Submit your papersSubmit Now
For Enquiries: [email protected]
IIARD LogoIIARD

Architectural Zoning and Circulation for Airborne Infection Control: A Qualitative Comparative Analysis of Four Nigerian Hospitals

Ayejimba Franklin Ifeanyichukwu, Arc. Okafor Calistus C. Nkemdilim Joachim, Chimelue

Abstract

Airborne infection control in hospitals depends not only on mechanical ventilation but also on how architecture separates risk groups, organises movement and supports safe airflow. This study qualitatively compares four Nigerian hospitals to assess the role of architectural zoning and circulation in airborne infection control. The objectives are to comparatively analyse their zoning, circulation and ventilation-related spatial characteristics, and to develop architectural recommendations for Nigerian hospitals. A qualitative comparative case-study method was adopted using published architectural and environmental evidence on Chukwuemeka Odumegwu Ojukwu University Teaching Hospital , Awka; Jos University Teaching Hospital , Jos; Umaru Shehu Ultra-Modern Hospital , Maiduguri; and Joint Presbyterian Hospital, Uburu. The cases were purposively selected for their healthcare relevance, availability of documented spatial or environmental evidence, relevance to zoning/circulation/ventilation, and contrasting climatic conditions. They were examined using risk zoning, circulation segregation, transitional space, ventilation pathway, occupancy arrangement and climatic responsiveness. The comparison shows that late triage and shared routes can undermine functional zoning, while ward configuration, opening design and airflow pathways materially affect passive ventilation. It also shows that passive ventilation is climate-dependent and may require filtered or mixed-mode support in semi-arid settings. The study concludes that zoning, circulation and airflow must be planned as one infection-control system. It recommends early risk separation, direct routes to higher-risk spaces, controlled transitional zones, climate-responsive passive ventilation in suitable areas, and more predictable ventilation for isolation and other high-risk functions.

Keywords

airborne infection control; healthcare architecture; architectural zoning; circulation; passive ventilation; indoor air quality; qualitative comparative analysis; Nigeria

