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Canadian health care facilities
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Technical Committee on Health Care Facility Engineering and Physical Plant
Subcommittee on the Design and Construction of Health Care Facilities
Preface
1.1 General
1.2 Exclusions
1.3 Terminology
3.1 Definitions
3.2 Abbreviations
4.1 Planning and design principles
4.2 Operations
4.2.1 Clinical functionality
4.2.2 Environment of care
4.3 Accessibility
4.3.1 General
4.3.2 Functional requirements
4.3.3 Reconciliation of competing principles
4.4 Safety and security
4.5 Infection prevention and control
4.5.1 General
4.5.2 Objectives
4.5.3 Inpatient bedrooms
4.5.4 Patient treatment places
4.5.5 Construction considerations
4.6 Sustainability
4.6.1 General
4.6.2 Flexibility
4.6.3 Total life cycle cost
5.1 Initial planning
5.1.1 Project process
5.1.2 Initial assessment
5.1.3 Role review
5.1.4 Master program
5.1.5 Master plan and assessment
5.1.6 Functional program
5.1.7 Furniture and equipment planning
5.1.8 Complementary plans
5.1.9 Test fit
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5.1.10 Operational model
5.1.11 Site evaluation
5.1.12 Existing infrastructure assessment
5.2 Design
5.2.1 Schematic design
5.2.2 Design development
5.2.3 Work planning
5.2.4 Mock-ups
5.2.5 Contract documents
5.2.6 Classification of areas
5.3 Procurement and construction
5.3.1 General
5.3.2 Risk management planning and mitigation
5.3.3 Phase planning
5.3.4 Qualification of contractors and construction personnel
5.3.5 Contractor orientation
5.3.6 Infection prevention and control
5.3.7 Noise and vibration management
5.3.8 Dust and odour mitigation
5.3.9 Service tie-ins and shutdown coordination
5.3.10 Site access management
5.3.11 Stop work process
5.3.12 Signage
5.3.13 Temporary provisions for life safety and emergency response
5.3.14 Coordination and interferences
5.3.15 Change management
5.3.16 As-built documentation
5.4 Commissioning
5.4.1 General
5.4.2 Operational commissioning
5.5 Take-over and occupancy
5.5.1 General
5.5.2 Take-over
5.5.3 Occupancy
5.6 Post-occupancy evaluation (POE)
6.1 Site requirements
6.1.1 General
6.1.2 Site design criteria
6.1.3 Site entry points
6.1.4 Site circulation
6.1.5 Pedestrian circulation
6.1.6 Vehicular circulation
6.1.7 Building entrance criteria
6.1.8 Parking
6.1.9 Wayfinding
6.1.10 Outdoor spaces
6.1.11 Utility services
6.1.12 Emergency exterior decontamination area
6.1.13 Environmental controls
6.1.14 Future expansion
6.2 Facility requirements
6.2.1 Building form and function
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6.2.2 Wayfinding
6.2.3 Future expansion — Internal
6.3 Key relationships and dependencies
6.3.1 General
6.3.2 Medical/surgical inpatient care
6.3.3 Critical care
6.3.4 Maternal and newborn care
6.3.5 Mental health and addiction services
6.3.6 Pediatric and adolescent inpatient care
6.3.7 Rehabilitation care
6.3.8 Inpatient continuing care
6.3.9 Ambulatory care — General
6.3.10 Ambulatory care — Renal dialysis
6.3.11 Ambulatory care — Oncology
6.3.12 Emergency care
6.3.13 Procedures
6.3.14 Allied health services
6.3.15 Laboratory services
6.3.16 Electrodiagnostic services
6.3.17 Respiratory services
6.3.18 Medical imaging
6.3.19 Pharmacy
6.3.20 Biomedical engineering
6.3.21 Environmental services
6.3.22 Nutrition and food services
6.3.23 Materials management
6.3.24 Plant maintenance
6.3.25 Security and parking
6.3.26 Medical device reprocessing
6.3.27 Building entry and parking
6.3.28 Heliport
6.3.29 Exterior garden/therapy area
6.3.30 Main entry and lobby
7.1 Planning
7.2 Materials and finishes
7.2.1 General
7.2.2 Surfaces
7.2.3 Doors and door frames
7.2.4 Windows
7.3 Furniture, fittings, and equipment
7.4 Technology and communications systems
7.5 Infection prevention and control
7.5.1 General
7.5.2 Separation of patients
7.5.3 Mechanical systems and equipment
7.5.4 Materials and finishes
7.5.5 Airborne isolation rooms
7.5.6 Waste management
7.5.7 Human waste management
7.5.8 Segregation of sterile, clean, and soiled items
7.5.9 Medical device reprocessing
7.5.10 Surveillance and information systems
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7.5.11 Hand hygiene facilities
7.5.12 Scrub sinks
7.6 Occupational health and safety
7.6.1 General
7.6.2 Biologics safety
7.6.3 Chemical safety
7.6.4 Safety from physical hazards
7.6.5 Safety from nuclear agents
7.6.6 Ergonomics
7.7 Safety and security
7.7.1 General safety and security considerations
7.7.2 Design elements to enhance security
7.7.3 Electronic and staff security elements
7.7.4 Design measures to enhance physical safety
7.7.5 Emergency management
7.7.6 Privacy, confidentiality, and patient dignity
7.8 Accessibility
7.8.1 General
7.8.2 Site access
7.8.3 Building access and circulation
7.8.4 Lighting
7.8.5 Furnishings and layout
7.8.6 Amenities and specialty areas
7.8.7 Signage
7.8.8 Accommodation of bariatric persons
