2010 Guidelines A Look at the Future

1. 1 2010 GuidelinesA Look at the Future Healthcare Facility Management Society Of New Jersey June 18, 2009

2. Schedule • Brainstorming - Completed • Proposal Period - Complete • Shaded Text Available - Complete • Comment Period - Complete • Final Meeting of the Committee – Complete • Document Release Date – January 2010

3. 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

4. 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

5. You had the opportunity to provide guidance to the committee!

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Major Topics of Discussion - Part 1 • Acoustics - Room Sound Absorption

13. Major Topics of Discussion - Part 1 • Acoustics - Room Noise Levels

14. Major Topics of Discussion - Part 1 • Acoustics - Sound Isolation of Spaces

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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.

26. 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.

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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)

35. 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

36. 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

37. Major Topics of Discussion - Part 3 • Updated the Gastrointestinal Endoscopy facility recommendations for pre and postoperative spaces

38. 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

39. 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

40. 40 These are your Guidelines, so please participate in the process!!! • Thank you and have a great remainder of the day and the conference.