Guidelines for Design and Construction of Health Care Facilities

1
Guidelines for Design and Construction of Health
Care Facilities
Update on the 2006 Edition
2
Projected Release of Document - Late June 06
3
Facts About the Committee

• FGI Facility Guidelines Institute
• HGRC Health Guidelines Revision Committee
• Steering Committee 15 HGRC Members
• 124 HGRC Members
• All members are volunteers

4
The Final Language

• In new construction, the maximum number of beds
  per room shall be one unless the functional
  program demonstrates the necessity of a two-bed
  arrangement. Approval of a two-bed arrangement
  shall be obtained from the licensing authority.
• Where renovation work is undertaken and the
  present capacity is more than one patient,
  maximum room capacity shall be no more than the
  present capacity, with a maximum of four patients.

5
What Does This Mean?

• Major accomplishment for patient advocates
• New minimum is one for general care
• State legislators and AHJs will need to approve
  change in their respective states
• Should be an interesting series of events
• More research is being planned
• (Some research is currently posted at
  www.aia.org/aah, click Guidelines.)

6
2006 Changes - General Chapters

• Added language on patient safety issues
• Added language to support the LEED movement,
  mostly appendix material
• Clarity of wayfinding
• Privacy/confidentiality
• Safety and security

7
Glossary

• Bed size for planning purposes the rectangular
  dimensions to be utilized are a width of 40
  inches and a length of 96 inches.
• Invasive procedure any procedure that penetrates
  the protective surfaces of a patients body
  (i.e., skin, mucous membrane, cornea) and that is
  performed with an aseptic field (procedural
  site). List of areas not included.

8
Glossary

• Minimum clearance The shortest unencumbered
  distance between the outermost dimensions of a
  specified object (often a patient bed) and
  specified, fixed reference points (e.g., walls,
  cabinets, sinks, and doors).
• Monolithic ceiling A ceiling constructed with a
  surface free of fissures, cracks, and crevices.
  Any penetrations such as lights, diffusers, and
  access panels shall be sealed or gasketed.
  (Lay-in ceilings are not considered
  monolithic.)

9
Glossary

• Clear Floor Area
• Floor area available for functional use
• Such area shall not include other defined spaces
  or built-in equipment (e.g., anterooms,
  vestibules, toilet rooms, closets, lockers,
  wardrobes, fixed casework, and alcoves)

10
Chapter 5 - ICRA

• New acronym - ICRMR (Infection Control Risk
  Mitigation Recommendations)
• Expanded the chapter to include more specific
  recommendations
• The owner shall ensure the requirements are
  incorporated into the project documents
• The owner shall inspect the initial installation
  and monitor the project throughout its duration

11
2006 Changes - Hospitals

• Hand-washing
• Sinks in the rooms are still a requirement
• In renovation, if existing conditions prohibit
  the installation of a sink, waterless cleaners
  may be substituted
• Convenient to staff entering and leaving the room
• Outside of the patient cubicle curtain

12
2006 Changes - Hospitals

• Intermediate Care Units
• Stepdown units for patients that require frequent
  monitoring of vital signs
• Maximum room capacity 4 beds
• Room size similar to medical / surgical
• Nurse call with emergency resuscitation alarm
• Administrative center/nurse station to monitor
  the unit (direct or remote visual observation of
  the patient)

13
2006 Changes - Hospitals

• Critical Care Unit
• In new construction, bed clearances for adult and
  pediatric shall be a minimum of
• 4.5 feet at the foot of the bed to the wall,
• 5 feet on the transfer side,
• 4 feet on the non-transfer side, and
• 8 feet between beds

14
2006 Changes - Hospitals

• In-Hospital Skilled Nursing Unit
• Located close to physical and rehabilitation
  medicine departments
• Spaces for living, dining and recreation at 25
  sq. ft. per bed
• When required, a private space for the use of
  individual patients, family, and caregivers to
  discuss specific patient needs and private family
  matters.