7.9 Catastrophic event management
7.9.1 General
7.9.2 Prevention and controls
7.9.3 Command centre
7.9.4 Areas of refuge
7.9.5 Operational timeframe
7.9.6 Redundancy
7.9.7 Surge capacity
7.9.8 Emergency care
7.9.9 Extended periods
7.10 Flexibility and adaptability
8.1 Medical/surgical inpatient
8.1.1 Description
8.1.2 Functional requirements
8.1.3 Technical requirements
8.1.4 Space details
8.2 Critical care
8.2.1 Description
8.2.2 Functional requirements
8.2.3 Technical requirements
8.2.4 Space details
8.3 Maternal and newborn
8.3.1 Description
8.3.2 Functional requirements
8.3.3 Technical requirements
8.3.4 Space details
8.4 Mental health and addiction services
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8.4.1 General
8.4.2 Functional requirements
8.4.3 Technical requirements
8.4.4 Space details
8.5 Pediatric and adolescent
8.5.1 Description
8.5.2 Functional requirements
8.5.3 Technical requirements
8.5.4 Space details
8.6 Rehabilitation care
8.6.1 Description
8.6.2 Functional requirements
8.6.3 Technical requirements
8.6.4 Space details
8.7 Burn unit
8.7.1 Description
8.7.2 Functional requirements
8.7.3 Space details
8.8 Inpatient continuing care
8.8.1 Description
8.8.2 Functional requirements
8.8.3 Technical requirements
8.8.4 Space details
9.1 Ambulatory care — General
9.1.1 Description
9.1.2 Functional requirements
9.1.3 Technical requirements
9.1.4 Space details
9.2 Ambulatory care — Dialysis
9.2.1 Description
9.2.2 Functional requirements
9.2.3 Technical requirements
9.2.4 Space details
9.3 Ambulatory care — Oncology
9.3.1 Description
9.3.2 Functional requirements
9.3.3 Technical requirements
9.3.4 Space details
9.4 Emergency care
9.4.1 Description
9.4.2 Functional requirements
9.4.3 Technical requirements
9.4.4 Space details
9.5 Procedures
9.5.1 Description
9.5.2 Functional requirements
9.5.3 Technical requirements
9.5.4 Space details
9.6 Allied health services
9.6.1 Description
9.6.2 Functional requirements
9.6.3 Technical requirements
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9.6.4 Space details
9.7 Clinical laboratory
9.7.1 Description
9.7.2 Functional requirements
9.7.3 Technical requirements
9.7.4 Space details
9.8 Electrodiagnostic services
9.8.1 Description
9.8.2 Functional requirements
9.8.3 Technical requirements
9.8.4 Space details
9.9 Respiratory services
9.9.1 Description
9.9.2 Functional requirements
9.9.3 Technical requirements
9.9.4 Space details
9.10 Medical imaging
9.10.1 Description
9.10.2 Functional requirements
9.10.3 Technical requirements
9.10.4 Space details
9.11 Pharmacy
9.11.1 Description
9.11.2 Functional requirements
9.11.3 Technical requirements
9.11.4 Space details
10.1 Biomedical engineering
10.1.1 Description
10.1.2 Functional requirements
10.1.3 Technical requirements
10.2 Environmental services
10.2.1 Description
10.2.2 Functional requirements
10.2.3 Technical requirements
10.2.4 Occupational health and safety
10.3 Nutrition and food services
10.3.1 Description
10.3.2 Functional requirements
10.3.3 Technical requirements
10.4 Materials management
10.4.1 Description
10.4.2 Functional requirements
10.4.3 Technical requirements
10.5 Plant maintenance
10.5.1 Description
10.5.2 Functional requirements
10.5.3 Space details
10.5.4 Technical requirements
10.6 Security and parking
10.6.1 Description
10.6.2 Functional requirements
10.6.3 Technical requirements
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10.6.4 Space details
10.7 Medical device reprocessing
10.7.1 Description
10.7.2 Functional relationships
10.7.3 Space details
10.7.4 Unique requirements
12.1 General
12.2 Architectural systems
12.2.1 Envelope
12.2.2 Ceilings and clearances
12.2.3 Doors
12.2.4 Windows
12.2.5 Finishes
12.2.6 Elevators
12.2.7 Acoustics and vibration
12.3 Structural systems
12.3.1 General
12.3.2 Structure
12.3.3 Design loads
12.3.4 Vibration control
12.4 Mechanical systems
12.4.1 General
12.4.2 Heating, ventilation, and air conditioning (HVAC) systems
12.4.3 Plumbing systems
12.4.4 Medical gas systems
12.4.5 Fire protection
12.4.6 Commissioning
12.4.7 Redundancy
12.4.8 Essential electrical systems
12.4.9 Equipment access
12.4.10 Sustainability
12.4.11 Pneumatic tube transport systems
12.4.12 Other robotic transportation systems
12.4.13 Catastrophic events management
12.5 Electrical systems
12.5.1 General
12.5.2 Lighting
12.5.3 Fire alarm
12.5.4 Nurse call systems
12.5.5 Transformer noise and vibration
12.5.6 Device back boxes
12.5.7 Conduit
12.6 Information technology
12.6.1 General
12.6.2 Structured cabling (voice/data cabling)
12.6.3 Data centre
12.6.4 Wireless
12.6.5 Network equipment
12.7 Security systems
12.7.1 General
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12.7.2 Access control system
12.7.3 Closed circuit video surveillance
12.7.4 Intrusion detection
12.7.5 Staff emergency assistance alarm systems
12.7.6 Patient wandering
12.7.7 Infant protection
12.7.8 Other systems
(informative) — Bibliography
(informative) — HCF examples by class
