?Health care code requirements Introduction: The health maintenance and enhancement, the safety and the comfort of people in health care facilities are seriously affected if specific building requirements are not met. Hospitals are the most complex of building types. Each hospital is comprised of a wide range of services and functional units.
Functional organization criteria classify health care facility environments as follows: nursing units, operating theatres, diagnostic facilities (radiology unit, laboratory units and so on), outpatients’ departments, administration area (offices), dietary facilities, linen services, engineering services and equipment areas, corridors and passages. Several specific requirements have been defined for each area in health care facilities: 1- Nursing unit: Open ward: a broad room with 20 to 30 beds
The space requirements should be at least: 6 to 8 square meters (sqm) per bed for open wards, inclusive of circulation and ancillary rooms In open wards, toilet facilities should be close to patients’ beds Multiple and single bedrooms: 5 to 7 sqm/bed for multiple bedrooms and 9 sqm for single bedrooms For single and multiple bedrooms, handwashing facilities should be provided in each room; lavatories may be omitted where a toilet room is provided to serve one single-bed room or one two-bed room Nursing stations:
Nursing stations should be large enough to accommodate desks and chairs for record keeping, tables and cabinets for preparation of drugs, instruments and supplies, chairs for sit-down conferences with physicians and other staff members, a wash-up sink and access to a staff toilet. 2- Operating theatres Two main classes of elements should be considered: operating rooms and service areas Operating rooms should be classified as follows: General perating room, needing a minimum clear area of 33. 5 sqm. Room for orthopaedic surgery (optional), needing enclosed storage space for splints and traction equipment room for cardiovascular surgery (optional), needing a minimum clear area of 44 sqm. In the clear area of the surgical suite, nearby the operating room, an additional pump room should be designed, where extracorporeal pump supplies and accessories are stored and serviced.
Room for endoscope procedures, needing a minimum clear area of 23 sqm rooms for waiting patients, induction of anaesthesia and recovery from anaesthesia. Service areas should include: Sterilizing facility with high-speed autoclave, Scrub facilities, Medical gas storage facilities and staff clothing change areas. 3- Diagnostic facilities: Each radiology unit should include : appointment desk and waiting areas iagnostic radiographic rooms, needing 23 sqm for fluoroscopic procedures and about 16 sqm for radiographic ones, plus a shielded control area, and rigid support structures for ceiling-mounted equipment (where necessary) dark room (where necessary), needing almost 5 sqm and appropriate ventilation for the developer contrast media preparation area, clean-up facilities, film quality control area, computer area and film storage area viewing area where films can be read and reports dictated.
The wall thickness in a radiology unit should be 8 to 12 cm (poured concrete) . The diagnostic activities in health care facilities may require tests in haematology, clinical chemistry, microbiology, pathology and cytology. Each laboratory area should be provided with work areas, sample and material storage facilities (refrigerated or not), specimen collection facilities, facilities and equipment for terminal sterilization and waste disposal, and a special facility for radioactive material storage. 4- Outpatient departments.
Clinical facilities should include: general-purpose examination rooms (7. 4 sqm), special-purpose examination rooms (varying with the specific equipment needed) and treatment rooms (11 sqm). In addition, administrative facilities are needed for the admittance of outpatients. 5- Administration area (offices). Facilities such as common office building areas are needed. These include a loading dock and storage areas for receiving supplies and equipment and dispatching materials not disposed of by the separate waste removal system. – Dietary facilities (optional). Where present, these should provide the following elements : a control station for receiving and controlling food supplies, storage spaces (including cold storage), food preparation facilities, handwashing facilities, facility for assembling and distributing patients’ meals, dining space, dishwashing space (located in a room or an alcove separated from the food preparation and serving area), waste storage facilities and toilets for dietary staff. 7- Linen services (optional).
Where present, these should provide the following elements: a room for receiving and holding soiled linen, a clean-linen storage area, a clean-linen inspection and mending area and handwashing facilities 8- Engineering services and equipment areas. Adequate areas, varying in size and characteristics for each health care facility, have to be provided for: boiler plant (and fuel storage, if necessary), electrical supply, emergency generator, maintenance workshops and stores, cold-water storage, plant rooms (for centralized or local ventilation) and medical gases 9- Corridors and passages.
These have to be organized to avoid confusion for visitors and disruptions in the work of hospital personnel; circulation of clean and dirty goods should be strictly separated. Minimum corridor width should be 2 m (Decree of the President of Ministers Council 1986). Doorways and elevators must be large enough to allow easy passage of stretchers and wheelchairs. Requirements for Building Materials and Furnishings The choice of materials in modern health care facilities is often aimed to reduce the risk in accidents and fire occurrence: materials must be non-inflammable and must not produce noxious gases or smokes when burnt.
Trends in hospital floor-covering materials have shown a shift from stone materials and linoleum to polyvinyl chloride (PVC). In operating rooms, in particular, PVC is considered the best choice to avoid electrostatic effects that may cause explosion of anaesthetic flammable gases. Up to some years ago, walls were painted; today, PVC coverings and fibreglass wallpaper are the most used wall finishes. False ceilings are today built mainly from mineral fibres instead of gypsum board; a new trend appears to be that of using stainless steel ceilings .
However, a more complete approach should consider that each material and furnishing may cause effects in the outdoor and indoor environmental systems. Accurately chosen building materials may reduce environmental pollution and high social costs and improve the safety and comfort of building occupants. At the same time, internal materials and finishes may influence the functional performance of the building and its management. Besides, the choice of materials in hospitals should also consider specific criteria, such as ease of cleaning, washing and disinfecting procedures and susceptibility to becoming a habitat for living beings.
Criteria and variables to be considered in the choice of materials Criteria Variables Functional performance Static load, transit load, impact load, durability, construction requirements Safety Collapse risk, fire risk (reaction to fire, fire resistance, flammability), static electric charge (explosion risk), disperse electric power (electric shock risk), sharp surface (wound risk), poisoning risk (hazardous chemical emission), slip risk, radioactivity Comfort and pleasantness
Acoustic comfort (features related to noise), optical and visual comfort (features related to light), tactile comfort (consistence, surface), hygrothermal comfort (features related to heat), aesthetics, odour emissions, indoor air quality perception Hygienicity Living beings habitat (insects, moulds, bacteria), susceptibility to stains, susceptibility to dust, easiness in cleaning, washing and disinfecting, maintenance procedures Flexibility Susceptibility to modifications, conformational factors (tile or panel dimensions and morphology) Environmental impact Raw material, industrial manufacturing, waste management
Cost Material cost, installation cost, maintenance cost Source: Catananti et al. 1994. Security and Safety In addition to the general safety concerns of all buildings, hospitals have several particular security concerns: Protection of hospital property and assets, including drugs Protection of patients, including incapacitated patients, and staff Safe control of violent or unstable patients Vulnerability to damage from terrorism because of proximity to high-vulnerability targets, or because they may be highly visible public buildings with an important role in the public health system.