Adult Inpatient Services - Revision history

Tobyvan: /* Airborne infection isolation and protective environments */ Changes made to burns unit requirements - negative pressure permitted as per BES guide

2020-12-15T08:38:48Z

Airborne infection isolation and protective environments: Changes made to burns unit requirements - negative pressure permitted as per BES guide

← Older revision		Revision as of 10:38, 15 December 2020
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	Additional information regarding engineering services design and planning for airborne precaution rooms can be found in the [http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/ IUSS Building Engineering Services Guideline][http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/ .][http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/][[File:Protective_Environment-Positive_pressure.png\|alt=\|none\|thumb\|468x468px\|Figure 2:Protective environment – positive pressure]]		Additional information regarding engineering services design and planning for airborne precaution rooms can be found in the [http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/ IUSS Building Engineering Services Guideline][http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/ .][http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/][[File:Protective_Environment-Positive_pressure.png\|alt=\|none\|thumb\|468x468px\|Figure 2:Protective environment – positive pressure]]

	A PE room is required for patients who are immunocompromised, but do not initially present with an airborne infectious disease. These rooms require an anteroom to ensure a clean environment in the PE room. Where these are located within open wards,such as high-care units (HCUs) or intensive-care units(ICU), and are held at pressure positive to adjacent rooms, they should include negative pressure anteroom to prevent the potential spread of infection out of the PE room. ~~This is a typical scenario for a~~ burns ward. Where airborne infection risk is suspected in these rooms, staff and visitors entering the PE room should wear respirators prior to entering the anteroom.Additional ventilation measures, such as ~~air that was filtered~~ using ~~high-efficiency particulate abosorption~~ (~~HEPA~~), filtered supply air may be required when treating allogeneic patients.[[File:Airborne_infection_protective_isolation.png\|alt=\|none\|thumb\|479x479px\|Figure 3: Airborne infection protective isolation]]Where patients are immunocompromised and initially suspected of presenting with an infectious airborne disease, they should be located in an '''airborne infection protective isolation''' room. These rooms shall be designed to maintain a negative pressure relative to the anteroom and adjacent rooms, with the exception of the en suite bathroom. These rooms demand very low air permeability with high-quality sealing. The Centres for Disease Control (CDC) Guidelines for Environmental Infection Control in Health Care Facilities (2003) recommend an effective leakage area of less than 0.045 m² for the entire room. Placing this in context, the equivalent gap for a single half-leaf door that has been hung relatively well is calculated in the order of 0.04 m².		A PE room is required for patients who are immunocompromised, but do not initially present with an airborne infectious disease. These rooms require an anteroom to ensure a clean environment in the PE room. Where these are located within open wards, such as high-care units (HCUs) or intensive-care units(ICU), and are held at pressure positive to adjacent rooms, they should include negative pressure anteroom to prevent the potential spread of infection out of the PE room. For burns ward; however, negative pressure isolation with a sink anteroom, which is more negative in pressure, could be prescribed where sufficient separation from susceptible patients in adjacent ICUs cannot be ensured. Where airborne infection risk is suspected in these rooms, staff and visitors entering the PE room should wear respirators prior to entering the anteroom. Additional ventilation measures, such as using at least HEPA (H13) filtered supply air may be required when treating burns or allogeneic patients.[[File:Airborne_infection_protective_isolation.png\|alt=\|none\|thumb\|479x479px\|Figure 3: Airborne infection protective isolation]]Where patients are immunocompromised and initially suspected of presenting with an infectious airborne disease, they should be located in an '''airborne infection protective isolation''' room. These rooms shall be designed to maintain a negative pressure relative to the anteroom and adjacent rooms, with the exception of the en suite bathroom. These rooms demand very low air permeability with high-quality sealing. The Centres for Disease Control (CDC) Guidelines for Environmental Infection Control in Health Care Facilities (2003) recommend an effective leakage area of less than 0.045 m² for the entire room. Placing this in context, the equivalent gap for a single half-leaf door that has been hung relatively well is calculated in the order of 0.04 m².

	Respiratory protection needs not be worn in the anteroom in this scenario, as the anteroom is held at a relative pressure positive to the patient room.		Respiratory protection needs not be worn in the anteroom in this scenario, as the anteroom is held at a relative pressure positive to the patient room.

