Healthcare Environment Control, Optimisation and Infection Risk Assessment (HECOIRA)
Lead Research Organisation:
University of Leeds
Department Name: Civil Engineering
Abstract
Hospital buildings are critical for supporting effective patient treatment. There is strong evidence that the design of patient environments influences well-being and comfort, recovery rates and can both cause and control transmission of infections, particularly those with an airborne component. Recent surveillance in England estimates 6% patients a year contract an infection while in hospital, which with hospital admissions of 15.9 million, totals almost 1 million people. Around 20% of infections are thought to be directly related to the environment. Hospital buildings have not progressed at the same rate as medical advances and many clinicians are treating patients in sub-optimal conditions. In addition recent scrutiny of healthcare buildings has been dominated by a focus on their energy usage, and there is increasing concern that decisions are made on energy and cost efficiency grounds without proper understanding of the risk to patients. This is counter-productive; efficiency savings in buildings leads to increased risks and hence costs in clinical delivery. With the NHS commitment to reduce recurrent revenue costs in supporting reduction of the national £22bn funding shortfall, it is essential that buildings are considered holistically and that the influence on patient outcomes is properly factored in.
A major barrier to delivering good patient environments is having usable tools to assess risks and adapt the environment and operations in a responsive manner. Current tools for designing and operating healthcare buildings and selecting technology are good at modelling energy, but are very limited from a health and infection control perspective. Our previous research developed new methods for modelling hospital environments and their influence on infection risk. In this project we aim to build on these approaches to develop and test novel computational based tools to assess, monitor and control real patient environments in hospitals for infection control, comfort and well-being. We will develop and couple models of physical, environmental, microbial and human parameters together with environmental sensor data to build new tools to dynamically model hospital environments. These will focus on addressing challenges with existing wards which are often constrained by the current building design and in many cases are naturally ventilated via opening windows. We will build a system that links sensors with a real-time fluid dynamics simulation model to enable live monitoring of environmental conditions and allow predictions to be made for rapid adaption. This will inform and control aspects like window opening, heaters and additional cooling to optimise the patient environment for comfort and air quality parameters. Alongside this we will develop a quantitative pathogen exposure model that can enable comparison of the relative risk of air and surface transmission and likely effectiveness of different design and infection control strategies. This tool will support decision making and scenario testing, as well as provide a valuable interactive training tool to demonstrate the interactions between pathogens, people and the physical environment.
The project has significant interaction with clinicians who manage complex ward environments and a wide range of patients, and expertise in industry in the design, specification and operation of hospitals. We will develop and test our approaches on real wards to understand their challenges, measure variability in conditions and evaluate how and where our models can best be used to inform practice. By working closely with industry partners we will understand how our pilot tools can be deployed in design and estates management and where they may inform guidance and governance. The project will deliver new risk based ways of assessing healthcare environments that support decisions, training, design and future guidance.
A major barrier to delivering good patient environments is having usable tools to assess risks and adapt the environment and operations in a responsive manner. Current tools for designing and operating healthcare buildings and selecting technology are good at modelling energy, but are very limited from a health and infection control perspective. Our previous research developed new methods for modelling hospital environments and their influence on infection risk. In this project we aim to build on these approaches to develop and test novel computational based tools to assess, monitor and control real patient environments in hospitals for infection control, comfort and well-being. We will develop and couple models of physical, environmental, microbial and human parameters together with environmental sensor data to build new tools to dynamically model hospital environments. These will focus on addressing challenges with existing wards which are often constrained by the current building design and in many cases are naturally ventilated via opening windows. We will build a system that links sensors with a real-time fluid dynamics simulation model to enable live monitoring of environmental conditions and allow predictions to be made for rapid adaption. This will inform and control aspects like window opening, heaters and additional cooling to optimise the patient environment for comfort and air quality parameters. Alongside this we will develop a quantitative pathogen exposure model that can enable comparison of the relative risk of air and surface transmission and likely effectiveness of different design and infection control strategies. This tool will support decision making and scenario testing, as well as provide a valuable interactive training tool to demonstrate the interactions between pathogens, people and the physical environment.
