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Effective of Ventilation System in Healthcare Facilities During Handling with

Pandemic COVID-19 in Egypt Effective of Ventilation System in Healthcare
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 Effective of Ventilation System in Healthcare Facilities
During Handling with Pandemic COVID-19 in Egypt
Eng. Ahmed Elsayed Abdul Salam
* NFPA Healthcare Facilities, Medical Gas Specialist ASSE 6005,
Lead Auditor ISO 45001, NIOSH, Hazopwer, ITM NFPA72*

Keywords: -. Air Ventilation System; Egypt Healthcare Facility; Ventilation; AC System Date:17 April 2020

Abstract
This study is to evaluate effectiveness of air ventilation systems in Egypt hospitals during the COVID - 19 and showing the factors of
the transmission of COVID – 19 in hospitals through ventilation systems, the study and data collection was conducted by google
questionnaire in Egypt that used typical and different type of air conditioning system. The result showed that the effectiveness of air
ventilation systems depends on installation of the typical air ventilation system to evaluate the risk of transmission of infection in
hospitals thru ventilation systems.

Introduction

Egypt is one of the largest countries in the African continent in
terms of population and area effectiveness of air ventilation
systems are a significant issue in health care. Airborne organisms
common in the environment can cause a serious threat to a
patient who is immune-compromised. Patient ill with a
respiratory infection can spread dangerous microbes to other
patients, staff, and visitors. Air pollution, both indoor and
outdoor, is often considered the major cause of environmental
health problems. Indoor ventilation with good air quality control
minimizes the spread of airborne respiratory and other infections
in hospitals. This article considers the role of ventilation in
preventing and controlling infection in hospital general wards
and isolation rooms. Also show the related aerodynamic,
temperature, relevant humidity of COVID 19.
The American Society of Heating, Refrigerating and Air
Conditioning Engineers (ASHRAE) has realized the significance
of properly designed ventilation systems to maintain clean
conditions in Healthcare premises and the organization has
prepared design guidance published in 2017 ASHRAE-170 that
provides detailed technical information on design to avoid
nosocomial infections The importance of air Ventilation System
is very critical in hospital and healthcare facilities.
Hospital air conditioning assumes a more important role than just
the promotion of comfort, is to protect all healthcare practitioner
and who's visiting the hospital with the standard we can reduce
the transmission of the airborne diseases like COVID -19 and
other diseases Hospitals in Egypt have different types of air
conditioning system. individual air conditioning, ducted split
unit, package unit and chiller system. However, the relatively
high cost of air conditioning has led to inadequate and
improperly designed system with not enough care to factor in
specific requirements for ventilation, filtration and cross
contamination. Therefore this study conducted to evaluate the air
Ventilation System in during handling with pandemic COVID-19
in Egypt hospital with the different types of AC used.

Typical Air Ventilation System According to Heating, Refrigerating and Air Conditioning Engineers (ASHRAE)

The Typical Isolation Rooms (-V)

The rooms shall be at negative Pressure rooms shall be < −2.5 Pa (0.01″ water
gauge) with monitoring, Air change per hour >12 ACH with monitor and 100%
fresh air, The temperature in the normal range 18~24 C and humidity from
30%~60%. The Exhaust grill ceiling should be above head of the patient and air
supply should be in the entrance of room Anti-Room with neutral pressure,
Install HEPA filters for the rooms 99.97% efficient at 0.3 microns in Exhaust
line. See (Figure) A
Note: Variable Air Volume (VAV) system is highly recommend in isolation
rooms to control of the variable pressures that can occurred.
Variable Frequency Drives (VFD) system is highly recommend in isolation
rooms to control of the variable in the exhaust fan can occurred.
Air Change Per Hour (ACH) Calculate the room volume to be ventilated Width x
Length x Height = ft3(cubic feet).