VSadiki: /* Bed services */

2020-07-23T11:18:53Z

Bed services

← Older revision		Revision as of 13:18, 23 July 2020
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	\|Training or meeting room( in district hospital staffrooms could be used)		\|Training or meeting room( in district hospital staffrooms could be used)
	\|}		\|}
	These zones create the therapeutic environment required for successful healthcare delivery at inpatient unit level.		These zones create the therapeutic environment required for successful healthcare delivery at inpatient unit level.[[File:Figure-17.png\|none\|thumb\|493x493px\|Figure 17: Adult inpatient accommodation: Internal zoning and relationships]]

	~~figure 17~~
	==Functional relationships within the inpatient unit==		==Functional relationships within the inpatient unit==

VSadiki at 10:25, 23 July 2020

2020-07-23T10:25:04Z

← Older revision		Revision as of 12:25, 23 July 2020
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	**A finish that does not detract or obscure the signs intention		**A finish that does not detract or obscure the signs intention

	[[File:Directional_signage.png\|alt=\|none\|thumb\|Figure 4: Directional signage]]Mapping is an important part of wayfinding system. ~~Maos~~ should be located at strategic points throughout the site and allow visitors to orlantate themselves. The maps should be consistent with the signage and the typology needs to be clear.[[File:Photo_1.png\|alt=\|none\|thumb\|Photograph 1: Mitchells Plain Hospital, Cape Town: Maps strategically placed per floor]]		[[File:Directional_signage.png\|alt=\|none\|thumb\|Figure 4: Directional signage]]Mapping is an important part of wayfinding system. Maps should be located at strategic points throughout the site and allow visitors to orlantate themselves. The maps should be consistent with the signage and the typology needs to be clear.[[File:Photo_1.png\|alt=\|none\|thumb\|Photograph 1: Mitchells Plain Hospital, Cape Town: Maps strategically placed per floor]]

	===In the inpatient facility===		===In the inpatient facility===
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	</div>		</div>
	===Key room relationships===		===Key room relationships===
	It is important that key room relationships are maintained such as illustrated in figure 18.[[File:Figure_18.png\|alt=\|none\|thumb\|361x361px\|Figure 18: Room relationships that promote the principal of ‘clean to dirty’ flow]]~~<br />~~[[File:Figure_19.png\|alt=\|none\|thumb\|363x363px\|Figure 19: Room relationships with the inpatient unit (Example 1)]][[File:Figure_20.png\|alt=\|none\|thumb\|368x368px\|Figure 20: Room relationships with the inpatient unit (Example 2)]]		It is important that key room relationships are maintained such as illustrated in figure 18.[[File:Figure_18.png\|alt=\|none\|thumb\|361x361px\|Figure 18: Room relationships that promote the principal of ‘clean to dirty’ flow]][[File:Figure_19.png\|alt=\|none\|thumb\|363x363px\|Figure 19: Room relationships with the inpatient unit (Example 1)]][[File:Figure_20.png\|alt=\|none\|thumb\|368x368px\|Figure 20: Room relationships with the inpatient unit (Example 2)]]

	==List of rooms==		==List of rooms==
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	The value of this type of system is that conflict of design principles can be detected early, such as door openings, spaces and the sizes of rooms in relation to the equipment for the space. (Code Book is a database system that could facilitate the development of a library for future use, Revit is a 3D design program)		The value of this type of system is that conflict of design principles can be detected early, such as door openings, spaces and the sizes of rooms in relation to the equipment for the space. (Code Book is a database system that could facilitate the development of a library for future use, Revit is a 3D design program)

	Table 8: Example list of rooms for a 32-Bed inpatient unit		Table 7: Example list of rooms for a 32-Bed inpatient unit
	{\| class="wikitable"		{\| class="wikitable"
	\|+		\|+

VSadiki at 10:18, 23 July 2020

2020-07-23T10:18:02Z

← Older revision		Revision as of 12:18, 23 July 2020
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	**A finish that does not detract or obscure the signs intention		**A finish that does not detract or obscure the signs intention

	[[File:Directional_signage.png\|alt=\|none\|thumb\|Figure 4: Directional signage]]Mapping is an important part of wayfinding system. Maos should be located at strategic points throughout the site and allow visitors to orlantate themselves. The maps should be consistent with the signage and the typology needs to be clear.		[[File:Directional_signage.png\|alt=\|none\|thumb\|Figure 4: Directional signage]]Mapping is an important part of wayfinding system. Maos should be located at strategic points throughout the site and allow visitors to orlantate themselves. The maps should be consistent with the signage and the typology needs to be clear.[[File:Photo_1.png\|alt=\|none\|thumb\|Photograph 1: Mitchells Plain Hospital, Cape Town: Maps strategically placed per floor]]

	[[File:~~Photo 1~~.png\|~~frameless]]~~

	Photograph 1: Mitchells Plain Hospital, Cape Town: Maps strategically placed per floor

	===In the inpatient facility===		===In the inpatient facility===

VSadiki at 14:53, 22 July 2020

2020-07-22T14:53:53Z

← Older revision		Revision as of 16:53, 22 July 2020
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	Epoxy grout is to be applied in all tiled areas.		Epoxy grout is to be applied in all tiled areas.

