Date of Award

Spring 5-2020

Degree Name

Doctor of Public Health (DrPH)



Second Advisor


Third Advisor



The delivery of healthcare in the United States is shifting from a largely inpatient model to an outpatient services model, but the physical infrastructure for outpatient clinics or medical offices may not be as robust as inpatient hospitals regarding whole room ventilation requirements. Guidelines for the design of healthcare facilities and national standards for ventilation establish generally acceptable ventilation rates for outpatient clinics, but it is unclear if these standards are actually being integrated into these settings. Published peer reviewed literature indicates that inadequate ventilation rates can be a risk factor in airborne transmission of infectious diseases in outpatient clinics, hospitals and residential buildings. This study examined whether outpatient clinics operating in a business occupancy setting were conducting procedures in rooms with ventilation rates above, at, or below thresholds defined in ANSI/ASHRAE/ASHE Standard 170 for Ventilation in Health Care Facilities, and whether lower ventilation rate and building characteristics increase the risk of transmission of infectious disease. Ventilation rates were measured in outpatient clinic rooms categized by services rendered (general exam, treatment or procedure room; aerosol-generating or minor surgical procedures) to compare against national standards. Analysis included evaluation of the building characteristics (where the clinic resides) as determinants of ventilation rates and estimated risk of infectious disease transmission based on the measured ventilation rates. The results of this study suggest that a subset of clinics operating in business occupancy settings may be conducting procedures in rooms with ventilation rates that are below those defined in national standards for healthcare settings. When compared to the ANSI/ASHRAE/ASHE Standard 170 for Ventilation in Health Care Facilities standards, 11 of the 105 (10%) clinic rooms assessed did not meet the minimum requirement for general exam rooms, 41 of 105 (39%) did not meet the requirement for treatment rooms, 87 of 105 (83%) did not meet the requirement for aerosol-generating procedures, and 92 of 105 (88%) did not meet the requirement for procedure rooms or minor surgical procedures. While lower air change rates were observed in all building types, newer constructed one-story stand-alone buildings exhibited higher air change rates as compared to the other building types. Based on the measured ventilation rates and the procedures being performed, these outpatient clinic rooms could possibly facilitate transmission of infectious disease rather than protect workers and patients. National ventilation standards should be considered for all healthcare settings and factored into clinic design and clinic lease agreements, which is currently not the case, as suggested by the evidence in this study.