15
2006 Changes - Hospitals

• Surgical Suites
• Room walls, ceilings, and floors, including
  penetrations, shall be sealed.
• Monolithic ceilings
• Bedside documentation area
• PACU
• 80 sq. ft. per gurney exclusive of the general
  circulation space
• Phase II Recovery
• 100 sq. ft. of clear floor area in single-bed
  rooms

16
2006 Changes - Hospitals

• LDR and LDRP
• In new construction, increased the clear floor
  area from 250 to 300 square feet
• In renovation the clear floor area remained at
  200
• Observation Units
• Hand-washing for each 4 treatment cubicles
• One toilet for each 8 treatment cubicles
• One shower for each 16 treatment cubicles
• Nourishment area

17
News Flash

• Pharmacy
• The HGRC did NOT insert compliance with USP 797
  nor was the ventilation table modified from the
  current 4 ACH with positive pressure.

18
2006 Changes - Hospitals

• Mechanical System
• All return ventilation shall be via a ducted
  system except for systems dedicated to one or
  more of the following
• Administrative
• Dining
• Public Lobbies
• Engineering
• Housekeeping
• Maintenance

19
2006 Changes - Hospitals

• Heating, Ventilating, and Air Conditioning
  Systems
• For Renovation
• Upon completion of the project, affected branches
  shall be returned to preconstruction flow rates
  or shall be rebalanced.
• Prior to starting a construction project, airflow
  and static pressure measurements shall be taken
  at the connection points of new ductwork to
  existing.Information is provided to the designer
  to determine the existing systems capacity for
  the extension.

20
2006 Changes - Hospitals

• Heating, Ventilating, and Air Conditioning
  Systems
• Operating Rooms
• Air shall be supplied from non-aspirating
  diffusers with a face velocity in the range of 25
  to 35 fpm.
• Return air shall be permitted high on the walls
  in addition to the low returns.
• Ventilation systems shall operate at all times,
  except for maintenance and conditions requiring
  shutdown by the building fire alarm.

21
2006 Changes - Hospitals

• Appendix - Heating, Ventilating, and Air
  Conditioning Systems
• The recommended air change rate in an operating
  room is 20 to 25 air changes per hour (ACH) for
  ceiling heights between 9 feet (2.74 meters) and
  12 feet (3.66 meters). The system should provide
  a single directional flow regime, with both high
  and low exhaust locations.

Appendix Material
22
2006 Changes - Hospitals

• Heating, Ventilating, and Air Conditioning
  Systems - Table 7.2
• Gastrointestinal Endoscopy Room
• Equal pressure to surrounding area (changed from
  negative)
• Endoscopy Instrument Processing Room
• Negative pressure (in) to the surrounding area
  and 10 air changes an hour
• Biochemistry and Serology
• Changed from positive airflow (out) to negative
  airflow (in)
• Laser Eye Room
• Positive pressure (out) and 3 fresh ACH and 15
  total ACH

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2006 Changes - Chapter x

• Small Inpatient Primary Care Hospital - Concept
• An adaptable facility that can meet the needs of
  the community it serves.
• Serve as a stand-alone overnight facility (96
  hours max.)
• Have outpatient treatment modalities connected to
  it, and to serve as a small inpatient primary
  care center or as a satellite of an existing
  hospital in a rural or designated underserved
  population area.
• Basic nursing unit concept - use of universal
  room design

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2006 Changes - Chapter x

• Small Inpatient Primary Care Facilities
• Nursing unit shall not exceed 25 beds
• Total number of beds in the facility shall not
  exceed 50
• Patient rooms to comply with hospital
  requirements
• Single bed
• 120 square feet of clear floor space
• Hand-washing station in the room
• Shall be set up for temporary critical care
• Shall be set up for temporary LDR/LDRP

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2006 Changes - Chapter 9

• Size of typical exam/treatment rooms
• General purpose -- 80 sq. ft.
• Special purpose (eye, nose, etc.) -- 80 sq. ft.
• Treatment rooms -- 120 sq. ft.
• Observation rooms -- 80 sq. ft.
• Class A operating room
• Increased from 120 to 150 sq. ft. with 12-foot
  clear dimension

