Specialist diagnostic and treatment services
These services, and consequently their relative rooms and systems, each for their own individual reasons, require professional input regarding the flow, exchange and recirculation of air. The activities performed here place workers and patients in direct contact with various types of potential contaminants (chemicals, bacteria, radioactive agents).
Nuclear medicine
The diagnostics department must have more than one separate entrance, one for patients (outpatients and inpatients) and one for staff and goods.
Special attention must be paid to systems along routes taken by staff and goods and at entrances to avoid contamination: it is essential that appropriate access filters (airlocks) and decontamination spaces in case of “incidents” are provided.
Raccomanded
- A “cold” area comprising waiting room, reception, possibly consultation rooms and support services.
- A “hot” area comprising waiting room with toilets (waste from which is collected in decay tanks), staff workspaces and laboratories, properly filtered administration rooms with equipment that is controlled and isolated from the rest of the building. Command and control areas will be outside of the diagnostic rooms.
- Dual ventilation systems and lead-lined walls are required.
- The rooms must be kept constantly under negative pressure conditions.
- Exhaust air requires absolute and activated carbon filtration.
- Canister and damper-type safety systems and containers required.
Minimum requirements
| AMBIENT PRESSURE COMPARED TO NEARBY/EXTERNAL ROOMS | FRESH AIR RENEWAL | ISO ENVIRONMENTAL CLASSIFICATION 14644-1 | ROOM RECIRCULATION | RELATIVE HUMIDITY | INTERNAL TEMPERATURE | TERMINAL FILTRATION | EXHAUST FILTRATION | TECHNICAL CAVITY WALLS INSIDE DEPRESSURISED ENVIRONMENTS | AIR FLOW | |
| Nuclear medicine (administration) | N 15-20 Pa | ≥ 10 | ISO 7 (AT REST) | Forbidden | 40-55% | 20°C ± 2°C WINTER 24°C ± 2°C SUMMER |
E10 | H13 + Activated carbon | — | T/U |
| Antiblastic Chemotherapy Handling Units | N 15-20 Pa | ≥ 10 | ISO 5 (OPERATIONAL) | Forbidden | 40-55% | 20°C ± 2°C WINTER 24°C ± 2°C SUMMER |
H14 under unidirectional flow ≥ E12 other zones |
H13 + Activated carbon | — | T/U |
Diagnostic imaging
This sector encompasses all diagnostic functions falling under traditional radiology: Radiology, Senology, CT, Magnetic Resonance, BMD, Ultrasound, etc., in addition to nuclear medicine and endoscopy, which are handled separately because of their specific spatial and functional characteristics.
Recommended
- The department will have at least two patient entrances, one for outpatients and the other for inpatients (long-stay and day patients, and patients sent from A&E). A third, secondary access, will be reserved for staff and goods. The reception and waiting areas will be arranged accordingly.
- The main problem here, is the radioactive particles released by the use of radiological equipment. The circulation of air in the premises must perform two roles: containing contamination, ensured by the absolute filter, and the proper exhaust of air.
- The air must always flow from top (this can also be turbulent) to bottom.
- The air return grilles should always be positioned low down, since pollutants tend to fall to the ground as they are heavier than air.
- The specific environmental circumstances and conditions require:
- Dual ventilation systems and lead-lined walls
- Exhaust with carbon filters
- Canister and damper systems
Minimum requirements
| AMBIENT PRESSURE COMPARED TO NEARBY/EXTERNAL ROOMS | FRESH AIR RENEWAL | ISO ENVIRONMENTAL CLASSIFICATION 14644-1 | ROOM RECIRCULATION | RELATIVE HUMIDITY | INTERNAL TEMPERATURE | TERMINAL FILTRATION | EXHAUST FILTRATION | TECHNICAL CAVITY WALLS INSIDE DEPRESSURISED ENVIRONMENTS | AIR FLOW | |
| Diagnostic Radiology | P 15-20 Pa | ≥ 6 | ISO 7 (AT REST) | — | 40-55% | 24°C ± 2°C | E10 | Not necessary | YES | T |
| Magnetic Resonance | P 20 Pa | ≥ 10 | ISO 7 (AT REST) | — | 40-55% | 24°C ± 2°C | E10 | Not necessary | YES | T |
Radiotherapy
The radiotherapy department performs diagnostic, treatment and follow-up activities.
