14 Health estates Flashcards
What are general principles when designing a hospital ward, with regards to cleaning?
Everything should be easily cleanable e.g smooth walls, cupboards
Electrical cables/ devices should withstand cleaning chemicals
Floor should be cleaned regularly
Avoid carpet - harbours large number of bacteria, and difficult to clean
Laundering process in place for bedding/ clothes
Beds in a hospital bay
How far apart should they be?
3.6m between centre of hospital beds - 2002 guidelines
Nurse should be able to interact with each patient, without encroaching on another patients area
What is unique about hospital sinks and their placement
Bowl shape designed to prevent splash-back
1 basin per hospital bay, or clinic room
1 side room should be available for every patient bay
Why do side rooms not have controllable positive/ negative pressure?
Errors have occurred, whereby infectious patient placed in positive pressure room, leading to spread of disease
Better to be fixed neg or pos pressure to prevent this occurring
Negative pressure side rooms
How often do air changes need to occur?
Has is contaminated air removed?
It is recommended that a minimum of six air changes per hour (ACH) is required for the protection of staff and visitors. However, in new buildings 12 ACHs are advised.
In addition there should be adequate temperature and humidity regulation, so that windows cannot be opened and doors can be kept closed when the room is in use.
The ventilation system should be designed to maintain a 15 pascal (Pa) pressure differential between rooms. The supply air system should provide 100 % fresh air and no recirculation should be permitted. The exhaust air from isolation rooms should be vented to the exterior and extracted air should terminate in a safe location away from the fresh air supply inlet and ideally 1.2 metres above the highest part of the building.
Where this is not possible or there are other buildings in close proximity, pre- and HEPA (high efficiency particulate air) filters should be used. Regular maintenance and monitoring programmes must be
Should have ante-room to enable PPE removal/ hand washing
What infection risk is there to patients if there is construction work at the hospital?
Aspergillus spores being released during construction
May be able to continue work, but need dust/ moisture protection, or protection of wards from exterior
If an oncology unit, may need to give prophylactic anti-fungals to patients
Why do operating theatres need airflow control?
Staff/ patient continually shed skin and microbes onto surfaces - risk of infection. Positive pressure theatre to direct airflow outwards
humidity/ temperature control
removal of aerosolised anaesthetic gases
sluice may have negative control, to prevent spread of bacteria into operating theatre
how many air changes per hour should an operating theatre have?
25
What is an ultraclean ventilated (UCV)/ laminar flow theare
In ultraclean ventilated (UCV) theatres, sometimes referred to as ‘laminar flow’ theatres,
highly filtered air descends in an organized flow from a canopy in the theatre ceiling
over the centre of the theatre.
This unidirectional downward flow rapidly removes contamination
generated by the surgical team working within this area and resists ingress
of contamination from outside, resulting in very low bacterial counts in this area.
UVC theatres are commonly used for orthopaedic prosthetic surgery where the consequences
of wound infection are substantial and can be catastrophic for patients. It is accepted
that ultraclean air (<10 cfu/m 3 ) reduces the risk of infection in implant surgery.
