2010 Health Guidelines Revision Committee - PowerPoint PPT Presentation

Loading...

PPT – 2010 Health Guidelines Revision Committee PowerPoint presentation | free to download - id: 845ddd-MjI4Y



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

2010 Health Guidelines Revision Committee

Description:

2010 Health Guidelines Revision Committee Interim Sound and Vibration Guidelines for Hospital and Healthcare Facilities Why interim guidelines have been ... – PowerPoint PPT presentation

Number of Views:66
Avg rating:3.0/5.0
Slides: 58
Provided by: kurt2165
Learn more at: http://speechprivacy.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: 2010 Health Guidelines Revision Committee


1
2010 Health Guidelines Revision Committee
  • Interim Sound and Vibration Guidelines for
    Hospital and Healthcare Facilities

2
Todays Presenters
David M. Sykes, Co-chair, ANSI S12 WG44 Jo M.
Solet, PhD, Harvard Medical School Gregory
C.Tocci, PE, FASA, INCE Bd Cert
Co-chair, ANSI S12 WG44 Health Guidelines
Revision Committee
April 17, 2007, Baltimore, MD
3
Why interim guidelines have been instituted
  • Guidance clearly needed on several topics
  • Needed now - not four years from now
  • Draft phase allows for research, testing,
    validation, revision, development of new
    standards, etc.

4
Status prior to 2010
  • Information is useful as an organized,
    peer-reviewed digest of expertise professional
    best practices
  • Sets benchmarks that can be tested through
    research field trials

5
II. Team scope
  • David M. Sykes, ASA, INCE
  • Co-chairman, ANSI S12 Workgroup 441
  • Co-chairman, ASA/INCE/NCAC Joint
    Subcommittee (TC-AA.NS.SC2)
  • Liaison to GGHC LEED HC - Acoustics EQ
  • Managing Partner, Remington Partners LLC
  • dsykes_at_healthcareacoustics.org
  • 1,2 Workgroup 44 Healthcare Acoustics Speech
    Privacy TC-AA.NS.SC Technical Sub-committee of
    the Committees on Architectural Acoustics, Noise,
    and Speech Communications

6
Who wrote this?
  • ANSI S12 Workgroup 44 formed in 10/04 as ASA
    Joint TC-AA.NS.SC focused on healthcare acoustics
    speech privacy
  • Group applied to ANSI in 05 for recognition
    which was awarded in 3/06
  • See www.healthcareacoustics.org

7
Committee scope
  • Membership is 470 professionals from
    nine constituencies
  • - Legislators - Planners, architects
    designers
  • - Regulatory agencies - Facility managers
    engineers
  • - Leaders of large HCOs - Acoustics researchers
  • - Clinical professionals practitioners
  • - Healthcare lawyers - Acoustics professionals
    in large
  • mfg. organizations

8
Goal common sense
  • The character and magnitude of the sounds in a
    building should be compatible with the intended
    use of the space.
  • William Cavanaugh
  • Architect, FASA, INCE Bd. Cert.,
  • 2006 recipient of
  • the Wallace Clement Sabine Medal

9
Six objectives
  • Authoritative
  • Comprehensive (but brief)
  • Focused on healthcare
  • Standards-based
  • Objective
  • Practical (solutions-based)

10
Six topics glossary
  • 1. Site exterior noise
  • 2. Acoustical finishes and details
  • Room noise levels
  • Sound isolation performance of constructions
    including speech privacy
  • Paging call systems, clinical alarms,
    masking systems sound reinforcement
  • Building vibration
  • Glossary

11
When was it written?
  • 8.05 co-chairman met with FGI board 2010 board
  • 9.05 FGI approved drafting party
  • 10.05 began organization drafting
  • 3.06 group recognized as ANSI S12/WG 44
  • 5.06 research team organized begins proposals
  • 6.06 peer review of draft began
  • 10.06 Public Draft 1 submitted to FGI
  • 11.06 meeting with GGHC v.2 Core Committee
  • 12.06-2.07 presented _at_ ASA-INCE ASHE-PDC

12
Basis for compliance
  • Document based on existing standards from
    recognized standards authorities widely
    accepted professional best practices
  • Certification?standard analyses tests can be
    performed in design tested in-situ to show
    general conformance to the established criteria
    specified in the Draft Guideline
  • For HCOs, this may be useful desirable for
    inspections (e.g., JCAHO, FDA, etc.)

