The purpose of this multi–method study was to compare indoor environmental quality (IEQ) of patient rooms and the effects on safety, satisfaction, and quality of care. Objective analysis of IEQ included temperature, relative humidity (RH), CO2, and TVOCs. Healthcare staff and patients were asked to complete surveys. A behavior mapping study focused on length of time healthcare staff and visitors spent with patients in their rooms. All statistical tests were conducted with an α level of .05. Results indicated that IEQ was compromised by low RH and high temperatures; and bacterial counts in the air were higher in rooms with vinyl flooring. Patients were more satisfied with their experience; less likely to be assigned at risk for falling; and contributed to social support with visitors spending more time with patients in rooms with carpet tile. This comparative study indicates that the indoor environment contributes to quality of care, patient satisfaction, and safety in patient rooms.
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References
1.
AHRQ (2008). Patient safety and quality: An evidence–based handbook for nurses. Rockville, MD: AHRQ.
2.
Al–EisawiK. W., KerkC. J., CongletonJ. J., AmendolaA. A., JenkinsO. C., & GainesW. (1999). Factors affecting minimum push and pull forces of manual carts. Applied Ergonomics, 30(3), 235–245.
3.
AlexandreN., & BenattiM. (1998). Occupational accidents involving the spine: Study on nurses at a university hospital. Revista Latino–Americana de Enfermagem, 6(2), 65–72.
4.
AllenE. (1995). How buildings work: The natural order of architecture (2nd ed.). New York: Oxford University Press.
5.
AndersenB. M., RaschM., KvistJ., TollefsenT., LukkassenR., SandvikL., . (2009). Floor cleaning: Effect on bacteria and organic materials in hospital rooms. Journal of Hospital Infection, 71(1), 57–65. doi: 10.1016/j.jhin.2008.09.014.
6.
AndersonR. L., MackelD. C., StolerB. S., & MallisonG. F. (1982). Carpeting in hospitals: An epidemiological evaluation. Journal of Clinical Microbiology, 15(3), 408–415.
7.
ArundelA. V., SterlingE. M., BigginJ. H., & SterlingT. D. (1986). Indirect health effects of relative humidity in indoor environments. Environmental Health Perspectives, 65, 351–361.
8.
ASHRAE. (2013). Ventilation and Acceptable Indoor Air Quality. ANSI/ASHRAE Standard 62.2–2013. Washington, DC: ASHRAE.
9.
BarbutF., MenuetD., VerachtenM., & GirouE. (2009). Comparison of the efficacy of a hydrogen peroxide dry–mist disinfection system and sodium hypochlorite solution for eradication of Clostridium difficile spores. Infection Control And Hospital Epidemiology, 30(6), 507–514.
10.
BayoM. V., GarciaA. M., & GarciaA. (1995). Noise levels in an urban hospital and workers’ subjective responses. Archives of Environment Health, 50(3), 247–251.
BellJ. L., CollinsJ. W., WolfL., GronqvistR., ChiouS., ChangW. R., . (2008). Evaluation of a comprehensive slip, trip and fall prevention programme for hospital employees. Ergonomics, 51(12), 1906–1925. doi: 10.1080/00140130802248092.
13.
BelojevicG., JakovljevicB., & SlepcevicV. (2003). Noise and mental performance: Personality attributes and noise sensitivity. Noise & Health, 6(21), 77–89.
14.
BerryL. L., & ParishJ. T. (2008). The impact of facility improvements on hospital nurses. HERD, 1(2), 5–13.
15.
BimanD., WimpeeJ., & BijonD. (2002). Ergonomics evaluation and redesign of a hospital meal cart. Applied Ergonomics, 33(4), 309–318.
16.
BlomkvistV., EriksenC. A., TheorellT., UlrichR., & RasmanisG. (2005). Acoustics and psychosocial environment in intensive coronary care. Occupational and Environmental Medicine, 62(3), e1. doi: 10.1136/oem.2004.017632.
17.
BuxtonO. M., EllenbogenJ. M., WeiW., CarballeiraA., O'ConnorS., CooperD., . (2012). Sleep disruption due to hospital noises. Annals of Internal Medicine, 157(3), 170–179.
18.
CarlingP. C. (2008). Evaluating the thoroughness of environmental cleaning in hospitals. Journal of Hospital Infection, 68(3), 273–274.
19.
CarlingP. C., ParryM. F., & Von BeherenS. M. (2008). Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals. Infection Control and Hospital Epidemiology, 29(1), 1–7.
