With the increase of facilities and housing for the elderly, there is the fear of the occurrence of infections in these buildings. The purpose of this paper is to study the state of maintenance and sanitation management in facilities and housing for the elderly. Data and documentation about the present condition and situation of facility development, maintenance, and sanitation management systems were collected and summarized. Many recurring cases of infection in facilities for the elderly were reported. One of the reports indicated that ventilation is important for the restriction of aerial infections. Studies on the relation between building environments in elderly facilities and the health of the elderly have been conducted in Europe. The construction of facilities and housing for the elderly are increasing in Japan. However, the standard for the maintenance of equipment in these buildings, especially with respect to the control of indoor environments, including indoor temperature and air quality, are not covered in the ministerial ordinance and regulations. Because “the Act on Maintenance of Sanitation in Buildings” concerning indoor environmental health does not include these specific facilities, public health centers or other health guardians cannot provide proper guidance and surveillance. Facility managers or operators are not obligated to hire professional administrators who have the relevant knowledge and skills of sanitation. However, it has been shown that the health management state of facilities where a professional administrator is placed is relatively good compared to facilities where such a person is not placed. It seems appropriate to note that in order to secure and maintain a favorable indoor environment and hygiene in a building for the elderly, interventions on environmental control are needed, such as recruitment of a professional administrator.
In recent years, the change in national age composition, which caused Japan to become a super-aged society, caused a remarkable shortage of facilities for the elderly. Meanwhile, in order to maintain the quality of life for elderly people who are susceptible to infection and health consequences, it is essential to manage high-quality building envelope structure and air conditioning equipment that support the maintenance of the living environment. The situation surrounding buildings has undergone drastic changes and various restrictions have been imposed on the building and its indoor environment. Regarding the health and hygiene of buildings providing for a large number of users and residents, the Building Sanitation Law (Acton Maintenance of Sanitation in Buildings) has been established to ensure compliance with measurements, the reporting of indoor environments, and management standards. However, it is not applied to facilities for the elderly. There is concern about the lack of awareness and information on building sanitation and facility management, but the actual situation is not clear yet. The authors started a questionnaire survey targeting social welfare institutions in Tokyo from 2012 and, in 2013 conducted a nationwide cross survey with a questionnaire targeting nursing homes to shed lights on the actual indoor environment and actual condition of building facility management and its characteristics. In 2014, 2015 and 2016, in order to examine regional differences, winter measurements were carried out at a special nursing home for the elderly in a northern area of Japan, and basic information for the clarification and improvement of indoor humidity formation was collected. In this paper, we summarize the findings, that were observed concerning facility management and the problems of health, sanitation, etc., in facilities, and discuss the findings.
The government of Kawasaki city focused on facilities for the elderly in an integrated community care system, and produced a manual for facility management. The authors investigated a summary of 50 facilities and investigated the management of the environment and health, odor, temperatures, humidity, and carbon dioxide concentrations in five facilities. Results showed the following: After 2000, large facilities increased and the care type changed from the conventional type with multi-bed rooms, to a unit care type with single bed rooms. Separate air conditioners are used in most facilities, and temperature and humidity is not monitored or controlled in some facilities. Smells of ordure and urine can be sensed in bedrooms, toilets, and utility rooms. Indoor temperatures meet the standard of environment and health of buildings (SEHB). However, humidity is very low in winter. Average concentrations of carbon dioxide are lower than 1,000 ppm (SEHB). The manual named “Manual on management of environment and health in facilities for the elderly” and sheets for checking points on air conditioners, water saving, and exhausting equipment were installed. SEHB was used as a guideline for the management of facilities for the elderly. The following distinctive factors were added: odor control, management of bathrooms and kitchens, cleaning and management of laundry, and hairdressing. This manual was introduced to sectors of facilities for the elderly in 2015 and is going to be sent to facilities in Kawasaki city.
In this study, targeting large-scale welfare facilities for the elderly (that consume a huge amount of energy), an improvement process for investigating the conditions of buildings, energy consumption, and contributing to energy and resource saving was investigated. Moreover, analyzing the thermal environment inside actual facilities and the health of the residents revealed the following four findings: (1) According to the results obtained by analyzing the conditions of buildings (scale, age, specification, etc.) by means of a questionnaire (which elicited 165 valid responses), the average total floor area and average age of facilities are respectively as follows: intensive-care nursing homes for the elderly: 3729 m2 and 20.3 years; low-cost nursing homes for the elderly: 3486 m2 and 18.0 years. (2) From the results of an investigation on various types of energy consumption (e.g., electricity, gas, and oil) of each building, three types of energy consumption (i.e., heating use, cooling use, and base use) was supposed. In detail, the basic unit of energy-consumption, energy-consumption ratio of heating use, and the coefficient of heat loss of the building are as follows: intensive-care nursing homes for the elderly: 2,512 MJ/(m2 year ), 44.5%, and 3.08 W/(m2 K); low-cost nursing homes for the elderly: 2,082 MJ/(m2 year ), 50.5%, and 2.58 W/ W/(m2 K). (3) By using the coefficient of heat loss acquired above, the effect of reducing energy consumption by improving thermal performance of a building was estimated. According to the results of the estimation, setting the thermal insulation performance of a building to the residential next-generation energysaving standard (area classification I) of 1.6 W/ W/(m2 K) cut energy consumption for heating by about 50%. (4) At three facilities in Sapporo city, indoor thermal environments and the health of residents were investigated. According to the results of the investigation, the temperatures of the common-use areas and private rooms differed by 5ºC at two of the facilities. However, in the majority of facilities, the relative humidity of both the common-use areas and private rooms was in the range of 20–30%. Results conclude that hypertensive persons in those two facilities are living in an environment in which the temperatures of the common-use areas and the private rooms differ significantly.