The project has significant interaction with clinicians who manage complex ward environments and a wide range of patients, and expertise in industry in the design, specification and operation of hospitals. We will develop and test our approaches on real wards to understand their challenges, measure variability in conditions and evaluate how and where our models can best be used to inform practice. By working closely with industry partners we will understand how our pilot tools can be deployed in design and estates management and where they may inform guidance and governance. The project will deliver new risk based ways of assessing healthcare environments that support decisions, training, design and future guidance.
Planned Impact
The hospital environment is a very significant element in providing safe and effective care and treatment to patients. The NHS estate comprises over 28 million square meters of buildings, over 300 acute hospital sites, and around 75% of it is over 20 years old. Hospitals spend millions of pounds every year on operating and maintaining these environments. Providing a good indoor environment for patients is a daily challenge for many hospitals and with a finite budget understanding how and where to invest in the environment is a key concern. Infection control is a key factor in the decision making, yet the tools to support the link between the environment and health are limited. By exploring these relationships and developing new tools to monitor the environment and quantify risk, the project will bring significant benefits to a number of stakeholders.
Hospitals and their patients are the major beneficiaries, bringing both economic and societal benefits. Our partner hospitals will be the first to benefit with detailed data on the operation of their wards and models and tools applied to explore their particular challenges. It is anticipated that this will enable the clinical and estates teams to take action during the project timescale to adapt their environments or change their management processes. Beyond the project it is anticipated that these benefits will extend to other areas of the partner hospitals and bring similar knowledge to other hospitals. The outcomes from the research will assist in monitoring their environments in real time and to carry out decision making and scenario planning to support investment. This brings ultimate benefits to patients by reducing their risks of infection while in hospital and creating environments that better support their health and well-being.
Impact on industry and hence the economy lies firstly with the partners in the application of the models to future healthcare design, planning and maintenance projects as well as in the future development of tools for commercial application by others. Those who could benefit include the manufacturers of ventilation and infection control technologies, those who design buildings, the construction sector who retrofit healthcare buildings and Internet of Things (IoT) device manufacturers and installers. The latter is potentially a significant new opportunity; the experience gained from the project could generate a new market and provide a platform for the predicted IoT revolution to gain traction especially in the healthcare sector. Economic beneficiaries also include government, professional bodies and policy makers, through the potential to provide new guidance for considering infection control and health aspects in hospital buildings. These include the Department of Health, NHS England, Care Quality Commission, PHE and bodies such as IHEEM and HIS who prepare standards and guidance and make recommendations.
Beneficiaries also include the people who are directly impacted by the research programme: investigators, postdoctoral researchers, partners and associated students. There are wider public benefits through increasing understanding of the influence that buildings have on health and well-being.
Hospitals and their patients are the major beneficiaries, bringing both economic and societal benefits. Our partner hospitals will be the first to benefit with detailed data on the operation of their wards and models and tools applied to explore their particular challenges. It is anticipated that this will enable the clinical and estates teams to take action during the project timescale to adapt their environments or change their management processes. Beyond the project it is anticipated that these benefits will extend to other areas of the partner hospitals and bring similar knowledge to other hospitals. The outcomes from the research will assist in monitoring their environments in real time and to carry out decision making and scenario planning to support investment. This brings ultimate benefits to patients by reducing their risks of infection while in hospital and creating environments that better support their health and well-being.
