Occupants’ Perception of Ventilation Quality in Orthopaedic Hospital Wards: Evidence From Teaching Hospitals In South-West Nigeria

Abstract

Ventilation is an important component of indoor environmental quality in healthcare facilities because it influences thermal comfort, air freshness, pollutant dilution, moisture control and the overall wellbeing of patients and healthcare workers. In orthopaedic hospitals, where patients may experience prolonged periods of occupancy and healthcare personnel undertake demanding clinical activities, inadequate ventilation can negatively affect comfort, health and the effectiveness of healthcare delivery. This study assessed the impact of ventilation on occupants of selected orthopaedic sections of teaching hospitals in South-West Nigeria, with the objective of developing architectural strategies for improving indoor environmental quality and informing the design of a proposed orthopaedic hospital for Oduduwa University, Ipetumodu. A mixed-method research approach was adopted. The study assessed climatic conditions of the selected hospital locations using climatic data and Mahoney Table analysis, while questionnaire surveys were administered to patients and healthcare workers to obtain information on existing ventilation conditions, factors influencing ventilation, occupants’ satisfaction and preferred architectural improvements. A total of 328 valid responses comprising 274 patients and 54 healthcare workers were analysed. Descriptive statistics, Mean Weighted Value (MWV), Satisfaction Index (SI), correlation analysis and other relevant analytical techniques were employed to interpret the findings, while healthcare workers’ responses and patient perceptions were used to identify architectural and environmental strategies for improving ventilation performance. The climatic assessment revealed that the selected locations experience hot-humid conditions, with relatively high temperatures and relative humidity, thereby creating a strong need for effective air movement, solar protection and moisture management. The assessment of existing ventilation conditions showed that poor ventilation, overcrowding and excessive indoor heat were the most prominent environmental challenges. Poor ventilation was identified by 74.0% of patients, followed by overcrowding at 69.1% and excessive heat at 65.3%. The weighted analysis similarly ranked poor ventilation first (MWV = 4.09), followed by overcrowding (MWV = 4.05) and excessive indoor heat (MWV = 3.82). The study also established significant positive relationships between ventilation and breathing comfort, with overall ventilation recording a correlation coefficient of r = 0.682 (p < 0.01) and ventilation condition recording r = 0.718 (p < 0.01). Occupants’ satisfaction with ventilation was generally positive but moderate. Air freshness recorded the highest satisfaction level (MWV = 3.55; SI = 0.55), followed by temperature comfort (MWV = 3.45; SI = 0.45), while humidity comfort, odour control and overall ventilation recorded comparatively lower values. The overall satisfaction level was MWV = 3.35 and SI = 0.35, indicating satisfaction but with considerable opportunity for improvement. Healthcare workers strongly supported the integration of ventilation considerations into future hospital design, with 98.1% agreeing that future hospital designs should incorporate ventilation-focused principles. Patients similarly prioritised increasing windows for natural ventilation (31.9%) and reducing the number of patients per room (25.6%) as preferred improvements. The study concludes that ventilation performance in orthopaedic hospitals is determined by the combined effects of architectural configuration, climatic conditions, occupancy density, material selection, maintenance and environmental management. It recommends the integration of climate-responsive passive ventilation, appropriate building orientation, effective window placement, adequate ward spacing, low-emission materials, moisture control, improved maintenance and suitable mechanical or hybrid ventilation systems where necessary. These strategies were incorporated into the proposed orthopaedic hospital design for Oduduwa University, Ipetumodu, providing an occupant-centred and climate-responsive framework for improving indoor environmental quality in future orthopaedic healthcare facilities.