The aging society is progressing in Japan. On October 1, 2015, people over 65 years of age accounted for 26.7 percent of the total population. Generally, as immune systems decline in association with aging, elderly people easily contract diseases and infections. Therefore, the hygiene management for the elderlyʼs living environments becomes more important than a healthy person's living environment. This paper describes the measurement results of the microbes in indoor environments of five aged welfare facilities and two aged care facilities. Since pathogenic bacteria, such as Eubacterium biforme, Prevotella intermedia, P.melaninogenica, Propionibacterium acnes, P.granulosum, Roseomonas mucosa, and Rothia aeria were detected in the indoor air, the surface of the TV remote control, and an air-conditioner filter, it was strongly suggested that it is necessary to improve the microbe environment of an elderly-people dwelling.
It is critical to understand the facility management system and the actual condition of indoor environments in order to improve quality of life, such as health and comfort, and to prevent the spread of infectious diseases. This article reports the results of measurement for VOCs, aldehydes, and endotoxins in the indoor air. VOCs concentrations were low in most of the facilities, while detergents, fragrances, and pharmaceutical components such as cineole and limonene were detected. In the one facility, TVOC concentration was observed at over 2000μg/m3 after the floor was cleaned and waxed. Airborne endotoxins frequently appeared in the single digits or less and almost in less than 1EU/m3. However, 10EU/m3 or higher concentrations were observed in the two facilities in winter, when the humidification by domestic humidifiers might have been associated with a high risk of bacterial contamination. Since the main source of bacteria is often the human body, endotoxin concentration tends to be high in common spaces where many people gather. The suitability of the climate during summer in the cold region contributes to an improvement in the indoor air environment. More importantly, it should be noted that the care staffsʼ recognition of the importance of ventilation would have a profound effect on indoor environments such as air temperature, humidity, and airflow, as well as airborne chemicals and microbes.
The aims of this study were to investigate awareness and measures to improve environmental hygiene management in facilities for the elderly, which are not regulated, to consider a policy supporting hygiene management of these facilities, and to propose a model plan for the policy. We investigated the indoor thermal environment of some facilities for the elderly in the southern Kanto region in winter. It is required that the number of the surveys and the survey area be increased so as to appraise the situation nationwide. This report describes indoor thermal environment results in the southern Kanto, Tohoku, and Hokkaido regions, and provides an analysis of the ventilation amount and required humidification amount in facilities for the elderly in the Tohoku and Hokkaido regions. From winter to summer, indoor temperature, humidity and CO2 concentration at 4 places (3 bedrooms and 1 common space), and outdoor temperature and humidity, were measured in 15 facilities for the elderly in the southern Kanto, Tohoku, and Hokkaido regions.
The winter results showed 1) the indoor temperature and CO2 concentration were almost within reference ranges, but the relative humidity was less than 40% in most facilities, 2) the managing temperature was higher in facilities in the Hokkaido region than the southern Kanto and Tohoku regions.
The summer results showed 1) temperature, relative humidity and CO2 concentration were within reference ranges, 2) there was ample ventilation when the windows were opened in the Hokkaido regions.
An analysis of the ventilation amount and required humidification amount in winter showed that 1) there was diversity in ventilation patterns, and ventilation modes in each facility, such as the opening of windows or opening and shutting the living room door, were closely related to building performances; 2) the colder the regions, the ventilation tended to increase; 3) there was a need to introduce an industrial humidifier at an early stage in the examination of specifications of facility construction so that indoor relative humidity could be more than 40%, because the humidification amount produced by portable humidifiers was insufficient ; and 4) if the upper limit of CO2 concentration was relaxed to 1,000 ppm, the lack of humidification could be reduced to below the current 50%.
This report confirmed that there can be various temperature-humidity situations due to differences in ventilation equipment, user/staff situations, and facilities operations, and estimated the lack of humidification from an analysis of ventilation amount.
