Research finds Victorians knew best over hospital ward design

Leeds University researchers found modern drives to save energy by keeping windows closed increases infection rates four fold but they fall dramatically if ventilation remains as intended. Nightingale wards, where patients are treated in two rows of beds, are still a feature of NHS hospitals although many have been adapted with patients treated in smaller bays.

A team headed by the university’s School of Civil Engineering studied a disused ward at St Luke’s Hospital in Bradford using a tracer gas representing infectious breath to simulate how airborne infections spread.

Cath Noakes, who led the research, said: “There is a big push on energy in buildings and it worries many of us who work on indoor air quality. People are being told to seal up their buildings to save energy. Some of these wards were designed by the Victorians, and our results show that they knew what they were doing.

“We found that when you operate them properly, with natural ventilation from the windows, they perform as the Department of Health would like them to. But there is a danger that we could be adapting our buildings to improve efficiency without thinking how it might affect patients.”

National guidelines recommend a ward should be ventilated six times an hour.

Research fellow Carl Gilkeson, who worked on the project, said: “When the windows were left open in the ward, we recorded ventilation rates that were either satisfactory or better than the NHS standard. When the windows were closed, the measured exposure to infection was typically four times higher, equivalent to a ventilation rate of only 1.5 air changes an hour.”

The team found the installation of small extractor fans, similar to a bathroom ventilator, beside each bed reduced risks to a comparable level to opening the windows.

Partitioning wards slightly increased risks in the immediate vicinity of an infected patient but reduced them elsewhere.

Dr Noakes added: “These wards still exist and in the current economic environment they are likely to remain for some time. However, we have shown that they can be modified and that their ventilation can be good if they are managed correctly.

“Introducing simple mechanical ventilation to supplement the airflow in the winter, could be an effective approach to ensuring good ventilation year-round, without the energy costs of a full air conditioning system.”