Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
August 2006
Paula Buick
Perspective
Technological Integration
1954 marked the
beginning of
production for the
Ericofon. Originally it
was intended for
institutional use. They
found their biggest
customers were
hospitals. Imagine
laying in a hospital
bed, trying to reach
over to a desk phone
to dial. The one piece
design of the Ericofon
seemed to be "just
what the doctor
ordered". Silk sheets
optional.
Knowledge
Guidelines 2006
Who
The Facility Guidelines Institute – FGI
AIA Academy of Architecture for Health AIA/AAH
With
U.S. Department of Health and Human Services
Funded
DHHS/CMS, ASHE and NIH
Changes
Bigger 175 pages to 325
Better format, legible, indexing and searching – CD – Punched
numbering [Clemson] and ‘Appendix’
Organization 4 Sections - ”All” - Hospitals - Ambulatory – Others
Process Request Formal Interpretation and Change
1 General
Section 1
Introduction – What, Why, Who, Major Additions Summary
Interpretation
Referenced Codes Listing, Web Sites
1.4 Equipment*
Equipment list included in contract documents
Equipment list specify new, existing to be relocated, owner provided NIC
1 General
1.5 Planning Design Construction p26
Interdisciplinary Design Team, Commissioning
1.5.2 Infection Control Risk Assessment Process
2.1.3. Monitoring The owner shall also provide monitoring
of the effectiveness of the applied ICRMR during the course of
the project
2.2.1 Design Location of special ventilation and filtration such as ED
waiting and intake areas
2.2.1.3 Air handling, ventilation needs in surgical svs, AI, PE, Labs etc
2.2.1.5 Finishes and Surfaces
2.2.2. Construction location of susceptible pts; Impact of potential
outages or emergencies and protection of pts during planned or
unplanned ..
2.3 Infection Control Risk Mitigation
2.3.2 Project Requirements the owner shall ensure that construction
related ICRMR as well as ICRA-generated design recommendations, are
incorporated into the project requirements
2.3.3 IC Monitoring The owner … provide continuous monitoring of their
effectiveness …
2.3.3.1. … may be conducted by in-house IC&S staff or independent
Reference Site: CDC
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/default.htm
Aspergillosis -
Clinical Features
In immunosuppressed hosts: invasive pulmonary infection, usually with fever, cough, and chest pain.
May disseminate to other organs, including brain, skin and bone. In immunocompetent hosts:
localized pulmonary infection in persons with underlying lung disease. Also causes allergic sinusitis
and allergic bronchopulmonary disease.
Etiologic Agent Aspergillus fumigatus, A. flavus. Less commonly A. terreus, A. nidulans, A. niger.
Reservoir Ubiquitous in the environment. Found in soil, decomposing plant matter, household dust,
building materials, ornamental plants, items of food, and water.
Incidence Not reportable. Population-based data available for San Francisco suggest a rate of 1-2 per
100,000 per year.
Sequelae If severe granulocytopenia persists, mortality rate can be very high (up to 100% in patients
with cerebral abscesses). Patient outcome depends on resolution of granulocytopenia and early
institution of effective antifungal drug therapy.
Transmission Inhalation of airborne conidia (spores). Nosocomial infection may be associated with
dust exposure during building renovation or construction. Occasional outbreaks of cutaneous
infection traced to contaminated biomedical devices.
Risk Groups Persons with severe, prolonged granulocytopenia (e.g., hematologic malignancy,
hematopoietic stem cell and solid organ transplant recipients, and patients on high-dose
corticosteroids). Rarely, persons with HIV infection.
Surveillance No national surveillance exists.
Challenges Identifying modifiable risk factors for disease in immunocompromised persons. Improving
understanding of sources and routes of transmission from the environment.
Aspergillus
http://www.aspergillus.org.uk/secure/articles/webbarnes.htm
Sources of infection: endogenous versus exogenous
A major issue in the prevention of nosocomial aspergillosis is the question of whether infection in an individual patient was acquired in hospital, or in the
community: our most energetic prevention efforts in the hospital will not prevent the latter. There are many uncertainties in this area, not least the
incubation period of the disease (estimated to vary from 48 hours to 3 months). Some light has been shed by the use of molecular typing methods
(2,15,16,19). If the criterion used for "hospital-acquired infection" is the isolation of the same fungal strain from the patient and the environment,
some 40 % of cases of invasive aspergillosis appear nosocomial (19). Further use of increasingly accurate typing methods will help to elucidate this
question in the future.
Prevention of nosocomial aspergillosis:
Outbreaks of nosocomial aspergillosis occur mainly among neutropenic patients. These have occurred in association with environmental disturbances:
hospital construction; contaminated fire-proofing materials, or air filters in the hospital ventilation system; contaminated carpeting.
Routes of transmission: airborne route
The first evidence for the protective effect of air filtration ..The recognition of a high incidence of aspergillosis in the hospital's BMT patients led to the
installation of high-efficiency particulate air (HEPA) filters. This was associated with a dramatic fall both in environmental counts of Aspergillus sp,
and in cases of invasive disease (14).
