and staff, there was an increase in the amount of pollutants in air and their total concentration grew from two to more than four times.
When analyzing risks for health of staff and patients, hazard identification within risk-based control of chemical air pollution in the hospital environment should include monitoring of formaldehyde, styrene, ammonia, ethanol, isopropanol, chloroform, dichloroethane, acetic acid along with identification of a wide range of volatile organic compounds; it should also cover ammonia as one of the priority pollutants occurring in the environment from human excretory products.
- Izmerov N.F. Trud i zdorov'e medikov: aktovaya Erismanovskaya lektsiya [Work and health of physicians: assembly Erisman lecture]. Moscow, Real'noe vremya Publ., 2005, 40 p. (in Russian).
- Shcherbo A.P., Andreeva O.M., Belkin A.S., Vetkina I.F., German A.M., Gurevich K.Ya., Zhelez¬nyak E.S., Zhidkov K.P. [et al.]. Bol'nichnaya gigiena [Hospital hygiene]: monograph. St. Petersburg, Mechnikov North-West State Medical University Publ., 2000, 489 p. (in Russian).
- Fedina N.V. A problem of physicians' occupational risk and quality of life. Zdravookhranenie Rossiiskoi Federatsii, 2008, no. 6, pp. 27–30 (in Russian).
- Znamenskii A.V. Gospital'naya gigiena: sanitarno-epidemiologicheskie trebovaniya k ustroistvu i ekspluatatsii lechebno-profilakticheskikh uchrezhdenii [Hospital hygiene: sanitary and epidemiological requirements for the organization and operation of medical and preventive institutions]. St. Petersburg, Foliant Publ., 2004, 240 p. (in Russian).
- Ziatdinov V.B., Badamshina G.G., Bakirov A.B., Zaripova A.Z., Isayeva G.Sh., Karimov D.O. Microbiological monitoring of the air environment in medical institutions. Meditsina truda i ekologiya cheloveka, 2016, no. 4 (8), pp. 86–90 (in Russian).
- Dubel E.V., Unguryanu T.N. Hygienic assessment of working conditions for medical personnel in clinical and paraclinical departments of the hospital. Gigiena i sanitariya, 2016, vol. 95, no. 1, pp. 53–57. DOI: 10.18821/0016-99002016-95-1-53-57 (in Russian).
- Kataeva V.A., Kozhevnikova N.G., Meshcheryakov D.G., Chuyanov Yu.V. Professional risk factors, health condition and preventive measures in the work of dentists. Endodontiya Today, 2016, vol. 14, no. 4, pp. 64–67 (in Russian).
- Rusakov N.V., Kalinina N.V., Gaponova E.B., Goshin M.E., Banin I.M. Hygienic assessment
of the complex of physical and chemical factors affecting a person in rooms of the different purpose in in-patients medical institutions. Gigiena i sanitariya, 2021, vol. 100, no. 6, pp. 546–554. DOI: 10.47470/0016-9900-2021-100-6-546-554 (in Russian). - Malysheva A.G., Kalinina N.V., Yudin S.M. Chemical air pollution in dwelling as a health risk factor. Health Risk Analysis, 2022, no. 3, pp. 72–82. DOI: 10.21668/health.risk/2022.3.06.eng
- Budovich V.L., Polotnyuk E.B. Measuring total volatile organic compounds in indoor air. Khimicheskaya bezopasnost', 2019, vol. 3, no. 1, pp. 7–27. DOI: 10.25514/CHS.2019.1.15000 (in Russian).
- Renz A.I. Measurement of the concentration of volatile organic compounds as a criterion for assessing the environmental safety of the indoor environment. Ekologiya urbanizirovannykh territorii, 2020, no. 4, pp. 58–62. DOI: 10.24412/1816-1863-2020-4-58-62 (in Russian).