Recommended
- The areas should be clearly differentiated:
- a) the diagnostic area, composed primarily of outpatient rooms for diagnostic and follow-up appointments;
- b) a treatment area with treatment and pre-treatment diagnostic bunkers (CT simulators). Each area will have its own waiting area.
- There are two main entrances: one for outpatients and another for inpatients; a further entrance is required for staff and goods (possibly separate).
- The main problem here, is the radioactive particles released by the use of radiological equipment. The circulation of air in the premises must perform two roles: containing contamination, ensured by the absolute filter, and the proper exhaust of air.
- Rooms must be depressurised.
- Dual ventilation systems and lead-lined walls.
- Exhaust air requires absolute and activated carbon filtration.
- Canister and damper systems.
Minimum requirements
| AMBIENT PRESSURE COMPARED TO NEARBY/EXTERNAL ROOMS | FRESH AIR RENEWAL | ISO ENVIRONMENTAL CLASSIFICATION 14644-1 | ROOM RECIRCULATION | RELATIVE HUMIDITY | INTERNAL TEMPERATURE | TERMINAL FILTRATION | EXHAUST FILTRATION | TECHNICAL CAVITY WALLS INSIDE DEPRESSURISED ENVIRONMENTS | AIR FLOW | |
| Nuclear medicine (administration) | N 15-20 Pa | ≥ 10 | ISO 7 (AT REST) | Forbidden | 40-55% | 20°C ± 2°C WINTER 24°C ± 2°C SUMMER |
E10 | H13 + Activated carbon | — | T/U |
Pre-admission
The pre-admissions department should be located near to the main lobby, and be directly accessible from the public area. It is used for performing a series of preparatory tests and procedures prior to surgery, for inpatients and outpatients (pre-hospitalisation).
Recommended
- These are high footfall areas.
- High performance in terms of comfort and aesthetics take precedence over the air quality performance.
Endoscopy
The endoscopy department will have two patient entrances: one for outpatients and the other for inpatients (long-stay and day patients, and patients sent from A&E). There will also be another entrance for staff and goods.
Recommended solutions
- Diagnostic rooms will be linked together and served by a separate corridor that is accessible by the necessary support areas (reporting areas, endoscope cleaning and equipment disinfecting areas, storerooms, etc.). When required, after they have undergone the examination, patients may be transferred to a “protected observation area” for post-examination checks, rest and recovery.
- Endoscopy facilities use equipment that displays the inside of the body’s cavities on a monitor. These departments can perform: gastroscopies, oesophagoscopies, cystoscopies, ureteroscopies, colonoscopies, rectoscopies.
- For endoscopies that require surgical intervention, such as: nephroscopies, ureteroscopies, arthroscopies and abdominal endoscopies, reference must be made to UNI standard 11425.
- With bronchoscopies there is the risk of patients emitting contaminated aerosols into the air, which workers and the surrounding environment must be protected from.
Minimum requirements
| AMBIENT PRESSURE COMPARED TO NEARBY/EXTERNAL ROOMS | FRESH AIR RENEWAL | ISO ENVIRONMENTAL CLASSIFICATION 14644-1 | ROOM RECIRCULATION | RELATIVE HUMIDITY | INTERNAL TEMPERATURE | TERMINAL FILTRATION | EXHAUST FILTRATION | TECHNICAL CAVITY WALLS INSIDE DEPRESSURISED ENVIRONMENTS | AIR FLOW | |
| Outpatient endoscopy – diagnostic endoscopy | N 15-20 Pa | 45 | ISO 7 (OPERATIONAL) | Forbidden | 40-55% | 20°C WINTER 24°C SUMMER |
Not necessary | H13 | — | T |
| Bronchoscopy | N 20 Pa | ≥ 45 | ISO 7 (OPERATIONAL) | Necessary | 40-55% | 20°C WINTER 24°C SUMMER |
Not necessary | H13 | — | T |
Blood test centre
The blood test centre is located in a connected area near to the entrance, directly accessible from outside. It is directly connected with the laboratories so samples can be sent there.
Recommended
- The blood test centre will essentially have one entrance for patients and one for staff, goods and samples/test-tubes. Preferably the blood test centre entrance and exit will be separate.
- It should be noted that these areas get incredibly busy, very quickly, during peak times. This requires high air exchange levels. During other times of the day this can be kept to a minimum.
Blood transfusion centre
Blood transfusion centres include the donation area and the connected laboratories/blood banks (test areas, registration, handling, reprocessing and storage of blood and blood products).Preferably, it will be located near to the hospital’s main entrance. This department requires a post-donation canteen area.