13
Solving acoustical problems
  • Solutions already exist
  • 8,500 acoustics professionals available
  • What holds up implementation?
  • Assumptions about cost
  • Quality issues like noise privacy often
    lost in value-engineering

14
Medical perspectiveacoustics matter
  • Jo M. Solet, Ph.D.
  • Clinical Instructor, Harvard Medical School
  • Cambridge Health Alliance, Behavioral Medicine
  • Member, 2010 Healthcare Guidelines Revision
    Committee
  • Commissioner, Cambridge Historical Commission
  • joanne_solet_at_hms.harvard.edu

15
Acoustics clinical outcomes mechanisms of
influence
  • Stress response
  • Lost privacy
  • Sleep disruption
  • Impaired communication
  • Clinician burnout

16
Stress response
  • Arousal
  • Trauma
  • Pain
  • Lack of control
  • Inability to interpret experience

17
Adapting the Neonatal Intensive Care Environment
to Decrease NoiseJohnson in J. of Perinatal
Neonatal Nursing 2003
  • Noise Effects
  • Lower oxygen saturation
  • Higher respiratory rate
  • Higher blood pressure
  • Faster heart rate
  • Lower weight gain
  • Impaired sleep

18
Influence of ICC Acoustics on the Quality of Care
and Physiological State of Patients
  • 2004 Hagerman, Rasmanis, Blomkvist, Ulrich,
    Erikson, Theorell, in Internatl. J. of Cardiology
  • Poorer acoustic environment higher
    re-hospitalization rates
  • Sickest patients showed the most reaction
  • Acute MI and unstable angina patients had
    raised pulse amplitudes, greater sympathetic
    arousal
  • Quieter environment elicited higher patient
  • quality of care ratings

19
Consequences of poor sleep
Risk of Injuries, Falls
Impaired Attention and Reaction Time
Insufficient or Disordered Sleep
Incidence of Pain
Decreased Memory and Concentration
Weight Gain
Worse Mood depression
Diabetes
Impaired Task Completion
Increased Consumption of Healthcare Resources
Cardiovascular Disease
Psychosocial difficulties
20
(No Transcript)
21
Interactions among patients, families providers

22
Accurate communication nurses stations
23
Quieter work environment
  • Lower stress levels/decreased sympathetic
    activation
  • Greater control in high demand situations
  • Increase in speech intelligibility
  • More sustained attention for careful
    decision-making fewer errors
  • Respectful of workers and their mission
  • Less burnout/staff turn-over


24
Pharmaceutical homonyms

  • Celexa
  • anti-depressant
  • Lamicil
  • anti-fungal
  • Propecia
  • hair growth stimulator
  • Klonipin
  • anxiolytic
  • Celebrex
  • anti-inflammatory
  • Lamictal
  • anti-convulsant
  • Precose
  • glucosidase inhibitor
  • Clozapine
  • anti-psychotic


25
Avoiding medical errors
26
Growing clinical evidence
  • ULRICH The Role of the Physical Environment in
    the Hospital of the 21st Century A
    once-in-a-lifetime opportunity (2004). Ulrich and
    Quan _at_ Center for Health Systems and Design at
    Texas AM Zimring, Anjali and Choudery _at_
    Georgia Institute of Technology
  • BUSCH-VISHNIAC Noise Levels in Johns Hopkins
    Hospital (2005) Busch-Vishniac, West, Barnhill,
    Hunter, Orellana, Chivakula, JASA, J. Acoust.
    Soc. Am.
  • RUBIN Status Report (1998) An investigation to
    determine whether the built environment affects
    patients medical outcomes. Rubin, Owens, and
    Golden, _at_ Center for Health Design at Johns
    Hopkins

27
Organizing intervention outcome studies
  • Compare guideline-compliant with standard rooms
  • Sleep quantity/quality
  • Patient comfort and satisfaction
  • Pain perception
  • Staff and caregiver experience
  • Privacy/speech intelligibility