Impact on industry and hence the economy lies firstly with the partners in the application of the models to future healthcare design, planning and maintenance projects as well as in the future development of tools for commercial application by others. Those who could benefit include the manufacturers of ventilation and infection control technologies, those who design buildings, the construction sector who retrofit healthcare buildings and Internet of Things (IoT) device manufacturers and installers. The latter is potentially a significant new opportunity; the experience gained from the project could generate a new market and provide a platform for the predicted IoT revolution to gain traction especially in the healthcare sector. Economic beneficiaries also include government, professional bodies and policy makers, through the potential to provide new guidance for considering infection control and health aspects in hospital buildings. These include the Department of Health, NHS England, Care Quality Commission, PHE and bodies such as IHEEM and HIS who prepare standards and guidance and make recommendations.
Beneficiaries also include the people who are directly impacted by the research programme: investigators, postdoctoral researchers, partners and associated students. There are wider public benefits through increasing understanding of the influence that buildings have on health and well-being.
Organisations
Publications
Al-Kashoash H
(2018)
Congestion control in wireless sensor and 6LoWPAN networks: toward the Internet of Things
in Wireless Networks
Hiwar W.
(2020)
Multiplate air passive sampler to measure deposition rate of airborne microorganisms over time
in 16th Conference of the International Society of Indoor Air Quality and Climate: Creative and Smart Solutions for Better Built Environments, Indoor Air 2020
Khan A.
(2022)
Non-conventional/traditional numerical methods for indoor and outdoor airflow modelling
in 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022
Khan A.
(2022)
WS6: Challenges in ventilation for the operating theatres of the future: Making the invisible visible
in 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022
King MF
(2020)
Bacterial transfer to fingertips during sequential surface contacts with and without gloves.
in Indoor air
King MF
(2021)
Why is mock care not a good proxy for predicting hand contamination during patient care?
in The Journal of hospital infection
López-García M
(2019)
A Multicompartment SIS Stochastic Model with Zonal Ventilation for the Spread of Nosocomial Infections: Detection, Outbreak Management, and Infection Control.
in Risk analysis : an official publication of the Society for Risk Analysis
Description | HECOIRA set out to develop new computational tools for evaluating hospital environments, focusing on approaches for real-time adaption of the physical environment (comfort and infection control) and quantitative evaluation of infection risks. The research covered both experimental measurement and computational modelling, with data from experiments used to understand the characteristics of healthcare environments and behaviour of microorganisms to inform the development of models and use of sensors. The key outcomes from the work focus on several different and interconnected aspects. Complex risks in hospital wards: data on human activity, environmental conditions and microbial measurements illustrated the complex interactions that potentially lead to exposure to pathogens in healthcare. Measurement of CO2 in naturally ventilated wards over >12 months showed ventilation was generally good, but that there was around 20-30% of the time when CO2 levels were indicative of over occupancy or poor ventilation. There was a notable drop in CO2 concentrations during spring 2020 when ward occupancy was much lower. Observation of healthcare activities provided data on frequency of touching surfaces and indicated that mock care is not always a good proxy for activity that happens in a real-care environment. Together with CFD modelling of hospital wards we developed a new model to explore how exposure to virus through aerosol deposition on surfaces and subsequent hand contamination could depend on the room layout, ventilation and care activity. Contamination of surfaces due to airborne microorganisms: A systematic review and meta-analysis highlighted that bacteria concentrations in air were positively associated with temperature, particles and CO2 concentrations, but that there were not significant correlations with fungi. A novel sequential surface sampling device was developed and verified to be able to remotely measure sequential surface deposition microbial samples. Time series sampling carried out in a respiratory