From an operational point of view, blood donor centres have several different types of rooms: laboratories, waiting rooms, blood banks. Here are the specific details for each type:
Minimum requirement
| AMBIENT PRESSURE COMPARED TO NEARBY/EXTERNAL ROOMS | FRESH AIR RENEWAL | ISO ENVIRONMENTAL CLASSIFICATION 14644-1 | ROOM RECIRCULATION | RELATIVE HUMIDITY | INTERNAL TEMPERATURE | TERMINAL FILTRATION | EXHAUST FILTRATION | TECHNICAL CAVITY WALLS INSIDE DEPRESSURISED ENVIRONMENTS | AIR FLOW | |
| Haemodynamics | P 15-20 Pa | ≥ 15 | ISO 5 (AT REST) | Necessary | See UNI 11425 | See UNI 11425 | SI VEDA UNI 11425 | Not necessary | YES | U |
Rehabilitation
The rehabilitation and physiotherapy department is used for pre-surgery preparation and post-acute rehabilitation for inpatients and outpatients, pre and post-admissions, and those suffering from disabilities caused by orthopaedic, neurological, pneumological, urogynaecological, cardiological and gastroenterological diseases.
Recommended
- It must have two fully-equipped areas, one for group activities (static and dynamic gyms) and another for individual therapies (cubicles for massage therapy, physical and instrumental therapy and joint manipulation), as well as an outpatient clinic.
- The department will have two patient entrances, one for outpatients and one for inpatients: there is a separate waiting area, reception and wheelchair storage facilities at each entrance.
- Patients will be escorted to the individual therapy areas or, via the changing rooms/filter, to the gym.
- There will be another entrance reserved for staff and goods.
- Similar to the gym area with T 22° Winter; T 26° Summer.
Outpatient clinics
Outpatient clinics provide sophisticated and specialist diagnostic, therapeutic and rehabilitative services related to the various medical and surgical disciplines, that do not require hospital admission.
Recommended
- Since they are designed for external patients, outpatient clinics are located in an area directly accessible from outside, where the patient is registered and directed to the waiting area that corresponds with the outpatient clinic(s) they will have their visit/procedure in. Outpatient clinics can also be common-use, that is, they can be used by different specialisms that do not require any particular equipment or instrumentation.
- Outpatient departments have large dedicated waiting and reception areas next to the entrances, further waiting areas for nursing services and also clinics shared with inpatients.
- Since they involve offices with a high turnover of patients, but where a single doctor or other health workers spend a large part of their time, the ambient air quality must meet two simultaneous requirements: the well-being of workers (to combat “sick building syndrome”) and the minimum but appropriate level of air exchange in between patients to avoid air contamination.
Clinical analysis laboratories
This includes clinical chemistry, haematology, microbiology, histology and cytology, and all other methods of analysing biological samples for routine, advanced or experimental use or for research purposes.
They may also contain specialist areas: level two labs, which have more stringent protective and isolation requirements.
Recommended
- Contamination-controlled laboratories must be clean-rooms fitted with negative air pressure absolute filtering systems and equipped with Biohazard hoods.
- The choice of exhaust diffuser is very important so as not to disturb the working of the hood, just as the filtration of both the ingoing air (H14 filter) and the return air is essential for confining high-risk premises.
- Laminar flow cabinets (sealed hood with sterilised airflow and space to pass the hands through) will be installed in the contamination-controlled laboratory.
Anatomical pathology laboratories
Anatomical pathology is a medical speciality that is concerned with studying disease through the macroscopic examination of tissues and cells.
Recommended
- These labs are functionally connected directly to operating theatres and functionally linked to mortuary services. Histological samples will be sent here directly from outpatients, endoscopies, operating theatres, mortuary services, etc.
- They usually consist of a single large space for lab work as well as archives, medical research posts and support services, etc.
- They feature negative pressure Biohazard hoods.
- The choice of exhaust diffuser is important so as to not disturb the working of the hood.
- Filtration of the air supply and return is essential for confining high-risk premises.
Inpatient wards
SagiCofim views hospitals as “controlled contaminated buildings” and has worked to accommodate the needs of the varied environments of the “hospital world” for many years, from critical and high-risk units to more standard, communal areas.
SagiCofim views hospitals as “controlled contaminated buildings” and has worked to accommodate the needs of the varied environments of the “hospital world” for many years, from critical and high-risk units to more standard, communal areas.
