Transcript 2010 Health Guidelines Revision Committee

FGI/AIA
Interim Sound & Vibration
Guidelines for Hospitals
& Healthcare Facilities
A 1-hour seminar
Developed by the founders &
co-chairmen of ANSI S12 WG44*:
David M. Sykes, ASA, INCE
Gregory C.Tocci, PE, FASA, INCE Bd Cert
with William Cavanaugh, FASA, INCE Bd Cert, &
Wallace Clement Sabine Medalist (2006)
*These individuals led the development of the documents discussed in this seminar:
the FGI/AIA Interim Guideline and the Green Guide for Health Care Acoustic Credits
Copyright 2007 ANSI S12 WG44
Thanks
The developers thank Doug Erickson, John
Kouletsis, Kurt Rockstroh, Martin Cohen, Robert
Loranger, Judene Bartley, Robin Guenther, Sholem
Prasow, Debra Levin, Roger Leib, Roger Ulrich,
Anjali Joseph, Bart Franey, Uriel Cohen, Orfeu
Buxton as well as Harvard Medical School, the
leaders and members of ASA, INCE & NCAC, and
the members and sponsors of ANSI S12 WG44 for
their commitment to & support of this work.
Copyright 2007 ANSI S12 WG44
3 goals of this seminar
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Inform you about the new AIA Interim Guideline
on acoustics (noise, privacy, sound & vibration) &
the Green Guide’s two new acoustic credits
Learn from users about situations where
acoustical issues arise in healthcare projects
Advise you where to turn for guidance when
questions arise (we are your portal to the
acoustics profession)
Context
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U.S. Noise Control Act (1972) de-funded in 1980
30 years of ‘benign neglect’ yielded 6% per year
growth in noise in healthcare facilities (>2X)
Now urgent: we have “pandemonium” and “an
epidemic of noise” in healthcare & elsewhere
Drive to fix acoustical problems began with HIPAA
& patient-centered care movement
New recognition by LEED that “environmental
quality” should include noise, vibration & sound
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Authority
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Commissioned in 2005 by AIA & the Facility
Guidelines Institute (www.fgi-guidelines.org)
Published 11.1.06
Prepared by ANSI S12 Workgroup 44 – healthcare
acoustics, speech privacy & security, A joint
technical committee of the three leading
organizations in acoustics: ASA, INCE and NCAC
Copies & interpretation:
www.healthcareacoustics.org
Read-only: www.fgi-guidelines.org
Copyright 2007 ANSI S12 WG44
The standard for GGHC’s
new EQ acoustics credits
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The LEED-based Green Guide for Healthcare V2.2
(1.31.07) now contains two credits for acoustics
The Interim Sound and Vibration Guideline is the
sole reference standard for these credits
Download from: www.gghc.org
See “Construction” section
“Environmental Quality-Acoustics Credit 9.1-9.2”
Copyright 2007 ANSI S12 WG44
Objectives of the documents
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Brief, comprehensive handbook
Healthcare specific
based on existing standards & best practices
Objective & measurable criteria
Practical guidance for designers
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Look-up tables
Code language linked to AIA Guidelines
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Design guidance
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Copyright 2007 ANSI S12 WG44
International scope
The drafting committee included 480 authorities from
10 constituencies & several countries:
- Legislators
- Regulatory agencies
- Leaders of large HCOs
- Clinical professionals
- Healthcare lawyers
- Planners
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- Planners, architects & designers
- Facility managers & engineers
- Acoustics researchers &
practitioners
- Acoustics professionals in large
mfg. organizations
Mission
The character and magnitude of all of the
sounds in a building should be compatible
with the intended use of the space.
This rarely means silence, but it implies “quiet”
which is the absence of distracting, annoying,
interfering or unpleasant sounds.
William Cavanaugh
MIT, B. Arch ’51, FASA, INCE Bd. Cert.
