Transcript 2010 Guidelines A Look at the Future

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2010 Guidelines
A Look at the Future
Healthcare Facility Management
Society Of New Jersey
June 18, 2009
Schedule
• Brainstorming - Completed
• Proposal Period - Complete
• Shaded Text Available - Complete
• Comment Period - Complete
• Final Meeting of the Committee – Complete
• Document Release Date – January 2010
Public Proposal Facts
• Processed over 1300 proposals
• Proposals ranged from:
▫ Glossary terms
▫ Editorial recommendations
▫ Single element recommendations
▫ Whole section inclusions
• All rejected proposals and those modified have
documented substantiations
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Public Comment Facts
• Extended comment period by
one month
• Over 1688 comments received
• Over 400 people submitted one or more comment
• Guidelines Committee will review all comments and
provide substantiation for actions
• 2010 document ready for vote by September 2009
You had the opportunity to provide
guidance to the committee!
Focus Groups
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Bariatric accommodations
Wayfinding
Staff effectiveness/retention
Sustainable design
Functional program
Patient movement
Imaging
Infection control
Surfaces and furnishings
Psychiatric facilities
Planning, design and
construction process
• Nursing facilities
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Common elements
Medical oncology
Children’s hospitals
Emergency facilities
Small hospitals
Reorganization
Engineering
Information technology
Major Topics of Discussion - General
• Moving Glossary to the front of the book
▫ Glossary to include new terms, for example:
 Readily accessible
 Adjacent
 Clear floor area (improve existing language)
 Appendix
 Linear surface, etc.
• Procedure/Treatment/Exam Room
• List of acronyms
• Reorganization
▫ Refining the work of the 2006 document
▫ Headed by Skip Gregory from Florida
Major Topics of Discussion - Part 1
• Functional Program
▫ If required by the functional program than you shall…
 This will be added to all sections of the document not
common to ALL hospitals
▫ Redefining the need for and use of the functional
program in design and operations.
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minimum space requirements
operational demand or use
staffing
departmental relationships
short and long-term considerations
Major Topics of Discussion - Part 1
• Refining of the ICRA process
▫ Sink design got a lot of discussion
• Patient movement - Appendix language
▫ New concept of Patient Handling and Movement
Assessment (PHAMA)
 risk assessment be conducted by the applicant
 becomes part of the Functional Program
• Developing a significant educational piece about
patient handling, mechanical assists, and related
considerations
Major Topics of Discussion - Part 1
• Patient Safety Risk Assessment (PSRA)
▫ During the functional programming phase
▫ Identify the specific physical hazards
▫ Likelihood of their occurrence based on historic data
▫ Degree of potential harm to patients
• PSRA Panel
▫ Interdisciplinary panel, representatives from clinical
departments
▫ Produce a report on features of design
Major Topics of Discussion - Part 1
▫ Sustainability
• New language on the reduction of greenhouse gas
(consideration in the selection of mechanical equipment)
• New appendix material on:
• LEED
• Green Globe
• Energy efficiencies
• Greenhouse gas emissions
Major Topics of Discussion - Part 1
▫ Acoustics - Room Sound Absorption
Major Topics of Discussion - Part 1
▫ Acoustics - Room Noise Levels
Major Topics of Discussion - Part 1
▫ Acoustics - Sound Isolation of Spaces
Major Topics of Discussion - Part 2
• Common Elements:
▫ Bathroom doors may be sliding but not pocket
▫ Nourishment room combined with clean utility room
▫ Combining housekeeping and soiled utility
• Nursing Unit:
▫ “Room” or “Office” shall be an enclosed space, area
may be open to other spaces
▫ Airborne Infection Isolation Rooms
 Door seals and sweeps
 Requirements for Ante Rooms if used in design
Major Topics of Discussion - Part 2
• New section on Medical Oncology Units
