Indoor Air Quality in Benghazi's Hospitals and Its Impact Among

Asian Journal of Medicine and Health

18(12): 39-52, 2020; Article no.AJMAH.65373 ISSN: 2456-8414

Indoor Air Quality in Benghazi’s Hospitals and Its Impact among Patients

Hadir Gawili1*, Hawa A. Bodabos1, Wafa A. Al-Awami1, Ahmed O. Al-Gargouri1 and Yahia F. Alhegazi1

1Department of Environmental Health, Faculty of Public Health, University of Benghazi, Benghazi, Libya.

Authors’ contributions

This work was carried out in collaboration among all authors. Author HG designed the study, wrote the protocol and wrote the first draft of the manuscript. Authors HAB and WAAA managed the analyses of the study. Author AOAG performed the statistical analysis and managed the literature searches. Author YFA managed the recommendation and organized the references. All authors read and approved the final manuscript.

Article Information

DOI: 10.9734/AJMAH/2020/v18i1230288 Editor(s): (1) Dr. Nicolas Padilla-Raygoza, Institute of Public Health, Mexico. (2) Dr. P. Veera Muthumari, V. V. Vanniaperumal College for Women, India. Reviewers: (1) Anubhav Chauhan, Shri Lal Bahadur Shastri Government Medical College and Hospital, India. (2) Takahiko Nagamine, Sunlight Brain Research Center, Japan. (3) Aparna Darshan Palshetkar, VES College of Pharmacy, India. Complete Peer review History: http://www.sdiarticle4.com/review-history/65373

Received 06 December 2020 Original Research Article Accepted 12 February 2021 Published 15 February 2021

ABSTRACT

Background: Indoor air quality (IAQ) is a very important topic; it contains a variety of factors: temperature, humidity, the presence of chemicals and the quality of outdoor air brought inside are typical metrics used to define IAQ. However, with poor quality usually lead to Sick Building Syndrome (SBS) and other serious symptoms. Aims: This study aimed to investigate Indoor air diseases and their symptoms of SBS among patients in ten hospitals in Benghazi, Libya and focusing on awareness/knowledge of patients and their education level regarding some pollutants and noise pollution. Study Design: This paper is a cross sectional descriptive study. Place and Duration of the Study: The study was conducted in December 2019 to September 2020 in Benghazi, Libya. Methodology: Performed sub analysis statistics have chosen 150 patients randomly in 10 hospitals (polyclinics/health centers) to fill out questionnaire about the most common symptoms are related to indoor air value in hospitals by also using the observational checklist. ______

*Corresponding author: E-mail: [email protected];

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Results: Mostly females 54% were of age above 46 years, 31.3% of the participants were university education level, 69.3% have suffered from different type of diseases, which are hypertension, diabetes, and asthma, and most pollutants were inducted from vehicle traffic 63.3%. Conclusion: the study indicated the highest contaminates impact and the health criteria in all ten hospitals were under the study, which are; temperature and humidity, PM, other chemical pollutants and noise effect.

Keywords: Indoor air; hospital; sick building syndrome; pollutants; temperature; humidity; noise exposure.

1. INTRODUCTION pollution. Natural air pollution is the result of natural incidences around the globe that Over time, technological advancements have concluded harmful concentrations of pollutants developed and increased the contaminate aspect are released into the air; for example natural form some industrial processes. In addition, as disasters, volcanic eruptions, forest fires, and things become easier, which makes human less radioactive materials. "The risk of being affected active and more exposed to the outcome by whether/related natural disasters is almost 80 emission, which rise health risk and adversely times higher in developing countries than in the affect for human lives in long-term. developed countries [1]."

According to the World Health Organization Unnatural –anthropogenic- air pollution, also (WHO), 9 out of 10 people were exposed to high known as "Man-made air pollution", is a type of levels of air pollutants and more than 80% of pollution which humans contribute in though daily people whom are living in urban areas, were activities, a great case in point is transportation, disposed to greater levels than the WHO "thermal power generating plants, and industrial guidelines has recommended [1]. parks [2]".