Copyright 2007 ANSI S12 WG44
Medical perspective:
Doctors know noise causes…
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Sleep disruption (slows recovery)
Stress response (compromises outcomes)
Impaired communication (medical errors)
Lost privacy (errors & misdiagnoses)
Clinician “burnout” (accidents & staff turnover)
Abundant medical evidence
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Copyright 2007 ANSI S12 WG44
Joseph & Ulrich: Sound Control for Improved Outcomes in
Healthcare Settings (2007). Center for Health Design
Quieting Weinberg 5C: A case study in Hospital Noise
Control (2006), Busch-Vishniac, et al. JASA
Ulrich & Quan, et al: The Role of the Physical Environment
in the Hospital of the 21st Century… (2004). Center for
Health Systems & Design/Texas A&M; with Zimring, Anjali,
Choudery, Georgia Institute of Technology
Busch-Vishniac & West, et al: Noise Levels in Johns
Hopkins Hospital (2005) with Barnhill, Hunter, Orellana,
Chivakula. JASA
Rubin, Owens & Goldern: Status Report (1998): An
investigation to determine whether the built environment
affects patients’ medical outcomes. Center for Health
Design at Johns Hopkins
Example: sleep loss…
Impaired Attention
and Reaction Time
Decreased Memory
and Concentration
Worse Mood;
depression
Insufficient
or
Disordered
Sleep
Increased
Consumption of
Healthcare
Resources
Risk of Injuries, Falls
Incidence of Pain
Weight Gain
Impaired Task
Completion
Diabetes
Psychosocial
difficulties
Cardiovascular
Disease
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Significance of sleep for US obesity?
70
60
Overweight and obese
in the U.S. (%)
50
40
1960 1970 1980 1990 2000
9.0
8.5
8.0
mean sleep duration (hrs)
7.5
7.0
SOURCES
Obesity: CDC(NHES,NHANES)
Sleep: Roffwarg Science 1966, NHIS (unpublished
data), National SleepFoundation polls ,
Hale J Public
Health 2005
Copyright 2007 ANSI S12 WG44
6.5
1960
1970
1980 1990
year
2000
Simple solutions
Solutions already exist
 Most architects have taken courses on acoustics
 8,500 acoustics professionals are available
 What has held up implementation?
- Assumptions about cost
- Quality issues like noise & privacy are often
lost in value-engineering
- Concerns about infection control
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AIA & GGHC acceptance change this
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Core concept in architectural
acoustics
Source
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>
Path
>
Receiver
Overview of the Guideline
1.
2.
3.
4.
5.
6.
7.
Copyright 2007 ANSI S12 WG44
Site exterior noise (5 pages)
Acoustical finishes and details
Room noise levels
Sound isolation performance of constructions
including speech privacy
Paging & call systems, clinical alarms, masking
systems & sound reinforcement
Building vibration
Glossary
1. Site exterior noise
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Sec.1: Directive
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Shall consider impact of exterior noise on hospital
Shall consider impact of hospital noise on community
Exterior noises which facility does not control:
- Highways, aircraft, trains, etc.
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- Helipads, ambulances
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Exterior noises which facility completely controls:
- Cooling towers & other building MEP equipment
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- Delivery vehicles, refrigeration trucks, etc.
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Sec.1: Four new categories
…of exterior site environmental sound
A.
Minimal—rural, quiet suburban
B.
Moderate—busy suburbs, multifamily residential
C.
Significant—commercial urban, busy streets
D.
Extreme—near highway or airport flight path
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Sec. 1: Category levels
Exterior Site Noise
Exposure Category
A
B
C
D
General description
Minimal
Moderate
Significant
Extreme
Day-night average sound level (Ldn) (dB)
< 65
65-70
70-75
> 75
Ave. hourly nominal max. (L01) (dBA)
< 75
75-80
80-85
> 85
Distance from nearest highway (ft)
1000
250-1000
60-250
< 60
Distance from aircraft flight track1 (ft)
> 7000
3500-7000
1800-3500
Distance from nearest rail line (ft)
1500
500-1500
100-500
< 100
Exterior shell composite STC rating2
(STCc)
35
40
45
50
Exterior patient sitting areas
OK
OK
NO
NO
Design goal for hospital MEP noise on
community
45
50
55
60
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< 1800
Sec. 1: “Composite STC”
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Sec. 1: “Ceiling Attenuation
Class”(CAC)
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Sec. 1: Action steps
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Determine site type (A,B,C,D)
Identify & characterize noise issues
Consider solutions
Sec. 2: Acoustical finishes
1.