28
The challenge
  • Evidence-based
  • Inter-disciplinary
  • IRB approved
  • COI free
  • Promptly reported
  • Practical

29
Overview of the draft
  • Gregory C. Tocci, PE, FASA, INCE Bd Cert
  • President, Cavanaugh Tocci Associates, Boston MA
  • Co-chairman, ASA/INCE/NCAC Joint Subcommittee
  • Co-chairman, ANSI S12 Workgroup 44 Speech Privacy
  • gtocci_at_healthcareacoustics.org
  • Consultants in sound and vibration

30
Comprehensive focused
  • 1. Site exterior noise (5 pages)
  • 2. Acoustical finishes and details (3 pages)
  • Room noise levels (2 pages)
  • Sound isolation performance of constructions
    including speech privacy (4 pages)
  • Paging call systems, clinical alarms, masking
    systems sound reinforcement (2 pages)
  • Building vibration (2 pages)
  • Glossary

31
1. Site Exterior Noise
  • Exterior hospital noise sourcesa) No
    controlhighways, aircraft, etc.b)
    Controlcooling towers, other MEPc) Some
    controlhelipads, ambulances
  • Shall consider exterior source noise impact upon
    HOSPITAL BUILDING.
  • Shall consider hospital source noise impact upon
    COMMUNITY

32
1. Site exterior noise
33
1. Site Exterior Noise
  • Categories of Exterior Hospital Site
    Environmental Sound
  • Minimalrural, quiet suburban
  • Moderatebusy suburban, typical of multifamily
    residential
  • Significantcommercial urban, busy streets
  • Extremeoverlooking interstate highway, close to
    airport under flight path

34
Exterior Site Noise Exposure Category A B C D
General description Minimal Moderate Significant Extreme
Day-night average sound level (Ldn) (dB) lt 65 65-70 70-75 gt 75
Ave. hourly nominal max. (L01) (dBA) lt 75 75-80 80-85 gt 85
Distance from nearest highway (ft) 1000 250-1000 60-250 lt 60
Distance from aircraft flight track1 (ft) gt 7000 3500-7000 1800-3500 lt 1800
Distance from nearest rail line (ft) 1500 500-1500 100-500 lt 100
Exterior shell composite STC rating2 (STCc) 35 40 45 50
Exterior patient sitting areas OK OK NO NO
Design goal for hospital MEP noise on community 45 50 55 60
35
2. Acoustical Finishes
  • Sound absorptive finishes
  • Appropriate reverberant characteristics
  • Noise controlspeech, equipment, etc.
  • Surface treatmentscarpet, ac clg, walls

36
2. Acoustical Finishes
Space design Subjective description
Private room 0.15 Average
Corridor 0.15 Average
Waiting 0.25 Medium-dry
Atrium 0.10 Medium-live
Office 0.15 Average
Treatment 0.15 Average
Average absorption coefficient ( )
37
2. Acoustical Finishes
  • The big challengeMicrobial resistant sound
    absorptive materials
  • Kirby Bauer Test for microbial content
  • New products sound absorptive products for
    healthcare
  • Fabrics (anti-microbial, color-fast)
  • Insulation (hydrophobic, thermo/acoustic,
    translucent)
  • Carpeting (anti-microbial)

38
2. Acoustical Finishes
39
3. Room Noise Levels
  • Methods to quantify room noise
  • Criteria for acceptable sound levels by space use
    and special acoustical needs. a) Anatomical
    sounds b) Hearing and voice testing c)
    Distractibility
  • NC, RC, RNC methods

40
(No Transcript)
41
3. Room Noise Levels
Room Type NC / RC(N) / RNC3 dBA
Patient rooms 30-40 35-45
Multiple occupant patient care areas 35-45 40-50
NICU1 25-35 30-40
Operating rooms2 35-45 40-50
Corridors and public spaces 35-45 40-50
Testing/research lab, minimal speech2 45-55 50-60
Research lab, extensive speech2 40-50 45-55
Group teaching lab 35-45 40-50
Doctors offices, exam rooms 30-40 35-45
Conference Rooms 25-35 30-40
Teleconferencing Rooms 25 (max) 30 (max)
Auditoria, large lecture rooms 25-30 30-35
42
4. Sound Isolation Privacy
  • Interior sound isolation between spaces based on
    adjacent space use Sound transmission class
    (STC) rating
  • Speech privacy Vocal effort Privacy need
    Isolation (partitions, screens) Background
    sound level

