What can we learn from Italian lessons?

Italy is well-known for its creative flair and contemporary design, but does this creativity translate to the healthcare sector? Having recently visited several Italian hospitals, Danny Gibson, technical director at international healthcare consultancy MJ Medical, contrasts the Italian healthcare system's use of equipment and technology with the UK approach, considers Italian hospital planners' attitude to future-proofing their buildings, and asks what lessons, if any, the UK can learn.

An investigation of the use of health building notes by UK healthcare building designers

Building design in the healthcare industry presents a complex architectural challenge. This paper reports a qualitative study to investigate the use of building design guidance by healthcare architects and planners in the United Kingdom. Sixteen architects, healthcare planners and facilities managers participated in 11 group and individual interviews. The data were analysed using NVivo2, resulting in three main themes: changes in the design culture over 20 years for the context of guidance use; quality of the evidence base to support the guidance; and future guidance needs to include patient expectations, new building techniques and generic room templates. The use of guidance was variable, with some participants seeing a clear role for new (more standardised) guidance in the future, whereas others were more concerned about loss of design freedom. Two clear roles for ergonomics were identified to: (1) facilitate the participation of patients and clinicians in the design process; and (2) generate new research evidence with respect to spatial requirements for clinical activities to support standardisation. These recommendations pertain specifically to healthcare facility design for the National Health Service in the UK.

Ground-breaking in more ways than one

A new cancer treatment and haematology centre which brings together into one modern, "cutting edge" facility oncology services from a diverse range of properties, many of them 1940s-built, at Oxford's Churchill Hospital, is claimed to be among the most eco-friendly, as well as technologically advanced, such units yet seen in Europe. Jonathan Baillie reports.

Firm foundations for sustainability

Ensuring that modern healthcare facilities are designed, constructed and maintained sustainably is now as important as specifying the right equipment to provide the very best in healthcare. But how can engineers, and those others in the healthcare sector responsible for the environmental aspects of new schemes, meet the current requirements, and what factors must be considered? Rob Pratt, director at independent engineering consultant Henderson Green, explains how BREEAM Healthcare can help organisations achieve a clean bill of health.

Step up in orthopaedic care for Stockport Trust

Specialist in the design and construction of modular healthcare buildings MTX Contracts has recently completed, on time and on budget, Stockport NHS Foundation Trust's impressive new four-storey orthopaedic and surgical facility at Stepping Hill Hospital. The company claims the new facility offers a quality of build and finish "as close to that of traditional build as is possible using modular construction techniques". Jonathan Baillie reports.

Good acoustics central to recovery

Good acoustic conditions in hospitals and other healthcare facilities are known not only to benefit patients by creating an environment that facilitates rest, sleeping, consultation and treatment, but also clinical and nursing staff. At the recent Healthcare Estates conference, Richard Budd of acoustic engineering and noise and vibration consultants Sound Research Laboratories, discussed the revised guidance on good acoustic design in a recently published Health Technical Memorandum, HTM 08-01-Acoustics.

Transforming Welsh healthcare

A fast-track procurement system for Welsh public healthcare projects involving three main project partners "pools" is speeding up the start and completion of hospital building projects, creating a more collaborative, less adversarial working environment, reducing cost and time uncertainties, and driving forward a tranche of schemes aimed at transforming the Welsh healthcare estate by 2015. Jonathan Baillie reports.

Framework for the design and operation of high-level isolation units: consensus of the European Network of Infectious Diseases

Patients with highly infectious diseases require safe, secure, high-quality medical care with high-level infection control, which may be most effectively delivered by specially trained staff in the setting of a high-level isolation unit (HLIU). The European Network of Infectious Diseases is a European Commission co-funded network of experts in the management of highly infectious diseases from national (or regional) centres designated for the care of this patient population. Participants took a consensus-based approach to develop a framework for the design and operation of HLIUs in Europe, covering clinical care provision, diagnostic services, transport, health and safety, and essential design and construction features, to support planning by health authorities for the safe and effective management of highly infectious diseases and preparedness for infectious disease emergencies in Europe.

Driving recovery via better buildings

The holistic role that architecturally innovative and imaginative healthcare buildings can have in aiding patient recovery, and the positive benefits of a relaxing, welcoming and aesthetically pleasing hospital environment on both patients and staff, were strongly in evidence at the 10th Building Better Healthcare Awards, held recently at London's The Brewery. Jonathan Baillie reports.