	Fittings, including grab rails, are to be installed to the toilet and shower area, including towel rails.[[File:Drawing_7.png\|alt=\|none\|thumb\|369x369px\|Drawing 7: Example of En suite bathroom (combined toilet and shower area) that accommodates wheelchairs]]~~<br />~~[[File:Drawing_8.png\|alt=\|none\|thumb\|371x371px\|Drawing 8: Example of En suite bathroom (separate toilet and shower) that does not accommodate wheelchairs]]		Fittings, including grab rails, are to be installed to the toilet and shower area, including towel rails.[[File:Drawing_7.png\|alt=\|none\|thumb\|369x369px\|Drawing 7: Example of En suite bathroom (combined toilet and shower area) that accommodates wheelchairs]][[File:Drawing_8.png\|alt=\|none\|thumb\|371x371px\|Drawing 8: Example of En suite bathroom (separate toilet and shower) that does not accommodate wheelchairs]]

	===Assisted shower===		===Assisted shower===
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	[[File:Drawing_17.png\|alt=\|none\|thumb\|Drawing 17: example of Nurses’ station]]		[[File:Drawing_17.png\|alt=\|none\|thumb\|Drawing 17: example of Nurses’ station]]

	=== Patient kitroom ===		===Patient kitroom===
	<div style="margin-left:0cm;margin-right:0cm;">		<div style="margin-left:0cm;margin-right:0cm;">
	====Description and function====		====Description and function====
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	[[File:Drawing_21.png\|alt=\|none\|thumb\|Drawing 21: Medicine store example]][[File:Photograph_7.png\|alt=\|none\|thumb\|325x325px\|Photograph 7: Examples of medicine trolleys]]		[[File:Drawing_21.png\|alt=\|none\|thumb\|Drawing 21: Medicine store example]][[File:Photograph_7.png\|alt=\|none\|thumb\|325x325px\|Photograph 7: Examples of medicine trolleys]]

	== Staff facilities ==		==Staff facilities==
	<div style="margin-left:0cm;margin-right:0cm;">		<div style="margin-left:0cm;margin-right:0cm;">
	===Staffroom===		===Staffroom===
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	====General requirements====		====General requirements====
	Natural light in patient areas is desirable.Waiting areas may be shared between inpatient units. Avoid any floor prostrutions that would influence wheels of beds and equipment. The width of a passage must allow at least two beds to pass in opposite directions, within the bumper rail measurement. The recommended minimum width for the main inpatient unit corridor (from bumper rail to bumper rail) is 2400 mm between bumper rails.[[File:Drawing_26.png\|alt=\|none\|thumb\|Drawing 26: Hospital passage requirements]]~~<br />~~		Natural light in patient areas is desirable.Waiting areas may be shared between inpatient units. Avoid any floor prostrutions that would influence wheels of beds and equipment. The width of a passage must allow at least two beds to pass in opposite directions, within the bumper rail measurement. The recommended minimum width for the main inpatient unit corridor (from bumper rail to bumper rail) is 2400 mm between bumper rails.[[File:Drawing_26.png\|alt=\|none\|thumb\|Drawing 26: Hospital passage requirements]]

	===Visitors' waiting area===		===Visitors' waiting area===

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	*The door is to be fitted with escape hardware to allow staff access in case of an emergency		*The door is to be fitted with escape hardware to allow staff access in case of an emergency

	[[File:Drawing_27.png\|alt=\|none\|thumb\|Drawing 27: Toilet for the disabled]]~~<br />~~[[File:Photograph_8.jpg\|alt=\|none\|thumb\|Photograph 8: Provision for emergency trolley]]~~<br />~~[[File:Drawing_28.png\|alt=\|none\|thumb\|Drawing 28: Clinical hand basin configure]]~~<br />~~[[File:Drawing_29.png\|alt=\|none\|thumb\|Drawing 29: Wheelchair Bay]]		[[File:Drawing_27.png\|alt=\|none\|thumb\|Drawing 27: Toilet for the disabled]][[File:Photograph_8.jpg\|alt=\|none\|thumb\|Photograph 8: Provision for emergency trolley]][[File:Drawing_28.png\|alt=\|none\|thumb\|Drawing 28: Clinical hand basin configure]][[File:Drawing_29.png\|alt=\|none\|thumb\|Drawing 29: Wheelchair Bay]]

