Role of Ventilation and Spatial Designs in Airborne Disease Transmission Within Residential Aged-Care Facilities
Abstract
1. Introduction
- To examine the role of built forms and functions in the transmission of COVID-19 in RAC facilities.
- To investigate various BVSs and techniques, building forms and designs, and how they impact the transmission of COVID-19 in RACs.
- To review the appropriateness of government policies in these facilities.
2. Materials and Methods
2.1. Literature Retrieval
2.2. Systematic Literature Review Process
- The literature review was based on articles with pre-set keywords published in the last 10 years and retrieved from Scopus, WoS, and PubMed (MEDLINE).
- The keywords must appear in the abstract, title, and keywords sections of the records to be eligible for inclusion in the current study.
- The Scopus, WoS, and PubMed repositories were used as information sources, which can be accessed at (1) scopus.com/search/form.uri?display=basic (last accessed on 1 January 2025) (2) webofknowledge.com (last accessed on 1 January 2025) and (3) pubmed.ncbi.nlm.nih.gov/advanced (last accessed on 1 January 2025).
- The search process comprises a search string with restrictions (inclusions and exclusions), as listed in Table 1.
- This study’s selection process consisted of keyword searching, screening at the title level, removing duplicates, and qualitative analysis of the abstracts and keywords.
- The retrieved articles were analyzed in detail using bibliometric measures such as citation, country of origin, and publication trend analysis.
- The considered data items included authors’ names, titles, sources, study remarks, keywords, setting type, variables such as BVSs and techniques, spatial designs, and research outcomes.
- The risk of bias for individual research studies did not affect the systematic literature review process, as the retrieved papers were individually reviewed by all authors and later collated and compared through a triangulation process to eliminate any potential bias.
- The narrative analysis covered key environmental factors such as building forms, spatial designs, ventilation in aged-care buildings, BV’s role in COVID-19 transmission, and related data.
- The research findings were ultimately compared with the other research studies to check for consistency.
- Additional analysis was performed by linking the factors of BV’s role in disease spread associated with building forms and ventilation strategies in RAC buildings.
2.3. Data Analysis
3. Results and Discussions
3.1. Bibliometric Analyses
3.2. Emergent Research Hotspots
3.2.1. Types of Building Ventilation Systems
- Hybrid/recirculating BVS;
- Mechanical BVS;
- Displacement BVS.
3.2.2. Role of Ventilation in COVID-19 Spread
3.2.3. Building Design and Spatial Layouts for Effective Ventilation
- Implementing cross-ventilation as an essential feature.
- Ensuring open-ended corridors to guarantee an effective ventilation rate.
- Use of hallways and closed-ended corridors must be avoided during a viral spread.
- Installing ventilation louvers at doorsteps and placing upper ventilation windows on dividing walls of hallways to reduce hot air recirculation.
- Rethinking the courtyard design to establish a cohesive ventilation route utilizing the courtyard area.
4. Regulations, Guidelines, and Recommendations for BVSs in RACs
- Building design and construction must consider the specific requirements of the regional climate and optimize the temperatures for residents’ routine activities.
- Engineering controls such as dilution ventilation, HEPA filtration, UVGI systems, scavenging equipment, and physical barrier walls should be adopted.
- A conventional infection control hierarchy, including elimination (a physical removal method for viral particles within spaces), replacement, engineering controls (segregating older people and infectious materials), and administrative controls (policies/practices to mitigate the risk of COVID-19 exposure), must be adopted.
- Personal protective equipment (gloves, gowns, masks, etc.) must be put in place.
- Specialized HVAC ventilation systems with appropriate interventions regarding humidity, airflow, ventilation rate, and temperature must be in place.
- Effective BVSs and thermal comfort must be prioritized as primary solutions to enhance IAQ.
- Smart BVSs should be used within indoor spaces that respond to emission events, such as opening windows during high-traffic hours and drawing activities.
- A building evaluation or rating approach must be mandated for RACs, ensuring that building characteristics are sufficient for occupancy density to counter the spread of infectious diseases.
- Automated air recirculation systems must be installed to maintain the ventilation rate and airflow in climatization systems based on real-time digital sensors and BVS.
- Air cleaners must be a mandatory feature of RACs as a complementary approach to cleaning any residual viral particles from indoor air.
- Awareness campaigns must be in place to inform all stakeholders, including managers and staff, about effective practices that can be implemented to enhance BVSs and IAQ.
- Decision-makers, policymakers, and architects should emphasize the recognition of environmental factors within indoor spaces.
- A detailed plan must be developed to address future pandemic scenarios, with a focus on environmental factors and BV.