26
2006 Changes - Chapter 9

• Outpatient PACU
• Recovery shall be accessible directly from the
  semirestricted area (non public corridor)
• Minimum of one recovery station per OR (removed 2
  for Class B and 3 for Class C from the 2001
  edition and moved to appendix)
• Clearance of 5 feet between stretchers and 4 feet
  between stretchers and walls
• Clearances are measures from the normal use
  position of the patient stretcher

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2006 Changes - Chapter 9

• Gastrointestinal Endoscopy Facility
• Completely rewritten for 2006
• 200 square feet of clear floor area per procedure
  room
• Dedicated instrument processing room
• Patient holding/prep/recovery area at 80 square
  feet per patient station
• Minimum public corridor width of 5 feet and 8
  feet where patients are transferred

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New Chapters for 2006

• New Chapters or Sections on
• Intermediate Care
• Psychiatric Outpatient Centers
• Assisted Living Facilities
• Adult Day Care
• Hospice Care
• New Appendix on
• Hyperbaric Facilities (multi and single chamber)

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So Where Do We Go From Here?

• Interim publications being considered
• Working with ASHRAE to incorporate 170
• Reformatting - Wait and see how user-friendly it
  will become!!!
• Electronic version
• Research

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Interim Publications

• New Process for 2006 Edition

31
The Rationale

• Allows the Guidelines to remain current with
  medical programs and technology
• Permits the Guidelines cycle to remain at 4
  years
• Gives owners, design community, and AHJs a
  consensus document to use in evaluating new
  designs

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Proposed Interim Publications

• Patient/Staff Safety (including patient lifts)
• Bariatric Care
• Medical Oncology
• Glossary
• Interventional Imaging Satellite Procedures
• Noise/Acoustical
• Surge Capacity

33
Reorganization

• A positive movement to make the Guidelines more
  user-friendly.

34
Reorganized Table of Contents

• Preface
• Major Additions and Revisions
• Acknowledgments
• Part 1 - General
• (Design Concepts and Considerations)
• 1.1 Introduction
• 1.2 Environment of Care
• 1.3 Site
• 1.4 Equipment
• 1.5 Planning, Design, and Construction
• 1.6 Common Requirements

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Reorganized Table of Contents

• Part 2 Hospitals
• (Inpatient Care)
• 2.1 General Hospitals
• 2.2 Small Inpatient Primary Care Hospitals
• 2.3 Psychiatric Hospitals
• 2.4 Rehabilitation Hospitals

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Reorganized Table of Contents

• Part 3 Ambulatory Care Facilities
• 3.1 Outpatient Facilities
• 3.2 Primary Care Outpatient Centers
• 3.3 Small (Neighborhood) Primary Care Outpatient
  Centers
• 3.4 Freestanding Outpatient D T Centers
• 3.5 Freestanding Urgent Care Facilities
• 3.6 Freestanding Birthing Centers
• continued

37
Reorganized Table of Contents

• Part 3 Ambulatory Care Facilities, continued
• 3.7 Outpatient Surgical Facilities
• 3.8 Office Surgical Facilities
• 3.9 Gastrointestinal Endoscopy Facilities
• 3.10 Renal Dialysis Centers
• 3.11 Psychiatric Outpatient Centers
• 3.12 Mobile, Transportable, and Relocatable
• Units

38
Reorganized Table of Contents

• Part 4 Other Health Care Facilities
• (Long-Term, Residential, and Other Settings)
• 4.1 Nursing Facilities
• 4.2 Hospice Care
• 4.3 Assisted Living
• 4.4 Adult Day Health Care Facilities
• Glossary
• Index
• Where to Find It Matrix

39
New Numbering System

• 2.1 - 1.2.3.4 (1) (a)
• 2.1-1.2.3.4 (1)(a)
• Index

Chapter
Section
Lists
40
Douglas S. Erickson, FASHE
Consultant, American Society for Healthcare
Engineering of the American Hospital
Association Email derick_at_bigplanet.com Mobile
847-347-0627
41
Joseph G. Sprague, FAIA, FACHA
Senior Vice President Director of Health
Facilities HKS, Inc. Dallas, Texas Email
jsprague_at_hksinc.com Phone [phone]