With the July posting of EES Healthy Environment we want to introduce you to a valuable resource for health care professionals that you may not even know about. The Guidelines for Design and Construction of Health Care Facilities are updated every four years and co-authored by The Facility Guidelines Institute and The American Institute of Architects Academy of Architecture for Health, with assistance provided by the U.S. Department of Health and Human Services. These guidelines set the minimum standards for American health care facility design, and give health care providers and design professionals guidance on good practice and emerging trends.
Below we have provided a brief review of Sections 1.3-4 and 1.5 covering environmental pollution control and planning, design and construction. For more information, or to purchase the Guidelines.
The guidelines detail a number of factors that you should be sure to pay attention to during construction and design. Health care facilities are subject to many environmental regulations on both the state and federal level regarding the design, construction, renovation, expansion, equipment, and operation of the facilities.
Keep in mind that state regulations often add additional provisions to federal guidelines, and your facility must follow both. Air quality related to incinerators and gas sterilizers; underground storage tanks; hazardous materials and waste storage; storm water control; medical waste storage; and much more are frequently subject to state regulation. For more detailed information regarding your specific location, contact the regional offices of the U.S. Department of Health and Human Services (DHHS) and U.S. Environmental Protection Agency (EPA), or your state environmental agency.
On both the federal and state level, it’s important to have all necessary permits. Your facility may be required to support permit applications with appropriate documentation of proposed impacts and mitigation. Usually, this documentation is reported in an Environmental Impact Statement (EIS) with respect to potential impacts on the environment, as well as in a Health Risk Assessment (HRA) with respect to potential impacts on public health. The scope of these documents is usually determined by a consultation with the appropriate regulatory agency, and sometimes a meeting that gives members of the public a chance to voice concerns.
Finally, remember to eliminate mercury. New facilities should not install any mercury-containing equipment, and existing facilities undergoing renovation should develop a plan to phase out mercury-containing sources. Many states and municipalities have enacted bans on the sale of mercury-containing devices and equipment, so be sure to proceed with caution and care.
Health Care and Facility Construction: ICRA
A critical aspect of any construction for a health care facility is an infection control risk assessment (for more information, see our article “6 Ways To Control Infections During Construction“. An ICRA is a determination of the potential risk of transmission of various air- and waterborne biological contaminants in the facility. The owner of your facility should provide the following as dictated by the ICRA:
Infection control risk mitigation recommendations (ICRMR)
How do I build an ICRA?
You’ll need the following:
ICRA panel. This is a panel comprised of personnel with expertise in infection control, direct patient care, risk management, facility design, construction and construction planning, ventilation, safety, and epidemiology.
Continuous updates. Throughout planning, design, construction, and commissioning, the panel should provide updated documentation whenever possible.
Monitoring. The owner should provide monitoring of the effectiveness of the applied ICRMR throughout the project.
What should my ICRA address?
It should address the following design features:
Number, location, and type of airborne infection isolation and protective environment rooms
Location of special ventilation and filtration such as emergency department waiting and intake areas
Air-handling and ventilation needs in surgical services, airborne infection isolation and protective environment rooms, laboratories, local exhaust systems for hazardous agents, and other special areas
Water systems to limit Legionella sp. and waterborne opportunistic pathogens
Finishes and surfaces
Your ICRA should also address these construction issues:
The impact of disrupting essential services to patients and employees
Determination of the specific hazards and protection levels for each area
Location of patients by susceptibility to infection and definition of risks to each
Impact of potential outages or emergencies and protection of patients during planned or unplanned outages, movement of debris, traffic flow, cleanup, and testing and certification
Assessment of external as well as internal construction activities
Location of known hazards
Finally, the ICRMR prepared for the ICRA should address the following:
Patient placement and relocation
Standards for barriers and other protective measures required to protect adjacent areas and susceptible patients from airborne contaminants
Temporary provisions or phasing for construction or modification of heating, ventilating, air conditioning, and water supply systems
Protection from demolition
Measures to be taken to train hospital staff, visitors, and construction personnel
HE Number 1 part 1