Impacto de la ingeniería hospitalaria en el mantenimiento de las instalaciones y los parámetros de calidad ambiental en hospitales

Abstract

The aim of this Doctoral Thesis is to investigate the relationship between the factors that affect the efficiency of hospital maintenance and their of environmental quality, in order to provide appropriate indicators that serve as a management tool, both in the design of new hospitals and in the optimization of resources in existing ones. To this end, the efficiency of the maintenance plan of different hospitals was analysed, considering the main variables that affect it: number of interventions carried out, time spent on these interventions, costs of materials and labour, useful surface, number of patients treated, etc., finding that there is a determining relationship between the healthcare activity of a hospital and the effective intensity of its maintenance. The influence of healthcare activity and other functional variables (number of beds, number of workers, useful surface, etc.) on the consumption of electrical energy, thermal energy, the main medical gases and water in 14 private hospitals in Spain - with a number of beds between 20 and 194, and with a surface between 2,314 and 23,300 m² - was also quantified between 2008 and 2017. A high correlation was found between average annual energy consumption in a hospital and the number of workers, its useful surface, the number of hospitalization stays, of hospital discharges, of emergencies attended and of beds. On the other hand, it was shown that the average annual consumption of oxygen was correlated with the following variables: number of hospitalization stays, number of beds, number of hospital discharges, number of workers and useful surface. On the other hand, the average annual rate of medical air consumption showed a clear correlation with the number of surgeries, hospital discharges, endoscopies, laboratory studies, beds, workers and stays. In addition, there were results that showed correlations between annual water consumption and the number of hospitalization stays, hospital discharges and the number of hospital surgeries. Furthermore, it was confirmed that all these variables were directly related to the useful surface, the number of beds and the number of workers. The relationship between the maintenance carried out on the facilities and the energy consumption of a public hospital in Extremadura was also investigated, proving that an average annual increase of 6% in the time dedicated to preventive maintenance operations, over a period of 5 years, leads to a 20% decrease in the demand for corrective maintenance and an average annual saving of 500 MWh in energy consumption without additional costs or extraordinary investment. This Doctoral Thesis has been carried out through the compilation of 5 scientific articles published in journals included in the Web of Science (WOS) and indexed in Journal Citation Reports (JCR), all of them in the first and second quartile. The results obtained are of great importance, and can be applied to decide where to invest the available technical-economic resources, to determine the effectiveness and efficiency of the measures adopted to improve the parameters of environmental quality, to size the facilities of new hospitals and even to determine what work has been carried out by the people responsible for maintenance management.