Because of the increase attention that pollutants As previously mentioned the classification of air emissions and their sources, to reduce and pollutant, which comes from different sources, eliminate the amount of harmful emissions, which and divided into natural and unnatural sources. can be done mainly by setting up guidelines and Natural sources of air pollution include "burning developing policies that could be applied to fossil fuels in electricity generation, ensure safe, and protected environment, whether transportation, industry and households; it is outer or inner environment. industrial processes and solvent use, for instance the chemical and mining industries; agriculture, The concept of (IAQ) is essential subject and waste treatment [3]". regarding the environments within hospitals and other healthcare facilities. The patients inside the "Even though that there are numerous sources of facility and medical staff directly impacted by the outdoor air pollution, the most abundant air quality in the building. IAQ is also a categories that contribute the most too the component of sustainable concepts that merge emission of pollutants in various locations are: into the design of the facilities. Successful IAQ is emissions of vehicles; stationary power a viable goal for overall building improvements generation; other industrial and agricultural and satisfaction at hospitals and other healthcare emissions; residential heating and cooking; re- facilities [1]. emission from terrestrial and aquatic surfaces; the manufacturing, distribution, and use of "Air pollution is defined as the presence of chemicals; and natural processes [4]." foreign matter in the air, in a concentration that is most probably will adversely affect the well-being "Air pollutants are gases and particles that harm and health of people, which is caused mainly people or other life, damage materials or reduce from multiple human activities, such as: visibility [5]." construction, transportation, industry, or natural resources, and is considered as one of the main Criteria of air pollutants according to the latest pollution problems around the world [2]." update by EPA (2017):

Natural and unnatural -anthropogenic- air 1. Carbon monoxide (CO), pollution are the main classification of air 2. Lead (Pb),

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3. Nitrogen dioxide (NO2), Long-term health effects (WHO. 2008): 4. Ground-level-ozone (O3), 5. Particulate matter (PM2.5/PM10) and 1. Decreased lung growth. 6. Sulfur dioxide (SO2) [6]. 2. Pulmonary functions impairment. 3. Increase in susceptibility to chronic- EPA (2019) mentioned other pollutants: obstructive lung diseases, with inclusion of asthma [11] 1. Formaldehyde

2. Volatile Organic Compounds (VOCs) [7]. EPA (2019) has defined noise pollution as the There are three main routes of any contaminant source of unwanted sound, thus, it becomes exposure (EPA, 2018.): disturbing and cause interference with normal human activities, and sound level exceed the 1. Inhalation: is inhaling / breathing acceptable standard [7]. contaminated air, contamination can be from PM, volatile contaminants, or even WHO (2018) has mentioned the standards of aerosols. exceeded sound to become a noise: 2. Ingestion: this type of exposure occurs when consuming contaminated products, - Less than 85 dB is considered as the such as food and water, which could average for sound levels. possibly contain residual chemicals. - Between 85 dB and 100 dB is when sound 3. Dermal: it results from direct contact with turns into unacceptable noise. skin and other contaminated media in the - More than 100 dB is the limit that when environment, such as water (swimming), exceeded, hearing will be lost [12]. soil (gardening/recreational activities), and indoor dust [8]. 1.2 Noise Pollution Adverse Health Effect

EPA (2017) recently updated the average levels As mentioned by the Health Europa (HE, 2019.): and duration of exposure that exceeded harm to individuals [6]. 1. Damage to the brain

1.1 Air Pollution Adverse Health Effect 2. Hearing impairment 3. Increased susceptibility to cardiovascular Short-term health effects (WHO. 2008): diseases 4. Psychological disorders 1. Mucous membranes irritations 5. Lack of sleep 2. Chest-tightness/coughing/wheezing 6. Interference with speech [13] 3. Increased responsiveness of respiratory airways to allergens The exposed to many types of pollutants in once 4. Increase in the incidence of acute lead to numerous discomforts that grouped respiratory-illnesses together and defined as Sick-Building Syndrome 5. Asthma exacerbation (SBS). According to EPA (2014), SBS is a term 6. Inflammation of trachea-bronchus that describes the situation of occupants in any