- Research should be conducted to continuously determine various conditions and optimal ranges of air quality and BV.
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
Abbreviations
BV | Building Ventilation |
BVS | Building Ventilation System |
RAC | Residential Aged Care |
PRISMA | Preferred Reporting Items for Systematic Reviews and Meta-Analysis |
WoS | Web of Science |
COVID-19 | Coronavirus Disease 2019 |
HEPA | High-Efficiency Particulate Air |
UVGI | Ultraviolet Germicidal Irradiation |
UV | Ultraviolet |
HVAC | Heating, Ventilation, and Air Conditioning |
ASHRAE | American Society of Heating, Refrigerating, and Air-Conditioning Engineers |
UKRI | United Kingdom Research and Innovation |
NHS | National Health Service |
PTAC | Packaged Terminal Air Conditioners |
MVHR | Mechanical BV units with Heat Recovery |
AHU | Air Handling Units |
IAQ | Indoor Air Quality |
ACH | Air Changes per Hour |
REHVA | Federation of European Heating, Ventilation, and Air-Conditioning Associations |
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Search Engines | String/Conditions | Articles Retrieved |
---|---|---|
Scopus, Elsevier | TITLE-ABS-KEY (“Ventilation” OR “Spatial Design” OR “Building Design” OR “Building Layout”) AND TITLE-ABS-KEY (“Aged Care” OR “Residential Care” OR “Old age Home” OR “Senior Living”) AND TITLE-ABS-KEY (“Pandemic” OR “Virus” OR “Coronavirus” OR “COVID19” OR “Communicable Disease”) AND (LIMIT-TO (DOCTYPE, “article”)) AND (LIMIT-TO (DOCTYPE, “review”)) AND (LIMIT-TO (LANGUAGE, “English”)) Time span: 2014–2024 | 27 |
Web of Science (WoS) | All Fields (“Ventilation” OR “Spatial Design” OR “Building Design” OR “Building Layout”) AND All Fields (“Aged Care” OR “Residential Care” OR “Old age Home” OR “Senior Living”) AND All Fields (“Pandemic” OR “Virus” OR “Coronavirus” OR “COVID19” OR “Communicable Disease”) and Article or Review Article (Document Types) and English (Languages) Time span: 2014–2024 | 23 |
PubMed (MEDLINE) | All Fields (“Ventilation” OR “Spatial Design” OR “Building Design” OR “Building Layout”) AND All Fields (“Aged Care” OR “Residential Care” OR “Old age Home” OR “Senior Living”) AND All Fields (“Pandemic” OR “Virus” OR “Coronavirus” OR “COVID19” OR “Communicable Disease”) and Article or Review Article (Document Types) and English (Languages) Time span: 2014–2024 | 20 |
Sum of Papers | 70 | |
Duplicates | 25 | |
Remaining | 44 | |
Irrelevant Focus | 8 | |
Final Shortlisted Relevant Articles | 36 |
Analysis Type | Assessment | Considerations | Scopus Results | WoS Results | PubMed |
---|---|---|---|---|---|
Co-occurrence | Counting method | Full counting | |||
Units of analysis | All keywords | 508 | 66 | 61 | |
Minimum occurrence | Scopus, 5; WoS, 2; PubMed, 2 | 27 | 9 | 14 | |
Co-authorship | Counting method | Full counting | |||
Units of analysis | Authors | 108 | 70 | 61 | |
Minimum citations | Scopus, 5; WoS, 5; PubMed, 0 | 43 | 29 | 61 | |
Counting method | Full counting | ||||
Units of analysis | Organizations | 79 | 26 | 29 | |
Minimum occurrence | Scopus, 5; WoS, 2; PubMed, 0 | 23 | 20 | 29 | |
Counting method | Full counting | ||||
Units of analysis | Countries | 19 | 8 | NA | |
Minimum occurrence | Scopus, 1; WoS, 1; PubMed, 0 Minimum citations, 1 | 15 | 5 | NA |
BV Systems | Ventilation Measures | Brief Description |
---|---|---|
Recirculating BV | Split AC system | The ceiling-mounted fan unit and wall-mounted unit work together to recirculate room air at high speeds, ensuring a consistent distribution of the air throughout the rooms. |
Hybrid ventilation | External air is blended with room air and dispersed throughout the spaces via a fan, guaranteeing swift and thorough mixing of air. | |
Ceiling fans | Fans are used to circulate room air at a high velocity, ensuring effective wind chill cooling and uniform distribution throughout the space. | |
Mixing BV | Mechanical ventilation with heat recovery (MVHR) | These systems, such as HVAC systems, are localized and known as balanced supply and extract systems. They incorporate heat recovery methods to mitigate heat loss associated with ventilation. |
Air handling units | Fresh outdoor air is delivered and conditioned in occupied spaces through ceiling ducts or floor diffusers. The fresh air is blended with stale air and distributed through various outlets into the occupied space. | |
Positive input ventilation | These localized fanned systems deliver fresh air through façade openings, utilizing positive pressure to facilitate exhaust and mirroring the airflow dynamics of air handling units. | |
