Insights into the utility of small form air quality monitoring in health care environments: lessons learned from the University Hospitals Birmingham NHS Foundation Trust

Nicole Hannah Cowell^1,2*Clarissa Baldo^1,3Kawun Williams⁴Catherine Muller²Siqi Hou²Daniel Rooney²Jian Zhong⁵Scarlett Healey⁶William Bloss²Suzanne Bartington⁷

• ¹Centre for Environmental Policy, Faculty of Natural Sciences, Imperial College London, London, United Kingdom
• ²University of Birmingham School of Geography Earth and Environmental Sciences, Birmingham, United Kingdom
• ³Univ Paris Est Creteil and Université Paris Cité, Paris, France
• ⁴University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
• ⁵Senior Lecturer in Urban Environment School of Computing and Mathematical Sciences, Faculty of Engineering and Science, University of Greenwich, Greenwich Maritime Campus, London, United Kingdom
• ⁶Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
• ⁷Department of Applied Health Sciences, School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom

Air pollution is a major environmental and public health challenge, with exposure to air pollution linked to 29,000-43,000 premature deaths annually in the UK (Mitsakou et al., 2022). The NHS experiences increased burden on its services due to air pollution related disease (Simpson et al., 2022). Acute NHS Trusts and other healthcare settings are often locations with high inpatient and outpatient populations at enhanced vulnerability to air pollution related disease, including the young and elderly, and those with chronic health conditions. Many UK healthcare facilities are located in areas of poor air quality. Noncommunicable disease from air pollution (PM2.5 and NO2) could cost health and social care providers estimated to >£18billion in the UK (between 2018-2035) if pollutant concentrations are not reduced (NHS England, 2019, Pimpin et al., 2018). The NHS Long Term Plan recognised the need for NHS services to take action to mitigate air pollutant emissions, including those arising from site activities and patient, visitor and staff travel. However undertaking air quality monitoring and implementing targeted air-pollution interventions can present organisational, financial, and logistical challenges. Furthermore, evidence of the effectiveness of highly localised interventions is limited in the healthcare context. The recent expansion in utility of small form air quality sensors offers major potential to overcome some of the challenges in monitoring and understanding efficacy of targeted interventions at healthcare settings. Here, we present a case study from Queen Elizabeth University Hospital Birmingham, a tertiary site managed by University Hospitals Birmingham NHS Foundation Trust. This study assesses the feasibility of small form monitoring (diffusion tubes and sensors) for evaluating local air quality interventions in healthcare settings, via an assessment of a localised traffic management scheme aiming to reduce local air pollutant concentrations.