The project is not moved, the drawings go first. For hospital engineering construction, the review of drawings is an indispensable process, which can eliminate errors in drawings in time and determine the feasibility of drawings so as to better carry out construction. Zhuyi Taiwan Rong Media invited industry experts to set up a "Picture Medical Construction" column, inviting experts to analyze the drawings and cases of the hospital for discussion and exchange, and jointly promote the progress of the hospital construction industry. Stay tuned!
Editor-in-chief of the invited column
Zhao Ameng
Consultant of the National Technical Committee for Standardization of Clean Rooms and Related Controlled Environments
Message from the editor-in-chief
There is a special section in hospital construction, which is the construction of clean rooms and related controlled environments of hospitals. This special plate belongs to the biological clean room series, it protects people, and its control purpose is to control the infection rate and prevent cross-contamination by preventing the growth of bacteria.
Hospital clean room and related controlled environment is a multi-disciplinary, multi-functional, multi-system system engineering, which is an artificial controlled small environment. It is composed of relatively independent and special medical functional unit areas, such as: clean operating room, negative pressure operating room, laminar flow ward, ICU, medical biology laboratory, reproductive center, central supply room, liquid distribution center, dialysis room, negative pressure isolation ward, fever outpatient area, and so on.
In the past two decades, in the process of large-scale and high-speed construction of Chinese hospitals, the construction of hospital clean rooms and related controlled environments has also made great achievements, and its number, scale, popularization, and longevity of scale construction are difficult to find in the world. However, reflecting on the rapid development process, there are still some problems in the design and construction of clean rooms and related controlled environments in our hospitals. These problems are first and foremost design problems, and design problems are first and foremost conceptual problems. The concept requires us to truly understand the nature of the hospital clean room and related controlled environment, and design it around the object of protection and around the purpose of control. We must not rigidly follow the rules and regulations of books to design for design, and we must figure out the "why" or "not why" in the design.
Here, through the "Illustration Medical Construction" column of Zhuyi Taiwan Rong Media, we set up "Hospital Clean Room and Related Controlled Environment Design Drawings Case Analysis and Review Column" to analyze some hospital drawing cases in the way of bricks and jade, so as to discuss and communicate.
- Zhao Ameng
Case review of drawings in this issue
Design drawing of ICU ward in purification area of a new hospital in Beijing
The following case study of "Illustrating Medical Construction" is an analysis of some ICU ward design drawings of a newly built hospital in Beijing. From the perspective of design drawings, the design of these lCU wards, like the vast majority of lCU design drawings in the country, has two common problems:
First, the scope of ICU protection objects is not clear, lCU protection objects are not only patients, medical staff in the ICU ward are also the objects that need key protection. The designers only focused on the protection of patients and neglected the protection of medical staff. Therefore, in the design, some basic facilities that should be configured in the working area of medical staff are not configured, or the configuration is incomplete, and the design seriously reduces the area of medical office living area and treatment and auxiliary area, and blindly expands the area of the monitoring area. The normal design ratio of each partition should be set to about 3:3:4. The staff in the ICU ward, every day in a fully closed environment, facing the treatment of high-risk patients, their mental pressure and physical pressure are very large, their work nature and environment, determine that there must be a good working environment and rest conditions.
In the design of our medical clean room and related controlled environment, we need to pay attention to: in the general positive pressure clean room environment, the key protection object is the patient, in the negative pressure area the key protection object is the medical staff, in the ICU ward key protection object is the patient and medical staff, both are equally important.
Second, when designing ICU wards in different departments, a special isolation ward will be designed, but the design of this isolation ward only considers the "independent area" factor, ignores other relevant requirements, and does not have the function of independent use. If the sewage treatment system is fully equipped and qualified, it can only be used as a patient with low-intensity contact infectious diseases, and cannot be used as a patient with high-intensity respiratory infectious diseases. If it is to be used as a patient with high-intensity respiratory infectious diseases, it must be carefully designed in accordance with the principle of "independent area, independent passage, independent system".
