Humidification in healthcare facilities - knowledge base and practice

Abstract

Humidification is not a common procedure in many buildings in the Netherlands. An exception are buildings used for healthcare, especially hospitals. There, e.g. in operating theatres, relative humidity (RH) generally is controlled stringently at levels around 50%. From an energy point-of-view humidification is an energy-intensive activity. Currently, more than 10% of the total energy used in healthcare buildings is spent on humidification. The basis for an RH of around 50%, however, is not clear. Therefore, we pursued a scoping review to find evidence for specific RH thresholds in such facilities. In addition, an inventory was made of the current practice in the Netherlands. After analyzing the title and abstracts, the remaining references were read by two persons and scored on several topics. Guidelines and current practice were analyzed by referring to existing (inter)national guidelines and standards, and by contacting experts from Dutch hospitals through a survey and semi-structured interviews. Outcomes from the literature review were grouped into four different topics: 1) micro-organisms and viruses, 2) medical devices, 3) human physiology and 4) perception. No scientific evidence was found for the currently generally applied RH set-point of ~50%. Some studies suggest a minimum RH of 30% but the evidence is weak, with exception of medical devices if specifications require it. A lack of research that addresses more long-term exposure (a couple of days) and includes frail subjects, is noted. It was found that RH requirements are strictly followed in all hospitals consulted, some only focusing on the hot zones, but in many cases extended to the whole hospital. Steam humidification is mostly applied for hygienic reasons. but is quite energy-intensive. The conclusion t is that there is no solid evidence to support the RH-setpoints as currently applied in the Netherlands. It merely appears a code of practice. Therefore, there appears room for quick and significant energy savings, and CO2 emission reductions, when considering control at lower RH values or refraining from humidification at all, while still fulfilling the indoor environment requirements and not negatively influencing the health risk. This outcome can be applied directly in current practice with the available techniques.