20.
CarlingP. C., Von BeherenS., KimP., & WoodsC. (2008). Intensive care unit environmental cleaning: An evaluation in sixteen hospitals using a novel assessment tool. Journal of Hospital Infection, 68(1), 39–44.
ChamR., & RedfernM. S. (2001). Effect of flooring on standing comfort and fatigue. Human Factors, 43(3), 381–391.
23.
ChaudhuryH., MahmoodA., & ValenteM. (2005). Advantages and disadvantages of single– versus multiple–occupancy rooms in acute care environments: A review and analysis of the literature. Environment & Behavior, 37(6), 760–786. doi: 10.1177/0013916504272658.
24.
CurtisL., CaliS., ConroyL., BakerK., OuC. H., HershowR., . (2005). Aspergillus surveillance project at a large tertiary–care hospital. Journal of Hospital Infection, 59(3), 188–196. doi: 10.1016/j.jhin.2004.05.017.
25.
DancerS. J. (2009). The role of environmental cleaning in the control of hospital–acquired infection. Journal of Hospital Infection, 73(4), 378–385. doi: 10.1016/j.jhin.2009.03.030.
26.
DavidsonJ. E., PowersK., HedayatK. M., TieszenM., KonA. A., ShepardE., . (2007). Clinical practice guidelines for support of the family in the patient–centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005. Critical Care Medicine, 35(2), 605–622. doi: 10.1097/01.ccm.0000254067.14607.eb.
27.
De LorenziS., FinziG., ParmiggianiR., CuginiP., CacciariP., & SalvatorelliG. (2006). Comparison of floor sanitation methods. Journal of Hospital Infection, 62(3), 346–348. doi: 10.1016/j.jhin.2005.09.021.
28.
DetkeL. A., HarrisD. D., & ParticiniC. A. (2013). Hospital facility design's influence on health care workers. The Internet Journal of Healthcare Administration, 8(2), 1–6.
29.
DettenkoferM., WenzlerS., AmthorS., AntesG., MotschallE., & DaschnerF. (2004). Does disinfection of environmental surfaces influence nosocomial infection rates? A systemic review. Journal of the Association for Professionals in Infection Control, 32(2), 84–89.
30.
DickinsonJ. I., ShroyerJ. L., & EliasJ. W. (2002). The influence of commercial–grade carpet on postural sway and balance strategy among older adults. The Gerontologist, 42(4), 552–559.
31.
DietertR. R., & HedgeA. (1996). Toxicological considerations in evaluating indoor air quality and human health: Impact of new carpet emissions. Critical Reviews in Toxicology, 26(6), 633–707. doi: 10.3109/10408449609037480.
32.
DrahotaA. K., WardD., UdellJ. E., SoilemeziD., OgollahR., HigginsB., . (2013). Pilot cluster randomised controlled trial of flooring to reduce injuries from falls in wards for older people. Age and Ageing, 42(5), 633–640. doi: 10.1093/ageing/aft067.
33.
DybendalT., WedbergW. C., & ElsayedS. (1991). Dust from carpeted and smooth floors. IV. Solid material, proteins and allergens collected in the different filter stages of vacuum cleaners after ten days of use in schools. Allergy, 46(6), 427–435.
EspejordI. (2000). Thermal factors––indoor climate. International Journal of Circumpolar Health, 59(3–4), 240–245.
36.
EvanoffB., WolfL., AtonE., CanosJ., & CollinsJ. (2003). Reduction in injury rates in nursing personnel through introduction of mechanical lifts in the workplace. American Journal of Industrial Medicine, 44(5), 451–457.
37.
EvansD. (2003). Hierarchy of evidence: A framework for ranking evidence evaluating healthcare interventions. Journal of Clinical Nursing, 12, 77–84. doi: 10.1046/j.1365-2702.2003.00662.x.
38.
FangerP. (1970). Thermal comfort: Analysis and application in environmental engineering. New York: McGraw–Hill Book Company.
39.
FGI (2014). Guidelines for Design and Construction of Hospitals and Outpatient Facilities (1st ed.). Chicago: ASHE (American Society for Healthcare Engineering).
40.
FiletothZ. (2008). Hospital–acquired infections. John Wiley & Sons.
41.
FoardeK., & BerryM. (2004). Comparison of biocontaminant levels associated with hard vs. carpet floors in nonproblem schools: Results of a year long study. Journal of Exposure Analysis & Environmental Epidemiology, 14, S41–S48. doi: 10.1038/sj.jea.7500357.
