An Experimental Analysis of the Bioharmological Properties of Polyclinics at Hospitals in August

This is an experimental study that explores the bioharmological properties of outpatient clinics at hospitals. Hospitals, in broad terms, are one of the institutions with the most complex structures. To ensure user satisfaction, it is highly important to indicate the bioharmological properties of polyclinics. The research sample includes hospitals in Elazig and uses the results of measurements for the parameters of CO, CO2 and O2, ambient temperature, light, relative humidity, noise, dust content and electromagnetic field. The results of the Image Permanence Institute (IPI) and Bioharmological Conformity Assessment (BCA) metrics are valid for the month of August. This study found that these outpatient clinics do not satisfy the criteria of auditory, visual and seasonal perception analyses.


Introduction
Hospitals are institutions used by people with health problems to be diagnosed, treated and cured. People also go to hospitals to maintain their health. Hospitals are institutions where patients feel safe. Outpatient clinics are public or private health centers that provide outpatient diagnosis and treatment and some medical operations. Polyclinics are mostly subject to the work hours indicated by the relevant regulations. One of the principles of hospital services is to examine patients the same day they visit the institution [1].
Service units that are related to each other should be grouped together in polyclinics. This provides a coordinated and efficient workflow, and helps to specify the physical connections, hygiene and sterility conditions, levels of cleanliness and the circulation of materials and humans [2].
To provide a healthy and safe hospital environment for patients, polyclinics' setup, order and cleanliness -properties easily recognized by visual perception-as well as lightning, air conditioning and heating systems, and control of acoustic and sound insulation are highly important.
The hospital environment plays a great role in the spread of infections in hospitals. The hospital acquired infection rate worldwide is 5-7%, whereas it is 10-15% in Turkey. This is because the use of special units to maintain hospital hygiene and control infections is not prevalent in Turkey [3]. In enclosed spaces, decorative features such as furniture, carpet, wallpaper and wall paint, interior space criteria (location, material choice, area, volume, light, heat, air, etc.), the number of users and air conditioning can be potential contaminants [4]. These contaminants include many visible or invisible particles and microorganisms in an enclosed space. These particles are a serious threat to people [5]. Therefore, it became necessary to determine microbiologically the emission potential of contaminants and analyze interior air, find architectural and engineering solutions and maintain interior air quality in accordance with standards [6].
Bioharmology is a science that examines the conformity of a building with all the living and non-living beings that have direct or indirect relation with it. It provides solutions for a healthy, safe and professional environment and plays an effective role in the implementation of these solutions [1,7]. Bioharmology is a field of study that includes all the units of construction and suggests a standardization required in the construction of hospitals. Table 2 and 3 show reference values for Bioharmological Conformity Assessment (BCA) and the Image Permanence Institute (IPI) developed to satisfy the needs of development and progress in standardization [1,7,8].

Research Significance
The quality of a hospital is recognized only in terms of its space standards and cost management. However, the aim should be healthy buildings and healthy living spaces and improving quality of life. Along with material factors, users' Environment and Ecology Research 3(6): 150-157, 2015 151 psycho-social needs and their purpose of use become more important, and solutions need to be found considering these issues. In this study, relative humidity, ambient temperature, quantity of light, carbon dioxide, carbon monoxide, level of noise, quantity of particulate matter and particles, oxygen, square meters, cubic meters and level electrical field were measured in outpatient clinics [1,7]. This study will contribute to determining effective parameters for building construction, their implementation and achieving healthy outcomes.

The Experimental Study and Its Principles
This experimental study measured the atmosphere of enclosed spaces in the units of polyclinics. The experimental measurements were taken with the written permission of Elazig Governorship Health Department. The results of the experiment were examined using EN ISO 14644 standards, IPI and BCA. The sample of the experimental study includes one public (H-1) and one private (H-2) hospital. The experimental measurements of IPI and BCA were done in August. A pre-interview was done with the administration of hospital to obtain information about its characteristics.
The aim of the design of H-1 and H-2's buildings was to provide health care services. There are four floors in the building of H-1. The general cleaning of its polyclinics is done hourly. There are air conditioners and natural air conditioning, ceiling fluorescent lighting and natural lighting. There is chipboard furniture, leather chairs with metal frames and chairs. The floor is marble. The ceilings, floors and wall have been painted with oil paint.
The building of H-2 has two basement levels, a ground floor, six higher floors and two attics. The general cleaning of outpatient clinics is done hourly. There are air conditioners and natural air conditioning, ceiling fluorescent lighting and natural lighting. It has metal armchairs and chairs covered with blue and orange polar fleece and chipboard furniture. The floor is covered with PVC (Polyvinyl Chloride). The ceilings, floors and wall have been painted with oil paint.
To measure the electrical fields in the outpatient clinics, an AARONIA AG (Spectran) ELF Meter (Triaxinal ELF Magnetic Field Meter) was used. To measure O 2 , CO and CO 2, Gas Measurement Instruments (GMI) VISA-66268 were used. To measure light, heat, relative humidity and sound levels, a DT-8820 Environment Meter was used. To measure particle quantity, a LIGHTHOUSE Handheld 30133 was used. The surface area and volume of outpatient clinics were measured with a tape measure [1].
Cleanroom standards are mainly about classifying clean rooms. This classification is determined by the limit values indicating concentration of volatile substances in the air (number of particulates per unit volume). The particulate concentrations of the outpatient clinics were measured using the measurement values of 0.3 micrometers, 1.0 micrometer and 5.0 micrometers. The results of the measurements were compared with the EN ISO 14644 (International Organization for Standardization) classification system. The classes of clean rooms were determined. This classification is between 1 and 9, in which Class-1 indicates the most clean room and Class-9 indicates the dirtiest room. A clean room is a hygienic environment that meets the standards of particulate concentrations required for higher quality service or production. In these environments, heat, relative humidity, levels of noise, oxygen, and pressure and air movement should be controlled [1,7,8,16].

Conclusions and Recommendations
To conclude, it is crucial to analyze the engineering and architectural, as well as IPI and BCA properties of hospitals. The hospitals analyzed in this study may be seen as highly suitable constructions and hospitals from a panoramic view with the naked eye. However, when they were analyzed using IPI and BCA principles, significant deficiencies were recognized. It is obvious that this may negatively affect users' quality of health care, as well as worker satisfaction.
Every department of a hospital has its own particularity. Therefore, the hospital design process needs to consider their different needs. The materials selected should have high resistance to the deformations caused by heat, temperature and exposure to air. Information about the materials to be used and hygiene documents should be obtained, and the most suitable air conditioning system should be used [12]. The quality of products used for cleaning, such as water, detergent or enzymatic stain removers, needs to be considered. Dry sweepers should not be used to clean floors to avoid spreading the dust and bacteria that accumulate due to the lack of air movement [13]. A deficient air-conditioner and air conditioning system may also preclude good hygiene [14]. Air conditioning systems should be cleaned and checked frequently. The norms and standards required for its cleaning and maintenance should be provided.
Children are more sensitive to dangerous air contaminants. It is well known that as the concentration of contaminants in the air in buildings and the duration of users' presence there increase, more serious health problems emerge [15].
Human health is a very important issue. Studies such as this one should be considered at every stage of construction to prevent building-related health problems [1,7,8]. Bioharmological solutions developed to overcome problems are becoming more important in today's world.

Note
This study was inspired by and is an extension of Nurdan Baykus' M.A. thesis supervised by Dr. Cevdet Emin Ekinci, which was submitted to Firat University's Institute of Science.