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IT INFRASTRUCTURE

The computerization of medical care is forcing a re-evaluation of the overall importance of information-technology (IT) infrastructures in medical facilities. In many facilities, there are no central-server systems integrating patient, radiological, laboratory, outpatient, emergency-room, maintenance, and operational records. Most of these are stand-alone systems requiring diverse protocols that cannot be incorporated into a single control unit.

Computerized controls for most systems often are installed by multiple vendors and cannot interact. Control modules/boards require continuous 24/7 cooling with backup to prevent overheating and burnout. Their shelf life is short — approximately three years — and they are expensive to replace if they burn out prematurely. Revenue losses occur if the equipment being controlled is inoperable because of board failure.

During the IT-space-planning process, the design must include adequate space for the equipment that will provide overall cooling. Then, the needs of individual pieces of IT equipment within the space must be met. IT equipment will have different cooling parameters than the overall space in which it resides. The space also must allow for inevitable future increases in computer servers and controllers.

INFECTION CONTROL

Controlling hospital infection rates during demolition and construction phases must be a key element of the design process. Interacting with the facility's infection-control group will be necessary to understand the extent of infection control needed. The architect/engineer design team must maintain and monitor acceptable indoor-air quality on a continuous basis during the construction phase.

The American Institute of Architects, the Centers for Disease Control, and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) have issued guidelines on this topic for patient areas. JCAHO has made the guidelines, which can be found in JCAHO Environment of Care Standard 1.7, Utility Systems Management, mandatory for their accreditation process. When carefully considered and implemented, the guidelines protect construction workers, hospital staff members, and patients.

ENVIRONMENTAL CONSIDERATIONS

The architect and engineers should base their design approach on system sustainability and incorporate energy-conservation measures that are appropriate in terms of cost and carbon-footprint reduction. The design also should be measured against the Leadership in Energy and Environmental Design (LEED) Green Building Rating System to determine if a LEED rating can be earned.

CODE ANALYSIS

The proposed solution — be it renovation or new construction — should be examined for compliance with applicable codes and regulations. The analysis should include the fire rating of the building and its materials; emergency egress; fire stairs and their allowable distances; seismic bracing; floor-loading capacity; emergency power, lighting, and distribution; fire-standpipe and sprinkler systems; fire-alarm and notification systems with accompanying shutdowns; smoke-evacuation systems; stair and building pressurization; ventilation requirements; infectious-disease control; air filtration and distribution; patient evacuation; and structural compliance.

When the project has been completed, a certificate of occupancy will be requested from the project's assigned jurisdiction official. The official will need proof of compliance with these requirements prior to signing off on a certificate of occupancy.

FINAL ANALYSES

The architect and engineers should prepare estimates of cost and construction duration for existing-building renovation and new-building construction. The estimates should be based on the owner's requirements at the conceptual-design level. A life-cycle-cost analysis, including energy usage, also should be prepared for both scenarios. Finally, both options should be analyzed for staffing efficiency and movement, patient care and movement, maintenance, operation, and facility housekeeping, as well as the cost implications of each.

CONCLUSION

The final decision to renovate or build inevitably will be the result of a series of compromises caused by the conflicting needs of the different constituents who will occupy the building. The key is to fully understand the compromises made and their impacts on the building's long-term use. The owner then can make a reasonable decision based on construction cost, time to market, and life-cycle operating and functionality costs.

The senior mechanical engineer for DLB Associates Consulting Engineers, William J. Dunne, PE, received a bachelor's degree in engineering from University College Dublin and a master's degree in business administration from New York University. He has extensive experience in health-care, education, industrial, and commercial projects. Joshua Burdick, AIA, LEED AP, is the president of SBLM Architects. He has a bachelor's degree from the University of Bridgeport and is a member of the Royal Institute of British Architects, the Royal Architectural Institute of Canada, the Construction Specifications Institute, the National Trust for Historic Preservation, and Building Officials and Code Administrators International.