• Critical Care Units
▫ Acknowledging different acuity units
(functional program needs to define size of room)
▫ Added one foot at the head of the bed
▫ Private rooms sized to permit two seated visitors
▫ Toilets
 Not required in the room
 Access to a toilet or soiled utility room for disposal of bodily waste
 If in the room - 6 feet from the bed location, or separated by an
alcove to prevent splashing
Major Topics of Discussion - Part 2
• Critical Care Units
▫ Clean storage readily accessible within each unit
▫ Staff room cannot be the multipurpose room
• Newborn Intensive Care Units
▫ New Requirements for:
 Sound/Noise
 Lighting
• New section on bariatric care units
▫ Room size of 200 square feet
▫ Minimum clearances of 5 feet
Major Topics of Discussion - Part 2
• Initial Emergency Management
▫ Entrances shall be at least 72” in clear width
▫ Treatment room for bariatric patients
 200 sq ft/800 lb lift/1000 lb scale in unit
▫ Trauma/Resuscitation
 Minimum clearance of 5 feet around
stretcher
▫ Decontamination Room
 Outside entry - not greater than 10 feet from main entrance
 If required by the AHJ, holding tank for floor drain
▫ Pediatric Treatment Facilities
▫ Observation Units
Major Topics of Discussion - Part 2
• Initial Emergency Management
▫ Fast-track Area
 Physician/nurse work station
 100 square feet of clear floor area
 Separate treatment/procedure room (120 square feet)
 Storage area within unit
• Pre-Operative Holding Areas
▫ Cubicle space
 80 square feet clear floor area
 5 feet between bed/stretcher/chair
 4 feet from a side and foot wall
Major Topics of Discussion - Part 2
• Post Anesthetic Care Unit (Phase II Recovery)
▫ 50 square feet clear floor area
▫ 100 square feet if a single-bed room
▫ 4 feet between stretchers/chairs
▫ 3 feet between sidewalls/foot
• Bariatric Accommodations in
OR Suite
• New section on Interventional Imaging
▫ Minimum room size 400 square feet
• Updated MRI suite and space requirements
Major Topics of Discussion - Part 2
• Cancer Treatment Unit
▫ Convenient access for outpatients
▫ Open area layout permitted, separate from public
areas
▫ 80 square feet of clear floor area per station
▫ 5 feet between bed/chair
▫ Nurses station within the unit
▫ Hand-washing station of one per four stations
Major Topics of Discussion - Part 2
• General Requirements - Architectural
▫ Patient room doors - 48” clear width x 7-0” high
▫ Windows shall be 10% of total room floor area
▫ Wall bases in areas frequently subject to wet cleaning
▫ Ceiling tile in semi-restricted spaces (1 pound/sq. ft)
▫ Staying with monolithic for ORs and restricted spaces
Major Topics of Discussion - Part 2
• General Requirements - Architectural
▫ New section on furnishings
 casework, millwork and built-ins
 Furniture and equipment
 Window treatments and cubicle curtains
Major Topics of Discussion - Part 2
• General Requirements - Plumbing
▫ Use of non-potable water supply systems
 Rainwater collection for
irrigation
 Municipal recycled or
reclaimed water
 System piping clearly
marked
Major Topics of Discussion - Part 2
• General Requirements - HVAC
▫ Natural and displacement ventilation?
▫ Acoustic considerations of equipment
▫ Use of airborne infection isolation rooms for normal
patient care permitted. Negative pressure shall
remain unchanged.
▫ Constant volume for airborne infection isolation and
protective environment rooms
▫ Protective environment rooms - HEPA placed right
before air enters the room.
Major Topics of Discussion - Part 2
• General Requirements - HVAC
▫ Non aspirating diffusers similar to ORs for cardiac
catheterization and interventional radiology
▫ Renal dialysis unit
 Temperature of 72 - 78 degrees
 Humidity of 30 - 50 percent RH
▫ Fresh air intakes
 25 feet from hazardous outlets (decon, autopsy, etc.)
 10 feet from exhaust fans, plumbing vents, etc.
Major Topics of Discussion - Part 2
• General Requirements - HVAC
▫ Exhaust outlets
 Termination above the highest wall height
 In equipment wells with three sides 3 feet above the
highest wall
 Contaminated exhaust located to minimize
recirculation and directed away from personnel
service areas
What does that mean?
