In the design of such complex buildings as hospitals the planner's problem is to provide a minimal amount of permanent structure so that it shall not get in the way of functional behavior of the occupants and their ability to change their environment. The purpose of this study was to discover which intervals seem to occur in hospitals by measuring the room size distribution found in existing buildings or buildings ready for construction. The results seem to confirm that the range of room sizes required is small and that exceptions are relatively rare. (+info)
New picture archiving and communications system plus new facility equals critical path planning challenge.
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The architectural design and construction of a new imaging department is one of the most complex challenges in healthcare architecture. When a client also plans a simultaneous change in basic operating system technology from film-based to filmless imaging, the challenge for both hospital management and the facility/technology design team is even more complicated. A purposeful planning process plus a carefully composed team of internal and external experts are the two essentials for success in executing this difficult conversion of both facility and technology. (+info)
A community outbreak of Legionnaires' disease linked to hospital cooling towers: an epidemiological method to calculate dose of exposure.
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BACKGROUND: From July to September 1994, 29 cases of community-acquired Legionnaires' disease (LD) were reported in Delaware. The authors conducted an investigation to a) identify the source of the outbreak and risk factors for developing Legionella pneumophila serogroup 1 (Lp-1) pneumonia and b) evaluate the risk associated with the components of cumulative exposure to the source (i.e. distance from the source, frequency of exposure, and duration of exposure). METHODS: A case-control study matched 21 patients to three controls per case by known risk factors for acquiring LD. Controls were selected from patients who attended the same clinic as the respective case-patients. Water samples taken at the hospital, from eight nearby cooling towers, and from four of the patient's homes were cultured for Legionella. Isolates were subtyped using monoclonal antibody (Mab) analysis and arbitrarily primed polymerase chain reaction (AP-PCR). RESULTS: Eleven (52%) of 21 case-patients worked at or visited the hospital compared with 17 (27%) of 63 controls (OR 5.0, 95% CI : 1.1-29). For those who lived, worked, or visited within 4 square miles of the hospital, the risk of illness decreased by 20% for each 0.10 mile from the hospital; it increased by 80% for each visit to the hospital; and it increased by 8% for each hour spent within 0.125 miles of the hospital. Lp-1 was isolated from three patients and both hospital cooling towers. Based on laboratory results no other samples contained Lp-1. The clinical and main-tower isolates all demonstrated Mab pattern 1,2,5,6. AP-PCR matched the main-tower samples with those from two case-patients. CONCLUSION: The results of our investigation suggested that the hospital cooling towers were the source of a community outbreak of LD. Increasing proximity to and frequency of exposure to the towers increased the risk of LD. New guidelines for cooling tower maintenance are needed. Knowing the location of cooling towers could facilitate maintenance inspections and outbreak investigations. (+info)
Multiple types of Legionella pneumophila serogroup 6 in a hospital heated-water system associated with sporadic infections.
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Five sporadic cases of nosocomial Legionnaires' disease were documented from 1989 to 1997 in a hospital in northern Italy. Two of them, which occurred in a 75-year-old man suffering from ischemic cardiopathy and in an 8-year-old girl suffering from acute leukemia, had fatal outcomes. Legionella pneumophila serogroup 6 was isolated from both patients and from hot-water samples taken at different sites in the hospital. These facts led us to consider the possibility that a single clone of L. pneumophila serogroup 6 had persisted in the hospital environment for 8 years and had caused sporadic infections. Comparison of clinical and environmental strains by monoclonal subtyping, macrorestriction analysis (MRA), and arbitrarily primed PCR (AP-PCR) showed that the strains were clustered into three different epidemiological types, of which only two types caused infection. An excellent correspondence between the MRA and AP-PCR results was observed, with both techniques having high discriminatory powers. However, it was not possible to differentiate the isolates by means of ribotyping and analysis of rrn operon polymorphism. Environmental strains that antigenically and chromosomally matched the infecting organism were present at the time of infection in hot-water samples taken from the ward where the patients had stayed. Interpretation of the temporal sequence of events on the basis of the typing results for clinical and environmental isolates enabled the identification of the ward where the patients became infected and the modes of transmission of Legionella infection. The long-term persistence in the hot-water system of different clones of L. pneumophila serogroup 6 indicates that repeated heat-based control measures were ineffective in eradicating the organism. (+info)
Airborne infection in a fully air-conditioned hospital. I. Air transfer between rooms.
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Measurements have been made of the extent of air exchange between patient rooms in a fully air-conditioned hospital using a tracer-gas method. When the rooms were ventilated at about six air changes per hour, had an excess airflow through the doorway of about 0.1 m.3/sec. and the temperature difference between rooms and corridor was less than 0.5 degrees C., concentrations of the tracer in rooms close to that in which it was being liberated were 1000-fold less than that in the source room. This ratio fell to about 200-fold in the absence of any excess airflow through the doorways. Considerable dilution took place along the corridors so that the concentration fell by around 10-fold for every 10 m. of corridor. (+info)
Investigation of cross-infection in isolation wards of different design.
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A survey was conducted in seven hospitals to assess the risk of cross-infection with the highly infectious air-borne diseases, varicella-zoster and measles, in isolation wards of different design. Existing wards and isolation techniques were found to afford a high degree of protection, but there was considerable variation in the incidence of cross-infection related to ward structure, ward practice and the availability of trained staff. Recommendations are made for the design of new isolation wards and for safe practice. (+info)
Laboratory automation and optimization: the role of architecture.
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The increasing automation of laboratory equipment has had far-reaching impacts on the organizational structure and spatial requirements of clinical laboratories. This report explores the changing role of the laboratory in the healthcare environment and shows the architectural impact of these changes, both inside and outside of the laboratory space. (+info)
New facility picture archiving and communication system implementation strategy.
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Strategies for deployment of picture archiving and communications systems (PACS) in new hospitals often involve the establishment of initial PACS operations. Such a strategy is flawed in the sense that the clinical and radiological users must adapt to PACS operations, while being faced with several other new facility learning curves. This increases the complexity and risk of the radiological services. A strategy of implementing PACS operations in the old facility and performing a zero-downtime transition into the new facility offers several advantages to this method. The successful undertaking of such a project will support not only the physical movement of the existing PACS, but the accomplishment of other re-engineering goals associated with the new hospital. This report will describe the strategy used in two successful transitions of PACS into newly constructed hospitals. (+info)