Inclusion and exclusion criteria
The relationship between health of employees and the work environment has been well studied in literature. An unsafe work environment has been associated with poor health outcomes that again are linked with productivity and morale of the employees. Some of the health conditions are related to ergonomic disorders, stress and suffocation, as mentioned by Theorell et al. (1).
As per the mandate of Safe Work Australia, all workplaces are to ensure that the WHS Act and Regulations are followed for enabling a safe working environment for the employee. Workplaces in Australia are required to follow the set guidelines as an obligation for reducing harm suffered by employees (2). McLinton et al. (3) stated that a cultural shift is at present evident in Australia through which employers are focusing on establishing workplaces that are supportive of social and physical health of employees.
The primary aim of the present systematic review was to engage in the identification of the exact health effects that indoor employees experience at their respective workplaces owing to the internal environment. The purpose of the review was to understand the relation between the different aspects of the indoor environment and the physical health outcomes, and to assess the barriers to optimal health outcomes of the employees. The findings of the study would be beneficial for establishing health promotion policies and strategies for overcoming challenges in maintaining health and wellbeing of indoor employees (Xiang et al. 4).
A systematic literature review is a planned and logical process of conducting a research wherein existing resources are analyzed and key information from the same are used for identifying gaps in literature. Such a review defines the concept being studies, summarizes the main points generated from the studies, critiques the relevancy of the paper and identifies the gap in literature and directions for future research (DePoy and Gitlin 6).
For the present literature review, the databases that were searched for were PubMed, Scopus and Medline. The keywords that were used for extracting the articles were as follows-health issue, health problem, challenges, indoor, indoor employee, workplace, office. The key search terms used has been summarized in appendix one.
The inclusion criteria followed for searching for databases were as follows-
- Peer reviewed journal articles
- Articles published after the year 2013
- Articles focusing on health impacts of indoor employees at workplaces
- Articles published in English language
The exclusion criteria followed for searching for databases were as follows-
- Not peer reviewed journal articles
- Articles published before the year 2013
- Articles not focusing on health impacts of indoor employees at workplaces
- Articles not published in English language
At the time of the literature review, the articles relevant to the research questions and extracted from the databases were compiled and the brief overview of the articles was presented (Holloway and Galvin 5). The aim, context settings, research methodology, and results of each of the study were highlighted and presented in a tabular form based on the “A Schema for Evaluating Evidence on Public Health Interventions” literature. The strengths and limitation presented by each of the articles had been interpreted for identifying the validity of the research findings. The results were also analyzed for identification of the gaps in literature. The directions for future research had also been presented in conjunction with the discussion.
Critical review process
The review of articles was done by following a standard guideline to extract information and present research articles as per the summary table. The summary table provided in appendix gives an insight into the information collected for each paper. The summary table gave details regarding author name, title of the study, year and journal name, aim of the study, research design, setting, study findings, strength and weakness and level of evidence. The examination of strength and weakness is effective as it enables determining the significance and validity of the research findings. Based on this method of review, gaps in research literature and future research work needed have also been proposed in the conclusion section.
Several research studies were reviewed and examined as per the inclusion and exclusion criteria to find articles exploring health issues in employees working indoors. The total studies found suitable to the research question included 20. Out of 20, two studies used review method and three studies used experimental research design. Rest of the studies were cross-sectional research studies. The following are themes which describe the health issues faced by indoor employees at workplace:
Sick building syndrome and physical symptoms in indoor employees: There were six studies which indicated about the relation between indoor work environment and sick building syndrome (7, 8, 17, 20, 25, 26). Sick building syndrome is a common health issue that affects workers in indoor environment and indoor workers most often report about five or more symptoms of SBS. The common symptoms include headache, dry cough, throat irritation and itchiness. Similarly symptoms of fatigue, headache and decrease in cognitive performance were also some of the symptoms observed in employees exposed to bio-effluents (17). Links has been found between green office environment and better performance as lean office with plants has been found to be associated with lesser complaints of disengagement and tiredness among employees (20)
There were six studies that reported about asthma and respiratory allergies in indoor employees (9, 12, 14, 15, 16, 19). Physician diagnosed asthma, allergy and sinusitis were highly reported in research studies and research evidences gave the indication that employee’s experiences discomfort because of indoor environmental factors like poor perceptions about relative humidity, air exchange and temperature. There was one study that evaluated about the impact of carpets on indoor air quality. It can be concluded that carpets act as sink where pollutants can deposit and occupants suffer from asthma and allergy related problems. One study evaluated impact of indoor waterparks on health of workers and it indicate about high prevalence of work-related respiratory symptoms and ocular symptoms in employee.