Choosing a specialist, competent partner to take on this role is essential from the outset. Even from the early stages of designing the buildings and different zones, the client and the project manager must work together to define their objectives and to make the best technical choices in order to achieve them, ensuring air quality – making it a close ally rather than one’s worst enemy – good isolation of the different rooms, maintenance of structural requirements and a proper analysis of the installations’ life cycle.
Intensive care units
Intensive care units provide critical patients with intensive care and treatment to support their vital functions, requiring the constant monitoring and immediate intervention of staff following recent major surgery or critical cardiological and respiratory conditions. The same requirements also apply to special care units for comatose patients.
Intensive care units have their own dedicated areas and are supported by specialist teams and equipment for monitoring, treating and supporting the normal bodily functions of patients in a critical condition.
Recommended
- Facilitated connection to A&E (via dedicated bed lifts), operating theatres, interventional radiology and diagnostic departments.
- There should be 3 separate entrances, all three fitted with filters: one for patients, one for staff and goods, and one for relatives.
- Intensive care units include:
- A secure area, comprising intensive care pods and monitoring and work-stations for medical and nursing staff.
- A secondary area, comprising all the supporting sanitary facilities for unit staff, including staff changing rooms, duty doctor and rest room, storerooms and the head-nurse’s office, which should coincide with the filter at the patient entrance, for checks and registration purposes.
- There is a third area for relatives and visitors, which will have a waiting area equipped with booths with window and intercom system for speaking to and seeing patients directly, to enable improved interactions between patients and visitors. There will be at least one room for doctor consultations.
Minimum requirements
| AMBIENT PRESSURE COMPARED TO NEARBY/EXTERNAL ROOMS | FRESH AIR RENEWAL | ISO ENVIRONMENTAL CLASSIFICATION 14644-1 | ROOM RECIRCULATION | RELATIVE HUMIDITY | INTERNAL TEMPERATURE | TERMINAL FILTRATION | EXHAUST FILTRATION | TECHNICAL CAVITY WALLS INSIDE DEPRESSURISED ENVIRONMENTS | AIR FLOW | |
| Intensive Care – Resuscitation – Coma Unit | P 15-20 Pa | ≥ 10 | ISO 6 (AT REST) | Recommended | 40-55% | 24°C WINTER/SUMMER | H13 | Not necessary | YES | U |
| NICU (Neonatal Intensive Care Unit) | P 15-20 Pa | ≥ 10 | ISO 6 (AT REST) | — | 22°C WINTER 26°C SUMMER |
H13 | Not necessary | YES | T/U |
Standard wards
The optimum layout for standard wards is based on individual cubicles or rooms with space for attendants, equipped with all necessary amenities, and which can also be used as double rooms.
Every inpatient ward will have its own personnel support services.
Minimum requirements
| AMBIENT PRESSURE COMPARED TO NEARBY/EXTERNAL ROOMS | FRESH AIR RENEWAL | ISO ENVIRONMENTAL CLASSIFICATION 14644-1 | ROOM RECIRCULATION | RELATIVE HUMIDITY | INTERNAL TEMPERATURE | TERMINAL FILTRATION | EXHAUST FILTRATION | TECHNICAL CAVITY WALLS INSIDE DEPRESSURISED ENVIRONMENTS | AIR FLOW | |
| Inpatient Wards | P 15-20 Pa | ≥ 30 | ISO 8 (AT REST) | Not necessary, forbidden in centralised systems. | 40-55% | 22°C ± 2°C WINTER 26°C ± 2°C SUMMER |
Not necessary | Not necessary | YES | T |
Birthing unit
A proper “birthing culture” understands that childbirth is an intimate family moment, underpinned by the safety offered by a hospital.
Birthing units are made up of a combination of the labour ward, maternity ward and crèche. There is one entrance for patients and visitors that is separate from the route taken by other hospital patients and visitors; the initial waiting area leads through to the visitors-reception area, the delivery unit – through a filter – as well as the maternity ward and crèche.
Birthing unit
The birthing unit is for neonatal care and admissions which must maintain a micro-climate and air quality conditions in line with the specific type of hospitalisation required.
Recommended
- Women in labour will enter the birthing unit once they have received medical assessment confirming that they are in active labour.
- The relatives’ waiting area is outside this department.
- Passing through a filtered area, the mother-to-be and one birth-partner will be taken to the labour and delivery room, where she will labour and deliver her baby.
- The room has a connected neonatal bassinet and dedicated toilet facility.
- If the birthing unit does not have its own operating theatre, it will be located near to the theatre unit..