(Figure) A

Effective of Ventilation System in Healthcare Facilities During Handling with Pandemic COVID-19 in Egypt

Page 1 of 6
 Exhaust Fan

Typical Exhaust for Isolation Rooms

A Outdoor Air Intakes
Figure (B) Showing that typical exhaust for Isolation rooms distance between
Exhaust fan and outdoor air intakes as part A 25 Ft (8m) to ensure that if there is
leakage of HEPA filter will not return into the area part E area has a clear distance
that shall be 3ft (1m) from the ground of the rooftop, also area part B shall be 10ft
(3M). B E
ROOFTOP

Relative Humidity Control Vs COVIED 19

Role of Meteorological (Figure) B Temperature and Relative Humidity
in The January-February 2020 Propagation of 2019-Ncov in Wuhan, China.
Long-term trend of temperature and relative humidity was obtained with a 14-days
adjacent-averaging filter, and lagged correlations of the number of daily confirmed
cases were explored. The analysis showed negative correlations between
temperatures with the number of daily confirmed cases. Maximum correlations
were found for 6-day lagged temperatures, which is likely reflecting the incubation
period of the virus. It was postulated that the indoor crowding effect is responsible
of the high incidence of 2019-nCoV cases, where low absolute humidity and close
human contact facilitate the transport of aerosol droplets.
Normal operating temperature set points should be maintained based on the
existing licensing requirements for the space use and occupancy. Consider
maintaining relative humidity between 40%-60% RH. ASHRAE Research Project
CO-RP-03 reports that scientific literature generally reflects the most unfavorable
survival for micro-organisms when the RH is between 40%-60%. See Figure (C).
(Figure) C
Aerodynamic Characteristics
Aerodynamic Characteristics and RNA Concentration of SARS-CoV-2 Aerosol in Wuhan Hospitals during COVID-19
Outbreak.

The aerosol deposition sample collected from the Renmin Hospital ICU room
had raw counts of SARS-CoV-2 RNA significantly above the detection limit as
shown in Table S1, although the TSP aerosol sample concentration inside this
ICU room was below detection limit during the 3-hour sampling period. The
much longer integration time of 7 days for the deposition sample has
contributed to the accumulation of virus sediment. The area normalized
deposition rate inside the ICU room is calculated to be 31 and 113 copies m−2
hour−1. The sample with the higher deposition rate was placed in the
hindrance-free corner of the room, approximately 3 meters from the patient’s
bed. The other sample recorded lower virus copies and it was placed in another
corner with medical equipment above, and approximately 2 meters from the
patient’s bed. This may have blocked the path of virus aerosol sediment.

Figure (E) shows the SARS-CoV-2 aerosol concentrations in different

aerodynamic size bins collected from PARRs in aerosol settling in still air as
Table (1) mean that a very small partical can lives more than 40 hours with red
zone in temperature and humidity.
# Particle (μm) Time
1. 100 μm 5.8 seconds
2. 10 μm 8.2 Minutes
3. 3μm 1.5 Hours
4. 1 μm 12 Hours
5. 0.5μm 41 Hours

Effective of Ventilation System in Healthcare Facilities During Handling with Pandemic COVID-19 in Egypt (Figure) E
Page 2 of 6
 Evaluation of Current Situation in Egypt Hospitals

The central agency for public mobilization and statistics

1157
showing that government hospitals decreasing about 488 1094
1146 1002 1017
1187 1179 941 927 926 920 937 941
hospitals between 2008 and 2009 compared in the private
664 679 686
sector that showing increasing 255 hospitals between 2008
658 660 657 659 660 662 676 691
643 646
and 2009, and continues to increase until 2018 has

recorded 1157 hospitals in the private sector and the chart

showing decreasing of MOH hospitals reached 691 in

2004 2006 2008 2010 2012 2014 2016 2018 2020
2018. MOH Private (Figure) F

Therefore, the total number of hospitals in the government sector is 10124 hospitals and the private sector is 11891

hospitals, then the total of these two sectors are 22015 during the 12 years, by average 1835 hospitals in the one year, both for the

private sector and the government together.

A Random Sample to Evaluate the Condition of Hospitals Air Ventilation System

More than 10 years more than 100 beds 155 More than 10 years more than 100 beds 24

More than 10 years less than 100 beds 20 More than 10 years less than 100 beds 12

Less 10 years more than 100 beds 33 Less 10 years more than 100 beds 6

Less than 100 beds less 10 years 8 Less than 100 beds less 10 years 4

0 50 100 150 200 0 5 10 15 20 25 30

Number of Isolation Rooms (Negative Pressure) (Figure) 1 Total Number of Hospitals Participating in the Questionnaire (Figure) 2

