Transcript Environmental controls Document N° 5.1, part 5: facility upgrade and

Unit 6.5. Facility design,
renovation, and use
TB Infection Control Training for
Managers
at National and Subnational Level
Objectives
After this unit, the participant will be able to:
• List basic design principles for
maximizing natural ventilation
• Provide an example of facilitating patient
flow to minimize exposure to infectious
patients
• Provide an example of rethinking the use
of space to decrease the risk of TB
transmission
2
Outline
A. The managerial activities of facility
design, renovation and use
B. How facility design, renovation, and
use can the risk of TB transmission
1. Reduce crowding
2. Maximize natural ventilation
3. Organize patient flow
C. Maintenance
3
A. Inadequate design and use of
space contribute to TB spread
Managerial activities at national and
facility levels:
• Ensure that health facility design,
construction, renovation and use are
appropriate
• Rethink the use of available spaces to
optimize implementation of controls
4
Facility upgrade and
reorganization includes:
•
Simple interventions that do not
require any structural change
•
More complex
solutions that
require engineer
or architect type
of expertise
5
B. How facility design,
renovation, and use can reduce
the risk of TB transmission
1. Reduce crowding
2. Maximize natural
ventilation
3. Organize patient flow
to minimize exposure
to infectious patients
6
1. Reduce crowding
98 patients exposed vs.
9 +
9 = 18
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2. Maximize natural ventilation
•
•
•
•
•
Orientation to prevailing winds
Elevation from the ground
Stack ventilation
Building dimensions
Placement and
size of window
openings for cross
ventilation
8
Cross ventilation and shape
9
Poor air mixing,
little air exchange
10
Cross ventilation
11
Cross ventilation
12
Windows design
Tilting windows
Sliding windows
~ 100% open area
< 50% open area
13
Tilting windows
Tilting windows (horizontal)
14
3. Organize patient flow to
minimize exposure to
infectious patients
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Mixing of patients and staff
16
Separation of patients and staff
17
Crowded, indoor corridor used
as a waiting area
18
Outdoor waiting area
19
Use of existing space
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Radiology
MDR ward
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Radiology
X
X
X
X
X
X
MDR ward
New external stairs
22
Sputum collection
Don’t!
Do!
Sputum
collection
outside: a
simple solution!
23
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C. Facility maintenance
Clinic design needs to support the operation and
maintenance of the facility throughout its life cycle
25
Budget for maintenance
If the building has a 60 year life span, and the
initial construction cost was 100 million, you will
need to:
• budget 4% per year (4 million) for
maintenance
• spend 240 million over the next 60 years
on maintenance, or nearly two and half
times the cost of initial construction
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Risk of inadequate building
maintenance
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Risk of inadequate engineering
service maintenance
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Summary
•
•
•
Managers should rethink the use of
available spaces and consider
renovation to optimize infection control
Buildings can be designed or upgraded
to decrease crowding and maximize
natural ventilation
Patient flow in facilities should be
organized to diminish exposure by
infectious patients.
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