Air Monitoring in Operating Rooms: Results from a Comprehensive Study in the Campania Region

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

 

Journal: Atmosphere (ISSN 2073-4433)

Manuscript: IDatmosphere-3039356

Type: Article

Title: Air monitoring in operation rooms: Results from a comprehensive study in the Campania Region

 

Comments and Suggestions for Authors:

Thank you for this comprehensive study on indoor environmental quality in operation rooms, based on measured data over 141 operating rooms across Campania region in the period 2015-2022.

Section 2

Row 91: I think you are referring to the brand “LSI Lastem”, not “LSI laser”. If you used the M-Log datalogger, the instruments are connected directly to it. Therefore it is not clear what do you mean with “microclimate control unit”. Please check.

For further clarity it would be useful having also at least a picture of the instrumental set up you used.

The technical features of all the instruments used should be summarized in a table, showing for each instrument the name of the model, the measured variable(s), the accuracy and the measurement range. If available, the date of the most recent calibration should be included, especially for the psychrometer, which is particularly sensitive to calibration time.

Row 99: additional details should be provided on the measurement of air change per hour via anemometers: where did you place the anemometers? Also the way to calculate supply air flow rate (m3/h) starting from measured air velocity should be mentioned.

Row 106: as a reference and replicability of the results, it would be useful to explicitly provide the metabolic activity rates (met) and clothing level insulations (clo) assumed for comfort calculations.

Section 3

Table 1:

-please specify the references you used for the adopted thresholds of thermal comfort and indoor air quality parameters. If not already done, check EN ISO 16798-1 and 16798-2 and ASHRAE 55:2020.

-the adopted limits could be represented in a separate table, instead of as footnotes of the table.

-in the “Out of Limits” column, you are presenting the number of “controls” in which the parameters where outside the limits. But how did you define if a “control” was outside limits? Was it just a one-time measurement for each “control”, or a long-term one (e.g. over some hours)? If it is the latter case, which method did you adopt to assess the long-term performance (e.g. “out of range hours” method, as in EN 16798?). Please specify.

-The unit of measurement of air change per hour is h^-1, not N/h.

Figure 2:

-In the air velocity chart, it is not clear how you obtained negative values of air velocity. The hot wire anemometer is not able to identify the direction of the air velocity vector, but only its modulus. Therefore, negative values are not expected. Please explain.

-for the bottom chart, air temperature, relative humidity and PPD should be represented using different vertical axis, with different scales, otherwise they cannot be read properly due to their different ranges.

-for each parameter, it would be useful to draw the respective limits on the chart (e.g. using the same colour as the respective measured data).

Section 4

It is useful your remark about conflicting information on recommended exposure limits on halogenated anesthetic gases. In the topic of indoor air quality, issues like this arise often, and it is good to contribute to further researches for defining more unique limits.

Section 5

It would be also good to mention the importance of maintenance programs for HVAC systems in operating rooms, highlighting the role of building managers and hospital managements staff in assuring adequate care and economic coverage to these activities.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This study aimed to evaluate the air quality in operating rooms (ORs) and estimate the compliance of healthcare workers and medical service management with the corrective guidelines derived from monitoring actions. Some questions need to be clarified.

 

1.      The rationale of this study needs to be clarified.

2.      There are some questions in the methodology section as follows:

l  The location distribution and layout of ORs should be described.

l  Some ORs sampled air every six months, while others did so every four months. How were these sampling data ultimately treated?

l  What were the sampling seasons or months for all the ORs?

l  What was the sampling time for each monitoring item?

l  How did you distinguish between the in-use and at-rest periods of the ORs? Was the number of people recorded?

l  This study lacked a section on data analysis.

l  The first instance of an abbreviation should be presented with the full name.

3.      It is suggested to reorganize the presentation of the results:

l  What are the differences in IAQ indices of ORs among hospitals, different departments (e.g., trauma, colorectal), different OR conditions (in use and at rest), and between weekdays and weekends?

l  It is suggested to perform trend analysis for each IAQ index.

l  The data analysis should align with the purpose of this study.

