Principles and Design Considerations for Sterile Processing

When you eat at a restaurant, do you ever consider how your dishes got washed?  Did a teenager wash them by hand at the rate of $7.75 per hour?  Wouldn't you rather have them washed in a dishwasher?  Would you feel like they had been sterilized if they had been in a dishwasher?

When the instruments in a hospital need cleaning, they usually go down to the basement to the central sterile processing room.  The employees who clean these instruments are usually paid a little over minimum wage.  They have to cover every inch of themselves to be protected from all the infectious diseases they are in contact with every day.  This is made even more difficult by the high temperatures in the sterilizing room since hot water is used to clean the instruments.  Sometimes the surgical instruments are cleaned with soap and hot water....only.  Hmmm.  Give me a dishwasher any day.

The American Institute of Architects in Atlanta gave a free CEU/Workshop last week at the offices of JE Dunn Construction in Dunwoody.  Neill Moore, Business Development Director at Getinge USA, was the speaker.  Mr. Moore introduced us to Getinge's sterile processing units, which work like dishwashers at a restaurant, only they save lives.

http://wefixitrt.wix.com

Sterile processing equipment is very expensive, but when you consider the penalties a hospital faces when they have a high rate of hospital acquired infections (HAIs), they will pay for themselves in the long run.  Of course, the first consideration is the patient, but too many hospitals are struggling with finances these days.  

http://www.getinge.com

Perhaps the insurance companies should consider investing in some sterile processing equipment in hospitals.  After all,  they stand to gain as much as the hospitals by having up to date equipment installed in every hospital.  Hey...and let's get those workers some windows and a raise PLEASE!

Healthcare Design Webinar: Clinical Evidence for the Use of Copper Touch Surfaces in Healthcare

On September 19, 2013, I attended a webinar sponsored by The Copper Development Alliance, (CDA).  The speakers were Harold Michels, PhD and Dr. Archelle Georgiou, MD.

The CDA is a not for profit trade association whose website is www.copper.org.  They represent the U.S. Copper Industry.  Since copper is plentiful in the United States, and is easily recycled, it is considered sustainable.

www.filtered-news.com

Hospital Acquired Infections, (HAIs), are a challenge in todays hospital system.  In the past, HAIs actually increased revenue for hospitals, but today there are federally enforced fines for hospitals that have more than their quota of HAIs.  80% of infectious diseases are transferred by touch.  They are invisible to the naked eye and are expensive to the U.S. healthcare system.  Methicillin-resistant Staphylococcus aureus, (MRSA), is a serious health problem since it is drug resistant.

The good news is that copper is anti-microbial.  There is no special coating of additive that makes this happen.  Simply put, copper kills germs.  Copper kills germs fast.  The most common copper alloy is brass.  Nickel is another common copper alloy.  Our coins are all made of copper and copper alloys.  That is why germs are not usually spread through financial exchange.  Germs, even MRSA, cannot survive on copper surfaces.  Additionally, tarnish does not reduce this effect.  Copper will kill 99.99% of germs that lie on it within 2 hours.

www.antimicrobialcopper.com

Some of the objects that people touch frequently in hospitals are:  sinks, IV poles, patient transfer stretchers, railings, grab bars, building products such as light switches, work surfaces, door hardware, cabinet hardware, and keyboards.  These products are becoming commercially available in copper and may bring about significant healthcare benefits to hospitals, their patients, their staff and visitors.

In thinking beyond hospitals, Harold Michels suggests that copper could prove beneficial in any situation where a patient has immune deficiencies, or where people gather and, possibly, spread germs. Some of the suggested places where copper might be used are schools, public transportation, food and hospitality venues,  spas and fitness centers.

I'm thinking about replacing my kitchen countertop with copper.

Meet George Smith, Senior Architectural Project Manager at Grady Memorial Hospital

George Smith has never met a stranger.  He gets my congeniality award for the week.  He should probably get the "Busiest Man on Earth" award as well.  When I walked into his office on the eighth floor at Grady, he was all smiles behind a desk with several piles of paperwork a foot deep.  No worries.  He assures me that he knows where everything is.

Two years ago I toured Grady with a group of classmates with George as our guide.  They were about to begin transforming the neonatal unit, making significant changes to the headwalls, finishes and lighting.  As part of this interview on September 18, 2013, I got to see the new neonatal unit fully functioning.  Wow!

http://www.knightarchitects.com/Featured-Project-Grady-NICU

As you can see, the circulation is greatly improved as is the lighting, acoustics, and overall feeling in this space.  

Grady has received Energy Star Certification for its energy efficient air control and LED lighting.  George says that Grady has been sustainable by using the existing building, changing their lighting, using energy efficient air control units, and using recyclable materials as much as possible.

Hospital design can be challenging because the technology changes more quickly than the architecture.  Many hospitals have been facing economic challenges and have closed their doors.  The Affordable Care Act, (or Obamacare), may provide even more challenges for hospitals when individuals have more choice as to where to receive treatment.  If George has it his way, Grady will be one of the most up-to-date hospitals in the United States.

The Marcus Stroke and Neuroscience Center provides state of the art equipment for the care of  patients with strokes, aneurysms, and epilepsy.

The Correll Cardiac Center at Grady was just unveiled this month.  George took me through the family waiting area which features some of the beautiful 3M resin panels in the form of sliding doors and decorative glass in-door panels.  He has been working on signage and way finding in the hospital and here is one of the new signs:

Of great architectural interest is the Chapel.  George Smith was active in the restoration of this Chapel, financed by the Goddard Family who financed it originally in 1958 with Philip Shutze as the architect.  The Goddard Chapel restoration won the Shutze Award for Craftsmanship in 2010.  George had it restored back to its original color which is a sort of putty color.  He describes its color and smooth finish as butter-like.

Finally, I asked George what advice he would give someone, like me, who is studying healthcare design.  He suggests we take nursing classes, keep up on trends, take mechanical classes and urban planning classes.  He says we should be familiar with zoning and circulation.  George said, "These help you see the relationships with people and operations."

Courtesy of George Smith, Senior Architectural Project Manager at 

Grady Memorial Hospital, part-time fisherman

India-American Adult Day Care Center

The following images are from a course in which I explored and designed a place which would provide abundant life for an elder from India, living in America.  I focused on two particular spaces: the bathing room and the puja room.  

In India, bathing is meaningful in spiritual life, as well as personal hygiene.  It is also a very important space in planning for the aging.  The bathing room is in a  corner of the day care center to provide privacy and to adhere to the Vastu Shastra philosophy.

Bathing Room - SW Perspective

Bathing Room - NW Perspective

The Puja room is for Indian worship, particularly in the Hindu religion.  A person in a wheelchair can easily turn around, approach the altar and shrine during their personal worship time.

Puja Room - Perspective

This plan includes an area for storing shoes at the entrance, an exercize/yoga and dance floor, storage for yoga mats, various sitting areas for visiting, a reading room for reading or being quiet, a nurse room with locked storage for medications, four bathrooms and a bathing room, a viewing room for television and video, an office for administration, and an outside garden area with plenty of seating and a walking path.