FGI/AIA Interim Sound & Vibration Guidelines for Hospitals & Healthcare Facilities

1. FGI/AIA Interim Sound & Vibration Guidelines for Hospitals & Healthcare Facilities

2. 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

3. 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.

4. 3 goals of this seminar • 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)

5. Context • 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

6. Authority • 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

7. The standard for GGHC’s new EQ acoustics credits • 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”

8. Objectives of the documents • Brief, comprehensive handbook • Healthcare specific • based on existing standards & best practices • Objective & measurable criteria • Practical guidance for designers • Look-up tables • Code language linked to AIA Guidelines • Design guidance

9. International scope The drafting committee included480 authorities from 10 constituencies & several countries: - Legislators - Planners, architects & designers - Regulatory agencies - Facility managers & engineers - Leaders of large HCOs - Acoustics researchers & - Clinical professionals practitioners - Healthcare lawyers - Acoustics professionals in large - Planners mfg. organizations

10. 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.

11. Medical perspective:Doctors know noise causes… • Sleep disruption (slows recovery) • Stress response (compromises outcomes) • Impaired communication (medical errors) • Lost privacy (errors & misdiagnoses) • Clinician “burnout” (accidents & staff turnover)

12. Abundant medical evidence • 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

13. Example: sleep loss… Impaired Attention and Reaction Time Insufficient or Disordered Sleep Risk of Injuries, Falls Decreased Memory and Concentration Incidence of Pain Worse Mood; depression Increased Consumption of Healthcare Resources Weight Gain Impaired Task Completion Diabetes Psychosocial difficulties Cardiovascular Disease

15. 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 AIA & GGHC acceptance change this

16. Core concept in architectural acoustics Source > Path > Receiver

17. Overview of the Guideline • 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

18. 1. Site exterior noise

19. Sec.1: Directive • Shall consider impact of exterior noise on hospital • Shall consider impact ofhospital noise on community • Exterior noises which facility does not control: - Highways, aircraft, trains, etc. • - Helipads, ambulances • Exterior noises which facility completely controls: • - Cooling towers & other building MEP equipment • - Delivery vehicles, refrigeration trucks, etc.

20. Sec.1: Four new categories …of exterior site environmental sound • Minimal—rural, quiet suburban • Moderate—busy suburbs, multifamily residential • Significant—commercial urban, busy streets • Extreme—near highway or airport flight path

21. Sec. 1: Category levels

22. Sec. 1: “Composite STC”

23. Sec. 1: “Ceiling Attenuation Class”(CAC)

24. Sec. 1: Action steps • Determine site type (A,B,C,D) • Identify & characterize noise issues • Consider solutions

25. Sec. 2: Acoustical finishes • 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

26. Sec. 2: Indoor reverberation

27. Sec. 2: Identify sound paths

28. Sec. 2: Compare materials NRC – noise reduction coefficient (ave. abs. coef. (a) 250 to 2000 Hz

29. 2. Calculate absorption New design tool: Average absorption coefficient ( )

30. Sec. 2: Choose materials • 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 • No special requirements from EPA, CMS, CDC, JCAHO, FGI, ASTM or ASHRAE • Manufacturers cite ASTM C1338, & ASTM G21

31. Sec. 2: Action steps • Analyze “source>path>receiver” issues • Consider design choices • Calculate absorption required • Choose acoustical finishes

32. Sec. 3: Room noise • 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

33. Sec. 3: Methods & criteria • Methods to quantify room noise: - dBA & NC are most common methods • 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?

34. NC curves:

35. NCcurve:

36. Sec. 3: Level by room type

37. Sec. 3: Action steps • Consider room types & uses • Select appropriate noise level criteria (NC or dBA) from table • Review design options with ME to achieve these criteria

38. Sec. 4: Isolation & privacy • 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

39. Sec. 4: Methods & criteria • 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)

40. Sec. 4: Closed-plan privacy

41. Sec. 4: Open plan privacy

42. Sec. 4: Consider adjacencies STCc – Composite sound transmission class rating

43. Sec. 4: Identify privacy goal Special consideration required Special consideration required

44. Sec. 4: Action steps • 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

45. Sec. 5: Sound systems • 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

46. Sec. 5: Paging, call, alarm, masking & sound systems • Criteria: audibility, intelligibility, minimal annoyance • You can limit annoyance, distraction, sleep loss by reducing levels in limited areas or considering non-audible & 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?

47. Sec. 5: Problem may be code minimums Page, call & sound reinforcement minimums: a. 70 dBA minimum sound level; orb. 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

48. Sec. 5: Criteria Alarms:NFPA 72 (ISO 7731) Masking systems:a. Not higher than 48 dBAb. Uniform coverage +/-2dBAc. Suitable spectrum shape (innocuous)d. May be too high for many space uses

49. Sec. 5: Action steps • 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. • Wired traditional sound system? • Light/code systems? • Wireless pagers?

50. Sec. 6: Vibration • 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