4.      The presentation of the Discussion section should relate to the results.

 

 

Comments on the Quality of English Language

NA

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Review

 

Air monitoring in operation rooms: Results from a comprehensive study in the Campania Region

 

Authors

Paolo Montuori, Immacolata Russo, Elvira De Rosa, Fabiana Di Duca, Bruna De Simone, Maria Triassi

 

Abstract: Lines 07-21

Please structure it as:

Introduction-Aims

Method

Results and interpretation

 

Introduction

Literature review should be developed, updated to 2024 and internationalized.

Please analyse critically the findings of the articles and the limitations.

Please also indicate at least three articles similar to your recent research published (last 5 years).

Method

Please insert a flowchart of your research methodology steps for better visibility and understanding by the journal readers as well as  large public

A sketch with the sensors location is required

Line 130 for Eq 1 please insert the datasource and explain what represents each component and measurement unit.

Please make the correlations of the parameter you monitored with the outdoor climate data.

References: update the references to 2024

The following paper can be useful for the paper literature review, too. Please see and cite also:

DOI

10.35530/IT.071.06.1756

DOI

10.25083/rbl/25.2/1362.1368

Is it relevant and
interesting?

The paper is relevant to the domain and synthesises the available literature data, focusing mainly on the efficiency of tests conducted in laboratory conditions. The paper is interesting because the monitoring and the results reflect the real conditions in indoor polluted environments.

How original is the topic?

It is an actual topic even if it is not very original; but the subject is important, especially for public health.

What does it add to the subject?
area compared with other published material?

The paper should be better documented (cca 30 scientific published articles in references list). The literature review should be developed and also updated to 2024.

Is the paper well written?

The paper is well written. The quality of the English translation is good.

Is the text clear and easy to read?

The text is well structured, clear and easy to read from the specialists in the field as well as from the persons from the public.

Are the conclusions consistent with the evidence and arguments presented?

The conclusions should be well represented in the paper.

Thanks a lot,

June  2024

Comments on the Quality of English Language

-

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

See the attached document.

Comments for author File: Comments.pdf

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the effort and the significant improvements. However, some important points still need to be addressed.

A2:

-Table S1 summarizes some important features of the instruments and their last calibration date. However, the accuracy of each instrument is still missing, and this is a very important parameter in experimental works.
-PPD and PMV are derived (calculated) variables, therefore they should not be mentioned in this table, which is only related to the variables directly measured by the instruments. Furthermore, according to the basics of the thermal comfort theory from Fanger, the minimum value for PPD is 5%, not 0%. A recommended reference is EN ISO 7730, Ergonomics of the thermal environment - Analytical determination and interpretation of thermal comfort using calculation of the PMV and PPD indices and local thermal comfort criteria.

A3:

-Due to the fluid dynamics of air flow in enclosed channels, the velocity measured at the center of a duct is typically higher than the average velocity, therefore a single measurement at the center of the duct overestimates the average velocity, necessitating the a correction factor, usually between 0.8 and 0.9. More accurate flow measurements often involve multiple sampling points across the duct's cross-section to account for this velocity profile.

A5:

Table 1 and 2 provide additional clarity to the method. However, there is still no reference to EN ISO 16798-1&2 and/or ASHRAE 55:2020. Although other national references have been provided in the paper, in a research work it is important to be aware of the most prominent international technical standards on the topic, in this case thermal comfort and indoor air quality. The above mentioned standards should be cited, at least to explain why they were not considered (e.g. if they provide different thresholds than Italian legislation). Also it is suggested to read EN 16798-3 – energy performance of buildings – ventilation for buildings – Part 3: for non-residential buildings – performance requirements for ventilation and room-conditioning systems.

A8:

In Figure S2, the caption and the vertical axes still report the unit N/h instead of h^-1.

A9:

The provided charts are useful.
-It would be good having the same scale of the vertical axis on the two charts of each variable.
-The text in the charts (particularly the axes' labels) can hardly be read.
-Even though RH and PPD are both expressed in percentage, it is better to not create a chart with only those two, as RH is one of the parameters influencing PMV and PPD. It would be better, e.g., having PMV and PPD on the same chart, using different scales on the two vertical axes.
-The PPD chart should be checked carefully, as it seems it is showing values of 0%, which are not possible according to Fanger's equations. Values of 0% are most likely due to measurements faults and should be removed from the dataset.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

-

Author Response

Thank you for your previous feedback. We feel that according your suggestion the paper has been improved.

Reviewer 4 Report

Comments and Suggestions for Authors I have read the attached pdf-files. I am satisfied with the authors' replies.