Displacement BV | Natural ventilation measures | Such building-related measures are devised to replace stale air with fresh air through buoyancy, utilizing various elements such as windows, solar chimneys, or passive stacks. |
Continuous extract ventilation | Centralized or localized fan-driven systems are linked to the extraction of stale air and the introduction of fresh air based on the building fabric openings, such as louvers or windows, which enable the inflow of fresh air through negative pressure. |
References | Country | Study Design | Build Type | Aim | Assessment Tool/Method | Findings |
---|---|---|---|---|---|---|
de Man et al. [47] | The Netherlands | Experimental | Single Dutch nursing home | Poor ventilation results in COVID-19 spread | Retrospective cohort study, environmental pollution measures, differential transmission rate between aged people and staff | COVID-19 spreads due to inadequate BV systems and recirculated contaminated air |
Brass et al. [48] | Australia | Experimental | RAC facilities | Assessment of CO2-based ventilation in RACs to eliminate viral transmission | CO2 sensor for monitoring in RACs, assessed the ventilation rate, and ACH determined by non-linear regression | High-risk viral transmission zones were identified by measuring the level of CO2. Ventilation strategies proposed to curb viral spread. |
Bentayeb et al. [52] | Europe | Experimental | Elderly Care Facilities; Nursing homes | Assessing the link between BV, air quality parameters, and COVID-19 spread | Questionnaires and medical examinations are used to assess air pollutants and ventilation measures | BV spreads infectious diseases and affects the IAQ in RACs |
Chow [43] | Hong Kong | Narrative Review | Nursing home | Review care homes for COVID-19 spread | Source control approach, early intervention | RACs are more vulnerable to COVID-19 due to poor BV |
Mouchtouri et al. [42] | Greece | Experimental | Nursing home; long-term care facility | Transmission of COVID due to BV and Environmental Contamination | Reverse transcriptase–polymerase chain reaction (RT-PCR) | COVID was spread due to inadequate mechanical BVS |
Wang [50] | China | Narrative Review | Senior-living facility | Environmental factors’ role in disease spread (COVID-19) | Quantitative and qualitative content analysis of guidelines for senior living facilities | Environmental, mechanical, design, and BVSs can control the COVID-19 spread |
Sanglier-Contreras et al. [44] | Spain | Experimental | Nursing homes | Investigation of the link between BV and COVID-19 spread | Multivariate statistical analysis was used to report the relationship between total deaths and the number of residents. | Outcome status in terms of the number of deaths due to poor BV |
Fadaei [53] | Iran | Systematic Review | RAC facilities | COVID-19 prevention through effective BVS | Systematic analysis to determine the BVS role in COVID-19 transmission | BV and AC systems, temperature, and humidity help prevent COVID-19 |
Morawska et al. [54] | Australia | Narrative Review | RAC facilities | Protecting workers, patients, and staff in RACs | Observational study of ventilation rate, air filtration, and disinfection factors in terms of COVID-19 transmission | Engineering controls for BVS, such as HVAC systems, eliminate COVID-19 |
Fadaei [51] | Iran | Systematic Review | Residential; indoor environment | Importance of ventilation in COVID-19 spread | Systematic review of 20 articles on the role of ventilation in preventing the spread of COVID-19 | Effective BV, social distancing, disinfection, and decontamination control are proposed |
Sopeyin et al. [22] | Africa | Narrative Review | RAC facilities | Evaluation of COVID-19 transmission in mechanical and natural BV environments | Interconnection between BVS (natural/mechanical) and COVID-19 spread was reviewed | Mechanical BV is more effective than natural ventilation in eliminating COVID-19 transmission |
Jafri et al. [55] | Malaysia | Experimental | RAC facilities | Spread risk assessment of COVID-19 in RACs | Environmental and Epidemiological data were collected, and swab samples were gathered for lab investigation | Lack of natural BV causes COVID-19 to spread. 66.67% and 55.5% attack rate for residents and staff of RACs |
Jayaweera et al. [33] | Sri Lanka | Narrative Review | RAC buildings | Investigation of airborne COVID-19 spread in indoor buildings | Literature on the transmission of COVID-19 due to aerosol, droplets, and ventilation was reviewed | Poor BV, droplets, and aerosols are responsible for COVID-19 transmission in RACs |