Equipping your facility for bariatric patients

As the number of extremely obese people increases worldwide, all healthcare facilities-not just those with bariatric surgical programs-are treating patients who have special equipment and space requirements. Is your facility ready? This article will help you analyze your current capabilities and identify the steps you still need to take to accommodate this segment of the population.

We shape our buildings, then they kill us: why health-care buildings contribute to the error pandemic

Hospitals are complex. The physical environment in which that complexity exists has a significant impact on health and safety. However, enhancing patient safety or improving quality has not been integrated into aspects of the design of hospital buildings. Despite recent discussions regarding design of 'patient-centered' healthcare facilities and 'evidence-based design', there has been little assessment of the impact of the built environment on patient outcomes. This paper will present a few examples of how changes in design can improve the quality of care.

[Investigation of the effect of constructions in hospital environment on the crucial units for immunocompromised patients and the development of opportunistic mold infections]

This study was planned to determine the effect of building constructions in and around our hospital, on the development of opportunistic mold infections in immunocompromised patients hospitalized in bone marrow and kidney transplantation units and haematology and oncology units. Samples were collected from high risk units by an air sampler (Air Ideal) from indoors and outdoors of a total of 43 patient rooms. The most commonly isolated species from indoor air cultures of our hospital were Penicillium spp. (50.6%), Cladosporium spp. (20%), Chrysonilia spp. (11%) and Aspergillus (10.6%) species. When outdoor samples were considered, Penicillium spp. (38.8%) was still in the first line, followed by Cladosporium spp. (24.3%), Paecillomyces spp. (10.7%) and Aspergillus (8.7%) species. There was no statistically significant difference of total colony and spore numbers between the samples obtained from indoor and outdoor air (p > 0.05), indicating the close relation with the construction studies in and around the hospital. Clinical samples including bronchoalveoler lavage (BAL) fluid, sputum, endotracheal aspirate and sinus tissue were collected from the total of 43 patients staying at these air sampled rooms, and eight of them (18.6%) yielded positivity for the growth of molds. Of them four were identified as Penicillium chrysogenum (sputum isolates), two as Aspergillus fumigatus (sputum and BAL isolates), one as Aspergillus flavus (BAL isolate), and one as Valsa sordida (sinus tissue) which is considered as a plant pathogen. A total of 53 sera, BAL, and tissue supernatant samples were screened by ELISA for the presence of galactomannan antigen, and five of the eight patients whose cultures were positive were also found positive for galactomannan antigen. One patient has died due to invasive aspergillosis whose BAL specimen and indoor air sample were positive for A. fumigatus. In evaluation of indoor air samples before and after the change of HEPA filters, statistically significant decrease was detected in total colony and spore numbers between the samples taken before and after the filter changes (p < 0.005). This study has emphasized the importance of examination of mold flora of indoor air and clinical samples of high risk group patients intermittantly, in order to prevent opportunistic mold infections in crucial units especially during hospital constructions.

Need for new design guidance identified

In the early 1980s, the Department of Health and Social Security (DHSS) developed an ergonomic database as part of Health Building Notes (HBNs) to act as guidance in the design of new hospitals and the adaptation of old buildings.

Family members' experiences of the intensive care unit waiting room

AIM

This paper is a report of a study to explore family members' perspectives and experiences of waiting rooms in adult intensive care units.

BACKGROUND

Waiting to visit family members who are hospitalized in intensive care units can be very stressful. Although flexible and or open visiting is practised in many hospitals, family members may spend a great deal of time in the waiting room.

METHOD

A qualitative design using semi-structured interviews was used and the data were collected in 2004. A convenience sample of six visitors was recruited from waiting rooms of three different adult intensive care units. Data collection and analysis were concurrent.

FINDINGS

Six categories emerged from the data that included structural and subjective aspects of waiting: 'close proximity' referred to the importance of a close physical distance to their family member; 'caring staff' captured the comfort family members felt when staff showed caring behaviours towards relative; 'need for a comfortable environment' represented the impact of the design of the waiting room on family members well-being; 'emotional support' referred to the waiting room as a place where comfort was found by sharing with others; 'rollercoaster of emotions' captured the range of emotions experienced by family members; 'information' referred to the importance of receiving information about their relative.

CONCLUSION

Future research should focus on the impact of the interior design of waiting rooms on the comfort and welfare of family members and on identifying needs of family members across different cultures.

