Surfaces and Finishes in Private Hospitals and Day Procedure Centres

Page 8 Private Health Services Regulation Unit – Jan 2013 Department of Health

Surfaces and finishes in private hospitals and day procedure centres

Information drawn from the Australasian Health Facility Guidelines – Parts C and D

Introduction – general information

Infection prevention and control is critical to the planning of health care facilities and needs to be incorporated into design plans and specifications.

The nature and type of surfaces and finishes used in health care facilities are critical to the management of infection control risks.

All fixtures, fittings, surfaces and finishes should be designed to allow for easy cleaning and to discourage the accumulation of dust.

Materials used for walls, floors and benches should be smooth, impervious and seamless, especially in treatment areas and where there may be patient contact, blood or body fluid spills. Materials should be resistant to corrosion and be able to withstand cleaning agents[1].

This document draws information from the Australasian Health Facility Guidelines to assist proprietors to make informed decisions when fitting out their facility having regard for the patient cohort, infection control risks and type of health services offered at the private hospital or day procedure centre (fit for purpose).

Ceilings

Ceilings should be easy to clean, maintain and repair. Ensure ceiling types and finishes meet all relevant regulatory requirements, in particular the Building Code of Australia (BCA) criteria for acceptable fire hazard properties.

Finish all exposed ceilings and ceiling structures in areas occupied by patients or staff and in food preparation or food storage areas.

Ceilings in areas of high clinical risk such as operating and delivery rooms, isolation rooms, nurseries and sterile processing rooms should be monolithic from wall-to-wall without fissures, open joints or crevices that may retain or permit passage of dirt particles. Light fittings should be recessed, flush-fitting and sealed to prevent dust ingress.

Acoustic and/or in-lay ceilings should not be used where particulate matter may interfere with hygienic infection control practices.

Floors

When choosing floor finishes the following matters should be considered;

·  Patient and visitor safety – slips, trips and falls.

·  Area function, sustainability and life cycle cost efficiency.

·  Infection and odour control.

·  The needs of special user groups.

·  Acoustic and aesthetic considerations.

·  Staff safety – OHS and manual handling.

Carpet may be used in patient waiting areas, with short dense pile recommended.

Clinical treatment areas and areas of high clinical risk including operating and delivery rooms, oncology treatment areas, isolation rooms and nurseries should not be carpeted. These areas should have slip-resistant (standard or safety) ‘fit for purpose’ vinyl with welded joints and coved skirtings or another appropriate hard floor surface.

Ensure that floor coverings are easy to repair and clean and will not be damaged or corroded by disinfection procedures. In areas subject to frequent wet cleaning, do not use floor materials which may be physically affected by germicidal cleaning agents.

Vinyl floor in patient ensuite

Skirtings

The functional area, rated from very high clinical risk to low/minimal clinical risk can provide the basis for selecting appropriate floor finishes and skirtings.

In all patient care areas, in kitchens, clean and dirty utility rooms, sterilising areas, and other areas subject to frequent wet cleaning, skirtings, floor and wall joins should be made integral with the floor, tightly sealed against the wall and constructed without voids.

Wall finishes should be smooth and easily cleaned and where close to plumbing fixtures, water resistant.

Gaps

Gaps are defined as a space where two materials do not meet leaving a space or opening that can harbour dust, microorganisms, mould or vermin.

In healthcare facilities, gaps between surfaces are not permitted and must be properly sealed. In particular gaps in the following areas are not permitted;

·  Between skirtings and floors.

·  Between utility benches and walls.

·  Between cupboards and floors or wall.

·  Between fixtures attached to floors and walls.

·  Ceiling joins.

Recommended surfaces and finishes by speciality

health service

1.  Operating suite including cardiac catheter laboratory

Refer AHFG pages 751-780

Fit out - surfaces and finishes

Floor finishes – Floor types should be:

·  Impervious to moisture

·  Easily cleaned

·  Stain resistant

·  Suitable for wheeled traffic

·  Comfortable for long periods of standing

In the operating and procedure room the colour should be such that there is sufficient contrast to find small, dropped items.

Non-slip vinyl sheeting with welded joints and coved skirtings is considered appropriate. NOTE: when choosing a colour, take into consideration that some substances heavily stain sheet vinyl.