42.
GriffinW. R. (2007). Bright and shiny. Cleaning and sealing ceramic tile and grout. Health Facilities Management, 20(12), 39–41.
43.
HacekD. M., OgleA. M., FisherA., RobicsekA., & PetersonL. R. (2010). Significant impact of terminal room cleaning with bleach on reducing nosocomial Clostridium difficile. American Journal of Infection Control, 38(5), 350–353.
44.
HagermanI., RasmanisG., BlomkvistV., UlrichR., EriksenC. A., & TheorellT. (2005). Influence of intensive coronary care acoustics on the quality of care and physiological state of patients. International Journal of Cardiology, 98(2), 267–270. doi: 10.1016/j.ijcard.2003.11.006.
45.
HarrisD., PachecoA., & LindnerA. (2010). Detecting Potential Pathogens on Hospital Surfaces: An Assessment of Carpet Tile Flooring in the Hospital Patient Environment. Indoor and Built Environment, 19(2), 239–249.
46.
HarrisD. (2015). The influence of flooring on environmental stressors: A study of three flooring materials in a hospital. Health Environments Research & Design Journal, 8(3), 9–29. doi: 10.1177/1937586715573730.
47.
HarrisD., & DetkeL. (2013). The role of flooring as a design element affecting patient and healthcare worker safety. Health Environments Research & Design, 6(3), 95–119.
48.
HarrisD., & FitzgeraldL. (2015). A life–cycle cost analysis for flooring materials for healthcare facilities. Journal of Hospital Administration, 4(4), 92–100. doi: 10.5430/jha.v4n4p92.
49.
HarrisD., ShepleyM., WhiteR., KolbergK., & HarrellJ. (2006). The impact of single family room design on patients and caregivers: Executive summary. Journal of Perinatology, 26, S38–S48. doi: 10.1038/sj.jp.7211583.
50.
HarrisP. B., McBrideG., RossC., & CurtisL. (2006). A place to heal: Environmental sources of satisfaction among hospital patients. Journal of Applied Social Psychology, 32(6), 1276–1299.
51.
HealeyF. (1994). Does flooring type affect risk of injury in older in–patients?Nursing Times, 90(27), 40–41.
52.
HeschongL. (1979). Thermal delight in architecture. MIT Press.
53.
HiltonB. A. (1985). Noise in acute patient care areas. Research in Nursing and Health, 8(3), 283–291.
54.
HotaB. (2004). Contamination, disinfection, and cross–colonization: Are hospital surfaces reservoirs for nosocomial infection?Clinical Infectious Diseases, 39(8), 1182–1189.
55.
HupceyJ. E. (2001). The meaning of social support for the critically ill patient. Intensive and Critical Care Nursing, 17(4), 206–212. doi:10.1054/iccn.2000.1568
56.
KovachT. (1990). Infection control concerns in hospital housekeeping. Executive Housekeeping Today, 11(8), 16–18.
57.
KraussM. J., NguyenS. L., DunaganW. C., BirgeS., CostantinouE., JohnsonS., . (2007). Circumstances of patient falls and injuries in 9 hospitals in a midwestern healthcare system. Infection Control and Hospital Epidemiology, 28(5), 544–550. doi: 10.1086/513725.
58.
LankfordM. G., CollinsS., YoungbergL., RooneyD. M., WarrenJ. R., & NoskinG. A. (2006). Assessment of materials commonly utilized in health care: Implications for bacterial survival and transmission. American Journal of Infection Control, 34(5), 258–263. doi: 10.1016/j.ajic.2005.10.008.
59.
LiJ., WolfL., & EvanoffB. (2004). Use of mechanical patient lifts decreased musculoskeletal symptoms and injuries among health care workers. Injury Prevention: Journal of the International Society For Child and Adolescent Injury Prevention, 10(4), 212–216.
60.
LinM. Y., AhernJ. E., GershonR. R., & GrimesM. (1998). The use of total quality improvement techniques to determine risk factors for back injuries in hospital workers. Clinical Performance and Quality Health Care, 6(1), 23–27.
61.
LozadaC. (2004). Flooring materials – Life cycle costing for M. E. Rinker, Sr. School of Building Construction at the University of Florida. (Interior Design), University of Florida, Gainesville, FL.
62.
MorrisonW. E., HaasE. C., ShaffnerD. H., GarrettE. S., & FacklerJ. C. (2003). Noise, stress, and annoyance in a pediatric intensive care unit. Crit Care Med, 31(1), 113–119.