	==Engineering Considerations==		==Engineering Considerations==

VSadiki at 14:46, 22 July 2020

2020-07-22T14:46:36Z

Show changes

VSadiki at 13:35, 22 July 2020

2020-07-22T13:35:04Z

Show changes

VSadiki at 12:36, 22 July 2020

2020-07-22T12:36:59Z

← Older revision		Revision as of 14:36, 22 July 2020
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	==Service context==		==Service context==
	</div>The business case and the health brief define the correct package of services and the required bed distribution per facility based on the Provincial Strategic Transformation Plan and the government policy document:Government Notice R. 185, 2 March 2012, National Health Act 61/2003Regulations: '''Categories of hospitals''': No.35101		</div>The business case and the health brief define the correct package of services and the required bed distribution per facility based on the Provincial Strategic Transformation Plan and the government policy document:Government Notice R. 185, 2 March 2012, National Health Act 61/2003Regulations: '''Categories of hospitals''': No.35101
	~~TABLE~~ 1:~~INPATIENT UNIT ALLOCATION PER CATEGORY OF HOSPITAL~~		Table 1: Inpatient unit allocation per category of hospitalL
	{\| class="wikitable"		{\| class="wikitable"
	!District hospital		!District hospital
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	A whiteboard, which lists the patients that are currently occupying the beds, should be mounted on the wall behind the nurses’ station. The whiteboard should be a ‘wipe’ board with a suitable surface for nurses to add and erase the information. The information should be indicated as follows with lines drawn to separate each row and column:		A whiteboard, which lists the patients that are currently occupying the beds, should be mounted on the wall behind the nurses’ station. The whiteboard should be a ‘wipe’ board with a suitable surface for nurses to add and erase the information. The information should be indicated as follows with lines drawn to separate each row and column:

	~~TABLE 3~~: ~~EXAMPLE OF THE PATIENT INFORMATION BOARD~~		Table 2: Example of the patient information board
	{\| class="wikitable"		{\| class="wikitable"
	!Bed no		!Bed no
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	*Central Cleaning Depot (CCD) – cleaning equipment		*Central Cleaning Depot (CCD) – cleaning equipment
	*Refuse – general waste (domestic), pathological waste for incineration, recyclable waste, sharps.		*Refuse – general waste (domestic), pathological waste for incineration, recyclable waste, sharps.
	~~</div><div style="margin-left:0cm;margin-right:0cm;">~~Material handling of inpatient unit supplies includes the following:
			Material handling of inpatient unit supplies includes the following:

	*To and from the laboratory – the collection of specimens		*To and from the laboratory – the collection of specimens
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	*General hospital policies relevant to the various departments, such as linen supply and waste management, should be applied		*General hospital policies relevant to the various departments, such as linen supply and waste management, should be applied
	</div>		</div>

	===Medication management===		===Medication management===

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	[[File:Figure_5.png\|alt=\|none\|thumb\|321x321px\|Figure 5: Interactive management and control of pharmaceutical substances]]The equipment store is intended for storage of equipment that has to be floor parked or stored on shelves and for equipment that may require the recharging of batteries. The requirements will vary and need to be defined so that appropriate storage space is allocated according to the requirements of the inpatient unit and the needs of the patients and staff.<div style="margin-left:0cm;margin-right:0cm;">		[[File:Figure_5.png\|alt=\|none\|thumb\|321x321px\|Figure 5: Interactive management and control of pharmaceutical substances]]The equipment store is intended for storage of equipment that has to be floor parked or stored on shelves and for equipment that may require the recharging of batteries. The requirements will vary and need to be defined so that appropriate storage space is allocated according to the requirements of the inpatient unit and the needs of the patients and staff.<div style="margin-left:0cm;margin-right:0cm;">
	===Options for dispensing within the inpatient unit===		===Options for dispensing within the inpatient unit===
	Lockable medication trolleys should be stored in the medicine storeroom behind or directly opposite the nurses' station so that the store is in full view of nurses at all times.		Lockable medication trolleys should be stored in the medicine storeroom behind or directly opposite the nurses' station so that the store is in full view of nurses at all times.[[File:Figure_6.png\|alt=\|none\|thumb\|Figure 6: Relationship of medicine store]]

	[[File:Figure_6.png\|alt=\|~~frameless~~\|~~362x362px~~]]

	~~FIGURE 6: RELATIONSHIP OF MEDICINE STORE~~

	===Equipment cleaning===		===Equipment cleaning===
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	<div style="margin-left:0cm;margin-right:0cm;">Sterile supplies should be handled and stored in a manner that maintains the integrity of packs and prevents contamination from any source, e.g. dust, vermin, sunlight, water and condensation. Sterile or surgical stores should be temperature- and light-controlled and easily cleaned. Sterile supplies (packs) are stored in the clean utility room. Surgical and medical consumables are stored in a stockroom.		<div style="margin-left:0cm;margin-right:0cm;">Sterile supplies should be handled and stored in a manner that maintains the integrity of packs and prevents contamination from any source, e.g. dust, vermin, sunlight, water and condensation. Sterile or surgical stores should be temperature- and light-controlled and easily cleaned. Sterile supplies (packs) are stored in the clean utility room. Surgical and medical consumables are stored in a stockroom.
	Supplies should be stored off the floor, with the lowest shelf at least 300 mm above floor level to avoid mechanical damage during cleaning, and the top shelf no higher than 1 850 mm.		Supplies should be stored off the floor, with the lowest shelf at least 300 mm above floor level to avoid mechanical damage during cleaning, and the top shelf no higher than 1 850 mm.[[File:Figure_7.png\|alt=\|none\|thumb\|339x339px\|Figure 7: Interactive relationship for the management and control of supplies and consumables]]

