Photo courtesy of Georgia-Pacific Gypsum

Healthcare facilities of all types can be designed to address the needs of people and the long-term performance requirements on the exterior and interior by specifying the most appropriate construction products, such as fiberglass mat-faced gypsum board.

Healthcare buildings of all types are generally considered important and desirable facilities in communities for the health and well-being of the residents. Not only do they need to be centers for providing healthcare, but they also need to be designed and constructed to address the rigors of high use and the health and safety concerns of all the people who use the buildings. That includes attention not only to the design, but also to the materials and assemblies used in the building for durability, cleanliness, and hygiene. In particular, measures to reduce or inhibit the growth of mold and bacteria carry special importance. Similarly, interior spaces need walls and surfaces constructed to be durable and resistant to damage. Beyond routine operations, in-patient facilities in particular—such as hospitals, long-term care facilities, and rehab centers—often become “mission critical” buildings that must remain functioning during severe weather events or other types of natural disasters. While a lot of attention is paid to operations and emergency preparedness in those cases, the reality is that the building construction itself plays a significant role in the resiliency of healthcare facilities. In this course, we look at some of the current issues related to healthcare buildings and examine several methods for safeguarding against risks and damage to the roof, exterior skin, and interior walls in numerous healthcare projects.

RISK MANAGEMENT, DURABILITY, AND RESILIENCE

Healthcare building owners and operators typically have many different concerns about their buildings functioning safely. In addition to being able to perform the basic operations needed for patient care, whether direct services or support services, there is an ongoing need for the facility to be clean and free of any potentially harmful conditions. While the positive motivation here is to focus on providing excellent care, there is always a need to mitigate risk to protect patients and staff from any adverse consequences.

Image courtesy of Facility Guidelines Institute

The Facility Guidelines Institute provides a set of industry standards for the design of Hospitals, Outpatient Facilities, and Residential Health Care and Support Facilities.

The design or renovation of healthcare facilities plays directly into the need for safety, cleanliness, and mitigated risk of these buildings. They need to be designed not only to function well, but also to have materials specified and properly installed that work and look good when first put into use, but also hold up over time. That means they must withstand whatever might get thrown at them. On the exterior, healthcare buildings need weather resistance that holds up in extreme conditions to keep out unwanted water and wind. This resilience could mean the difference between remaining operational or shutting down, all or part of a facility, during an emergency or disaster event—a time when healthcare facilities are needed most. Inside, surfaces need to be durable enough to resist use from multiple people (i.e., patients, staff, cleaning crews, maintenance teams, etc.) and the necessary equipment and cleaning products. In all cases, all healthcare functions must be maintained—including those for rooms with air pressure that is higher or lower than most of the other rooms (i.e. patient rooms, operating rooms, etc.)

In addition to designing for durability and resiliency, the building itself must not create or contribute to any additional risk to patients or staff. For patient care settings, that means that the building construction needs to avoid using any materials known to be harmful to health or safety. Further, materials must not contribute to the creation of harmful conditions, such as the development of mold or mildew. This is a very common and pervasive concern since buildings often provide conditions conducive to mold and mildew growth. Those conditions include a moderate temperature (i.e. room temperature), the presence of water (either as airborne vapor/moisture or bulk water), and organic materials such as wood or paper that act as food stocks for mold growth.

Healthcare Design Standards

Architects, construction professionals, and building owners and operators have some great resources available to help address these concerns, particularly related to moisture, mold, and related health impacts, when designing facilities. Some of these are:

• The Joint Commission: This is perhaps the best-recognized organization for accrediting and certifying healthcare facilities. Their stated focus is on enabling and empowering healthcare organizations around the world to build a foundation for quality care and patient safety. Their website (jointcommission.org) indicates that they have accredited and certified over 22,000 healthcare organizations in over 70 countries around the world. They also offer a wealth of resources with over 2,000 available to support patient safety and care quality.

