الفهرس 
Introduction and Aim of the studyOnly 14 pages are availabe for public view
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Abstract
Indoor air quality (IAQ) refers to the air quality within buildings and workplaces as related to the health and comfort of the occupants. US Environmental Protection Agency ranks IAQ as the most prominent environmental problem.
The hospital IAQ (H-IAQ) is especially important. It directly impacts the in-patients, staff caring for them, and visitors. Poor H-IAQ is dramatically critical due to the presence of highly sensitive patients.
Risk assessment (RA) is a tool used to describe the overall process of identifying, evaluating, characterizing the risks and enables suggesting the most appropriate ways of control.
This study aims to assess the risks of H-IAQ in Alexandria, Egypt, as related to different traffic congestions (Heavy, Moderate, low traffic congested areas, and sea-road) in various regions. as a step in the way to reduce knowledge gap on H-IAQ as well as improve the IAQ to a vulnerable group.
This study was carried out at four public hospitals in Alexandria, which was selected for conducting this study based on the traffic pattern of the surrounding area. The selection was done by classifying Alexandria main roads according to their congestion and vehicles speeds into three classes, including heavy, moderate, and low traffic roads. In addition, the fourth class was selected sea road hospital.
This was a cross sectional study that was conducting during hot and cold months from outdoor and indoor environment during the period of July 2019 to February 2020. Six-hours air sampling of indoor and outdoor respirable particulates (PM10), Sulfur Dioxide (SO2), Nitrogen Dioxide (NO2), and Total Volatile organic compounds (VOCs) during the morning shift hours (worst conditions) at different locations.
The used methods for sampling and analysis are the standard methods, NO2 was collected and analyzed using ”Modified Jacob and Hochheiser Method”, SO2 was collected and analyzed using ”Improved West and Gaeke Method ”, PM10 was be collected using the standard PM10 sampler, and then analyzed gravimetrically. VOCs were collected using standard charcoal absorbance tube and analyzed gravimetrically.
A 3x3 risk matrix was selected as it is the most simple and appropriate to represent the results. The risk factors RF of the PM10, SO2, NO2, and VOCs were calculated by multiplying the severity by likelihood scores to their occupational exposure.
This study found that the highest outdoor concentrations of PM10, NO2, and VOCs are at the heavy traffic congestion roads during hot months, unlike SO2 of which the highest concentrations were at the sea-road during cold months.
There were strong positive significant correlation coefficients between the increase in traffic congestion with the outdoor concentrations of PM10, NO2, and VOCs at the four roads during hot and cold months. While the effect of traffic and season is faded in case of the outdoor SO2 concentrations due to the large effect of the sea.
The indoor levels of the four pollutants were the highest in HTH, followed by MTH, SRH, and LTH. The Spearman’s rho correlation in the four hospital’s concentrations during hot and cold months revealed that, there was a weak negative significant correlation between the traffic congestion and SO2 concentrations. However, the correlation coefficients between the concentrations of PM10, NO2, VOCs and traffic congestion were significant direct moderate, strong, and weak respectively.
The Spearman’s rho correlation in the four hospitals revealed that, there was a very weak positive insignificant correlation between the season (hot and cold months) and PM10 concentrations. However, the correlation coefficients between the season and the concentrations of SO2, NO2, and VOCs were significant direct weak, weak, moderate, respectively.
The RFs of PM10 during hot and cold months 72.7% of the locations in HTH have very high unacceptable RFs, at the MTH during hot and cold months, 66.7% of the locations had very high. While at the LTH, the very high were observed in 54.5 % of its locations. At the SRH, the very high and high were 42.9% for both at its locations.
The RFs of SO2 during hot and cold months at 72.7% of the locations in HTH have moderate unacceptable RFs. However, at the MTH, 77.8% of the locations had moderate, while at the LTH, the moderate was observed in 54.5% of its locations. At the SRH, the high was exhibited in 14.3% and 28.6% of its locations during hot and cold months respectively.
The NO2 RFs at HTH were high RFs in 72.7% and 63.6% of its locations during hot and cold months respectively. However, at the MTH 77.8% of the locations had moderate RFs, while at the LTH moderate were at 54.5 % of the locations. At the SRH, the moderate RFs was exhibited in 57.1% of its locations.
VOCs RFs during hot and cold months, 72.7% of the locations in HTH have very high unacceptable RFs. However, at the MTH 77.8% of the locations had very high. While at the LTH, the very high were observed in 54.5 %, 45.5% of its locations during hot and cold months respectively. At the SRH, the very high were 57.1% of its locations during hot and cold months.
In conclusion the highest indoor concentrations of PM10, NO2, and VOCs were at heavy traffic hospital (HTH) during the hot months and the lowest PM10 levels were at SRH during hot months, and the lowest NO2 and VOCs were at the LTH during cold months.
During hot and cold seasons, the RFs of PM10 were very high and high within the four hospitals at most locations. The RFs of VOCs at all sampling locations within the four hospitals range from high to very high. Moreover, the least number of NO2 sampling locations have high RFs that are focused at HTH. This may increase the patients risks more and more than the occupational risks affecting the staff. Therefore, a suitable Engineering control method is necessary in these locations.
However, the RFs of SO2 at most locations within the four hospitals during hot and cold seasons are moderate that still needs administrative control measures. Just two locations at the SRH have high RFs that need to follow suitable Engineering control.