	[[File:Figure_7.png\|alt=\|~~frameless~~\|~~485x485px~~]]

	~~FIGURE 7: INTERACTIVE RELATIONSHIP FOR THE MANAGEMENT AND CONTROL OF SUPPLIES AND CONSUMABLES~~

	===Storage of patients' belongings===		===Storage of patients' belongings===
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	*Patients might be disabled or might be semi-mobile due to weakness, age, or the disease profile		*Patients might be disabled or might be semi-mobile due to weakness, age, or the disease profile

	~~TABLE 4~~: ~~INPATIENT UNIT ACTIVITIES~~		Table 3: Inpatient unit activities
	{\| class="wikitable"		{\| class="wikitable"
	\|+		\|+
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	===Staff overnight facilities===		===Staff overnight facilities===

	<div style="margin-left:0cm;margin-right:0cm;">District hospitals only have overnight facilities in the maternity wards and EU sections. Regional hospitals have overnight facilities for ICUs, EUs, maternity wards, diagnostic radiology and paediatrics with facilities for medical and surgical inpatient units not necessarily in the inpatient unit. Tertiary hospitals may have a separate overnight facility for students and qualified staff in one location or separate locations.		<div style="margin-left:0cm;margin-right:0cm;">District hospitals only have overnight facilities in the maternity wards and EU sections. Regional hospitals have overnight facilities for ICUs, EUs, maternity wards, diagnostic radiology and paediatrics with facilities for medical and surgical inpatient units not necessarily in the inpatient unit. Tertiary hospitals may have a separate overnight facility for students and qualified staff in one location or separate locations.[[File:Figure_8.png\|alt=\|none\|thumb\|Figure 8: Hospital model of care]]Figure 8 illustrates the position of the inpatient units in relation to the hospital support services and the outpatient services. Inpatient units should be located separately, away from the mainstream, in the hospital complex to enable better privacy and separate the flow path of inpatients from outpatients after entering the main entrance to the hospital. This reduces the volume of traffic in the main passage to the inpatient units and avoids visitors, staff and service traffic through the inpatient units.
	[[File:Figure_8.png\|alt=\|~~frameless~~\|~~399x399px~~]]

	~~FIGURE 8: HOSPITAL MODEL OF CARE~~
	Figure 8 illustrates the position of the inpatient units in relation to the hospital support services and the outpatient services. Inpatient units should be located separately, away from the mainstream, in the hospital complex to enable better privacy and separate the flow path of inpatients from outpatients after entering the main entrance to the hospital. This reduces the volume of traffic in the main passage to the inpatient units and avoids visitors, staff and service traffic through the inpatient units.

	*District hospital		*District hospital
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	**Subspecialist inpatients, such as neurosurgery and cardiology, are the inpatients most closely associated with the theatres.		**Subspecialist inpatients, such as neurosurgery and cardiology, are the inpatients most closely associated with the theatres.

	[[File:Figure_9.png\|alt=\|~~frameless~~\|~~342x342px~~]]		[[File:Figure_9.png\|alt=\|none\|thumb\|Figure 9: Departmental relationships]]

	~~FIGURE 9: DEPARTMENTAL RELATIONSHIPS~~

	==Flow patterns==		==Flow patterns==

VSadiki at 11:46, 22 July 2020

2020-07-22T11:46:55Z

← Older revision		Revision as of 13:46, 22 July 2020
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	All swing doors shall be equipped with door closers to ensure that they remain shut when not in use. Hold-open devices are not recommended for these doors. Sliding doors are also not recommended as these pose difficulties in maintaining an adequate seal.		All swing doors shall be equipped with door closers to ensure that they remain shut when not in use. Hold-open devices are not recommended for these doors. Sliding doors are also not recommended as these pose difficulties in maintaining an adequate seal.

