Medical Construction & Design

JUL-AUG 2015

Medical Construction & Design (MCD) is the industry's leading source for news and information and reaches all disciplines involved in the healthcare construction and design process.

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applicable codes and stan- dards, and weeding through the myriad requirements can be challenging for design professionals. But it is important to know and understand what the most stringent requirements are in order to be in compliance. The goal of The Joint Commission's standards is to promote a safe, functional and supportive environ- ment within the healthcare organization so quality and safety are preserved. In order to be accredited by The Joint Commission, healthcare organizations must meet these standards. The Environment of Care standards chapter in the ac- creditation manual contains references to the design-re- lated standards and is made up of three basic elements: > The building or space, in- cluding how it is arranged and special features that protect individuals served, visitors and staf > Equipment used to sup- port care, treatment or services, or to safely oper- ate the building or space > People, including those who work within the organization, individuals served and anyone else who enters the environ- ment, all of whom have a role in reducing risks The Environment of Care standards chapter stresses the importance of manag- ing risks in the environment of care, which are dif erent from the risks associated with the provision of care, treatment and services. Any healthcare organiza- tion, regardless of its size or location, faces risks in the environment, including those associated with safety and security, fi re, hazard- ous materials and waste, medical equipment and utility systems. When staf is educated about the elements of a safe environment, they are more likely to follow processes for identifying, reporting and taking action on environmental risks. The standards in this chapter apply to buildings in which care, treatment or services are provided. This is where the appropriate application of other external guide- lines also comes into play. When planning for new, altered or renovated space, Joint Commission- accredited organizations are required to follow the design criteria of either the state where the organization is located or the Guidelines for Design and Construction of Health Care Facilities, 2010 edition, administered by the Facility Guidelines Institute and published by the American Society for Healthcare Engineering. The Joint Commission also adheres to the 2000 edi- tion of the National Fire Protection Association's NFPA 101: Life Safety Code. If the rules, regulations and guidelines of the state or the FGI guidelines do not meet specifi c design needs for the facility, then other reputable standards and guidelines that provide equivalent design criteria should be followed. The Joint Commission ad- opted the 2010 edition of the FGI guidelines, ef ective Jan. 1, 2011. This means any space that is new, altered or reno- vated after this date must meet the 2010 guidelines. The Joint Commission's Environment of Care stan- dards also include require- ments for managing the environment during demo- lition, renovation or new construction to reduce risk to those in the organization. Risk mitigation must address safeguards for employees, visitors and patients. Some examples of risk mitigation areas to pay close attention to include air quality requirements, infection control, utility requirements, noise, vibra- tion and other hazards that af ect care, treatment and services such as an interim life safety measures assess- ment if features of life safety are af ected. It is important to note that issues identi- fi ed in the assessment must be proactively addressed in order to adequately mini- mize any associated risk. Common noncompliance items The Joint Commission often sees noncompliance with these requirements due to improper application of state rules and regulations and/or the FGI guidelines for construction and renovation projects, or failure to manage the risks associated with demolition, construction or renovation activity as determined by the organization's policies. For example, a hospital may have decided to create a new gastrointestinal endoscopy unit but the cleaning and decontamination of the endoscopy instruments is being conducted in the same room. The FGI guidelines call for dedicated rooms where each activity is conducted separately. Because this was a new project, the FGI guidelines should have been met. Another Joint Commission design-related standard addresses managing risks associated with utility systems. When designing a facility, the utility systems must be designed and installed to meet patient care and operational needs. For example, if an organization's renovation included adding services that added to its emergency power needs, then the increased capacity must be addressed. While the facility may have originally been designed with one automatic transfer switch, as allowed by NFPA 99-1999, 3-4.2.2.1, the current needs exceed the limits of the original design and an upgrade would be required. This situation typically would apply to a small hospital and the oversight can have a signifi cant fi nancial impact if corrections are needed. It is important to note that The Joint Commission's standards vary by health- care setting. The Joint Commission's Department of Engineering provides guid- ance by phone and email and can verify what the standards requirements are for design- ers that need assistance. For more information, contact The Joint Commission Department of Engineering at 630-792-5900, option 3. John D. Maurer, SASHE, CHFM, CHSP, is an engineer at The Joint Commission. The Joint Commission's Environment of Care standards also include requirements for managing the environment during demolition, renovation or new construction to reduce risk to those in the organization. Risk mitigation must address safeguards for employees, visitors and patients. MCDM AG.COM | J U LY/AUGUST 2015 | Medical Construction & Design 53

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