Objectives: Our purpose is to ensure that the indoor environments in facilities for the elderly are in good condition. After investigating their indoor environments, we carefully clarified points on the design and management of these facilities. Methods: We interviewed the care managers of 129 buildings in the Kanto and Kansai area about the interest in the indoor environments and disease prevention. We performed maintenance on the air conditioning systems in facilities for the elderly, and compared measurement data from the optimally functioning systems against the standard value of the indoor environment. Results: The care managers are think it is important to keep indoor environments in good condition for the sake of disease prevention among the elderly. Unfortunately, they cannot do so because they do not have enough knowledge about design and management method. Conclusion: It is important to indicate the result that estimates the state of the indoor environment from the perspective of disease prevention and to build a support system on which the specialists can appropriately advise care managers from the planning to the management stage.
Former investigations on the indoor environment of facilities for the elderly showed that the indoor relative humidity is not satisfactory for the standard of Act on Maintenance of Sanitation in Buildings (40- 70RH%). It is important to keep humidity adequate in facilities for the elderly in order to control influenza infection. However, humidifiers are not installed in the air-conditioning system in most facilities. In order to keep humidity high, many portable humidifiers are used, but the humidity is very low. The main factor of this low humidity is thought to be high ventilation rates.
With consideration in these characteristics of indoor environments in facilities for the elderly, the index of influenza air-borne infection risk is proposed using absolute humidity and ventilation rate a person. A method is proposed to improve indoor humidity considering relationships between energy consumption and influenza air-borne infection risk. The results of estimation on these investigated facilities showed that influenza air-borne infection risks depends on ventilation rate a person, because humidity is very low and the possibility of preventing influenza infection by high humidity is also low in all facilities.
The results of studies on the improvement of indoor humidity using above estimation, highlighted the following guidelines. 1) It is necessary to reduce ventilation rate a person with the consideration of indoor pollution such as odor, and 2) It is necessary to insulate openings to prevent vapor condensation.
Objectives: A questionnaire survey was conducted to determine the health status, health behavior and medical care in evacuation centers during flood situations in three villages in the suburb of Khon Kaen City. Methods: A total of 393 respondents was randomly selected proportional to size to respond to the questionnaire. Results and discussion: As for the health status, villagers were generally covered or insured for medical care and have good health promoting practices. Athlete's foot, tinea pedis, low prevalence of diarrhea and only 2 cases of leptospirosis were reported during flood situations. No serious illnesses were reported. Although the villagers have the tendency to use traditional treatments, there were doctors and nurses in evacuation centers and medicines were provided. Possibly because of this, serious diseases were not observed in a significant manner. In terms of health behaviors including knowledge, attitudes and practices, villagers generally have high knowledge on sanitation, but had incorrect knowledge on some sanitation aspects such as disposal of dead animals, diarrhea prevention and eye care. Villagers need to acquire knowledge on matters they did not understand correctly. Drinking water while in evacuation centers consisted of bottled water, rain water and piped water. Especially, piped water had high total coliform bacteria (TCB) and fecal coliform bacteria (FCB) content and no residual chlorine detected. Detection of TCB and FCB means possible contamination with enteric pathogens. Therefore, villagers need to be warned of the problem with water source purity. Moreover, flood water was used for washing tableware and cleaning of clothes, therefore the hygienic conditions among them were poor. The questionnaire survey revealed that the villagers' health status during floods was generally good with only common ailments associated with flood situations seen. But certain hygienic and sanitation knowledge and practices needed improvement, together with the condition of the water supply system.
Abstract Requested by the Inspection Section of Long-term Care Insurance, Ministry of Health, Labour and Welfare, National Institute of Public Health (NIPH) started operating a short-term training course designed for inspectors of the Long-term Care Insurance in 2009, which ended in 2016. The Ministry would commission a private organization to run the training course since 2017. NIPH had played a role to develop the national model training program. From a viewpoint of a chief program manager of the training course, policy backgrounds, development process and the contents of the model program would be reported. Then, implications and lessons learned for the roles of NIPH as a developer of national training programs under decentralization would be discussed.
Abstract Purpose: Parent support group meetings (hereinafter: ‘meetings’) are said to be effective for parents with a high risk of child abuse to prevent such behaviors. However, the characteristics of mothers participating to the meetings have not been clarified. The purpose of this study was to identify the characteristics of mothers who were recommended to attend the meetings by public health nurses to gain suggestions for support to mothers with a high risk of child abuse. Study Design and Methods: This cross-sectional study compared the mothers who participated in parent support group meetings (support group) and mothers who were not eligible for such meetings (control group) in Ibaraki Prefecture, Japan. And then “continuation group” and “discontinuation group” in support group were also compared. Data on emotions related to child-rearing were obtained from the questionnaire distributed to mothers who participated in the meetings in the past and newly distributed to the control group. Analysis was performed using the Mann-Whitney U test. Results: Support group tended to experience greater anxiety related to child-rearing and child abuse. The continuation group in particular exhibited a stronger tendency for not wanting to look after their child but putting up with these feelings day after day. Conclusions: Results suggested that mothers who were recommended to attend the meeting by public health nurses experience strong anxiety related child-rearing and have higher risk of child abuse. It is necessary to provide support to reduce mother’s negative feelings toward child-rearing which are unique characteristics of continuation group in the meetings.