	It is recommended that isolation rooms be provided with outside views where possible, without presenting a biosecurity risk. Privacy blinds should be installed, but these should not present a hygiene risk or hinder the nursing staff view of the patient.</div>[[File:Negative_pressure_isolation.png\|alt=\|none\|thumb\|~~600x600px~~\|Figure 1: Negative pressure isolation]]<div style="margin-left:0cm;margin-right:0cm;">		It is recommended that isolation rooms be provided with outside views where possible, without presenting a biosecurity risk. Privacy blinds should be installed, but these should not present a hygiene risk or hinder the nursing staff view of the patient.</div>[[File:Negative_pressure_isolation.png\|alt=\|none\|thumb\|444x444px\|Figure 1: Negative pressure isolation]]<div style="margin-left:0cm;margin-right:0cm;">

	'''Negative pressure isolation''' is only required for patients presenting with airborne infections, for example, measles, Severe Acute Respiratory Syndrome (SARS), and TB. These infections spread primarily through the respiratory route where the infectious particles have a diameter of less than 5 µm. The unit for measuring ventilation is air changes per hour (ACH). In accordance with the national building regulations, isolation rooms shall be single occupancy with ventilation rates in excess of 12 ACH (including en suite bathrooms and anterooms). Where airborne contamination control in these rooms is achieved through dilution, these rooms shall have near perfect mixing with air change efficiencies approaching 50%. This implies that the ventilation efficiency in the isolation room shall be 50% as efficient as plug flow. Contamination removal effectiveness around the patient can be improved by placing an extraction point near the head of the bed. Airflow patterns within the room shall be developed so that the air shall flow from the passage door and air inlet terminal, across the patient and towards the bathroom and extraction points.		'''Negative pressure isolation''' is only required for patients presenting with airborne infections, for example, measles, Severe Acute Respiratory Syndrome (SARS), and TB. These infections spread primarily through the respiratory route where the infectious particles have a diameter of less than 5 µm. The unit for measuring ventilation is air changes per hour (ACH). In accordance with the national building regulations, isolation rooms shall be single occupancy with ventilation rates in excess of 12 ACH (including en suite bathrooms and anterooms). Where airborne contamination control in these rooms is achieved through dilution, these rooms shall have near perfect mixing with air change efficiencies approaching 50%. This implies that the ventilation efficiency in the isolation room shall be 50% as efficient as plug flow. Contamination removal effectiveness around the patient can be improved by placing an extraction point near the head of the bed. Airflow patterns within the room shall be developed so that the air shall flow from the passage door and air inlet terminal, across the patient and towards the bathroom and extraction points.
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	Supply and extraction systems should be interlocked so that a failure of the exhaust air system shuts the air supply off, preventing the isolation room from going into an overpressure status. It is acceptable to install a balanced-blade pressure stabiliser to ensure that the room does not experience extremes of pressure under supply fan failure, control system failure, or severe transient environmental conditions. However, the inclusion of these devices can increase the design capacity of the system under normal operation.		Supply and extraction systems should be interlocked so that a failure of the exhaust air system shuts the air supply off, preventing the isolation room from going into an overpressure status. It is acceptable to install a balanced-blade pressure stabiliser to ensure that the room does not experience extremes of pressure under supply fan failure, control system failure, or severe transient environmental conditions. However, the inclusion of these devices can increase the design capacity of the system under normal operation.

	Additional information regarding engineering services design and planning for airborne precaution rooms can be found in the [http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/ IUSS Building Engineering Services Guideline][http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/ .][http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/][[File:Protective_Environment-Positive_pressure.png\|alt=\|none\|thumb\|~~552x552px~~\|Figure 2:Protective environment – positive pressure]]		Additional information regarding engineering services design and planning for airborne precaution rooms can be found in the [http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/ IUSS Building Engineering Services Guideline][http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/ .][http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/][[File:Protective_Environment-Positive_pressure.png\|alt=\|none\|thumb\|468x468px\|Figure 2:Protective environment – positive pressure]]

			A PE room is required for patients who are immunocompromised, but do not initially present with an airborne infectious disease. These rooms require an anteroom to ensure a clean environment in the PE room. Where these are located within open wards,such as high-care units (HCUs) or intensive-care units(ICU), and are held at pressure positive to adjacent rooms, they should include negative pressure anteroom to prevent the potential spread of infection out of the PE room. This is a typical scenario for a burns ward. Where airborne infection risk is suspected in these rooms, staff and visitors entering the PE room should wear respirators prior to entering the anteroom.Additional ventilation measures, such as air that was filtered using high-efficiency particulate abosorption (HEPA), filtered supply air may be required when treating allogeneic patients.[[File:Airborne_infection_protective_isolation.png\|alt=\|none\|thumb\|479x479px\|Figure 3: Airborne infection protective isolation]]Where patients are immunocompromised and initially suspected of presenting with an infectious airborne disease, they should be located in an '''airborne infection protective isolation''' room. These rooms shall be designed to maintain a negative pressure relative to the anteroom and adjacent rooms, with the exception of the en suite bathroom. These rooms demand very low air permeability with high-quality sealing. The Centres for Disease Control (CDC) Guidelines for Environmental Infection Control in Health Care Facilities (2003) recommend an effective leakage area of less than 0.045 m² for the entire room. Placing this in context, the equivalent gap for a single half-leaf door that has been hung relatively well is calculated in the order of 0.04 m².
	~~FIGURE 2: PROTECTIVE ENVIRONMENT – POSITIVE PRESSURE~~