The above two problems are common problems in the design of ICU in most hospitals in China.
one
Three-story infection operating room/ICU
This picture is the plan of the three-story infection operating room/ICU of a hospital, through the above drawing content, it is found that there are several problems that need attention:
1
From the perspective of the medical staff process, if the medical staff enter the office area from the bottom side, and then to the restricted area, this process is correct. But from the drawing, there is also a process channel on the upper side of the drawing, and if there are medical staff who take this process into the office area, then this process is wrong. This process has a section that passes through semi-restricted areas before you can get to the ordinary office area in the non-restricted area.
Expert advice: If the process channel must be retained, it is recommended to change the small section on the left side of the dirt corridor above into a clean office corridor, and move the blood gas laboratory to another place, so that this area is a clean corridor and connects with the original designed office corridor, so that there will be no cross-contamination of the process.
The identification of the exit path of medical staff from the contaminated area is not clear, and the location of the first slow removal and the second slow removal should be clearly marked.
2
If the patient process is entered from the upper right side, it is correct, but the layout of the patient's family conversation room is wrong in the contaminated area, and the patient's family cannot enter the contaminated area when talking.
Expert advice: Move the family conversation room to the air conditioning room or an appropriate location, and suggest adding a video visiting area.
3
The cleaning process does not see the unpacking, sanitary access area, is this process transported in another way after it is processed in another area?
4
The facilities related to the sewage process are not well equipped. Dirt treatment should be divided into: classification, cleaning, disinfection, packaging, storage, terminal disinfection and other functional areas.
The isolation ICU area lacks a disinfection area for the patient's excreta. It is recommended that the upper part of the conversation room on the original design drawing be changed to a dirty washing room for liquid disinfection, and the lower part of the conversation room be changed to a blood gas laboratory.
5
The two operating rooms should not be made into negative pressure operating rooms with Class III cleanliness. With cleanliness requirements, the positive pressure clean operating room is the positive pressure clean operating room, and the negative pressure operating room is the biosafety operating room. Positive pressure operating room is the requirement of positive pressure operating room, which is to reduce the surgical infection rate through air circulation purification, and its main protection object is patients. Negative pressure operating room is the requirement of negative pressure operating room, it is through the air flow full discharge of the concentration of virus in the air diluted to a relatively safe range, to protect relevant personnel and the environment, its focus on protection objects are medical staff and related personnel. Mixing the requirements of the two strongly, the result is extremely high cost and average effect.
Let's analyze the parameters in the design:
The analysis shows that the difference in the cooling capacity of the Class III clean operating room and the Class III cleanliness negative pressure operating room is more than 9 times, the heat difference is more than 6 times, the fresh air volume is more than 4 times (and it is still a new air sent to the whole discharge), the exhaust air volume is nearly 13 times different, and the energy consumption is wasted.
Expert advice: do not make the operating room into a class III clean negative pressure operating room, only a negative pressure operating room. Some surgeries have corresponding air purification requirements, you can change the fresh air collection port of the fresh air unit to the fresh air collection box and cabinet, increase the initial and intermediate filtration area, put the three-stage filtration of the fresh air unit in place, and set up an ion purification and sterilization system at the air supply port, which can achieve dynamic purification and sterilization, and can improve the number of colonies in the operating room to reach and better than the index of the class III clean operating room. In this way, the circulating unit on the purified air system can save use, save the area of the machine room, save investment and a lot of operating costs.
The decontamination design of the decontamination ward in the isolation area can also be implemented according to these schemes.
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two
Three-story surgical intensive care unit SICU
SlCU is a large surgical ICU department of the hospital, with a reasonable proportion of each division, a patient-oriented service center design scheme, and clear divisions of medical office area, treatment area, monitoring area, and auxiliary area. The offices of front-line physicians and central monitoring physicians are located in areas close to patients, and nursing monitoring points are directly located in the most reasonable position of each nursing point, so that there are no dead ends in the nearest monitoring to each bed. The beds are arranged in single and double rooms to facilitate the treatment and rehabilitation of patients.
