Hospital Design and Patient Safety Ppt

HOSPITAL DESIGN AND PATIENT SAFETY

By

Dr. Bidhan Das

“WE SHAPE OUR BUILDINGS AND AFTERWARDS OUR BUILDINGS SHAPE

US.”

-WINSTON CHURCHILL, MAY 10, 1941

“I am convinced that designing a building around safety will create a culture of safety.”

-JOHN REILING, PRESIDENT AND CEO ST. JOSEPH’S

COMMUNITY HOSPITAL AND Synergy Health

How Infrastructure Is Related to Safety?

• Infrastructure usually forms the starting point in the journey to ensure safety.

• It is more important in a hospital setting because of incapacitated patient’s Safety.

• Changing role of hospitals is likely to be a major factor in future.

• Proper planning of the expected role/ functions of the hospital is essential.

ROLE OF INFRASTRUCTURE IN SAFETY..

Hospitals: very complex organization• Deals with LIFES • Need to control the flow of customers • Need to Control Infections• Need proper planning as sterilization has to

maintained in some Departments like in CSSD , OT , ICU

• Need to avoid crisscrossing and unidirectional flow of traffic. (staff, Patients, Sterile items, non-sterile items, kitchen and food flow, store items, Biomedical waste)

• Generally have high levels of occupancy

• Usually patients are temporarily incapacitated, need help in moving about

• Extra work load & specific role in disasters

• Imperative need for flexibility & expandability

• Environmental issues are must to be considered.

PLANNING AND BUILDING A NEW HOSPITAL

HOSPITAL SAFETY = PATIENT SAFETY ??

Hospital Safety

The degree to which the risk of an intervention/ procedure, in the care

environment are reduced for a patient, visitor and health care providers

POOR HOSPITAL DESIGN EFFECTS

• The negative effects of Poor hospital design: PsychologicalPhysiological and behavioral

• Poor air quality and ventilation are major causes of Nosocomial infection.

• Inadequate lighting is linked to patient depression as well as to staff medication error

We then ask ourselves several Questions?

• How and via what mechanisms does the physical environment participate in patient safety?

• How does the environment of the peri-operative system effect safety?

• What exactly is the peri-operative environment? • What characteristics are used to describe an

environment? • What process creates the physical environment? • Is it possible to change either the creation process

or the result to improve safety

MICRO PLANNING CONSIDERATIONS

A. PHYSICAL FACILITY1.Scales Of Accommodation2.Electrical System3.Ventilation4.Water Supply5.Plumbing6.Refrigeration7.Landscaping8.Gas Supply9.Elevators / Lifts / Dumbwaiter10.Telephone / Epabx11.Fire Fighting

12. Waste Disposal13. Hospital Space Module14. Engineering Grid15. Ward AreaoPrimary--- Ward UnitoAncillary--- Nursing Station, Duty Doctor,Treatment Room. 16. Sanitary---- Toilets, Dirty Utility.17. Auxiliary--- Pantry, Store, Clean Utility.18. Corridor19. Floor Height20. Head Room

Built-up Area : Plot Area FSI = 1:1.73

19. Windows

20. Floor

21. Walls

22.Doors

23.Light, Power Sockets

24.Stand-by Generator

25.Ventilation

MICROPLANNING Contd...Air- Conditioning Requirements in Specialized OT

Air Changes Per Hour:• Minimum total air changes should be 30• The fresh air component of the air change is

required to be minimum 5 air changes out of total minimum 30 air changes.

• If HCO chooses to have 100% fresh air system than appropriate energy saving devices like Heat Recovery Wheel, Run Around Pipes etc should be installed.


Air Velocity: • The vertical down flow of air coming out of the

diffusers should be able to carry bacteria carrying particle load away from the operating table.

• The airflow needs to be unidirectional and downwards on the OT table.

• The air velocity recommended as per the international and national guidelines is 90-120 FPM at the Grille/ Diffuser level.


Positive Pressure

• There is a requirement to maintain positive pressure differential between OT and adjoining areas to prevent outside air entry into OT.

• The minimum positive pressure recommended is 15 Pascal (0.05 inches of water) as per ISO 14644 Clean Room Standard.


Air Handling in the OT including air Quality:• Air is supplied through Terminal HEPA filters in the

ceiling.• The minimum size of the filtration area should be 8’ x 6’

to cover the entire OT table and surgical team. • The air quality at the supply i.e at grille level should be

Class 100/ ISO Class 5 (at rest condition). • Class 100 means a cubic foot of air must have no more

than 100 particles measuring 0.5 microns or larger.


Temperature and Humidity

• The temperature should be maintained at 21 +/- 3 Deg C inside the OT all the time with corresponding relative humidity between 40 to 60% though the ideal Rh is considered to be 55%.

• Appropriate devices to monitor and display these conditions inside the OT may be installed.


Air Filtration: • The AHU must be an air purification unit and air

filtration unit. • There must be two sets of washable flange type pre

filters of capacity 10 microns and 5 microns with Aluminum frame within the AHU.

• The necessary service panels to be provided for servicing the filters, motors & blowers.