Carpet may be used in the waiting area; a short dense pile is recommended.

Wall finishes – Ceramic tiles are not recommended due to their potential to compromise infection control. These tiles are also susceptible to damage from trolleys and if individual tiles become cracked or broken they may be difficult to replace.

Wall finishes should be scrubbable and in the immediate vicinity of plumbing fixtures, should be smooth and water-resistant.

Ceiling finishes – should be monolithic from wall to wall without fissures, open joints or crevices that may retain or permit passage of dirt particles.

NOTE: Acoustic and/or inlay ceilings should not be used where particulate matter may interfere with hygienic environmental control such as procedure room ceilings.

Fixtures, fittings and equipment – Bench tops should be of a smooth, impervious finish, resistant to damage and stains. Joins should be avoided as they are difficult to keep clean. A range of products are suitable including; laminates synthetics and stainless steel. NOTE: Stainless steel is preferred in procedural areas and CSSD.

Fit out - patient safety and amenity

Infection control – Due to the invasive procedures undertaken, infection control is a key issue in the operating suite. It is important to keep clean and dirty goods separate as well as installing separate corridor systems for patients.

Refer Standard Components – Room Data Sheets for specific requirements for rooms and facilities in the operating suite.

2.  Day procedure centre – renal dialysis

Refer AHFG pages 898-921

Fit out - surfaces and finishes

Floor finishes – Floor coverings must be easy to clean and resistant to disinfection procedures. In treatment bays, standard, seamless and coved slip-resistant vinyl is required[2]. Treatment areas must not be carpeted.

Fixtures, fittings and equipment – All surfaces and fixtures are to be easily and thoroughly cleaned on a regular and repeated basis.

All cupboards require bulkheads to be fitted to the ceiling to prevent dust collection on top of the cupboard and to reduce the need for high dusting.

Fit out - patient safety and amenity

Acoustics – many functions undertaken in the Renal Dialysis Unit require consideration of acoustic privacy including;

·  Discussions/interviews with people and families

·  Isolation of noisy areas such as waiting rooms from Treatment Areas

·  Staff discussions regarding confidential matters.

Solutions to be considered include;

·  Selection of sound absorbing materials and finishes

·  Use of sound isolating construction

·  Planning to separate quiet areas from noisy areas

·  Changes to operational management. This may include separate areas for patients with special needs.

Infection Control – Placement of hand basins is at a ratio of one per three treatment bays as well as in separate treatment areas, utility areas, toilets and showers.

Walls – wall finishes must be scrubbable and should be smooth and water resistant especially in the immediate vicinity of plumbing fixtures.

Skirtings – wall bases in treatment areas, kitchens, clean and dirty utility rooms and toilets should be made integral to the floor, tightly sealed against the wall and constructed without voids.

Ceilings – all exposed ceilings and ceiling structures must be easy to clean. All areas where dust fallout would present a potential problem must have finished ceilings that cover all conduits, piping, duct work and open construction systems.

Lighting – Natural light contributes to a sense of wellbeing, assists orientation to building locations and improves service outcomes. The use of natural light should be maximised through the Unit. Natural light and a view to pleasant and interesting outdoor areas is of particular importance for people who spend long periods of time sitting in dialysis chairs.

Refer Standard Components – Room Data Sheets for specific requirements for rooms and facilities in Renal Dialysis Units.

3.  Acute services – intensive care (ICU)

Refer AHFG pages 539-559

Fit out - surfaces and finishes

Floor finishes – in most patient care areas sheet vinyl is the most appropriate floor finish because of ease of cleaning. In some areas, carpet reduces noises from trolleys and traffic, but it increases cleaning time and cost.

Wherever there is a change in floor coverings e.g. vinyl to carpet, there should not be a change in floor level.

Wall protection will be required wherever there is potential damage from beds, trolleys etc and for hygienic reasons around hand washing facilities.

Fixtures, fittings and equipment – all work surfaces and benches should be smooth and impervious.

Fit out - patient safety and amenity

Acoustics – signals from patient call systems, alarms from monitoring equipment and telephones add to the sensory load in Critical Care Units.

