Indoor Air Quality

March 10, 2017 | Healthcare Risk, Quality, & Safety Guidance

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Indoor air quality is not typically within the purview of the risk manager; rather it may fall within the responsibilities of environmental health and safety or facilities management. Nonetheless, good-quality indoor air can affect several domains of enterprise risk management, including patient safety and satisfaction, human capital, legal and regulatory, financial, and hazard risks. Air contaminants such as viruses, bacteria, and spores can exacerbate a patient's current condition, cause illness, or even lead to death in highly vulnerable patients (Mills and Moeller). Poor-quality indoor air can also make workers ill, increase absenteeism, cause job dissatisfaction, and even lead to workers' compensations claims. (For more information, see the guidance article Enterprise Risk Management: An Overview. )

Indoor air quality is affected not only by indoor air pollutants—whether physical (e.g., nonbiologic particulate matter), chemical, or biologic (which, in addition to bacteria and viruses, include dust mites, microscopic protozoa, pollen, and other biologically based materials)—but also by a variety of other aspects of the indoor environment. Temperature, humidity, odors, and carbon dioxide levels can all affect the safety and comfort of a building's occupants (U.S. EPA). See Factors that Affect Indoor Air Quality and Effects on Patients for more examples.

Enterprise Risk Management: An Overview

How an individual perceives the quality of the air in an indoor space is somewhat subjective. Some people are more tolerant of heat or humidity than others, while some may have allergic reactions to dust or fragrances. Nonetheless, the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) has defined acceptable indoor air quality as "air in which there are no known contaminants at harmful concentrations . . . and with which a substantial majority (80% or more) of the people exposed do not express dissatisfaction" (ASHRAE standard 62.1-2016). Even this seemingly precise definition contains a subjective component—namely, that people must be "dissatisfied."

As a result of the first energy crisis in the 1970s, commercial buildings are now constructed more tightly than in the past: windows are often sealed shut, walls are insulated, and doors and roofs provide barriers to the weather and extreme temperatures. Outside air does not easily get inside, nor does inside air get out (Heinkel). This means buildings are more energy efficient, but it also means that they require an HVAC system to mix outdoor...

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