• HEPA filters of efficiency 99.97% down to o.3 microns or higher efficiency are to be provided in the OT and not in the AHU.

MICROPLANNING Contd... Air-conditioning

ICU

Air-conditioning

50-60% humidity 20-25°C temp

Ventilation 10-15 air changes / hr- Fresh air Positive air pressure maintained

MICROPLANNING Contd...

B . LEGAL & REGULATORY COMPLIANCES

Hospital should have all the Licenses as per the Countries Law

C . HUMAN POWER As per the workload /norms the Hospital

should have its Human Power so that it is able to meet the Customer’s Expectations .

MICROPLANNING Contd...

D . EQUIPMENTS

I. AMC/CMC

II. Technology commensurations to services

III.Calibration and traceability to international standard.

IV.Statutory Obligations

DESIGN CONSIDERATIONS

• Noise reduction• Scalability, adaptability, flexibility• Visibility of patients to staff• Patients involved with care• Standardization• Automate where possible• Minimize fatigue• Immediate accessibility of information, close

to the point of service.

ELECTRICAL SAFETY• Electrical devices shall be protected from wet floors.

• Frame of all electrically operated machinery shall be grounded.

• If a "shock is felt" , immediately remove from service, and report to

the facility Department

• Switch to "off" position before connecting or disconnecting.

• Do not disconnect the plug from the wall by grasping the power

cord.

• Remove from service device that has been dropped, abused, had

liquid spilled on it or has evidence of overheating.

• Discontinue use if any wire or power cord shows fraying, extreme

wear, cut in insulation or evidence of burning.

• Preventing overload

ELECTRICAL SAFETY

• Areas around electrical switchboards kept clear for a distance of at least 1 meter.

• Fire extinguisher adjacent to electrical switchboards.

CHEMICAL SAFETY

• Safe storage

• Safe Transportation

• Disposal

• Accidental exposure

FIRE SAFETY

• Preventive measures:– Use of non combustible materials in load bearing

elements, stairways & corridors– Electrical wirings in separate ducts, sealed on

alternate floors with NC materials– All heating appliances used with proper amperage– Proper storage & segregation of combustible &

explosive materials– Regular formal periodic inspection of exits, detectors

& extinguishing systems.National Building Code,2005

FIRE SAFETY…..

• Detection & Alarm systems:– Fire, Smoke, Heat, Flame detectors are

available for installation– Newer generation systems are “wiser”– Addressable systems allow precise

location of fire, hence better control– Intelligent systems (2nd level) have

automatic alteration of sensitivity threshold level between “alarm” & “non alarm”

FIRE SAFETY…..

• Restriction of Spread of fire:– Unit based construction, rooms with 2hrs FR*– Structural frame: fire resistance of 2hrs– Smoke stop doors between galleries, wards with FR of

min 30 minutes, swing type opening in direction of escape

– A/c ducts should have dampers at inlet in plant, fire wall, entry to vertical shaft, outlet duct on all floors/compartments

– At least 2 areas of refuge in each horizontal plane– Floor assembly (RCC) should have FR of 2hrs * FR- Fire Resistance

FIRE SAFETY…..• At least 2 fire exits(2m x2m) in an area 500

meter square• Corridors min 2.4mts wide, clear of obstruction,

sign posted• Life risk areas should be separated from

hazardous service areas• High fire hazard areas in separate structures

with 2 hrs FR construction materials• For buildings more than 24mts high, more refuge

area(@0.3sq m/person )

FIRE SAFETY…

• Fire extinguishing systems:– Different for all types of fires– Entire complex surrounded by network of

hydrants 30-60 mts apart– Wet riser system kept charged, 1 riser for floor

area of 1000 sq mts– Exclusive UG tank having:

• 50,000 - for up to G + 2 floors• 100,000 - for 15-24mts high buildings• 150,000 - for buildings 24-30 mts high

National Building Code, 2005

SEISMIC FACTORS

• Structural & non structural components • DBE: EQ which can reasonably be expected

to occur at least once in life• MCE: refers to EQs most severe effects• Zone factor(Z) to obtain the design

spectrum on max seismic risk by MCE in the zone where hospital is located

• India is divided into 4 seismic zones (II,III,IV,V) depending on probability of occurrence of EQ

SEISMIC FACTORS…

• General principles & design criteria:– Horizontal seismic forces are more important for

consideration– Design should be such that it has minimum strength to

withstand all minor(<DBE) earthquakes,resist mod EQs (DBE) without structural damage, aims at withstanding MCE without collapse

– Simple designs are better than complex/irregular designs

– In longer buildings, seismic expansion joints at 30mts intervals is desirable.

SEISMIC FACTORS…

• General principles & design criteria…– Avoid concentration of mass at higher floors– Avoid “soft” storey- more vulnerable to

damage– Measures to reduce structural vulnerability:

• Retrofitting by adding diagonal bracings• Adding buttresses, moment resisting frames• Base isolation techniques

CONCLUSION

• World-wide patient safety issues are presently in the limelight.

• If this is overlooked/neglected, one may have to pay a very heavy price for consequences.

Thank You !

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Hospital Design and Patient Safety Ppt