NoweirM. H., & al–JiffryM. S. (1991). Study of noise pollution in Jeddah hospitals. Journal of the Egyptian Public Health Association, 66(3–4), 291–303.
65.
OlesenB. W. (1977). Thermal comfort requirements for floors occupied by people with bare feet: Polyteknisk Forlag.
66.
PatiD. (2011). A framework for evaluating evidence in evidence–based design. Health Environments Research & Design Journal (HERD) (Vendome Group LLC), 4(3), 50–71.
67.
PinesA., CleghornD., & PollakE. (2002). Occupational accidents in a hospital setting: An epidemiological analysis. Journal of Occupational Accidents, 7(3), 195–215.
68.
ReasonJ. (2000). Human error: Models and management. Western Journal of Medicine, 172(6), 393–396.
69.
ReblinM., & UchinoB. N. (2008). Social and emotional support and its implication for health. Current Opinion in Psychiatry, 21(2), 201–205. doi: 10.1097/YCO.0b013e3282f3ad89.
70.
RobinovitchS. N., & ChiuJ. (1998). Surface stiffness affects impact force during a fall on the outstretched hand. Journal of Orthopaedic Research, 16(3), 309–313. doi: 10.1002/jor.1100160306.
71.
RolandP., RussellJ., RichardsK. C., & SullivanS. C. (2001). Visitation in critical care: Processes and outcomes of a performance improvement initiative. Journal of Nursing Care Quality, 15(2), 18–26.
72.
SadlerB. L., DuBoseJ., & ZimringC. M. (2008). The business case for building better hospitals through evidence–based design. HERD, 1(3), 22–39.
73.
ShapeyS., MachinK., LeviK., & BoswellT. C. (2008). Activity of a dry mist hydrogen peroxide system against environmental Clostridium difficile contamination in elderly care wards. The Journal of Hospital Infection, 70(2), 136–141.
74.
SimpsonA. H., LambS., RobertsP. J., GardnerT. N., & EvansJ. G. (2004). Does the type of flooring affect the risk of hip fracture?Age and Ageing, 33(3), 242–246. doi: 10.1093/ageing/afh07133/3/242.
75.
SpendloveJ. C., & FanninK. F. (1983). Source, significance, and control of indoor microbial aerosols: Human health aspects. Public Health Reports, 98(3), 229–244.
76.
StocktonK. A., MorleyP. S., HyattD. R., BurgessB. A., PattersonG., DunowskaM., . (2006). Evaluation of the effects of footwear hygiene protocols on nonspecific bacterial contamination of floor surfaces in an equine hospital. Journal of the American Veterinary Medical Association, 228(7), 1068–1073. doi: 10.2460/javma.228.7.1068.
77.
TopfM. (1985). Noise–induced stress in hospital patients: Coping and nonauditory health outcomes. Journal of Human Stress, 11(3), 125–134.
78.
TrillisF.3rd, EcksteinE. C., BudavichR., PultzM. J., & DonskeyC. J. (2008). Contamination of hospital curtains with healthcare–associated pathogens. Infection Control and Hospital Epidemiology, 29(11), 1074–1076. doi: 10.1086/591863.
79.
UlrichR., ZimringC., QuanX., & JosephA (2007). The role of the physical environment in the hospital of the 21st century: A once–in–a–lifetime opportunity. 2004. Center for Health Systems and Design, College of Architecture, Texas A & M and College of Architecture, Institute of Technology, GA, Texas.
WhiteL. F., DancerS. J., & RobertsonC. (2007). A microbiological evaluation of hospital cleaning methods. International Journal of Environmental Health Research, 17(4), 285–295. doi: 10.1080/09603120701372433.
82.
WilkeO., JannO., & BrödnerD. (2004). VOC– and SVOC–emissions from adhesives, floor coverings and complete floor structures. Indoor Air, 14, 98–107. doi: 10.1111/j.1600-0668.2004.00314.x.
83.
WillmottM. (1986). The effect of a vinyl floor surface and a carpeted floor surface upon walking in elderly hospital in–patients. Age and Ageing, 15(2), 119–120.
84.
YassiA., CooperJ. E., TateR. B., GerlachS., MuirM., TrottierJ., . (2001). A randomized controlled trial to prevent patient lift and transfer injuries of health care workers. Spine, 26(16), 1739–1746.
85.
ZeiselJ. (2006). Inquiry by design (Revised ed.). New York: W. W. Norton & Company Inc.
