Hospitals Are Different: What a Healthcare Specification Needs to Cover

Introduction

You don’t go to hospital for a holiday, and documenting one is no holiday either.
The finishes may look familiar: plasterboard, vinyl, doors, ceilings, joinery, paint and glazing. But beneath the surface, the performance requirements are very different.
A product that works perfectly well in a commercial office, hotel or apartment building may be completely inappropriate inside a hospital.

Why?

Because healthcare environments have another layer of requirements driven by clinical operations, infection prevention and control, cleaning regimes, patient safety, specialist equipment and some very specific risks.

Get these wrong, and the consequences can extend well beyond aesthetics or maintenance. They can affect clinical operations, patient and staff safety, infection control and whether the facility can actually operate as intended.

Here are some of the hospital-specific requirements that need to find their way into the project specification.

Infection Prevention and Control

Let’s start with one of the big ones.
Hospitals need to be designed so they can be effectively cleaned, disinfected and maintained.
That sounds simple until you start interrogating every junction, material and fitting.

Consider:

• Are surfaces smooth, durable and readily cleanable?
• Can the finish withstand the nominated hospital-grade cleaning and disinfecting regime?
• Are joints, penetrations and interfaces adequately sealed?
• Are there unnecessary ledges, gaps or recesses where dust and contaminants can accumulate?
• Are wall finishes sufficiently resistant to repeated trolley, bed and equipment impacts?
• Can components be cleaned without degrading coatings, sealants or adhesives?
• Are fixtures and fittings detailed to minimise difficult-to-clean interfaces?

Facility design itself can influence healthcare-associated infection. Australian infection prevention guidance specifically identifies cleanable surface finishes, isolation capability, appropriate ventilation, separation of clean and dirty workflows, hand hygiene facilities and adequate storage as important design considerations.
The specification therefore needs to do more than nominate a vinyl colour.
It needs to define how vinyl, skirting, wall protection, sealant, door frame, joinery and adjoining construction collectively support the infection prevention strategy.

Cleanrooms and Controlled Environments

Then things get more specialised.

Pharmacy aseptic production areas, sterile processing environments and other controlled clinical spaces can have stringent requirements relating to particulate control, air cleanliness, pressure relationships and surface performance.
The architectural specification may need to address:

• Impervious and readily cleanable finishes.
• Flush construction and minimisation of ledges and exposed fixings.
• Sealed wall, floor and ceiling junctions.
• Airtight penetrations through walls and ceilings.
• Compatible sealants.
• Doors and access panels capable of maintaining the required enclosure integrity.
• Coordination of services penetrations.
• Requirements for inspection, testing and commissioning.

The mechanical engineer may design the air pressure and filtration system, but if the walls, doors, ceilings and penetrations leak like a sieve, the mechanical design has an uphill battle.

The specification therefore has an important role in coordinating the physical enclosure with the engineering performance requirements.

Hospital pharmacy guidance, for example, includes specific planning and design requirements for aseptic production suites used for sterile, cytotoxic and biological products.

Pressure Control and Isolation Rooms

Positive pressure. Negative pressure. Neutral pressure. Anterooms. HEPA filtration. Air leakage testing.

Welcome to healthcare.

Negative-pressure isolation rooms are used to help contain airborne infectious material, while positive-pressure environments may be used to protect vulnerable or immunocompromised patients.

Current AusHFG isolation room guidance covers room pressure relationships, air changes, filtration, door arrangements, alarms, monitoring, room air leakage and commissioning.

Again, this isn’t purely a mechanical specification issue.

The architectural specification may need to address:

• Airtight wall and ceiling construction.
• Sealing around doors and frames.
• Sealing of service penetrations.
• Access panels and proprietary systems.
• Junctions between different construction elements.
• Door closers, seals and hardware.
• Testing of enclosure integrity.
• Coordination with pressure monitoring and commissioning.

One poorly detailed penetration can compromise a carefully engineered room.

Mental Health Requirements

Mental health environments introduce a completely different risk profile.
The objective isn’t to turn the hospital into a prison. Modern mental health design aims to provide a therapeutic, recovery-focused environment using the least restrictive solution appropriate to the identified risk.

At the same time, patient safety cannot be compromised.

Depending on the room and risk assessment, specification requirements may include:

• Ligature resistance: Fixtures, hardware and fittings may need to minimise points to which a ligature could be attached. Current AusHFG guidance expects products identified as anti-ligature or ligature-resistant to be specifically designed for that purpose, tested or supported by an established track record and installed correctly.
• Tamper resistance: Fixings, access panels, services, fittings and components may need to prevent unauthorised removal or dismantling.
• Anti-barricade measures: Door and hardware arrangements may need to allow staff access where a patient attempts to barricade themselves within a room.
• Impact resistance: Walls, glazing, doors, joinery and fittings may require increased resistance to deliberate or accidental impact.
• Concealed services and fixings: Items readily dismantled in another building may create a safety risk within a mental health environment.
• Secure construction: Ceilings, access panels, doors, glazing and interfaces may form part of the physical containment strategy.

There isn’t necessarily one product solution that applies across an entire mental health facility.

Risk differs between bedrooms, ensuites, corridors, interview rooms, seclusion rooms, staff areas and public spaces. The specification needs to respond accordingly.