42%
46%
58%
54%

Yes
No
Yes No

%ventilation system in isolation rooms comply with international % Availability of plan to Improve indoor air quality during COVID 19
standards (Figure) 3 (Figure) 4

Effective of Ventilation System in Healthcare Facilities During Handling with Pandemic COVID-19 in Egypt

Page 3 of 6
 More than 10 years more than 100
beds
More than 10 years less than 100 beds 4
Less 10 years more than 100 beds 3
Less than 100 beds less 10 years 5
0 5 10
# Staff have been infected by COVID 19 (Figure) 5
Temperatures in Cairo & Alexandria (Figure) 7
Results
As per the Central Agency For Public Mobilization and
Statistics shown that Egypt have more than 22015 hospitals
during the 12 years since 2006 until 2018, by average 1835
hospitals in the one year, both for the private sector and the
government together and biggest number of the hospitals were
located in Cairo and Alexandria and as per the (figure 6,7) the
temperature and humidity are in the red zone as per ASHRAE
shown (figure C) that can keep good environment for COVID-
19 lives more, if hospitals Depend on natural ventilation that can
affect the medical supply and instrument Medication , dry store
rooms etc.
In (figure 2) shown total number of hospitals participating in the
questionnaire 46 with different age of establishment and beds
capacity in lining with availability of typical isolations rooms as
per ASHRAE 170-2017 and shown in (figure 1) was 216 rooms
Effective of Ventilation System in Healthcare Facilities During Handling with Pandemic COVID-19 in Egypt
16
15 20
% of Humidity in Alexandria (Figure) 6
, if looking for the average of 46 hospitals that participation it's
mean that in each hospitals have around 4~5 isolation rooms ,
also (figure 3) shown that number of isolation rooms was
comply with the international standard 58% of 46 hospitals was
not comply to standard and 42% was comply to standard it’s
mean that 58% of 22015 hospitals that established the
ventilations system in isolation rooms was not comply to
standard if we if the questionnaire is circulated, that can the
transferring the infection COVID-19 to the healthcare
practitioners as shown in (figure 5) that was 28 staff was
infected since 14 Feb 2020 sync with first and confirmed cases to
17 April 2020 from total cases 2,614 mean 1% of confirmed
cases. that mean when the total of the confirmed cases increasing
for example to 10,000 the medical staff will be more than 100
cases.
Page 4 of 6
 Recommendation

Since 2013, many epidemic diseases have appeared to 2020 1. UV is UV-C In-Duct Air Disinfection Requires high
that are transmitted by air, spray, or other methods, which UV doses to inactivate microorganisms on-the-fly as
require that countries be prepared for these epidemics and to they pass through the irradiated zone due to limited
rehabilitate hospitals to address these epidemics. Infectious exposure time.
aerosols can be disseminated through buildings by pathways  Systems typically designed for 500 fpm moving
that include air distribution systems and interzone airflows. airstream.
Various strategies have been found to be effective at  Minimum irradiance zone of two feet.
controlling transmission, including optimized airflow  Minimum UV exposure time of 0.25 second.
patterns, directional airflow, zone pressurization, dilution 2. Safe Maintenance practices for example (BIBO –DOP
ventilation, in-room air-cleaning systems, general exhaust test ets.).
ventilation, personalized ventilation, local exhaust ventilation 3. In general, disabling of heating, ventilating, and air-
at the source, central system filtration, UVGI,and controlling conditioning systems is not a recommended measure to
indoor temperature and relative humidity. Design engineers reduce the transmission of the virus.
can make an essential contribution to reducing infectious 4. As part of General Authority for Healthcare
aerosol transmission through the application of these Accreditation and Regulation GAHAR is to enhance
strategies. Research on the role of airborne dissemination and hospitals facilities to ensure safe environment for staff,
resuspension from surfaces in pathogen transmission is visitors and paint one of this mission is to provide a
rapidly evolving. Managing indoor air to control distribution clear standard for typical isolation rooms, for
of infectious aerosols is an effective intervention which adds establishing new hospitals as Infrastructure guideline,
another strategy to medical treatments and behavioral also old hospital shall have a clear future action plan
interventions in disease prevention. dated.
As shown in (Figure 4) 54 % of Hospitals has no plan to
Improve indoor air quality during COVID 19 we recommend
to improve the indoor air quality during the COVID 19:

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