For these reasons;

·  Floor coverings that absorb sound should be used while taking infection control, maintenance and equipment movement needs into consideration.

·  Walls and ceilings should be constructed of materials with high sound absorption capabilities.

·  Ceiling soffits and baffles help reduce echoed sounds.

·  Doorways should be offset rather than being placed in symmetrically opposed positions, to reduce sound transmission.

·  Counters, partitions, and glass doors are also effective in reducing noise levels.

Infection control – Clinical hand washing facilities should be provided convenient to the staff station and patient bed areas. The ratio of provision should be 1 clinical hand wash basin for every 2 patient beds in open-plan areas and 1 in each patient bedroom or cubicle.

Lighting – The use of natural light should be encouraged through the ICU as it contributes to both patient and staff morale and improves patient outcomes.

Appropriate lighting, both general and task specific, is to be provided in ICU.

Refer Standard Components – Room Data Sheets for specific requirements for rooms and facilities in Intensive Care Units.

4.  Acute services – emergency department

Refer AHFG pages 422-451

Fit out - surfaces and finishes

Floor finishes - The floor finishes in all patient care areas and corridors in the ED should have the following characteristics:

·  Non-slip surface.

·  Impermeable to water and body fluids.

·  Durable.

·  Easy to clean.

·  Acoustic properties that reduce sound transmission.

·  Shock absorbing to optimise staff comfort but facilitate movement of beds.

Generally only offices, training rooms, meeting rooms, and clerical areas should be carpeted.

Wall protection is required due to the large number of users and trolley movements in the ED.

Fit out - patient safety and amenity

Acoustics - Many functions undertaken within an ED require consideration of acoustic privacy including:

·  Discussions / interviews with clients.

·  Exclusion of disturbing or distracting noises during client consultations.

·  Activities including noise from other Treatment Areas.

·  Isolation of noisy areas such as public waiting.

·  Staff discussions regarding patient information.

Solutions to be considered include:

·  Selection of sound absorbing materials and finishes;

·  Use of sound isolating construction;

·  Planning by separating quiet areas from noisy areas;

·  Changes to operational management. Consider implications for safety when designing for patients who may be behaviourally disturbed or cognitively impaired; this includes safety implications for patients, visitors and staff.

Infection control – Clinical hand basins should be available within each treatment area and should be accessible without entering any other clinical area.

As the diagnosis or infectious status of patients may not be known on admission, standard precautions must be used at all times. The design and layout should allow for the movement of patients to an isolation room within the Unit due to suspected or known infectious disease.

Lighting - Natural lighting contributes to a sense of wellbeing, assists orientation of building users and improves service outcomes. The use of natural light should be maximised throughout the ED.

The lighting design needs to provide for both patient and staff comfort and function. There are different considerations for different types of patient care and staff areas.

Functional requirements for lighting of clinical treatment spaces include the ability to dim for comfort, the ability to focus strong light for bedside procedures, and there should be no colour distortion to ensure accurate assessment of skin tone.

Refer Standard Components – Room Data Sheets for specific requirements for rooms and facilities in the Emergency Department.

5.  Acute services – obstetrics

Refer AHFG Maternity Unit pages 727-750

Fit out - surfaces and finishes

Fixtures, fittings and equipment – Provide leaning/squatting rails for active birth in birthing rooms.

Infection control – There should be a Type A clinical hand basin in each birthing room.

A clinical hand basin should be provided in each bedroom and outside each pair of designated isolation rooms if provided.

There should be at least 1 hand basin per 6 cots in the nursery.

Fit out - patient safety and amenity

Acoustics – Acoustic treatment is essential in birthing rooms.

One of the prime considerations in the nursery is the amount of noise created by babies crying, monitors, suction pumps, ventilators etc. Methods of sound dampening should be carefully considered, but should not interfere with observation and ease of access between the nursery and staff/support areas.

Lighting – Colour corrected dimmable lighting is essential in all patient areas where high dependency care is provided including; birthing/assessment rooms and birthing room ensuites and bathrooms, all nurseries and baby bathing/examination and resuscitation areas.

Natural light is essential in all bedrooms, birthing rooms and the nursery.