Specialist healthcare laboratories, such as pathology, microbiology and research spaces, can require physical containment classifications including PC2 and PC3.
These environments rely on the building fabric, services and operational controls working together to contain potentially hazardous biological material and maintain the required laboratory environment.

This can affect seemingly ordinary architectural elements:

• Walls and partitions.
• Ceilings.
• Floors and finishes.
• Doors and frames.
• Glazing.
• Access panels.
• Joinery and laboratory fixtures.
• Sealants and junctions.
• Service penetrations.
• Interfaces with ventilation systems.

PC2 generally requires controlled access, cleanable and impervious finishes, sealed junctions and penetrations, appropriate laboratory fixtures and coordinated decontamination and ventilation provisions.

PC3 introduces a much higher level of containment, including sealed construction, controlled entry, pressure differentials, dedicated ventilation, HEPA filtration, sealed penetrations, pressure monitoring and detailed testing and commissioning.

There is little point designing a sophisticated pressure-controlled laboratory if the walls, ceilings, doors and penetrations do not maintain the required containment envelope.
Physical containment needs to be considered as a complete system, with coordination between architecture, mechanical engineering, laboratory planning and specialist consultants from the outset.

Bariatric Requirements

Healthcare facilities also need to accommodate patients across a significantly broader range of physical abilities and body sizes than many other building types.
Bariatric design is therefore not simply about providing a wider doorway.
It can affect:

• Clear door openings.
• Circulation and manoeuvring clearances.
• Sanitary fixtures.
• Grabrails.
• Shower seats.
• Furniture and seating.
• Joinery.
• Bed and equipment movement.
• Wall reinforcement.
• Hardware.
• Hoists and support systems.
• Structural loading requirements.

AusHFG specifically incorporates bariatric patient requirements within inpatient planning and includes dedicated bariatric Standard Components.

The specification needs to nominate appropriate load capacities and product performance where relevant, while coordinating those requirements with the structural design, room layouts and specialist equipment.

Otherwise, that beautifully detailed grabrail may be fixed to nothing more substantial than plasterboard.

Radiation Protection

Medical imaging and radiation oncology introduce another specialist interface.
X-ray, CT, PET, nuclear medicine, fluoroscopy and radiation treatment facilities may require shielding to walls, doors, glazing, ceilings, floors and penetrations.

But this is not an area for guesswork by the architect or specification consultant.

Shielding requirements should be established by the appropriate radiation consultant based on the specific equipment, energy levels, workload, room arrangement and surrounding occupancy.

The architectural specification then needs to translate those requirements into coordinated construction.

That may include:

• Lead sheet or other shielding materials.
• Shielded plasterboard systems.
• Radiation-rated glazing.
• Shielded doors and frames.
• Protected service penetrations.
• Continuity of shielding at junctions.
• Installation workmanship.
• Inspection.
• Verification and certification.

AusHFG guidance for imaging facilities specifically requires radiation shielding to respond to the particular equipment and the radiation consultant’s advice.

A small unprotected penetration through an otherwise compliant shielding system can defeat the purpose of the entire assembly.h an otherwise compliant shielding system can defeat the purpose of the entire assembly.

Health Facility Operational Requirements

Possibly the most important consideration is understanding how the hospital actually operates.

Specifications should respond to the operational requirements developed by the health service, clinical planners and design team.

Ask questions such as:

1. How is the room cleaned?
2. What equipment moves through it?
3. What hits the walls?
4. Which areas are clean and which are dirty?
5. What chemicals are used?
6. Does the room need to remain operational 24/7?
7. Who has access?
8. What needs to be maintained or replaced?
9. Can maintenance staff reach services without entering a clinical environment?
10. What happens during an outbreak?
11. What happens when something fails?

Healthcare specifications need to respond to the reality of operating the facility, not simply how the building looks on opening day.

The Coordination Challenge

And this is where hospital specifications become interesting.

Many requirements don’t sit neatly with one discipline.

Pressure control involves mechanical engineering, but also doors, seals, ceilings and partitions.

Radiation protection involves a radiation consultant, but also wall construction, doors, glazing and penetrations.

Mental health safety involves clinical risk assessments, but also hardware, joinery, sanitaryware, glazing, ceilings and fixtures.

Bariatric requirements involve equipment, architecture, structures and accessibility.
Infection prevention touches almost everything.

The specification becomes one of the mechanisms that connect those requirements.

Conclusion

Hospitals are among the most complicated buildings we specify.
The products themselves aren’t necessarily complicated.
It’s the additional layers of performance that make the difference.
Infection prevention. Cleanability. Pressure control. Ligature resistance. Tamper resistance. Bariatric loads. Physical containment. Radiation shielding. Specialist operational requirements.

And importantly, the interfaces between them.

A good hospital specification doesn’t simply describe the products selected by the architect.

It interrogates how those products need to perform within a clinical environment and coordinates the requirements of the architects, engineers, health planners and specialist consultants into something that can actually be procured and built.
That requires healthcare experience, because sometimes knowing what additional questions to ask is just as important as knowing what clauses to write.

Could your next healthcare project benefit from a dedicated specification consultant with hospital experience?

Earlymark works collaboratively with design teams to develop project-specific architectural specifications and schedules, coordinate specialist requirements and reduce the documentation risk associated with complex healthcare environments.

Reach out to us, and let’s work together to improve the natural and built environment with every project.

www.earlymark.com