There are problems to explore
| 1） | In such a large ICU, the duty rest area of medical staff is too small, and there are not enough toilet pits. |
| 2） | The fresh air room, purification machine room, purification exhaust fan room, and UPS power room occupy prime positions, can they be transferred to other areas? |
| 3） | The negative pressure single room should not be connected with the ordinary ICU single room, and the negative pressure room is wrongly placed. |
Such a design can only admit patients with contact infectious diseases, and cannot admit patients infected through the respiratory tract like new coronary pneumonia. Moreover, the wards receiving contact patients do not need to be equipped with a negative pressure system, but only need to be set up as an ordinary isolation ward area.
The negative pressure ward should not be located in the innermost part of the lCU, allowing the entry process of patients with highly intense infectious diseases to pass through the entire treatment and monitoring area of the ICU, which is very likely to cause virus transmission and contamination along the way.
The design of the negative pressure isolation area should follow the principle of "three independents", that is, independent area, independent channel, independent system. At present, this design does not meet the requirements for the admission of patients with highly infectious diseases. Independent areas are easy to implement, while independent channels are strict. The process of medical staff should be a directional process, and there should be preparation, buffering and other processes to enter the isolation area, and the process of coming out should have one elimination, two elimination, and buffering. The patient flow should be far away from the public area, as close as possible to the infection special channel, and not through the public area of the ICU (for example, when the patient needs to enter the isolation ward from the public area without the setting conditions of the patient's independent channel, the patient must be transported by negative pressure isolation vehicle or negative pressure isolation stretcher). The cleaning process can be set up independently if conditional, and then passed in through buffering, and unconditionally can be implemented by borrowing medical staff to enter the channel. Dirty processes and facilities are not allowed to be shared with other common areas and must be self-contained. The sewage must also have a process of chemical disinfection before discharge, and there must also be an independent pipeline system for discharge.
In an independent system, the uninterruptible power supply system for ventilation and emissions also covers the load of the supply and exhaust units.
It is recommended that the design of this part be readjusted.
| 4） | The cleaning process of the ICU has no unpacking and sanitary access channels. |
| 5） | With so many beds, the SICU ward should have its own testing laboratory. |
| 6） | Most wards do not have toilets, and it is recommended to add a dirty room for pouring, cleaning and disinfecting the patient's excreta. |
| 7） | Lack of people, clean the working and rest environment of workers. |
| 8） | Is it necessary to have a hospice room? |
| 9） | It is recommended to add a negative ion dynamic sterilization facility. |
three
Four-tier surgical intensive care ICU
This ICU ward is a super-large ICU ward area, adjacent to the cardiac surgery area, with reasonable layout, which is convenient for the admission and transportation of surgical patients, mainly 6 people, 4 people room and negative pressure single room sub-unit monitoring management area. The size of this ICU design is too large, highlighting the relative lack of configuration in other areas, and the problems that need to be paid attention to are as follows:
1
The changing area is too small to meet the changing needs of more than 170 medical staff. The rest area on duty is even more insufficient. It is recommended that the design ratio of the monitoring area, the medical office area and the treatment and auxiliary area be 4:3:3, and if it is really impossible to adjust, some beds should be sacrificed. Because the key protection object in the clean operating room is the patient, and the key protection object in the ICU is the patient and medical staff, the good working environment of the ICU medical staff must not be sloppy.
2
The location layout of the negative pressure ward must consider the flow of patients, and medical staff entering or exiting the negative pressure ward area must have multi-level buffer sanitize area requirements. The management of sewage treatment facilities and processes should be self-contained and meet the strict requirements of infection control management. This negative pressure isolation area should form a closed, self-contained relatively independent and complete area, and it is recommended that this area be redesigned.
3
Such a large lCU ward also needs to be equipped with consultation rooms, conference rooms, patient preparation areas and other facilities.
4
Almost every ICU ward in different areas on each floor has a demonstration classroom, can a special classroom area be set up to save the valuable use area of each ICU ward?