ward to simultaneously measure air and surface microbial concentrations, environmental data and activities was used to calculate deposition rates and evaluate correlations between microbial data an activity. Data from chamber experiments enabled modelling of transient exposure to airborne sources, and calculation of deposition rates of microorganisms from the air which showed that rates vary depending on the relative location compared to the ventilation supply and extract. Real-time prediction of complex indoor environments: We developed a tool to combine coupled wifi environmental sensors which can be used to analyse spatial distribution of CO2, temperature and humidity in a room. An adaption of this tool for COVID-19 was used to look at CO2 distribution around different types of masks. New data assimilation methods for coupling sensor data into a Lattice Boltzmann CFD model were developed and demonstrated using synthetic sensors to adapt airflow and thermal properties in real-time to produce a more accurate simulation of the indoor environment under changing conditions. Mathematical models for exposure to pathogens: models were developed to consider airborne and surface contact exposures in different healthcare settings for a range of pathogens including norovirus, pseudomonas and COVID-19. Adaption of models for COVID-19 included application to PPE donning/doffing, mask wearing in ambulances, hand and surface cleaning and environmental interventions. |
Exploitation Route | HECOIRA established a range of modelling approaches to evaluate infection transmission risks in healthcare settings and demonstrated the importance of incorporating realistic human behaviour and ventilation data. These models have already been adapted for COVID-19 and key principles formed the basis of simple exposure models used in SAGE EMG papers and model development as part of the PROTECT National Core Study on Transmission and the Environment and the EPSRC TRACK project. A collaboration developed with the University of Arizona was significant in development of stochastic QMRA models, and this collaboration is continuing. Follow on work through a PhD studentship is continuing to develop multi-zone transient models for airborne exposure that are coupled to ventilation network models. The data assimilation models have significant potential for further application. AI and data-driven fluid dynamics is a growing discipline and our study is one of the first demonstrations of new approaches to complex indoor environmental flows. The approaches are relevant across all indoor environments and have application for considering energy efficiency and indoor air quality together. The surface sampling device has potential for wider application, including commercialisation, and experimental studies have defined protocols that are important for future assessment of technologies for mitigating infection transmission. This includes a new collaboration to measure exposure to virus during dental procedures. |
Sectors | Healthcare |
Description | Outputs from HECOIRA relating to modelling airborne and surface contract transmission of infection are referenced in several SAGE papers on COVID-19 transmission and mitigations, and hence formed part of the evidence base for the national guidance on reducing transmission risk for the public and across all sectors. The methodologies are being applied within the PROTECT National Core Study on Transmission and the Environment and the EPSRC TRACK project, and have also led to a follow on PhD studentship in collaboration with Leeds Teaching Hospitals NHS Trust. Modelling of airborne risks was used to directly support NHS Scotland in risk assessments while repurposing hospital spaces in the early stages of the pandemic. Similar modelling approaches were also used as part of understanding of COVID-19 risks in dentistry which featured in an NHS Scotland SBAR. Expertise developed through the award enabled contribution to new guidance for the NHS on the use of air cleaning devices in hospitals. |
First Year Of Impact | 2019 |
Sector | Environment,Healthcare,Government, Democracy and Justice,Other |
Impact Types | Societal Policy & public services |
Description | Academy of Medical Sciences |
Geographic Reach | National |
Policy Influence Type | Contribution to a national consultation/review |
URL | https://acmedsci.ac.uk/policy/policy-projects/coronavirus-preparing-for-challenges-this-winter |
Description | Advisory group - cabinet office ventilation |
Geographic Reach | National |
Policy Influence Type | Participation in a guidance/advisory committee |
Description | COVID-19 select committee |
Geographic Reach | National |
Policy Influence Type | Contribution to a national consultation/review |