Table 1. Criteria air pollutants acceptable average exposure duration and levels

Pollutant Average duration Level Carbon Monoxide (CO) 1 Hour 35 ppm 8 Hours 9 ppm Lead (Pb) 3 Months 15 µg/m3 Nitrogen Dioxide (NO2) 1 Hour 100 ppb 1 Year 53 ppb Ozone (O3) 8 Hours 0.070 ppm 3 Particulate Matter (PM) PM2.5 24 Hours 35 µg/m 1 Year 12.0 µg/m3 3 PM10 24 Hours 150 µg/m Sulfur Dioxide (SO2) 1 Hour 75 ppb 3 Hours 0.5 ppm

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Table 2. Formaldehyde and VOCs acceptable average exposure duration and level

Pollutant Average duration Level Formaldehyde 30 Minutes 0.1 mg/m3 Volatile-Organic-Compounds 24 Hours 25 ug/m3

Table 3. Thermohygrometric parameters of healthcare facilities standards

Temperature (°C) 21°C to 24°C [9] Relative humidity (%) Range between 40 and 60% [9] Pressure (Pa) About 2.5 Pa [10] building through experiencing acute discomfort; 2. LITERATURE REVIEW this also leads to the appearance of some health effects, which related to the spending time in Paper in Sweden 1995, agreed that there is a building. However, this phenomenon does directly proportional relationship between both not have specific symptoms, nor cause a indoor environmental and psychological factors particular illness, thus, the cause remains in hospitals and the prevalence of SBS unknown [14]. symptoms especially in new buildings, thus; to reduce these symptoms there are some Building-Related Illness (BRI) is another term important improvements, which includes that mixed up with SBS, it is the appearance of reduction of ventilation noise, smoking, and other clinically diagnosable symptoms that could indoor climatic factors [15]. directly attributed to a specific-known disease, and thus, the cause in this term is known. A study hold in Scotland, stated out an important source of fine particulates in indoor areas, There are indicators that identify SBS, but the especially those with 2.5 diameter (PM2.5), most common are Headache / Concentration which as stated was the environmental tobacco difficulties, Itchy skin, Fatigue, and smoke (ETS), and there is an association Eye/Nose/Throat irritations between ETS and increased morbidity of respiratory diseases [16]. Possible causes of SBS: Research article in Taiwan 2008, have 1. Inadequate ventilation, determined some pollutants by using Indoor-Air 2. Occupant activities Quality Index, which is a system establish on 3. Presence of contaminants, results, assessment, epidemiological studies, 4. Inadequate building design and current regulations, the major chemical pollutants were CO2, and O3, and the greatest Preferred solutions for SBS source of pollution was traffic emission, which results from the effect of the outdoor environment 1. Increasing ventilation on indoor environment [17]. 2. Cleaning air through filters 3. Removing the source of pollutant [14] This study in Oman, and have stated both the design and the structure of building that have a 1.3 Aim of this Study great effect on the presence and the concentration of pollutants that lead to indoor-air Identify health effects of poor Indoor Air Quality issues. However, the routine investigations on patients within hospital environment. applied according to operating parameters, with most importantly maintenance of clean heating, 1.4 Study Objectives ventilation and air-conditioning in order to sustain an acceptable IAQ [18].  Identify quality of indoor air in Benghazi hospitals Paper was done in Finland, the objective was to  Assessing level of awareness of patients to evaluate both the condition and the performance poor IAQ effects of ventilation system in 10 central hospitals, and  Determining the greater impact between its impact on indoor-air quality and the air and noise pollution on patient`s health appearance of symptoms among hospital staff,