43
4. Sound Isolation
Adjacency combination Adjacency combination STCc
Patient Room Patient Room (horizontal) 451
Patient Room Patient Room (vertical) 50
Patient Room Corridor (with entrance) 352
Patient Room Public Space 50
Patient Room Service Area 603
Exam Room Corridor (with entrance) 352
Exam Room Public Space 50
Toilet Room Public Space 45
Consultation Room Public Space 50
Consultation Room Patient Rooms 50
Consultation Room Corridor (with entrance) 352
44
4. Sound Isolation Privacy
Privacy Goal Articulation Index(AI) Privacy Index(PI) Sound Transmission Index(STI) Speech Intelligibility Index (SII)
Closed Plan
NormalConfidentialSecure lt0.15lt0.05 gt85gt95 lt0.19lt0.12 lt0.20lt0.10
Open Plan
NormalConfidential lt0.20 gt80 lt0.23 lt0.25
Special consideration required
Special consideration required
45
4. Speech Privacy
46
5. Paging, Call, Alarm, Masking Sound Systems
  • Performance for audibility
  • Limit annoyancea) Level limitsb) Wireless and
    non-audible signals
  • Operational considerations (e.g., should we have
    a paging system?)

47
5. Paging, Call, Alarm, Masking Sound Systems
  • Page, call, and sound reinforcement systemsa)
    70 dBA minimum sound level orb) 10 dBA above
    background noise levels (whichever is higher)
    and c) Coverage within /- 4 dB at 2000 Hz
    throughout areas served.

48
5. Paging, Call, Alarm, Masking Sound Systems
  • AlarmsNFPA 72 (ISO 7731)
  • Maskinga) Not higher than 48 dBAb) Uniform
    coverage /-2dBAc) Suitable spectrum shape
    (innocuous)

49
6. Building Vibration
  • Not the same as structural integrity.
  • Sourcesfootfall, MEP equipment
  • Controlsa) building stiffness, massb) vibration
    isolation of MEP equipmentc) segregating
    vibration producers from vibration sensitive
    receptors

50
6. Building Vibration
Space Type Footfall Vibration Peak Velocity (min/s)
Patient Rooms and other Patient Areas 4000
Operating and other Treatment Rooms 4000
Administrative Areas 8000
Public Circulation 8000
Table 6.3.2-1 Recommended limits on footfall
vibration in hospitals.
51
Note the building science revolution
  • Many recent products are available well-suited
    for balancing acoustics and infection control
  • Fabrics (anti-microbial, color-fast)
  • Insulation (hydrophobic, thermo/acoustic,
    translucent)
  • Paints surface coatings
  • Flooring carpeting (anti-microbial)
  • Filtration methods (air water)
  • Wireless communications

52
Example of a new material aerogel (1931)
  • Thermo-acoustic insulation that is
  • Hydrophobic
  • Translucent
  • Lightweight (97 air)
  • Thin (imagine a translucent curtain that blocks
    sound)
  • Multiple product forms (insulation blankets,
    rigid glazing panels with R20, etc.)
  • Available from established manufacturers

53

54
FYI Others Involved Inc.GGHC LEED HC
  • The Green Guide for Healthcare Version 2.2
    (released 1/31/07) contains two new credits for
    acoustics
  • See Environmental Quality - Acoustics Credit 9
  • The Draft Interim Guideline on Sound and
    Vibration is the sole reference standard cited
  • Download from www.gghc.org

55
Where do we go from here?
56
Approval process
  • HCO peer review (11/068/07)
  • Appoint HGRC Workgroup (4/07)
  • April HGRC all hands meeting (4/17-20/07)
  • Proposal to HGRC (8/07)
  • Public review period (11/068/07 1/088/08)
  • Integration into 2010 edition
  • Send comments to www.fgi-guidelines.org

57
Questions
About PowerShow.com