Impact | Evidence provided to the Science and Technology Select Committee by Noakes focused on the mechanisms for transmission of COVID-19 and appropriate mitigation measures. The evidence formed part of the Select committee review into the COVID-19 pandemic which was published in Jan 2021 |
URL | https://committees.parliament.uk/work/91/uk-science-research-and-technology-capability-and-influence... |
Description | Dentistry SBAR |
Geographic Reach | National |
Policy Influence Type | Participation in a guidance/advisory committee |
Impact | The SBAR provided evidence based guidance for practice in dental settings which supported COVID-19 mitigation actions during the pandemic |
URL | https://www.scottishdental.org/ventilation-water-and-environmental-cleaning-in-dental-surgeries-rela... |
Description | HEPA standard |
Geographic Reach | National |
Policy Influence Type | Participation in a guidance/advisory committee |
Description | HEPA standard |
Geographic Reach | National |
Policy Influence Type | Participation in a guidance/advisory committee |
URL | https://www.england.nhs.uk/long-read/application-of-hepa-filter-devices-for-air-cleaning-in-healthca... |
Description | HTM03-01 2021 |
Geographic Reach | National |
Policy Influence Type | Membership of a guideline committee |
Impact | The new guidance provides updated advice and expectations for healthcare ventilation in new hospitals and substantial refurb projects. The guidance will impact on all NHS trusts however it is difficult to quantify the specific benefits. |
Description | Infection Resilient Environments Pt 2 |
Geographic Reach | National |
Policy Influence Type | Contribution to a national consultation/review |
URL | https://nepc.raeng.org.uk/infection-resilient-environments |
Description | RAEng Infection Resilient Environments Pt 1 |
Geographic Reach | National |
Policy Influence Type | Contribution to new or Improved professional practice |
Impact | Report had a rapid impact on COVID-19 response including improved guidance from HSE and BEIS for organisations, establishment of ventilation advisory groups and the commissioning of a follow on piece of work to assess research capability, social benefit, best practice. |
URL | https://www.raeng.org.uk/policy/policy-projects-and-issues/infection-resilient-environments |
Description | SAGE COVID-19 advice |
Geographic Reach | National |
Policy Influence Type | Participation in a guidance/advisory committee |
Impact | Research outputs and methodologies plus academic expertise have supported the scientific evidence on COVID-19 transmission and appropriate mitigation strategies. Noakes was a participant in SAGE and chaired the SAGE Environment and Modelling Group. This group has contributed to over 50 evidence papers relating to the transmission of COVID-19, which underpin the public advice on reducing risk of infection and the advice to all sectors of the economy on implementing appropriate mitigation strategies. Several papers reference outputs/models from HECOIRA and previous EPSRC awards relating to transmission of infection, and a number of papers apply modelling approaches developed through these awards. |
URL | https://www.gov.uk/government/collections/scientific-evidence-supporting-the-government-response-to-... |
Description | SLWG Scotland Healthcare |
Geographic Reach | National |
Policy Influence Type | Participation in a guidance/advisory committee |
Description | UV standard |
Geographic Reach | National |
Policy Influence Type | Participation in a guidance/advisory committee |
URL | https://www.england.nhs.uk/long-read/application-of-ultraviolet-uvc-devices-for-air-cleaning-in-occu... |
Description | WHO Europe High level group |
Geographic Reach | Europe |
Policy Influence Type | Participation in a guidance/advisory committee |
Description | WHO High Level Expert Group |
Geographic Reach | Europe |
Policy Influence Type | Participation in a guidance/advisory committee |
Description | An investigation into aerosol production during endodontic procedures and its potential mitigation; a simulation study with bioaerosols |
Amount | £38,995 (GBP) |
Funding ID | 123091 |
Organisation | British Endodontic Society |
Sector | Learned Society |
Country | United Kingdom |
Start | 08/2020 |
End | 02/2021 |
Description | CECAM - Chamber for Environmental Control of Airborne Microorganisms |
Amount | £826,836 (GBP) |
Funding ID | EP/W006375/1 |
Organisation | Engineering and Physical Sciences Research Council (EPSRC) |
Sector | Public |
Country | United Kingdom |
Start | 12/2021 |
End | 11/2025 |
Description | FAR UVC light for reducing airborne transmission of bacteria and viruses |
Amount | £116,900 (GBP) |
Funding ID | AssureResearch21-0001 |
