1 The Physical Environment In Healthcare Facilities April 10, 2018 York Chan, CHFM, CHC, SASHE
2 YORK CHAN, CHFM, CHSP, SASHE Vice President, Facility Services Board of Directors 2008-2012 Faculty 2013 - Current Environment of Care Advisory Board 2005-2012 Faculty 2005-2016 Editorial Advisory Board 2005-2012 Board of Directors 2006 2014 City of Chicago Solar Advisory Board 2012-2015
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4 AGENDA Hospital Acquired Infections Regulatory Environment CMS Code Adoption Changes NFPA 101-2012; NFPA 99-2012 ASHRAE 170 ASHRAE 188 Ventilation in the Healthcare Environment Impact on Clinical Outcomes Patient Experience (Satisfaction) Trends in Healthcare Facilities Design
5 HOSPITAL ACQUIRED INFECTIONS Every year, 1.7 Million people contract Hospital Acquired Infections* (HAI s) 74,000 People died a year from HAI s 2014 data* Doing better - 99,000 deaths in 2010* What is at stake? Patients that acquire Hospital Acquire Infections stay an extra 6.5 days An additional $35 Billion in healthcare costs Five times more likely to be readmitted with complications Twice as likely to DIE In contrast, less than ONE patient died a year in American hospital fires We need to put the same focus on infection prevention as we have in fire prevention * Center for Disease Control
HOSPITAL ACQUIRED INFECTIONS Number of deaths equivalent of two 747 s crashing every week! The aviation industry doesn t tolerate it! Why should healthcare? 6
7 The Physical Environment and HAI s Air pressure relationships Air shall always migrates from clean to less clean Surgery (positive) Protective Environment (positive) Critical and Intensive Care (positive) Airborne Infectious Isolation (negative) Soiled Utility (negative) Patient Rooms (no recommendation)
8 The Physical Environment and HAI s Temperature/Humidity Parameters Patient Room Temperatures directly impact patient satisfaction Impacts patient satisfaction which affects reimbursements Operating Rooms Peri-surgical patients body temperatures have an impact on surgical site infection rates
9 The Physical Environment and HAI s Filtration
10 The Physical Environment and HAI s Filtration Requirements
11 ASPARGILLUS Occurs in everyday environment such as soil, dust Innocuous to healthy human beings Breeds (multiplies) in decaying cellulose Deadly to immuno-compromised patients Organ transplant patients Stem cell transplant patients Bone marrow transplant patients Cancer patients undergoing chemotherapy Burn victims
12 LEGIONELLA ASHRAE 188 Occurs in natural everyday settings Soil Aquatic environments Symptoms Pontiac Fever Pneumonia Water is a natural reservoir 40% to 80% fatality in hospitals Immunocompromised patients
13 LEGIONELLA ASHRAE 188 ASHRAE 188 Guidelines Published in 2016 Adopted as code only in the State of New York Site specific risks assessments Identify potential high risks areas/systems Site specific management plans Monthly testing at each site being Establish remediation procedures
14 Sources of Legionella in Hospitals Cooling Towers Building Potable Water Systems Respiratory Therapy Equipment Hot Tubs Cooling Coil Drain Pans Showers Humidifiers and Nebulizers
Passive Dead Leg A section of pipework through which water cannot be drawn off or flow. Pipe not cut back to a main. These can give rise to bacterial growth Defined as pipe lengths greater than two times the pipe diameter terminating at a capped, closed valve or fitting
MOST COMMON DEAD LEG 16
17 CMS Adoption of 2012 Editions of NFPA 99 and NFPA 101 Effective Date July 5, 2016 NFPA 99 2012 now references ASHRAE 170
18 AHJ s in Life Safety & Environment of Care All healthcare organizations that receive government funding from the Medicare and Medicaid Programs must meet CMS s (Center for Medicare and Medicaid Services) Conditions of Participation Rules (COP s) COP s for facilities revolves around NFPA 101 and NFPA 99 The Joint Commission, DNV and HFAP have Deemed status to accredit hospitals in accordance with the COP s Illinois Department of Public Health (IDPH) also acts as a validation agent for CMS but also surveys for Illinois Hospital Licensure.
HOSPITAL VALUE BASED PURCHASING PROGRAM Medicare and Medicaid reimbursements tied to: Safety Clinical outcomes Efficiency and Cost Reduction The Patient Experience (Patient Satisfaction) Quietness and cleanliness focused Patient room temperatures 19
#3 EC.02.05.01 73% EP 15: Appropriate ventilation in critical care areas: Negative or positive pressures in relationship to adjacent areas Correct number of air changes per hour Filtration Temperature and Humidity Ongoing process for monitoring
21 Comingling of Essential Electrical System Top IDPH/CMS Finding Essential Electrical Circuits Equipment Critical Life Safety Non-Essential Circuits Normal Cannot share raceway or conduit Costs hospital millions to correct
22 NFPA 99-2012 Highlights 9.3.1 - Heating, cooling, ventilating, and process systems serving spaces or providing healthcare functions shall be provided in accordance with ASHRAE 170. 9.3.2 Energy Conservation Shall comply with ASHRAE 90.1 (Energy Standards for Buildings) or another locally adopted energy code. 9.3.3.1 - Heating, cooling, ventilating, and process systems serving spaces or providing healthcare functions shall be commissioned in accordance with ASHRAE 90.1. (ASHRAE Guideline 1.1 or any publicly reviewed document acceptable to the authority having jurisdiction).
23 COMMISSIONING NFPA 99-2012 9.3.3.1 Heating, cooling, ventilating and process systems serving spaces or providing health care functions shall be commissioned in accordance with ASHRAE 90.1
24 Renovation(s) Involving Existing HVAC Systems 2014 FGI Guidelines (formerly AIA Guidelines) If system modifications affect greater than 10 percent of the system capacity, designers shall utilize pre-renovation water/air flow rate measurements in the affected zones to verify that sufficient capacity is available and that renovations have not adversely affected flow rates in non-renovated areas. Adopted in 40 states Illinois is NOT one of them Should be Best Practice
25 Trends In Health Care Facility Design and Construction Moving from In-Patient to Out-Patient Facilities Fewer hospitals being built Modular Construction Mechanical Racks Prefabricated Operating Room Ceiling Systems Bathrooms, Exam Rooms, Patient Rooms Integrated Project Delivery (IPD) Single Contract Better Collaboration Commissioning and Retro-Commissioning (HFCx)
26 Trends In Health Care Facility MEP Systems BIM Life Cycle Management Systems Integration Smart Rooms HVAC controls tied to patient scheduling Modular Construction Energy Management Analytics USP 800 (United States Pharmacopeial) Protection of pharmacists from Hazardous Drugs (HD s) Published but not yet adopted by any AHJ Anticipating this Fall
27 Summary MEP systems in hospitals are unique Installation and testing have strict code requirements Installation process is critical (shutdowns, connections to existing systems, infection control) Communications and coordination are essential Impact on patient satisfaction Safety to the patient is number 1 priority!
York Chan, CHC, CHFM, SASHE york.chan@advocatehealth.com 630.929.5565 28