And in California, an evolution for patients
Although California has not adopted the American Institute of Architects’ guidelines for healthcare facilities, many hospitals across the state have nonetheless embraced the concepts.
The largest construction program incorporating evidence-based design is being carried out by Kaiser Permanente. The healthcare provider has 31 California-based hospitals, three of which are brand-new. The rest are being retrofitted or reconstructed to meet seismic requirements. Kaiser is also building six new hospitals in California areas where its membership is expanding.
That construction effort includes the creation of single-occupancy patient rooms and emergency departments with enclosed rooms and negative air pressure to protect against airborne infections in each of its hospitals.
In its new hospitals, Kaiser’s ventilation systems circulate 100% outside air, which, according to John Kouletsis, the organization’s national director of strategy, planning and design, reduces the risk of infection and airborne pathogens distributed throughout the building.
These same ventilation systems can be shut down floor by floor in the event of an infectious outbreak. Patient units can be cordoned off and function independently. Fresh air can be fed in and exhaust pulled directly out through the roof so other patients in the building do not share the infected air. These methods are particularly effective in an outbreak such as pandemic influenza or SARS. A study published in the Journal of the American Medical Assn. in 2003 following SARS infections among healthcare workers in the First Hospital of Peking University, Beijing, hospital wards with the highest ventilation rate had significantly less infection among healthcare workers.
In addition, Kaiser is among the first healthcare organizations in the country currently building single-bed neonatal intensive care units, having found that, just as with adult patient units, such environments make it easier to control the spread of infection.
Kaiser, in partnership with the Centers for Disease Control and the National Institute of Occupational Safety and Health, will be measuring results at its new hospitals compared with the old buildings.
The Center for Health Design, meanwhile, is working with four California-based hospitals -- Palomar Pomerado Health in Escondido, Rady Children’s Hospital and Health Center in San Diego, Laguna Honda Hospital and Rehabilitation Center in San Francisco, and Loma Linda University Medical Center -- that are constructing hospital buildings incorporating evidence-based designs. All the hospitals will collect data on the effects their newly designed facilities have on a host of safety issues, such as hospital-acquired infections, medical errors, falls and injuries, confidentiality and privacy.
Roger Ulrich of the Center for Health Design believes that as the body of evidence-based design research grows, more hospitals are likely to follow suit.