A significant part of accrediting a facility is based on the building design and construction, including renovations which are omnipresent in healthcare. In that light, the Joint Commission has prioritized infection control and sustainability as significant aspects for architects to address. That includes attention to indoor environmental quality issues that contribute to the safety and health of patients, staff, and visitors, as well as the general well-being of all who are in the facility.

Among other things, the Joint Commission has specific guidelines for facilities to manage their environment during demolition, construction, or renovation to reduce risk to the people in the facilities. Beyond state rules and regulations, they reference the Facilities Guidelines Institute for Design and Construction of Healthcare Facilities, and ANSI/ASHRAE/ASHE Standard 170 – “Ventilation of Healthcare Facilities. These guidelines state that the installation of clean materials (i.e., ductwork, drywall, wood/paper/fabric materials) that have not been damaged by water is paramount to mitigating risk.

• The Facility Guidelines Institute: This organization is referenced by the Joint Commission, specifically for their published guidelines on the design and construction of three different types of healthcare facilities: 1.) Hospitals 2.) Outpatient Facilities and 3.) Residential Health, Care, and Support Facilities (https://shop.fgiguidelines.org/). These publications are the most widely recognized standard for planning, designing, and constructing health and residential care facilities. The Guidelines address programming, space usage, risk assessment, infection prevention, architectural detail, surface, built-in furnishing, and building system requirements all in a singular place. State and federal agencies use these guidelines to regulate new construction and major renovations of health and residential care facilities.

The guidelines have a wide variety of public and private uses, including adoption by states for regulatory purposes and reference in laws, codes, rules, and regulations. They are also used for the promotion of safe practices and methods in the planning, design, and construction of various types of healthcare facilities. As such, they are directly concerned with details of durability, safety, and patient protection in the ways that walls, roofs, and other building assemblies are designed and constructed.

• National Institutes of Health (NIH):At the Federal level, the National Institutes of Health has published a 2023 manual of “Moisture and Mold Remediation Standard Operating Procedures.” This document recognizes that “the presence of excessive moisture in buildings has been linked with occupant illnesses and deterioration of building material.” Specifically, they see the linkage to the creation of mold within healthcare buildings as the primary problem. While they indicate that there are currently no federal regulations for airborne concentrations of mold spores, they do cite two standards that are the basis for the NIH Mold and Water Intrusion Program - ANSI/IICRC S500-2021, Standard and Reference Guide for Professional Water Damage Restoration and ANSI/IICRC S520-2015, “Standard for Professional Mold Remediation.” Regarding acceptable moisture levels for selected building materials, gypsum wallboard is listed at 7-10 percent before it needs to be replaced.
• Green Building Design: The movement is still very strong to continue designing new and renovated healthcare facilities that address not only general environmental concerns but also the health and wellness issues of people related to their time spent inside these facilities. This is true for patients, staff, visitors, and any others who spend time in the buildings. Toward that end, there are several well-known and common strategies.

The LEED Green Building Rating System is still the best-known and most widely used basis for sustainable buildings. There are versions specifically dedicated to hospital design that address the particular needs of these facilities. It also recognizes other related standards as a basis for LEED certification, including the WELL standard which has become a premier methodology for addressing human wellness in buildings. All of these are based on strategies of design and the selection of materials, products, and systems that enhance human health, safety, and well-being.

• Material and Product Standards: When it comes to the specific materials or products used in healthcare facilities, there are several strategies and organizations that are helpful. While LEED and other organizations use Environmental Product Declarations (EPDs) as a basis for assessing the environmental impacts of different materials, there are also Health Product Declarations (HPD) that follow the protocols established by the HPD Collaborative (HPDC). These independently verified analyses of the components of construction materials provide a basis for designers to assess different products for any potential health risks or ability to mitigate concerns. This information can be used to contribute to LEED certification or other certifications required through the Joint Commission or following the FGI standards.