• Only one ventilation design standard
• ASHRAE and the Guidelines Revision Committee
are working together
• More opportunity for expert input
• More opportunity for research
• The Guidelines will be a one-stop shop for health
care ventilation requirements
Major Topics of Discussion - Part 2
• New section on Communications Systems
▫ Major topic areas
 Telecommunications service entrance room
 Technology equipment center
 Technology distribution rooms
▫ Electrical requirements will be in NFPA 99, Health
Care Facilities Code
Major Topics of Discussion - Part 3
• Common Elements
▫ Parking - separate and additional space for delivery
and patient transfer vehicles
▫ Exam room used as an observation room
 located convenient to control station
 toilet room shall be immediately accessible
▫ Special purpose exam rooms (ENT etc.) - increased
from 80 sq ft to 100 sq ft
Major Topics of Discussion - Part 3
• Medical Records - All media types
▫ Space defined by the functional program
▫ Located to maintain confidentiality
▫ Protected from loss or damage
 water damage
 fire damage
Major Topics of Discussion - Part 3
• Hand-Washing
▫ Hand-sanitizing cannot replace hand-washing stations
▫ Provided in any room where hands on patient contact
is preformed
▫ Station shall not be accessed through a door, doorway
or barrier
▫ Stations shall not be used for other purposes
▫ Sinks shall be at least 9 inches deep and 16 inches
side-to-side
Major Topics of Discussion - Part 3
• Floor, wall and ceiling finishes have been tightened
down
• Freestanding Urgent Care Facilities
▫ Capacity of Procedure Rooms
 maximum of one patient
 minimum clear floor area of 80 sq ft.
• New chapter on Freestanding Birthing Centers
Major Topics of Discussion - Part 3
• Outpatient Surgical Facilities
▫ Recommendation to redefine OR classifications
 From Class A, B, and C to Level 1, 2, and 3 as defined by the
American Society for Anesthesiologists’ Continuum of
Depth of Sedation
 Level 3 - “minimal” sedation (respond normally to verbal
commands)
 Level 2 - “moderate” sedation (patients respond
purposefully to verbal commands, either alone or
accomplished by light tactile stimulation)
 Level 1 - “deep” sedation (cannot be easily aroused but
respond purposefully following repeated and painful
stimulation)
Major Topics of Discussion - Part 3
• Preoperative Holding Areas
▫ Major rewrite
 Level 1 - one per OR
 Level 2 - one per OR
 Level 3
 if accessed from a semi restricted space - one per OR
 if accessed from an unrestricted space - functional program
and preop can be in the OR
▫ 80 sq ft of clear area per station
▫ clearance of 5 feet between stretchers
▫ clearance of 4 feet from walls
Major Topics of Discussion - Part 3
• Postoperative Recovery
▫ Recovery room analysis approved by AHJ or,
 Level 1 - 3 recovery positions for each operating room
 Level 2 - 2 recovery positions for each operating room
 Level 3 - 1 recovery position for each operating room
▫ If six positions or more - half can be in step down
recovery positions
▫ Square footage (80) and clearances (5 feet and 4 feet)
have not changed
Major Topics of Discussion - Part 3
• Updated the Gastrointestinal Endoscopy facility
recommendations for pre and postoperative spaces
Major Topics of Discussion - Part 4
• Rejected proposal to go to single bedded rooms for
nursing homes
• Preparing a surfaces and furnishings checklist or
matrix for every facility chapter
• Great acceptance for a series of recommendations on
Nursing Homes based on research from the Univ. of
MN
The Future
• Official release date is
projected for January 2, 2010
• Workshops and Webinars will be available
highlighting the major changes
• A handbook is being considered for this edition
• White papers on:
▫ Patient Handling and Safe Movement Assessment
and,
▫ Critical Access Hospitals
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These are your Guidelines, so please
participate in the process!!!
Thank you and have a great
remainder of the day and the
conference.