References

Agarwal, A., Nagi, N., Chatterjee, P., Sarkar, S., Mourya, D., Sahay, R. R., & Bhatia, R. (2020). Guidance for building a dedicated health facility to contain the spread of the 2019 novel coronavirus outbreak. Indian Journal of Medical Research, 151(2–3), 177–183. https://doi.org/10.4103/ijmr.IJMR_518_20. American Society of Heating, Refrigerating and Air-Conditioning Engineers . (2023). ASHRAE Standard 241: Control of Infectious Aerosols. Atlanta, GA: ASHRAE. Bazant, M. Z., & Bush, J. W. M. (2021). A guideline to limit indoor airborne transmission of COVID-19. Proceedings of the National Academy of Sciences, 118(17), e2018995118. https://doi.org/10.1073/pnas.2018995118. Bhagat, R. K., Davies Wykes, M. S., Dalziel, S. B., & Linden, P. F. (2020). Effects of ventilation on the indoor spread of COVID-19. Journal of Fluid Mechanics, 903, F1. https://doi.org/10.1017/jfm.2020.720. DuBose, J. R., Matić, Z., Sala, M. F. W., Mumma, J. M., Kraft, C. S., Casanova, L. M., et al. (2018). Design strategies to improve healthcare worker safety in biocontainment units: Learning from Ebola preparedness. Infection Control & Hospital Epidemiology, 39(8), 961–967. https://doi.org/10.1017/ice.2018.125. Emmanuel, U., Osondu, E. D., & Kalu, K. C. (2020). Architectural design strategies for infection prevention and control in health-care facilities: Towards curbing the spread of COVID-19. Journal of Environmental Health Science and Engineering, 18, 1699–1707. https://doi.org/10.1007/s40201-020-00580-y. Escombe, A. R., Oeser, C. C., Gilman, R. H., Navincopa, M., Ticona, E., Pan, W., et al. (2007). Natural ventilation for the prevention of airborne contagion. PLoS Medicine, 4(2), e68. https://doi.org/10.1371/journal.pmed.0040068. Fahimipour, A. K., Hartmann, E. M., Siemens, A., Kline, J., Levin, D. A., Wilson, H., et al. (2018). Daylight exposure modulates bacterial communities associated with household dust. Microbiome, 6, 175. https://doi.org/10.1186/s40168-018-0559-4. Garibaldi, B. T., Kelen, G. D., Brower, R. G., et al. (2016). The creation of a biocontainment unit at a tertiary care hospital: The Johns Hopkins Medicine experience. Annals of the American Thoracic Society, 13(5), 600–608. https://doi.org/10.1513/AnnalsATS.201509-587PS. Gilkeson, C. A., Camargo-Valero, M. A., Pickin, L. E., & Noakes, C. J. (2013). Measurement of ventilation and airborne infection risk in large naturally ventilated hospital wards. Building and Environment, 65, 35–48. https://doi.org/10.1016/j.buildenv.2013.03.006. Gordon, D., Ward, J., Yao, C. J., & Lee, J. (2021). Built environment airborne infection control strategies in pandemic alternative care sites. HERD: Health Environments Research & Design Journal, 14(2), 38–48. https://doi.org/10.1177/1937586720979832. Greenhalgh, T., Jimenez, J. L., Prather, K. A., Tufekci, Z., Fisman, D., & Schooley, R. (2021). Ten scientific reasons in support of airborne transmission of SARS-CoV-2. The Lancet, 397(10285), 1603–1605. https://doi.org/10.1016/S0140-6736(21)00869- 2. Hobday, R. A., & Dancer, S. J. (2013). Roles of sunlight and natural ventilation for controlling infection: Historical and current perspectives. Journal of Hospital Infection, 84(4), 271–282. https://doi.org/10.1016/j.jhin.2013.04.011. Li, Y., Leung, G. M., Tang, J. W., Yang, X., Chao, C. Y. H., Lin, J. Z., et al. (2007). Role of ventilation in airborne transmission of infectious agents in the built environment: A multidisciplinary systematic review. Indoor Air, 17(1), 2–18. IJGEM IIARD International Journal of Geography & Environmental Management https://doi.org/10.1111/j.1600-0668.2006.00445.x. Lipinski, T., Ahmad, D., Serey, N., & Jouhara, H. (2020). Review of ventilation strategies to reduce the risk of disease transmission in high occupancy buildings. International Journal of Thermofluids, 7–8, 100045. https://doi.org/10.1016/j.ijft.2020.100045. Memarzadeh, F., Olmsted, R. N., & Bartley, J. M. (2010). Applications of ultraviolet germicidal irradiation disinfection in health care facilities: Effective adjunct, but not stand-alone technology. American Journal of Infection Control, 38(Suppl.), S13–S24. https://doi.org/10.1016/j.ajic.2010.04.208. Mezue, C. S., Ezezue, A. M., & Agwu, K. (2026). Developing an architectural framework to reduce airborne disease transmission in Nigerian healthcare facilities: A proposed airborne disease treatment and research centre, Awka. NIA Anambra State Chapter Journal of Architecture and Environment, 4(1), 28–40. https://doi.org/10.420001/6cqves23. Mohammed, M. A., Dudek, S. J. M., & Hamza, N. (2013). Natural ventilation in hospitals of semi-arid climates: A case for excluding mosquitoes and Harmattan dust. Proceedings of the FutureBuild Conference, University of Bath, 4–6 September 2013. Mohammed, M. A. (2015). Natural ventilation: An evaluation of strategies for improving indoor air quality in hospitals located in semi-arid climates (Doctoral thesis). Newcastle University, Newcastle upon Tyne, UK. Morawska, L., Allen, J., Bahnfleth, W., Bluyssen, P. M., Boerstra, A., Buonanno, G., et al. (2021). A paradigm shift to combat indoor respiratory infection. Science, 372(6543), 689–691. https://doi.org/10.1126/science.abg2025. Mphaphlele, M., Dharmadhikari, A. S., Jensen, P. A., Rudnick, S. N., van Reenen, T. H., Pagano, M. A., et al. (2015). Institutional tuberculosis transmission: Controlled trial of upper room ultraviolet air disinfection—A basis for new dosing guidelines. American Journal of Respiratory and Critical Care Medicine, 192(4), 477–484. https://doi.org/10.1164/rccm.201501-0060OC. Nimlyat, P. S., Anumah, J. J., Odoala, M. C., & Benjamin, G. K. (2018). Spatial distribution of the nature of indoor environmental quality in hospital ward buildings in Nigeria. In Indoor Environmental Quality. IntechOpen. https://doi.org/10.5772/intechopen.78327. Qian, H., Li, Y., Nielsen, P. V., & Huang, X. (2009). Spatial distribution of infection risk of SARS transmission in a hospital ward. Building and Environment, 44(8), 1651–1658. https://doi.org/10.1016/j.buildenv.2008.11.002. Qian, H., Li, Y., Seto, W. H., Ching, P., Ching, W. H., & Sun, H. Q. (2010). Natural ventilation for reducing airborne infection in hospitals. Building and Environment, 45(3), 559–565. https://doi.org/10.1016/j.buildenv.2009.07.011. Uzuegbunam, F. O., Aja, F. N., & Ibem, E. O. (2025). Influence of building attributes on thermal comfort in naturally ventilated hospital wards in the hot-humid tropics of southeast Nigeria. International Journal of Building Pathology and Adaptation, 43(5), 1279–1302. https://doi.org/10.1108/IJBPA-12-2022-0189. Wong, M. F., Matic, Z., Campiglia, G. C., Zimring, C. M., Mumma, J. M., Kraft, C. S., et al. (2019). Design strategies for biocontainment units to reduce risk during doffing of high-level personal protective equipment. Clinical Infectious Diseases, 69(Suppl. 3), S241–S247. https://doi.org/10.1093/cid/ciz617. World Health Organization . (2009). Natural Ventilation for Infection Control in Health-Care Settings. Geneva: World Health Organization. World Health Organization . (2021). Roadmap to Improve and Ensure Good Indoor Ventilation in the Context of COVID-19. Geneva: World Health Organization. Yin, R. K. (2018). Case Study Research and Applications: Design and Methods (6th ed.). Thousand Oaks, CA: Sage.