	A PE room is required for patients who are immunocompromised, but do not initially present with an airborne infectious disease. These rooms require an anteroom to ensure a clean environment in the PE room. Where these are located within open wards,such as high-care units (HCUs) or intensive-care units(ICU), and are held at pressure positive to adjacent rooms, they should include negative pressure anteroom to prevent the potential spread of infection out of the PE room. This is a typical scenario for a burns ward. Where airborne infection risk is suspected in these rooms, staff and visitors entering the PE room should wear respirators prior to entering the anteroom.Additional ventilation measures, such as air that was filtered using high-efficiency particulate abosorption (HEPA), filtered supply air may be required when treating allogeneic patients.

	[[File:Airborne_infection_protective_isolation.png\|alt=\|~~frameless~~\|~~485x485px~~]]

	~~FIGURE 3: AIRBORNE INFECTION PROTECTIVE ISOLATION~~

	Where patients are immunocompromised and initially suspected of presenting with an infectious airborne disease, they should be located in an '''airborne infection protective isolation''' room. These rooms shall be designed to maintain a negative pressure relative to the anteroom and adjacent rooms, with the exception of the en suite bathroom. These rooms demand very low air permeability with high-quality sealing. The Centres for Disease Control (CDC) Guidelines for Environmental Infection Control in Health Care Facilities (2003) recommend an effective leakage area of less than 0.045 m² for the entire room. Placing this in context, the equivalent gap for a single half-leaf door that has been hung relatively well is calculated in the order of 0.04 m².

	Respiratory protection needs not be worn in the anteroom in this scenario, as the anteroom is held at a relative pressure positive to the patient room.		Respiratory protection needs not be worn in the anteroom in this scenario, as the anteroom is held at a relative pressure positive to the patient room.
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	**A finish that does not detract or obscure the signs intention		**A finish that does not detract or obscure the signs intention

	[[File:Directional_signage.png\|alt=\|~~frameless~~\|~~361x361px~~]]		[[File:Directional_signage.png\|alt=\|none\|thumb\|Figure 4: Directional signage]]Mapping is an important part of wayfinding system. Maos should be located at strategic points throughout the site and allow visitors to orlantate themselves. The maps should be consistent with the signage and the typology needs to be clear.

	~~FIGURE 4: DIRECTIONAL SIGNAGE~~

	Mapping is an important part of wayfinding system. Maos should be located at strategic points throughout the site and allow visitors to orlantate themselves. The maps should be consistent with the signage and the typology needs to be clear.

	[[File:Photo 1.png\|frameless]]		[[File:Photo 1.png\|frameless]]
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	*If additives are introduced to intravenous fluids in the inpatient unit, it should occur in the clean utility room.		*If additives are introduced to intravenous fluids in the inpatient unit, it should occur in the clean utility room.

	~~<br />~~[[File:Figure_5.png\|alt=\|~~frameless~~\|~~357x357px~~]]		[[File:Figure_5.png\|alt=\|none\|thumb\|321x321px\|Figure 5: Interactive management and control of pharmaceutical substances]]The equipment store is intended for storage of equipment that has to be floor parked or stored on shelves and for equipment that may require the recharging of batteries. The requirements will vary and need to be defined so that appropriate storage space is allocated according to the requirements of the inpatient unit and the needs of the patients and staff.<div style="margin-left:0cm;margin-right:0cm;">

	~~FIGURE 5: INTERACTIVE MANAGEMENT AND CONTROL OF PHARMACEUTICAL SUBSTANCES <br /><div style="margin-left:0cm;margin-right:0cm;">~~The equipment store is intended for storage of equipment that has to be floor parked or stored on shelves and for equipment that may require the recharging of batteries. The requirements will vary and need to be defined so that appropriate storage space is allocated according to the requirements of the inpatient unit and the needs of the patients and staff.

	===Options for dispensing within the inpatient unit===		===Options for dispensing within the inpatient unit===
	Lockable medication trolleys should be stored in the medicine storeroom behind or directly opposite the nurses' station so that the store is in full view of nurses at all times.		Lockable medication trolleys should be stored in the medicine storeroom behind or directly opposite the nurses' station so that the store is in full view of nurses at all times.