(informative) — Site assessment checklist
— Key relationships and dependencies
— Medical/surgical inpatient care — Important relationships
— Critical care — Essential relationships
— Critical care — Important relationships
— Maternal and newborn care — Essential relationships
— Maternal and newborn care — Important relationships
— Mental health and addiction services — Essential relationships
— Mental health and addiction services — Important relationships
— Pediatric and adolescent inpatient care — Essential relationships
— Pediatric and adolescent inpatient care — Important relationships
— Rehabilitation care — Essential relationships
— Rehabilitation care — Important relationships
— Inpatient continuing care — Important relationships
— General ambulatory care — Important relationships
— Renal dialysis ambulatory care — Important relationships
— Oncology ambulatory care — Essential relationships
— Oncology ambulatory care — Important relationships
— Emergency care — Essential relationships
— Emergency care — Important relationships
— Procedures — Essential relationships
— Procedures — Important relationships
— Allied health services — Important relationships
— Laboratory services — Essential relationships
— Laboratory services — Important relationships
— Electrodiagnostic services — Important relationships
— Respiratory services — Important relationships
— Medical imaging — Essential relationships
— Medical imaging — Important relationships
— Pharmacy — Essential relationships
— Biomedical engineering — Important relationships
— Environmental services — Important relationships
— Nutrition and food services — Important relationships
— Materials management — Essential relationships
— Materials management — Important relationships
— Plant maintenance — Important relationships
— Security and parking — Essential relationships
— Security and parking — Important relationships
— Medical device reprocessing — Essential relationships
— Medical device reprocessing — Important relationships
— Building entry and parking — Essential relationships
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— Building entry and parking — Important relationships
— Heliport — Essential relationships
— Exterior garden/therapy area — Essential relationships
— Exterior garden/therapy area — Important relationships
— Main entry and lobby — Important relationships
— Minimum distances for inpatient and critical care beds
— Inpatient bedrooms
— Critical care
— Maternal and infant care
— Mental health and addiction services
— Pediatric and adolescent
— Rehabilitation care
— Burn treatment services
— Inpatient continuing care
— Ambulatory care — General
— Ambulatory care — Dialysis
— Ambulatory care — Oncology
— Emergency care
— Procedures
— Allied health
— Clinical laboratory
— Electrodiagnostic services
— Respiratory services
— Medical imaging
— Pharmacy
— Medical device reprocessing
— Recommended size of reprocessing areas, m2
— Illuminating Engineering Society of North America (IES) recommended illuminance levels for
work environments
— Common area requirements
— Wall sound transmission class (STC) requirements for various room types
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St. Michael’s Hospital,
Toronto, Ontario
Teegor Consulting Inc.,
Fredericton, New Brunswick
R.J. Burnside and Associates Ltd.,
Wasaga Beach, Ontario
The Mitchell Partnership Inc.,
Toronto, Ontario
Ministère de la Santé et des Services sociaux,
Québec, Québec
R Tec Consulting,
Toronto, Ontario
Alberta Infrastructure,
Calgary, Alberta
Toronto, Ontario
Ontario Ministry of Health and Long Term Care,
Toronto, Ontario
Niagara Health System,
Burlington, Ontario
Lunenburg, Nova Scotia
QuadraTec Inc.,
St. John’s, Newfoundland and Labrador
Fredericton, New Brunswick
Manitoba Health,
Winnipeg, Manitoba
H.H. Angus & Associates Ltd.,
Toronto, Ontario
Newfoundland Department of Health and
Community Services,
St. John’s, Newfoundland and Labrador
Canadian Standards Association,
Mississauga, Ontario
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Ain Allas (1952–2009)
The Technical Committee on Health Care Facility Engineering and Physical Plant and the Subcommittee on
the Design and Construction of Health Care Facilities wish to acknowledge the tremendous contribution
of the late Ain Allas towards the development of this Standard. Ain was a strong and dedicated supporter
from the very beginning of the project, and in his role as Subcommittee Chair was instrumental in
recruiting facility designers, engineers, health care professionals, and provincial/territorial government
representatives. His contributions continued over the next several years as he led the committee through
the monumental task of creating a new HCF design and construction standard. The sudden loss of Ain
Allas in January 2009 was a shock to everyone involved in this project. We greatly appreciate all that he did
to make this Standard a reality.