2.
3.
4.
5.
6.
7.
Copyright 2007 ANSI S12 WG44
Site exterior noise
Acoustical finishes and details (3 pages)
Room noise levels
Sound isolation performance of constructions
including speech privacy
Paging & call systems, clinical alarms, masking
systems & sound reinforcement
Building vibration
Glossary
Sec. 2: Indoor reverberation
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Sec. 2: Identify sound paths
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Sec. 2: Compare materials
Material
NRC
Brick, unglazed
0.05
1/2" GWB on metal studs
0.05
Carpet on concrete
0.30
Wood floor
0.10
Glass, ¼” plate
0.05
3/4" fissured mineral tile
0.70
Carpet on pad
0.55
Vinyl tile floor
0.05
NRC – noise reduction coefficient (ave. abs. coef. (a) 250 to 2000 Hz
Copyright 2007 ANSI S12 WG44
2. Calculate absorption
Space
a
Subjective description
design
Private room
0.15
“Average”
Corridor
0.15
“Average”
Waiting
0.25
“Medium-dry”
Atrium
0.10
“Medium-live”
Office
0.15
“Average”
Treatment
0.15
“Average”
New design tool: Average absorption coefficient (
Copyright 2007 ANSI S12 WG44
a
)
Sec. 2: Choose materials
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Hospitals have a growing problems with
nosocomial infections
“Devices that touch patients are the source”
Important to use sound absorbing materials that
are cleanable
Many products are well-suited:
Baffles, ceiling tiles, insulation, wall coverings, fabrics,
furniture, flooring & carpet
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Copyright 2007 ANSI S12 WG44
No special requirements from EPA, CMS, CDC,
JCAHO, FGI, ASTM or ASHRAE
Manufacturers cite ASTM C1338, & ASTM G21
Sec. 2: Action steps
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Copyright 2007 ANSI S12 WG44
Analyze “source>path>receiver” issues
Consider design choices
Calculate absorption required
Choose acoustical finishes
Sec. 3: Room noise
1.
2.
3.
4.
5.
6.
7.
Copyright 2007 ANSI S12 WG44
Site exterior noise
Acoustical finishes and details
Room noise levels (2 pages)
Sound isolation performance of constructions
including speech privacy
Paging & call systems, clinical alarms,
masking systems & sound reinforcement
Building vibration
Glossary
Sec. 3: Methods & criteria
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Methods to quantify room noise:
- dBA & NC are most common methods
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Criteria for acceptable sound levels set by
space use & special acoustical needs:
a. Anatomical sounds (heartbeats, etc.)?
b. Hearing and voice testing?
c. Distraction & annoyance?
d. Communication issues?
e. Sleep interference?
Copyright 2007 ANSI S12 WG44
NC
curves:
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NC
curve:
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Sec. 3: Level by room type
Room Type
NC
dBA
Patient rooms
30-40
35-45
Multiple occupant patient care areas
35-45
40-50
NICU
25-35
30-40
Operating rooms
35-45
40-50
Corridors and public spaces
35-45
40-50
Testing/research lab, min. speech
45-55
50-60
Research lab, extensive speech
40-50
45-55
Group teaching lab
35-45
40-50
Doctor’s offices, exam rooms
30-40
35-45
Conference Rooms
25-35
30-40
25 (max)
30 (max)
25-30
30-35
Teleconferencing Rooms
Auditoria, large lecture rooms
Copyright 2007 ANSI S12 WG44
Sec. 3: Action steps
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Consider room types & uses
Select appropriate noise level criteria (NC or
dBA) from table
Review design options with ME to achieve
these criteria
Sec. 4: Isolation & privacy
1.
2.
3.
4.
5.
6.
7.