- Weschler C.J. Changes in indoor pollutants since the 1950s. Atmospheric environment, 2009, vol. 43, no. 1, pp. 153–169. DOI: 10.1016/j.atmosenv.2008.09.044
- Holøs S.B., Yang A., Lind M., Thunshelle K., Schild P.G., Mysen M. VOC emission rates in newly built and renovated buildings, and the influence of ventilation–a review and meta-analysis. The International Journal of Ventilation, 2018, vol. 18, no. 3, pp. 153–166. DOI: 10.1080/14733315.2018.1435026
- Abdul-Wahab S.A., Fah En S.C., Elkamel A., Ahmadi L., Yetilmezsoy K. A review of standards and guidelines set by international bodies for the parameters of indoor air quality. Atmospheric Pollution Research, 2015, vol. 6, no. 5, pp. 751–767. DOI: 10.5094/APR.2015.084
- Chen Y.-Y., Sung F.-C., Chen M.-L., Chen M.-L., Mao I.-F., Lu C.-Y. Indoor air quality in the metro system in north Taiwan. Int. J. Environ. Res. Public Health, 2016, vol. 13, no. 12, pp. 1200. DOI: 10.3390/ijerph13121200
- Ministry of Health, Labour and Welfare. Committee on Sick House Syndrome: Indoor Air Pollution Progress Report No. 21. Japan, 2000.
- Mečiarová L., Vilčeková S., Krídlová Burdová E., Kiselák J. Factors affecting the total volatile organic compound (TVOC) concentrations in Slovak households. Int. J. Environ. Res. Public Health, 2017, vol. 14, no. 12, pp. 1443. DOI: 10.3390/ijerph14121443
- Bai Z., Wang Z., Zhu T., Zhang J. Developing indoor air quality related standards in China. Journal of Asian Architecture and Building Engineering, 2003, vol. 2, no. 1, pp. 55–60. DOI: 10.3130/jaabe.2.55
- Novikova S.I., Prokopenko A.A. Distribution of germicidal UV radiation in relation to the type of emitters and technology of application. Problemy veterinarnoi sanitarii, gigieny i ecologii, 2016, no. 2 (18), pp. 58–62 (in Russian).
- Rakhmanin Yu.A., Kalinina N.V., Gaponova E.B., Zagainova A.V., Nedachin A.E., Doskina T.V. Hygienic assessment of the safety and efficiency of using ultraviolet plants of the closed type for disinfection of the air environment in the rooms of inpatients facilities. Gigiena i sanitariya, 2019, vol. 98, no. 8, pp. 804–810. DOI: 10.18821/0016-9900-2019-98-8-804-810 (in Russian).
- Vasserman A.L., Shandala, M.G., Yuzbashev V.G. Primenenie ul'trafioletovogo izlucheniya dlya obezzarazhivaniya vozdukha v lechebnykh palatakh v ryadu meropriyatii po profilaktike vnutribol'nichnykh infektsii [Use of ultraviolet radiation for air disinfection in medical wards within measures for prevention of nosocomial infections]. Poliklinika, 2013, no. 6, pp. 74–76 (in Russian).
- Malysheva A.G., Yudin S.M. Transformation of chemicals in the environment as an unaccounted danger factor for public health. Khimicheskaya bezopasnost', 2019, vol. 3, no. 2, pp. 45–66. DOI: 10.25514/CHS.2019.2.16005 (in Russian).
- Zaitseva N.V., May I.V., Shur P.Z. Analiz riska zdorov'yu naseleniya na sovremennom etape [Analysis of population health risk at present]. Zdravookhranenie Rossiiskoi Federatsii, 2013, no. 2, pp. 20–24 (in Russian).
- Mironenko O.V., Kiselev A.V., Noskov S.N., Pan’kin A.V., Magomedov Kh.K., Shengelia Z.N., Myakisheva S.N. Prognosis of morbidity and health risk assessment during hygienic research associated with of chemical impact. Vestnik SPbSU. Medicine, 2017, vol. 12, no. 4, pp. 419–428. DOI: 10.21638/11701/spbu11.2017.410 (in Russian).
- Nekhoroshev A.S., Zakharov A.P., Danilova N.B. Methodical problems of the risk level evaluation in stomatologists resulting from environment chemical pollution. Vestnik Sankt-Peterburgskoi gosudarstvennoi meditsinskoi akademii im. I.I. Mechnikova, 2005, no. 3, pp. 117–120 (in Russian).