Organisation | NHS National Services Scotland (NSS) |
Sector | Public |
Country | United Kingdom |
Start | 01/2022 |
End | 06/2022 |
Description | GCRF_NF359: Modelling the exposure risk tradeoff between public transit and private paratransit for transport decision making in the era of Covid19 |
Amount | £193,466 (GBP) |
Funding ID | EP/V043226/1 |
Organisation | Engineering and Physical Sciences Research Council (EPSRC) |
Sector | Public |
Country | United Kingdom |
Start | 09/2020 |
End | 02/2022 |
Description | Kan Tong Po Travel Grant to Hong Kong |
Amount | £2,100 (GBP) |
Funding ID | KTP\R1\191021 |
Organisation | The Royal Society |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 09/2019 |
End | 03/2020 |
Description | Leeds Institute of Fluid Dynamics Mobility Travel Grant |
Amount | £1,000 (GBP) |
Organisation | University of Leeds |
Department | Leeds Institute of Fluid Dynamics |
Sector | Academic/University |
Country | United Kingdom |
Start | 09/2019 |
End | 10/2019 |
Description | MRC Festival of Science |
Amount | £1,200 (GBP) |
Organisation | Medical Research Council (MRC) |
Sector | Public |
Country | United Kingdom |
Start | 06/2017 |
End | 07/2017 |
Description | PROTECT National Core Study on Transmission and the Environment (COVID-19) |
Amount | £21,000,000 (GBP) |
Organisation | Health and Safety Executive (HSE) |
Sector | Public |
Country | United Kingdom |
Start | 11/2020 |
End | 03/2023 |
Description | TRACK: Transport Risk Assessment for COVID Knowledge |
Amount | £3,126,526 (GBP) |
Funding ID | EP/V032658/1 |
Organisation | Engineering and Physical Sciences Research Council (EPSRC) |
Sector | Public |
Country | United Kingdom |
Start | 08/2020 |
End | 09/2023 |
Description | ICPIC 2019 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | A contributed poster to the International Conference on Prevention and Infection Control. Over 1000 audience members of both industry and practitioners found the poster informative and novel. They requested further information. |
Year(s) Of Engagement Activity | 2019 |
URL | https://www.conference.icpic.com |
Description | Infection Prevention Society Talk |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Professional Practitioners |
Results and Impact | As part of the Infection Prevention Society Yorkshire monthly meeting, Marco-Felipe King presented HECOIRA to group of 50 infection control practitioners, estates managers and local businesses. The aim was to introduce the complexity of our research to the local practitioners in a way that was easily accisible but to gain important insight into the challenges faced at a local, regional and national level. The talk was very well received with Game Healthcare requesting a meeting to discuss potential KTP or PhD co-supervision. |
Year(s) Of Engagement Activity | 2020 |
Description | MRC festival of science: Surfaces and hand-hygiene: washing away fluorescent germs |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | Marco-Felipe King (Civil Engineering), Martin Lopez Garcia (Maths) and Catherine Noakes (Civil Engineering) received £1200 from the Medical Research Council to offer an activity directly related to making infection transmission research accessible to the general public. We explained to visitors at the Thackray Medical Museum in Leeds the importance of hand-hygiene to avoid the spread of bacteria, and why this is especially problematic in hospital settings. People of all ages learnt through the means of videogames and fluorescent gel hand hygiene games how mathematical and computational modelling can help to better understand these infection processes. We had a school visit attend along with the general public of about 30 people in total. These events help us to learn how to communicate research in a very fundamental way that is helpful to both of us when we are dealing with the general public, and we learn about how the research is perceived. From the evaluation survey we gave people, it's great to see that most people have reported a change in attitude to hand hygiene. |
Year(s) Of Engagement Activity | 2017 |
URL | https://hecoira.leeds.ac.uk/news/mrc-festival-thackray-medical-museum-14th-of-june-2017/ |
Description | Presentation at Fluids Conference - Cambridge |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | A presentation of the use of computational fluid dynamics in predicting infection transmission in hospital settings. Approximately 50 audience members attended from a diverse background including PhD students and academics. The presentation was well received suggesting that audience members would become increasingly aware of the air as a mode for transmitting infections. |
Year(s) Of Engagement Activity | 2019 |