Designing sustainable healthcare facilities

A sustainable approach to the design of healthcare premises is essential if the business effectiveness of facilities is to be maximised through their whole life. This report, by Phil Nedin, president of IHEEM and Arup global healthcare business leader, is based on a paper he presented at this year's annual general meeting of the Institute.

Best Practices in OR Suite Layout and Equipment Choices to Reduce Slips, Trips, and Falls

Slips, trips, and falls (STFs) account for about 20% of lost-time injuries for health care personnel. Although the effect that OR layout and equipment choices have on STF risk has not been specifically addressed in the literature, STFs in the perioperative suite are of particular concern because of their potential to cause adverse patient consequences. Increased renovation of ORs to include equipment for minimally invasive procedures intensifies the importance of examining best practices in OR layout and equipment choices to reduce the potential for STFs.

Radiation shielding for gamma stereotactic radiosurgery units

Shielding calculations for gamma stereotactic radiosurgery units are complicated by the fact that the radiation is highly anisotropic. Shielding design for these devices is unique. Although manufacturers will answer questions about the data that they provide for shielding evaluation, they will not perform calculations for customers. More than 237 such units are now installed in centers worldwide. Centers installing a gamma radiosurgery unit find themselves in the position of having to either invent or reinvent a method for performing shielding design.

This paper introduces a rigorous and conservative method for barrier design for gamma stereotactic radiosurgery treatment rooms. This method should be useful to centers planning either to install a new unit or to replace an existing unit. The method described here is consistent with the principles outlined in Report No. 151 from the U.S. National Council on Radiation Protection and Measurements. In as little as 1 hour, a simple electronic spreadsheet can be set up, which will provide radiation levels on planes parallel to the barriers and 0.3 m outside the barriers.

PACS numbers: 87.53.Ly, 87.56By, 87.52Tr

CHES and ASHE build bridges in construction

The Canadian Healthcare Engineering Society (CHES) and the American Society for Healthcare Engineering (ASHE) are partnering with a significant education initiative. They are providing construction and contract personnel with the insights necessary to recognise the inherent risks of progressing healthcare facility projects in patient-occupied buildings, writes Gordon D. Burrill, P. Eng.

Championing NHS design cause

In support of NHS governance arrangements for assuring design quality and improving the patient environment, the Department of Health has recommended that all Trusts and PCTs embarking on new developments, whether they are refurbishment or new build projects, should appoint a Design Champion to their board of directors. Health Estate Journal reports.

Power increase at first ProCure21 project

Throughout the UK, hospitals are embarking on new-build programmes to meet the needs of growing communities. However, site acreage and accommodation are often already under pressure, as Dale Power Solutions found when it was commissioned to increase standby power availability at the Friarage Hospital in Northallerton, North Yorkshire.

Healthy buildings: impact on nurses and nursing practice

Mounting evidence indicates that buildings can be a significant cause of human illness and environmental degradation. According to the United States (US) Environmental Protection Agency, indoor air pollution is one of the top five environmental risks to public health in the US. This may be related, to a large extent, to the fact that US citizens spend as much as 95% of their time indoors. Health care leaders, designers, and architects, recognizing the connection between health and the buildings in which much time is spent, are engaging in sustainable design and construction for healthy, 'green' buildings. The purpose of this article is to assist nurses in understanding the impact that unhealthy buildings can have on nurses and nursing practice and to provide tools and resources to assist nurses in transforming the health care industry with the goal of creating healing environments and reducing the negative environmental impact of the health care industry. First definitions, current initiatives, and motivations related to sustainable designs will be presented. Next sustainable health care design strategies, such as site planning, clean transportation, water conservation, healthy materials selection, indoor environmental quality, and also the benefits of sustainable design will be discussed. The article will conclude by sharing a variety of resources nurses can use to create healing environments in health care settings.

Safe design of healthcare facilities

The physical environment has a significant impact on health and safety; however, hospitals have not been designed with the explicit goal of enhancing patient safety through facility design. In April 2002, St Joseph's Community Hospital of West Bend, a member of SynergyHealth, brought together leaders in healthcare and systems engineering to develop a set of safety-driven facility design recommendations and principles that would guide the design of a new hospital facility focused on patient safety. By introducing safety-driven innovations into the facility design process, environmental designers and healthcare leaders will be able to make significant contributions to patient safety.