- After the birth, the new mother will be transferred to a postnatal observation area and then to the maternity ward.
- The newborn will be taken to the crèche:
- only the newborn’s parents may enter the crèche, under the supervision of the nursing staff.
- inside, there will be a room where mothers can learn how to breastfeed, bath their baby and care for the umbilical cord.
- The crèche staff are responsible for caring for, managing, feeding and transporting the newborns.
- The neonatal room will have a viewing pane so visitors may view the newborns.
- The maternity ward is made up of individual rooms, arranged with space for a companion if required.
- Rooms must be particularly well thought-out to allow forrooming-in of the baby (area with facilities for the newborn inside the patient’s room) or simply to leave enough room to have the crib in the room.
Minimum requirements
| AMBIENT PRESSURE COMPARED TO NEARBY/EXTERNAL ROOMS | FRESH AIR RENEWAL | ISO ENVIRONMENTAL CLASSIFICATION 14644-1 | ROOM RECIRCULATION | RELATIVE HUMIDITY | INTERNAL TEMPERATURE | TERMINAL FILTRATION | EXHAUST FILTRATION | TECHNICAL CAVITY WALLS INSIDE DEPRESSURISED ENVIRONMENTS | AIR FLOW | |
| Neonatal Unit | P 15-20 Pa | ≥ 6 | ISO 6 (AT REST) | — | 40-55% | 22°C WINTER 26°C SUMMER |
E10 | Not necessary | YES | T |
Delivery room / caesarean surgery
These are contamination-controlled environments for assisted deliveries and/or deliveries by caesarean section.
Recommended
- According to Standard UNI 11425 (Operating rooms).
- Equipped with a neonatal island inside or immediately next to the room as well as emergency neonatal intervention systems.
- ISPESL delivery unit guidelines – July 2007.
Labour / delivery room
Spaces for labouring and possibly for natural deliveries.
Recommended
- Located in the immediate vicinity of an assisted delivery room or, failing that, an operating theatre.
- There will be a neonatal island inside or immediately next to the room.
Accident and emergency
Accident and Emergency is a hospital department specifically for emergencies and with room for brief periods of observation. It is here that all accidents and emergencies are first treated (trauma, heart attacks, etc.) and are therefore attended on an “emergency admission” basis.
Minor injuries unit / Triage / A&E
The role of the minor injuries unit has been absorbed into the wider Accident and Emergency (A&E) Department, although some smaller hospitals still have minor injuries units that do not have the full range of assistance provided by a full A&E department but that are able to provide emergency care.
Triage must be organised so that incoming cases can be immediately sorted based on the accident or emergency, allocating an order of priority based on the seriousness of the case. Corridors that connect directly and easily and facilitate the transportation of patients to intensive care, operating blocks and other diagnostic departments are essential.
Recommended
- Corridors that connect directly and easily and facilitate the transportation of patients to intensive care, operating blocks and other diagnostic departments.
- MIU has at least one emergency room, including a red room for more serious cases, consultation rooms, brief observation rooms (reception ward), waiting rooms and reception desks.
- A&E has areas for stabilising patients and emergency treatment, cubicles with technical treatment beds, an observation area for briefly observing patients, and its own admissions ward (extended observation – no more than 48 hours), a walk-in clinic and diagnostic departments (radiology, etc.), plaster room, and support services.
- The vehicle entrance to A&E has an outdoor heated chamber.
Minimum requirements
| AMBIENT PRESSURE COMPARED TO NEARBY/EXTERNAL ROOMS | FRESH AIR RENEWAL | ISO ENVIRONMENTAL CLASSIFICATION 14644-1 | ROOM RECIRCULATION | RELATIVE HUMIDITY | INTERNAL TEMPERATURE | TERMINAL FILTRATION | EXHAUST FILTRATION | TECHNICAL CAVITY WALLS INSIDE DEPRESSURISED ENVIRONMENTS | AIR FLOW | |
| Minor Injuries Unit / Triage / A&E | N 15-20 Pa (Triage) |
≥ 6 ≥ 10 in triage |
UNCLASSIFIED | Forbidden | 40-55% | 22°C ± 2°C WINTER 26°C ± 2°C SUMMER |
Not necessary | Not necessary | — | T |
| Emergency Operating Room | P | ≥ 15 | ISO 5 (OPERATIONAL) | Necessary | See UNI 11425 |
See UNI 11425 |
See UNI 11425 |
Not necessary | YES | U |