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and how regular maintenance effect the air reaching to the utmost conclusion of how quality. In the results, almost 40% of them was economic status of the state can greatly affect reported back as poor, and the prevalence of the capabilities of it to create a healthy indoor air symptoms and complaints was higher in these environment [2] hospitals, which required extensive repair [19]. EPA 2017, has defined the main categories of Another study have evaluated IAQ inside hospital exposure to pollutants; acute and chronic in Saudi Arabia, and have discovered a direct exposures, and their effect, with conclusion of association between outdoor and indoor how indoor air quality can effect individual`s environment, and poor IAQ cause the occurrence performance, especially some parameters like of BRIs. Also the location was surrounded by temperature, humidity, ventilation, and also the direct sources of pollution including both air and presence of any source of pollution, could noise pollution sources, with significance level of adversely affect the mental and physical aspects VOCs were higher in indoor-environment, the of individuals [6] Air-Quality Guidelines (AQG) of each pollutant was stated by WHO as the following: CO (9 A study was in France, has pointed out the most ppm), SO2 (0.14 ppm), NO2 (0.05 ppm), O3 indoor air chemical concentrations is the (0.08 ppm), VOCs (0.24 ppm), PM10 (150 healthcare activities, and mentioned ventilation ug/m3), TSP (150 ug/m3), Temp. (20-27 Co), RH as an important factor that when it's in at a low (30-60%) [20]. rate, level of pollutants would be increased [23].

A study in New Zealand has indicated that 3. METHODS AND MATERIALS outdoor air pollution highly contributes to indoor air pollution and the level of pollutants, with major contributing of ventilation, also the 3.1 Type of Study concentration of VOCs is connected to building`s structure, with further suggestions of periodical A descriptive (cross-section) study about Indoor screening to minimize costs and improve IAQ Air Quality (IAQ) in hospitals and its impact on [21]. patients in Benghazi, Libya.

Moreover, noise exposure is related to sleeping 3.2 Study Period issues and passive emotional outcomes, in addition to an important connection between The study was between December 2019 to pollution and noise annoyance and their effect on September 2020 in the city of Benghazi, the quality of life, and a great effect on human (polyclinics, health centers which providing health. Furthermore, these problems increase in primary healthcare for local community). residential areas close to motorways more than rural areas [21]. 3.3 Study Tools

A paper was conducted in Poland, has focused The questionnaire was about the most common on ventilation systems design, and the passive symptoms and complains related to indoor effect on IAQ; which leads to increase the hospitals environment among patients, the study incidence of health problems, and represented lack for the indoor air measurements that not the environmental factors that affect IAQ; and available in hospitals neither any hospitals sub-categorized them into human activities, equipment. environment condition, and both types and quantity of chemical compounds [22]. The questionnaire included two main parts the first criteria is about general information such as A research in Libya focused on assessing the gender, age, smoking, and education level. The level of pollutants emission, and pointed out the second part was about health data criteria of sources of pollution, starting with lowest source ventilation system, temperature, and humidity. of emission, which was cement-manufacturing Focusing on the most common environmental industry, reaching to maximum source, the problems inside hospitals like the number of electricity industry. In addition, it stated some patients, air pollutants and their short term effect important percentages of numerous pollutants, on patient. The last part of questionnaire deals which are CO2 (96.76%), CO (2.13%), PM with hearing state and defect, and noise (0.55%), SO2 (0.21%), NO2 (0.18%), and pollution.

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3.4 Data Analysis 5. DISCUSSION

The information collected from 150 patients Indoor air quality (IAQ) in hospitals is required for randomly, inside the 10 hospitals and analysed safe and healthy environment for patients and by using SPSS version 21. healthcare workers. This paper has focused on the effective guidelines for assessing the major 4. RESULTS source of pollutants and essential IAQ management in some Benghazi’s hospital. The In Table 5, 69.3% have suffered from different observational questionnaire provides four highest type of diseases, which are hypertension, aspects, temperature and humidity, PM, other diabetes, and asthma. chemical pollutants and noise effect.