..reports show that modern ventilation and filtration systems are capable of dramatically reducing aspergillus spore counts.(4,7)
In summary, the prevention of nosocomial aspergillosis involves the proper installation, use, and maintenance of ventilation systems; and the elimination
of exposure to fungal spores generated by construction.(1,15,16) The environmental controls required to protect vulnerable patients are detailed in
the CDC recommendations, shown in tables 1 and 2. Table 1 shows the measures needed to minimize exposure to fungal spores to produce the
"protected environment" required for neutropenic patients: essentially HEPA filtration, directed air flow, positive pressure, a well sealed room, and
high rates of room air changes.
Table 2 contains the full guidelines on prevention and control. Section 4 pertains to existing facilities with no cases of nosocomial aspergillosis: a couple of
additional points may be made. It is worth emphasising the importance of preventing dust-accumulation by daily damp-dusting of horizontal
surfaces. Some authorities feel that mould proliferation around sink outlets, etc, may represent another environmental reservoir: so water leaks
should be cleaned up and repaired. BMT units should minimize exposure of patients to activities such as carpet cleaning or vacuuming, that may
cause aerosolization of Aspergillus spores, and the ward vacuum cleaner should be fitted with HEPA filters.
When construction is undertaken, the measures suggested to protect vulnerable patients include the use of impermeable barriers between patient care and
construction areas; directing pedestrian traffic away from the area to prevent dust dispersal; and cleaning of the new premises before patients are
moved there. Finally, air and environmental monitoring for spores may be indicated when building works are taking place adjacent to an area
housing high-risk patients.
3.4.6 NICU
3.4.6.1. Space requirements 120 sf and aisle adjacent to each min 4’
in multips. Single or fixed cubicle partitions aisle not less
than 8 feet in clear and unobstructed width…
4.1 Obstetrical
4.4. LDR LDRP – single occupancy [min clear 300 sf – 2001 – min
dimension 13’ exclusive closets etc] Dimension 15’preferable
2.1 General Hospitals p 37 -134
3.1.1 Capacity p 40
New construction max 1 unless functional program demonstrates….Approval of a 2
bed shall be obtained from the licensing authority
30
250
clear
15
2. General Hospitals
5 13
200
clear 5.5.4
Where to put it ?
Where to put it ?
2. General Hospitals
5. Diagnostic and Treatment Locations
5.1 Emergency Service p68
Surge Capacity .. Up to 10 or a fourhold increase …
Adjacent space for triage and management
Utility upgrades for those areas – Oxy H2O Electrical
Exhaust – ventilation – routes to admission
Classification of Emergency Departments/Services/Trauma Centers
www.facs.org American College Surgeons
www.acep.org American College Emergency Physicans
Note: 2.0 General Hospital 5.3 Surgery 5.3.2 Operating and Procedure Rooms – Class A, B C* p77
2. General Hospitals
5. Diagnostic and Treatment Locations
5.3 Surgery
5.3.2 Operating and Procedure Rooms – Class A, B C* p77
5.3.2.1 General Operating Rooms*
New - (d) Renovation
5.3.2.2 Special [CardioVascular Ortho Neuro]* p78
5.3.2.4 Surgical Cystoscopy Rooms*
4
5
80 80 50 50
80 80 100
4.4.4 4.4.4 w 4.4.4. 4.4.4.
Pre & Post PACU Phase II Single
2. General Hospitals
STC sound table p 129
2. General Hospitals
5. Diagnostic and Treatment Locations
5.4 Interventional Imaging Facilities p82
5.4.1 Cardiac Cath lab located in Imaging suite permitted
Area 400 sf clear floor ExC
Dimensions
Clearances
5.5.1 Imaging Suite General* p83
5.5.2 Angiography* p84
A5.2.1.1 (1) The procedure room should be min 400 sf
A5.2.3 Viewing areas should be min 10’ length
A5.4.1 Radiographic rooms should be min 180 sf [dedicated chest smaller]
A5.4.2 Tomography and radiography/fluroscopy (R&F) rooms min 250 sf
A5.5.4.3 Mammography rooms min 100 sf
A5.5.5.3 MRI Control Rooms min 100 sf and may be larger
5.5.6 Ultrasound*
5.5.7 Cardiac Cath Lab*
5.6 Nuclear Medicine*
A5.6.3 PET Facilities Space Requirements
2. General Hospitals
General Finishes p 113
8.2.3.2 Flooring*
8.2.3.7 PE and Anterooms
shall have seamless flooring with integral coved base
4
5
80 80 100
w GI prep/recov Single
2. General Hospitals
3. Ambulatory Facilities
3.9 GI Endoscopy Facilities p 233
3.2 Instrument Processing Rooms P 235
Dedicated processing room(s) for cleaning and decontaminating
instruments shall be provided.
3.2.1.3 Layout The cleaning area shall allow for the flow of instruments from
the contaminated area to the clean assembly area and then to storage. A
physical barrier shall be provided to prevent droplet contamination on the
clean side.
A3.2.2.1 This may require soaking sink(s), rinse sink(s, automated cleaning
device(s), or a combination.
5. Construction Standards
5.2.1.1 Corridor Width (1) min public 5’ except where pts are transported on
stretchers shall be 8’ [Doors 3’8”]
(2) Staff access corridors may be 3’8” [Doors 3’]
Exam Room Table 60 years ago
3.0 Ambulatory Care Facilities p 189