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2010 GuidelinesA 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•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• 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 accessibleAdjacentClear floor area (improve existing language)AppendixLinear 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.

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 RoomsDoor seals and sweepsRequirements 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/NoiseLighting

•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 inOR 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 unitTemperature of 72 - 78 degreesHumidity of 30 - 50 percent RH

▫Fresh air intakes25 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 outletsTermination above the highest wall heightIn 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 areasTelecommunications service entrance roomTechnology equipment centerTechnology 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 Roomsmaximum of one patientminimum 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 rewriteLevel 1 - one per ORLevel 2 - one per ORLevel 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 isprojected 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.