Fig. 1. The ten hospitals in Benghazi map

Table 4. The main general characteristics of participants (n =150)

Characteristics of participant Frequency no. Percentage 100 % Age 15 to 25 30 20 % 26 to 35 29 19.3 % 36 to 45 39 26 % 46 ≥ 52 34.7 % Gender Male 69 46 % Female 81 54 % Educational level Elementary school 13 8.7 % Middle School 41 27.3 % High School 32 21.3 % University 47 31.3 % Higher than university 3 2 % Other* 14 9.4 %

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Table 5. Knowledge of health effect in hospitals

Knowledge of health effects in hospitals Frequency no. % Admission`s length Hours 55 36.7 % Days 68 45.3 % Weeks 15 10 % Months 4 2.7 % Else 8 5.3 % Do you have any specific diseases Yes 104 69.3 % No 46 30.7 % Do you consider ventilation inside hospital Yes 89 59.3 % appropriate? No 52 34.7 % I don`t know 9 6 % Does your admission`s room have any Yes 34 34 humidity issues? No 95 95 I don`t know 21 21 During your admission, did you experience Shortness of 33 22 % any of the following symptoms? breath Itchy eyes 15 10 % Headache/ 43 28.7 % Dizziness Skin allergy 7 4.7 % Excessive 8 5.3 % sneezing At which period of the day, does these Morning 9 6 % symptoms increase? Evening 26 17.3 % Night 18 12 % All day 31 20.7 % None 66 44 % In your opinion, which of the following Smoking 15 10 % pollutants are most commonly present in Car exhausts 95 63.3 % hospital environment? Cleaning 34 22.7 % products Else 6 4 %

Table 6. Effects of the surrounding environment in/out hospitals

Effects of the surrounding environment in/out hospitals Frequency no. % Do you consider hospital`s environment Yes 102 68 % quiet? No 48 32 % If the answer is (No), What is the sources Inner 47 31.3 % nature? Outer 30 20 % Inner and Outer 27 18 % None 46 30.7 % If the answer is (Inner), the cause Visitors 44 29 % Workers 27 18 % Devices 27 18 % All the above 2 1.3 % None 51 33.7 % If the answer is (Outer), the cause Traffic 31 20.7 % Electricity generators 25 16.7 % Firearms 28 18.7 % All the above 13 8.6 % None 53 35.3 %

According to Williams et al. 1996 in new Zealand, humidity and temperature, exposure time to a a strong association exists between inspired gas given humidity level, The increase in humidity