Copyright 2007 ANSI S12 WG44
Site exterior noise
Acoustical finishes and details
Room noise levels
Sound isolation performance of constructions
including speech privacy (4 pages)
Paging & call systems, clinical alarms, masking
systems & sound reinforcement
Building vibration
Glossary
Sec. 4: Methods & criteria
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Sound isolation requirement depends on use
of adjacent spaces
Sound Transmission Class rating (STC)
for
enclosed rooms (ASTM E90 & E413)
Articulation Index (AI) for open plan (ASTM E1130)
Speech Privacy criteria:
- What level? (“normal,” “confidential,” “secure”)
- Vocal effort? (normal, raised, loud)
- Room absorption & isolation? (partitions, screens)
- Background sound level? (ambient noise, masking)
Copyright 2007 ANSI S12 WG44
Sec. 4: Closed-plan privacy
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Sec. 4: Open plan privacy
Copyright 2007 ANSI S12 WG44
Sec. 4: Consider adjacencies
Adjacency combination
Patient Room
Patient Room (horizontal)
45
Patient Room
Patient Room (vertical)
50
Patient Room
Corridor (w/ entrance)
35
Patient Room
Public Space
50
Patient Room
Service Area
60
Exam Room
Corridor (w/ entrance)
35
Exam Room
Public Space
50
Toilet Room
Public Space
45
Consultation Room
Public Space
50
Consultation Room
Patient Rooms
50
Consultation Room
Corridor (w/ entrance)
35
STCc – Composite sound transmission class rating
Copyright 2007 ANSI S12 WG44
STCc
Sec. 4: Identify privacy goal
Privacy Goal
STI
SII
Privacy
Index
Sound
Transmission
Index
Speech
Intelligibility
Index
>85%
>95%
<0.19
<0.12
<0.20
<0.10
AI
PI
Articulation
Index
<0.15
<0.05
Closed Plan
Normal
Confidential
Secure
Special consideration required
Open Plan
Normal
Confidential
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<0.20
>80%
<0.23
Special consideration required
<0.25
Sec. 4: Action steps
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Copyright 2007 ANSI S12 WG44
Consider isolation/privacy requirement depending
on adjacencies of “sources” & “receivers”
Select appropriate isolation/privacy criteria from
tables (STC, AI etc.)
Evaluate adjacent spaces as possible “sources” or
“receivers”
Evaluate performance of various constructions
(doors, partitions, partial-height barriers, ceilings,
etc.) including composite effects of multiple
elements within partitions)
Detail & specify isolating elements to assure
optimum field performance
Sec. 5: Sound systems
1.
2.
3.
4.
5.
6.
7.
Copyright 2007 ANSI S12 WG44
Site exterior noise
Acoustical finishes and details
Room noise levels
Sound isolation performance of constructions
including speech privacy
Paging & call systems, clinical alarms,
masking & sound reinforcement (2 pages)
Building vibration
Glossary
Sec. 5: Paging, call, alarm,
masking & sound systems
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Criteria: audibility, intelligibility, minimal annoyance
You can limit annoyance, distraction, sleep loss by
reducing levels in limited areas or considering nonaudible & wireless signals
HCO’s should consider “positive distractions” &
Active-Noise-Cancelling systems for individual
patients
Operational consideration:
Should paging be routinely used in hospitals
or used only for life/safety emergencies?
Copyright 2007 ANSI S12 WG44
Sec. 5: Problem may be
code minimums
Page, call & sound reinforcement minimums:
a. 70 dBA minimum sound level; or
b. 10 dBA above background noise levels
(whichever is higher); and
c. Coverage within +/- 4 dB at 2000 Hz
throughout areas served
These levels can represent serious intrusion!
Consider limiting their use in patient- sensitive
areas
Copyright 2007 ANSI S12 WG44
Sec. 5: Criteria
Alarms:
NFPA 72 (ISO 7731)
Masking systems:
a. Not higher than 48 dBA
b. Uniform coverage +/-2dBA
c. Suitable spectrum shape (innocuous)
d. May be too high for many space uses
Copyright 2007 ANSI S12 WG44
Sec. 5: Action steps
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Consider impact of criteria-determined minimum
sound levels in relation to patient/staff needs
Evaluate communication system options for
critical areas & set appropriate criteria, e.g.
-
Copyright 2007 ANSI S12 WG44
Wired traditional sound system?
Light/code systems?
Wireless pagers?
Sec. 6: Vibration
1.
2.
3.
4.
5.
6.
7.