Khaliq et al. [56] | UK | Experimental (Modelling) | Aged-care homes | Monitoring of environmental data and infection risk from COVID-19 | CONTAM airflow model used for ventilation rate and CO2 level measurement | Effective BVS is needed to increase the ventilation rate and reduce the COVID-19 spread |
Somsen et al. [28] | The Netherlands | Experimental | Nursing homes; elderly care facilities | Droplet measurement and BVS to curb COVID-19 spread | Spray Scan laser sheet used for tracking droplets, comparison of mechanical and natural ventilation | Both droplets and BV are significant factors in COVID-19 transmission in poorly ventilated spaces |
Chirico et al. [46] | Italy | Narrative Review | RACs; nursing homes | Evaluation of COVID-19 risk related to HVAC systems | Snowball strategy applied to highlight the risk of coronavirus spread due to AC and BV systems | Evidence is not established; more research and safety consultants are needed |
Guo et al. [39] | China | Narrative Review | Indoor environment | The linkage between HVAC systems and COVID-19 spread | Observation and descriptive strategies used to determine BVS strategies in indoor environments | BV is of paramount importance in curbing coronavirus |
Type of Controls | Examples of Ventilation Solutions |
---|---|
Elimination | Recirculating air within confined areas should be avoided. Reduce overcrowding and limit the usage of enclosed rooms. Avoid placing individuals infected with COVID-19 in rooms with positive airflow pressure. Use HEPA filters in all air supply systems. |
Replacement | Replace existing split AC systems with smart HVAC systems and HEPA filters. |
Isolation | Isolate infected individuals in suitably designed rooms that do not share air with other rooms. |
Engineering Controls | Ensure that supply and exhaust systems comply with permissible air exchange standards (6 ACH for standard rooms; 12 ACH for rooms with infected individuals; 10 ACH for utility rooms to control odor). Modify HVAC controls to reduce the risk of COVID-19 exposure by introducing an adequate amount of outdoor air (ventilation rate), maintaining a temperature of 20–25 °C, achieving 40 to 60% relative humidity (using portable humidifiers), and controlling airflow direction. Enhance the air exchange rate in outdoor spaces and minimize the recirculation of unfiltered air. Use mechanical air filters (HEPA filters) or air cleaners to upgrade the existing BVS. Deploy portable air filtration units in corridors and rooms. Implement floor-to-ceiling filtration, such as physical barrier walls like ZipWalls, to inhibit airflow and separate clean areas (staff occupied) from infected spaces. Regularly disinfect the air using UV radiation in exhaust vents before the recirculation process. Ensure that BVSs along the air passage and ceiling are fully ducted to minimize leakage. Increase air exchange through exhaust air grills, variation in damper settings, and louvers for air supply. |
Administrative Controls | A technician or engineer should properly monitor and clean filters, HVAC systems, purifiers, and humidifiers. Ensure regular testing and maintenance of BVS, including HEPA filters, and changing them according to the manufacturer’s specifications. Strictly adhere to relevant guidelines and standards. Monitor air quality, airflow, and air exchange per hour in all rooms and corridors regularly to prevent airborne viral infections. Minimize the usage of fans as they lead to an enhanced circulation of viral particles. Install smart BVSs to optimize energy consumption. |
Personal Protective Equipment | All staff, workers, elderly people, and elderly people with disabilities should wear appropriate PPE during a transmission event. Use approved PPE during cleaning, maintenance, and installation of BVS. |
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Ullah, F.; Olatunji, O.; Qayyum, S.; Tanveer, R. Role of Ventilation and Spatial Designs in Airborne Disease Transmission Within Residential Aged-Care Facilities. Designs 2025, 9, 110. https://doi.org/10.3390/designs9050110
Ullah F, Olatunji O, Qayyum S, Tanveer R. Role of Ventilation and Spatial Designs in Airborne Disease Transmission Within Residential Aged-Care Facilities. Designs. 2025; 9(5):110. https://doi.org/10.3390/designs9050110
Chicago/Turabian StyleUllah, Fahim, Oluwole Olatunji, Siddra Qayyum, and Rameesha Tanveer. 2025. "Role of Ventilation and Spatial Designs in Airborne Disease Transmission Within Residential Aged-Care Facilities" Designs 9, no. 5: 110. https://doi.org/10.3390/designs9050110
APA StyleUllah, F., Olatunji, O., Qayyum, S., & Tanveer, R. (2025). Role of Ventilation and Spatial Designs in Airborne Disease Transmission Within Residential Aged-Care Facilities. Designs, 9(5), 110. https://doi.org/10.3390/designs9050110