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deviation, leads to quick mucosal dysfunction the afternoon period was the most noisy among progresses. This typical suggests is an optimal the day time which is the time of visit of patient's level of core temperature and 100% humidity in relatives. both cases above and below which, there is impaired mucosal function. In addition, this study According to study of D.F.Juang et al. 2010 in conducted that high level of humidity can cause Taiwan, the main objectives of this study are to different types of respiratory diseases [24]. investigate the levels of noise pollution in some hospitals to determine the effects of noise Z Mu et al. 2017 in China, the study has pollution on the physiological and psychological indicated that if the indoor humidity was low, reactions and annoyance response of medical moderate, and high, the indoor temperature ORs care staff, patients and visitors in these hospitals. (hospitals operation rooms thermal measure in In compared to the normal noise limit 50decibels hospitals) were 0.969 (95% CI confidence the Results showed that the daily average sound intervals 0.922 to 1.017), 0.977 (0.962 to levels measured inside these hospitals during 0.999),and 0.920 (95% CI 0.908 to 0.933), in that daytime were between 52.6 and 64.6 decibels. order. These are higher than the daytime environmental noise level [27]. Likewise, the risk effect of noise Low temperature which is under the normal level on psychological reactions leads to weakness 18.2°C was a risk factor for COPD (chronic performance and concentration of health care obstruct pulmonary disease) patients, in addition workers and increase the stress after period. to high humidity above 70% leads to increase its risk on COPD. Also related to severe disease El-Sharkawy and Noweir study in 2014 in Saudi problem like hypertension, diabetes [25]. Arabia has showed the acceptable limit of temperature and relative humidity (RH), in winter D. Lyons et al. 2017 in Canada, the paper has was 20-24°C, and 30-60% of RH. While in mentioned that OSA (obstruct sleep apnea) summer was 23-27°C that lead to grow different results from noise pollution inside healthcare type of fungal species as recorded units can increase the risk of developing Cladosporium, followed by Penicillium [20] hypertension, LV hypertrophy (left ventricle Furthermore, RH and the air pollution level in hypertrophy enlargement and thinking of walls), hospital confirmed a positive weak correlation cardiac arrhythmias, and stroke [26]. between RH inside hospital and levels of SO2, PM, CO, and VOCs and a negative weak The study described the harmful effects of noise correlation for O3 and NO2 [17]. However, our on patients but 91.3% of the result was the results showed that no humidity appearance or opposite which was no harm from noise because pollutants found inside patient's rooms and the the lack of knowledge and awareness, otherwise most pollutants source was vehicle exhaust according to the most of the participants opinion interact in indoor air surrounding area.

Table 7. Noise effect on patients inside hospitals

Noise effects inside hospitals Frequency no. % Do you have any hearing or concentration Yes 46 30.7 % issues? No 104 69.3 % I don`t know 0 0 % If the answer is (Yes) Occurred suddenly 11 7.3 % Occurred gradually 35 23.3 % Didn`t occur 104 69.4 % Have you ever lost control of yourself Yes 74 49.3% because of noise? No 76 50.7% At which period of the day, does noise levels Morning 47 31.3 % increase? Evening 76 50.7 % Night 15 10 % All day 0 0 % None 12 8 % Do you think noise passively affects staff`s Yes 97 64.7 % behavior (Nurses/Doctors)? No 53 35.3 % How do you evaluate your current hearing Well 96 64% sense? Poor 54 36%

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Table 8. Healthcare facilities inspection and Observational Checklist evaluation

Ventilation mechanism Present Not present Natural (Windows) 7 3 Central ventilation systems 1 9 Air conditioning units 1 9 Condition : Walls Ceiling Floor Mold 3 0 0 Humidity 3 1 0 Dust 2 1 1 Fire marks 1 1 0 Sanitation : Poor Moderate Excellent 2 7 1 Cleaning products : Present Not present Air refreshers 4 6 Disinfectants 9 1 Chlorine-beach powder products 5 5 Household cleaners 4 6 Dusting sprays 4 6 Furniture polishers 0 10 Dry cleaning fluids 0 10 Spot removals 0 10 Cidal-products Pesticides Insecticides Herbicides 5 0 0 Presence of insects Flies Mosquitos Cockroaches Other conditions Temperature Normal Raised 5 5 Pressure Normal Raised 8 2 Cleaning products ▲Conc. ▼Conc. Not noticed 3 4 3 Cigarette smoke ▲Conc. ▼Conc. Not noticed 4 2 4 Unpleasant odors 2 High 3 Medium 5 Absent *The numbers are out of ten, which are the hospitals are participated in this study

In addition, the paper has compared outdoor and (Including printed questionnaires and indoor level of pollutants, such as (PM10, TSP, Observational checklists), the outcome was the CO, SO2, NO2, O3) were higher in outdoor area following: except the volatile organic compounds (VOCs) level were high in the indoor area. Because of Firstly, due to the lack of the required systems, the chemicals used for disinfecting and cleaning, such as central ventilation systems, we found out the IAQ inside healthcare facilities (HCFs) was that the greater dependency was on natural greatly affected by outdoor sources and methods, such as using windows to refresh and particularly by vehicle traffic [17]. Furthermore, circulate the air within the admission rooms, the study describe the effect of outdoor air which increases the effect of outdoor air and its pollution on indoor air quality, most pollutants pollutant on indoor air and environment. was inducted from vehicle traffic 63.3% from outdoor area also the disinfecting that is used Secondly, there was a great increase in the basic substances cleaning 22.7%. IAQ elements, including temperature and