VSadiki at 10:57, 22 July 2020

2020-07-22T10:57:15Z

← Older revision		Revision as of 12:57, 22 July 2020
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	All swing doors shall be equipped with door closers to ensure that they remain shut when not in use. Hold-open devices are not recommended for these doors. Sliding doors are also not recommended as these pose difficulties in maintaining an adequate seal.		All swing doors shall be equipped with door closers to ensure that they remain shut when not in use. Hold-open devices are not recommended for these doors. Sliding doors are also not recommended as these pose difficulties in maintaining an adequate seal.

	It is recommended that isolation rooms be provided with outside views where possible, without presenting a biosecurity risk. Privacy blinds should be installed, but these should not present a hygiene risk or hinder the nursing staff view of the patient.</div>[[File:Negative_pressure_isolation.png\|alt=\|none\|thumb\|600x600px\|~~FIGURE~~ 1: ~~NEGATIVE PRESSURE ISOLATION~~]]<div style="margin-left:0cm;margin-right:0cm;">		It is recommended that isolation rooms be provided with outside views where possible, without presenting a biosecurity risk. Privacy blinds should be installed, but these should not present a hygiene risk or hinder the nursing staff view of the patient.</div>[[File:Negative_pressure_isolation.png\|alt=\|none\|thumb\|600x600px\|Figure 1: Negative pressure isolation]]<div style="margin-left:0cm;margin-right:0cm;">

	'''Negative pressure isolation''' is only required for patients presenting with airborne infections, for example, measles, Severe Acute Respiratory Syndrome (SARS), and TB. These infections spread primarily through the respiratory route where the infectious particles have a diameter of less than 5 µm. The unit for measuring ventilation is air changes per hour (ACH). In accordance with the national building regulations, isolation rooms shall be single occupancy with ventilation rates in excess of 12 ACH (including en suite bathrooms and anterooms). Where airborne contamination control in these rooms is achieved through dilution, these rooms shall have near perfect mixing with air change efficiencies approaching 50%. This implies that the ventilation efficiency in the isolation room shall be 50% as efficient as plug flow. Contamination removal effectiveness around the patient can be improved by placing an extraction point near the head of the bed. Airflow patterns within the room shall be developed so that the air shall flow from the passage door and air inlet terminal, across the patient and towards the bathroom and extraction points.		'''Negative pressure isolation''' is only required for patients presenting with airborne infections, for example, measles, Severe Acute Respiratory Syndrome (SARS), and TB. These infections spread primarily through the respiratory route where the infectious particles have a diameter of less than 5 µm. The unit for measuring ventilation is air changes per hour (ACH). In accordance with the national building regulations, isolation rooms shall be single occupancy with ventilation rates in excess of 12 ACH (including en suite bathrooms and anterooms). Where airborne contamination control in these rooms is achieved through dilution, these rooms shall have near perfect mixing with air change efficiencies approaching 50%. This implies that the ventilation efficiency in the isolation room shall be 50% as efficient as plug flow. Contamination removal effectiveness around the patient can be improved by placing an extraction point near the head of the bed. Airflow patterns within the room shall be developed so that the air shall flow from the passage door and air inlet terminal, across the patient and towards the bathroom and extraction points.
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	Supply and extraction systems should be interlocked so that a failure of the exhaust air system shuts the air supply off, preventing the isolation room from going into an overpressure status. It is acceptable to install a balanced-blade pressure stabiliser to ensure that the room does not experience extremes of pressure under supply fan failure, control system failure, or severe transient environmental conditions. However, the inclusion of these devices can increase the design capacity of the system under normal operation.		Supply and extraction systems should be interlocked so that a failure of the exhaust air system shuts the air supply off, preventing the isolation room from going into an overpressure status. It is acceptable to install a balanced-blade pressure stabiliser to ensure that the room does not experience extremes of pressure under supply fan failure, control system failure, or severe transient environmental conditions. However, the inclusion of these devices can increase the design capacity of the system under normal operation.

	Additional information regarding engineering services design and planning for airborne precaution rooms can be found in the [http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/ IUSS Building Engineering Services Guideline][http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/ .][http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/]		Additional information regarding engineering services design and planning for airborne precaution rooms can be found in the [http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/ IUSS Building Engineering Services Guideline][http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/ .][http://www.iussonline.co.za/norms-and-standards/cross-cutting-issues/][[File:Protective_Environment-Positive_pressure.png\|alt=\|none\|thumb\|552x552px\|Figure 2:Protective environment – positive pressure]]

	~~[[File:Protective_Environment-Positive_pressure.png\|alt=\|border\|frameless\|485x485px]]~~

	FIGURE 2: PROTECTIVE ENVIRONMENT – POSITIVE PRESSURE		FIGURE 2: PROTECTIVE ENVIRONMENT – POSITIVE PRESSURE