Sick building syndrome and physical symptoms in indoor employees
Eight studies established links between indoor environment and psychological symptoms (10, 11, 12, 13, 18, 21, 22, 23). Indoor room temperature and illumination influenced work productibitt and performance. Hence, factors like building space, equipment and furniture must be considered so that employees can work in an efficient way. Noise, lighting, temperature and humidity significantly influenced psychological characteristics of employees. The study gives important implications to enhance the macro-ergonomic compatibility of employees (11). The satisfaction with acoustics and privacy influences mental health of employees. Employees in enclosed space mainly reported about cognitive irritation, lower work ability and lower mental well-being (12). There was one study which evaluated cognitive outcomes and revealed high workload and subjective fatigue among workers (13). A review of research literature also revealed indoor air quality, thermal comfort, lighting and day lighting, office layout, noise and acoustics and location as an important factor affecting occupant’s productivity and satisfaction with office environment (18).
Job stress is one of the symptoms of indoor air quality. This is indicated by a research study which revealed association between indoor nature contact and job stress (21). The findings gives the implication to add natural elements in the physical work environment in office so that subjective health complaints among workers can be reduced. Employees most complained about environmental factors like noise, stuffy air, unpleasant odour and dry air. The symptoms of fatigue and feeling heavy headed have been highly reported by employees (22).
There was only one study which reported about viral illness in workplace. The spread of human viruses occurred due to contact with contaminated surface, mouths and nose. This results in increase absenteeism (24). Hence, reduction of communicable infection must be prioritized in indoor working environments.
The main aim of the literature review was to examine different types of health issues experiences by employees in different work context. The review of 20 articles gives an insight into the common health complaints raised by employees working in indoor environment. A list of different health issues and results has been explained in summary table in appendix. The present literature review had been successful in bringing into limelight the relation of indoor workplace conditions and the health impacts of employees. Although many research literatures were obtained which reported about prevalence of respiratory symptoms, psychological symptoms and sick building syndrome in employees, however most of the studies provided low level of evidence. There was a need of conducting research using systematic review and RCT method obtains highest level of evidence.
Prevalence of asthma, respiratory disease and allergic disease in indoor employees
Out of 20 studies, six studies gave indication regarding the incidence of SBS in indoor employees (7, 8, 17, 20, 25, 26). Such symptoms occur because of poor indoor air quality and its role in asthma exacerbation and other respiratory allergies. It also negatively affects productivity and annual savings of a company. Among building related syndrome, lower respiratory rate were also most commonly reported (26). The results indicated that low relative humidity had an association with ‘sick building syndrome’ and lower respiratory rate syndromes. No other environmental conditions that had been tested by the parameters such as formaldehyde and PM 10 had a correlation with health symptoms of individuals in a direct manner. The other health conditions that came into limelight were allergy or atopy such as asthma and sinusitis. These conditions were present singly or in combination with each other. There was an association of these health conditions with increased symptom days and increased absenteeism from work. The study indicated that in buildings with air quality indicators within the range of acceptable indoor air quality standards, a considerable section of the population suffer from allergic disease and asthma who feel discomfort in a disproportionate manner.
Another most predominant disorder found among indoor employees included issues related to headache, heaviness of the head and other neuropsychological disorders (10, 11, 12, 13, 18, 21, 22, 23). These research findings give the implication that features of the working environment, such as building space, furniture, equipment and the overall environment on the whole have a key influence on the wellbeing of the individual. Hence, on the whole it is evident from the literature review that indoor building design and acoustics plays a vital role in employee’s well-being and performance in workplace. Indoor environmental quality is influences by factors like noise, lighting, air, ventilation rate, atmospheric pollutants and odours. This is the major reason for sick building syndrome and changes in psychological state of employees. The literature review shed’s light into different environmental factors that affect well-being and performance of employees. Occupants comfort can be considered while designing office buildings by using green building rating system and improving different elements like noise and acoustics and office layout to enhance concentration of employees (27).
Conclusion
The present literature review was conducted with the aim of highlighting the key health issues faced by indoor employees in relation to their working environment. The three articles selected for the review presented some key information addressing the research question. Further, a critical analysis of the articles considered for the review was noteworthy. The key health problems that emerged from the studies were sick building symptoms, or allergy that is sinusitis or asthma and physiological stress. Though the symptoms presented by indoor workers are reversible, not much has been done in the past in the workplaces to eliminate the effects on individuals. The present study therefore guides policy reforms related to working conditions in different workplaces. Though certain studies have been undertaken for understanding the direct health impact of indoor working environment, limited research have taken into account both the perceptions of employees, the actual exposure to environment conditions and objective stage of health. There is therefore a need of undertaking research in the future that would clarify the association between different health conditions and the actual level of exposure to conditions. Such research must consider rigorous study methodologies with appropriate data collection method and sample size so that that validity and reliability of the study results are more enhanced.
Psychological symptoms and job stress in indoor employees
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