6. CONCLUSION humidity, and also the lack of basic sensory devices to detect any abnormal change in such To outline the final discoveries of our research, elements, which also leads to other outcomes which mainly based on observational methods such as increased discomfort and by which also

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being a possible precursor for SBS symptoms any unpleasant odors, and depend more appearance, which all affects the outcome of the on the basic air renewal protocols. whole medical staff. • Raise awareness of the mis-concept regarding cleaning products, of which it`s Thirdly, this study pointed out that the greater understood that the higher the source of noise pollution was mainly from inside concentration, the better the effect, the hospital, the greatest was from visitors and whereas some products are more effective healthcare staff. All of these issues significantly when diluted, and the passive effect on affect patients in many ways, such as increasing patients comfort is avoided. admission`s period, and prolonging recovery • It`s always more beneficial economically to time. detect any defects/issues at an early stage with strict follow-up protocols, rather than Other sources from outside healthcare facility treating the outcomes at late stages at was due to traffic noise, because of the faulty which it would be very much more and improper design and allocation from the complicated, with conclusion that beginning. prevention is better than treatment. • Electronic thermo-meters should monitor Fourthly, due to absence of basic sanitation the regular room temperature, and should protocols, there was a great misuse in cleaning provide alarming system that detects any products, such as the appropriate concentrations abnormal change in order to sustain the of each product and the applying method, standard temperature of any room. because of the low educational level of the help • According to source of noise, whether it`s workers. from outside the facility or within the facility, each source can be dealt with Finally, due to low economic status of the according to its source through the country, cannot always met the basic standard following: requirements, which lead to using alternative (cheap) solutions. 7.1 Noise Source is from Outside the Facility 7. RECOMMENDATION • Designing soundproof surroundings, such There are some important points can be taken to as in windows considering it as the main reduce and monitor indoor air pollutants inside cause of noise entry. healthcare facilities. Moreover, this paper focused on the most problems that increase the 7.2 Noise Source is from Inside the spread of some diseases in hospitals. Facility

• Regular IAQ checkout on 3 months-basis • Whether it`s caused by the healthcare in order to assure good quality. staff, or by the visitors, posters should be • Designing a record-based observation placed in obvious locations to indicate the follow-up and notify about any possible sensitivity of each area, in order to avoid problems that may have passive effects on any cause of discomfort to any admitted patients health. patients. • Setting up defined protocols regarding • A focal point regarding noise, is that high IAQ, including noise level during any tasks, noise levels may affect the recovery and preserving the normal level that does process of any patient, as the patient lose not negatively affect patients comfort and ability to sleep and have the required general well-being during their time of amount of resting, leading to prolonged admission in the health care facility. recovery period. • Periodical assessing meetings of all • Installation of high sensitivity detectors that medical staff in order to keep-up with any are capable of detecting any pollution or changes, and to assure that the basic change in humidity levels, or any element protocols and procedures are well of the IAQ elements. maintained, and for raising awareness for • Using windows to refreshing the rooms all employees, old or newly-hired. and allow air exchange for at least 20 min • Avoid the dependence on cheap cleaning before admission and after discharge of products and air refreshers to eliminate any patient.

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APPENDIX

Fig. A1. Benghazi Medical Center (BMC)/ Al Gomhouria Hospital Benghazi

Fig. A2. Al Hawari General Hospital/ Nose, Ear and Throat Clinic

Gawili et al.; AJMAH, 18(12): 39-52, 2020; Article no.AJMAH.65373

Fig. A3. Al kwyvih Hospital Respiratory ______© 2020 Gawili et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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