Regulatory standards steer hospital washroom design

Infection prevention and control and privacy and dignity are affecting product development for hospital washrooms

Infection control is becoming increasingly important when designing hospital bathrooms and washing facilities

This article looks at how the design of hospital washroom facilities has been impacted by guidance and regulations around infection control, single-sex accommodation and privacy and dignity issues as well as ease of maintenance and changing healthcare priorities

Privacy and dignity, infection control, and new rules banning mixed-sex inpatient accommodation have led to significant changes in the demand for, and design of, hospital washrooms and the equipment that goes into them.

Ward washrooms, in particular, have evolved significantly over recent years, mainly as a result of increased emphasis on infection prevention.

Not only are more handwash basins being fitted inside and outside inpatient environments, but WCs and shower and bathing rooms are increasingly coming under the gaze of infection control managers.

Infection control will remain at the forefront of the design process, particularly in environments or institutions where people are more vulnerable, such as in intensive care units

Tony Rheinberg, channel marketing manager at bathroom manufacturer, Armitage Shanks, said: “Infection control is really important when designing hospital bathrooms and washing facilities and has been for a number of years. It is about combating the spread of healthcare associated infections like MRSA and C.difficile and other water-based bugs like Legionella and pseudomonas.”

Over the past decade this has led to new designs for taps and other washroom fixtures. Rheinberg said: “The key thing for us has been around handwashing and the washbasins themselves. With pseudomonas, in particular, the NHS has done a lot of research and has found that bacteria are more likely to form towards the end of the outlet where the water comes out. Water that sits here is more likely to become a breeding ground for this bacteria.

Infection prevention

“Over the past five years we have looked at the design of hospital taps and those we produce are manufactured in line with guidance and regulations. Swan necks, for example, were used on taps some years ago, but these provided a place for bacteria to collect and when taps were not in regular use and flushed through, this created a danger zone. We have done away with those and our aim is to cut out anything that creates a dead leg where stagnant water is able to collect.”

Armitage Shanks’s Bioguard technology addresses some of the most common problems associated with infection prevention in hospital washroom facilities. Traditional outlets have a mesh across the part of the tap where the water comes out, designed to direct flow, but this has been found to increase the risk of bacteria forming. Armitage Shanks’s range, in contrast, has a plain, simple outlet with antibacterial protection built in.

Rheinberg said: “This alteration was something we did because we knew there was a problem there and that is the challenge for manufacturers.”

We have got to develop products that are easy and quick for cash-strapped hospitals to maintain

Another key consideration for makers of washroom equipment is to ensure that it is easy to maintain, and this means that serviceable parts need to be accessible, preferably without having to remove wall panels.

Rheinberg said: “We have got to develop products that are easy and quick for cash-strapped hospitals to maintain. Within our clinical taps we have built in the ability to disinfect them by merely connecting the hot inlet to the cold inlet using a special bridging hose. This allows the cold water inlet and mixed water outlet to be flushed through with very hot water. That can be done from the front without the need to remove panels.

“This is the sort of ease of use that hospitals are looking for when they choose products to go into bathrooms and WCs.”

In addition, health trusts are being ordered to improve patient privacy and dignity and this has led to the requirement for more toilet and washroom facilities due to the need to designate specific rooms for both of the sexes.

Recognising the role manufacturers have to play in meeting all of these demands, the Design Council and the Department of Health launched the Design for Patient Dignity initiative, challenging teams to come up with new solutions for hospital environments and products.

This led to the funding of a new pre-manufactured washroom by Avanti Architects and Panaloc Worldwide Manufacturing. This was designed as a solution to the rules on single-sex hospital accommodation, which led to the need for additional washroom facilities on wards.

The resulting Washroom Pod turns a bathroom into a standardised product that could be installed in a hospital in just two or three days. It can be attached to the outside of the building, stacked one on top of the other if need be to reach upper floors, and can be connected to existing drainage and power. It can also be installed internally, with a macerator to deal with drainage.

Ease of use

“We knew the most difficult element of providing same-sex accommodation was introducing a new facility into an old building,” said Joanna Marriott, associate at Avanti Architects. “We proposed designing a bathroom that can be introduced into the space in the simplest way possible, avoiding complicated procurement or employing a major building contractor.”

We knew the most difficult element of providing same-sex accommodation was introducing a new facility into an old building. We proposed designing a bathroom that can be introduced into the space in the simplest way possible, avoiding complicated procurement or employing a major building contractor

The team’s solution takes nearly 50 different elements of the washroom design and installation process — equipment, people and utilities — and brings them together into one easily-installed pod.

“But the genuine benefit to the patient is that they don’t have to go through the distressing experience of walking through other wards to get to the bathroom,” said Marriott.

Again, ease of use and maintenance has driven improvements in design and has further highlighted the important role industry has to play.

Rheinberg said: “We expect that we will continue to evolve designs in line with the changing priorities of healthcare providers. Infection control will remain at the forefront of the design process, particularly in environments or institutions where people are more vulnerable, such as in intensive care units.

“But changes in practice will also impact on suppliers. The NHS is pushing handwashing and we will have to support them in that aim. But all the time we have to find the right balance so that by improving handwash technologies we are not making staff complacent about the need to wash their hands. All these things affect the way we build technologies and the way they are used.”

In terms of published guidance, there are a lot of studies on infection control procedures, but most hospital estates and facilities managers also use Health Building Notes (HBNs) and Health Technical Memorandums (HTMs), of which there are several relating to bathrooms and other washroom facilities, including HBN 00-01: General Design Principles and HBN 00-02: Sanitary Spaces 2. These look at everything from room sizes to partitioning and layouts. They also dictate what fixtures and fittings should be installed.

References

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This pre-manufactured washroom by Avanti Architects and Panaloc Worldwide Manufacturing is being retrofitted into hospitals to deal with single-sex accommodation regulations

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