Copyright 2007 ANSI S12 WG44
Site exterior noise
Acoustical finishes and details
Room noise levels
Sound isolation performance of constructions
including speech privacy
Paging & call systems, clinical alarms, masking
systems & sound reinforcement
Building vibration (2 pages)
Glossary
Sec. 6: Means “minimal
vibration” of building structure
Sources of vibration: footfall, MEP equipment
Controls:
a. building stiffness, mass
b. vibration isolation of all MEP equipment
c. minimize proximity of vibration and
impact sources from sensitive receivers
& activities
Copyright 2007 ANSI S12 WG44
Sec. 6: Typical sources
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Sec. 6: Criteria
Space Type
Footfall Vibration
Peak Velocity
(min/s)
Patient rooms & other patient areas
4000
Operating & other treatment rooms
4000
Administrative areas
8000
Public circulation
8000
Table 6.3.2-1: Recommended limits on footfall vibration in hospitals.
Copyright 2007 ANSI S12 WG44
Sec. 6: Action steps
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Copyright 2007 ANSI S12 WG44
Consider location of MEP equipment rooms,
MRI, and foot traffic with respect to patient &
research areas
Select appropriate criteria for building structure,
mass, stiffness, etc.
Plan circulation pathways to minimize intrusions
Evaluate mobile equipment (e.g. cart wheels)
Detail & specify appropriate materials & finishes
Bottom line for designers
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Copyright 2007 ANSI S12 WG44
You can’t see noise but it has profound effects on patients
& staff
A row of trees will not protect a hospital from highway noise
There are no paints that can absorb sound
Curtains will not protect privacy in patient areas
In quality surveys, doctors, nurses, administrators, patients
& families identify “noise & lack of privacy” as the top, most
onerous issues
HCOs are learning how to deal with this—you can lead the
dialogue as designers of the healthcare environment
90% of acoustical problems in HCFs can be solved in
design at modest cost
“Fixing the problem later” is always more expensive
Concluding comments
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Basis for compliance
A note about solutions
Example of a “new product”
Getting to code
Discussion, Q&A
Contact information
Acknowledgements
Basis for compliance
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Documents are based on existing standards from
recognized standards authorities & widely
accepted professional best practices
Certification—standard analyses & tests can be
performed in design & tested in-situ to show
general conformance to the Guideline
For AHJ’s & HCO’s, this may be useful &
desirable for inspections (e.g., JCAHO, etc.)
Copyright 2007 ANSI S12 WG44
Solutions: the revolution
in building sciences
Many already available products are well suited for
improving acoustics without compromising
infection control
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Fabrics (stain-proof, wrinkle-proof, color-fast)
Insulation for ceilings, walls & floors
Flooring & carpeting materials
Filtration methods (e.g., for HVAC systems)
Wireless communications
Sources: Cleantech, Greentech, MEMs & Nano-tech
Copyright 2007 ANSI S12 WG44
Example: aerogels are a
“new & green” material
Thermo-acoustic insulation material that is:
 Hydrophobic
 Translucent
 Lightweight
(97% air) & thin
 Available in multiple forms (insulation ‘blankets’
& rigid exterior glazing panels with R20)
 Widely available in volume
Copyright 2007 ANSI S12 WG44
Thermal Performance
 R-20 The insulating value
of a 6” stud wall
Testing
Permanence of
performance
 Non-combustible/
no smoke
 Mold/mildew resistance
 Condensation resistance
 UV Stable
Copyright 2007 ANSI S12 WG44
Light
 20% Light
Transmission
Noise
 50% Sound
Reduction
Questions?
Copyright 2007 ANSI S12 WG44
Frequently asked questions
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When’s the best time to consider acoustics?
How do we apply this to project work?
Who pays for expertise when needed & how much?
How do I find an acoustical consultant?
What questions do healthcare people raise?*
*ex: “can absorptive materials compromise infection control?”
Copyright 2007 ANSI S12 WG44
Contact information
David Sykes: [email protected]
Gregory Tocci: [email protected]
Bill Cavanaugh:
[email protected]
Copyright 2007 ANSI S12 WG44
Committee sponsors
Armstrong
Cabot Corporation
CertainTeed
Dupont
Logison
Copyright 2007 ANSI S12 WG44
Owens Corning
Quiet Solution
Sonare Technologies
Speech Privacy Systems
USG