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St. Michael’s Hospital,
Toronto, Ontario
Resource Planning Group Inc.,
Vancouver, British Columbia
Teegor Consulting Inc.,
Fredericton, New Brunswick
H.H. Angus & Associates Ltd.,
Toronto, Ontario
Agnew Peckham and Associates,
Toronto, Ontario
Honeywell Building Solutions,
Lachine, Québec
Kasian Architecture Interior,
Vancouver, British Columbia
University of Western Ontario,
London, Ontario
R&C Dixon Consulting Ltd.,
Vancouver, British Columbia
Ministère de la Santé et des Services sociaux,
Québec, Québec
Alberta Infrastructure,
Calgary, Alberta
Alberta Infrastructure,
Edmonton, Alberta
Ontario Ministry of Health and Long-Term Care,
Toronto, Ontario
Stantec Consulting,
Vancouver, British Columbia
University of California,
San Francisco, California, USA
Lunenburg, Nova Scotia
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Canadian Society of Physician Executives,
Kelowna, British Columbia
Stantec Architects Ltd.,
Toronto, Ontario
Fredericton, New Brunswick
Alberta Health Services,
Edmonton, Alberta
Manitoba Health,
Winnipeg, Manitoba
North Bay General Hospital,
North Bay, Ontario
Parkin Architects Limited,
Toronto, Ontario
Fraser Health,
Providence Health Care,
Provincial Health Services Authority,
Vancouver Coastal Health,
Vancouver, British Columbia
Marsh Canada Limited,
Toronto, Ontario
The Ottawa Hospital,
Ottawa, Ontario
Newfoundland Department of Health and
Community Services,
St. John’s, Newfoundland and Labrador
British Columbia Ministry of Health Services,
Victoria, British Columbia
Resource Planning Group, Inc.,
Toronto, Ontario
Alberta Health Services,
Edmonton, Alberta
ORNAC,
Hamilton, Ontario
Canadian Standards Association,
Mississauga, Ontario
The Subcommittee also thanks N. Hallett of the Newfoundland Department of Health and Community
Services for her contributions to the development of this Standard.
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This is the first edition of CSA Z8000, .
CSA acknowledges that the development of this Standard was made possible, in part, by the financial
support of the governments of Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and
Labrador, Northwest Territories, Nova Scotia, Nunavut, Ontario, Prince Edward Island, Quebec,
Saskatchewan, and Yukon, as administered by the Canadian Agency for Drugs and Technologies in
Health (CADTH).
This Standard was prepared by the Subcommittee on the Design and Construction of Health Care
Facilities, under the jurisdiction of the Technical Committee on Health Care Facility Engineering and
Physical Plant and the Strategic Steering Committee on Health Care Technology, and has been formally
approved by the Technical Committee.
CSA Policy governing standardization — Code of
good practice for standardization
CSA Directives and guidelines governing
standardization Info Update
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0 Introduction
0.1
This Standard provides requirements and guidance for the planning, design, and construction of Canadian
health care facilities. It is intended to be used by all facilities providing health care services regardless of
type, size, location, or range of services. This Standard was developed for use by architects, engineers,
planning and project managers, contractors and builders, commissioning teams, facility managers,
maintenance managers, infection prevention and control personnel, and other health care professionals.
0.2
This Standard was developed to provide a consistent methodology and practical requirements for health
care facilities (HCFs) across the country, to achieve the following benefits:
(a) establish a common standard that Canadian authorities can adopt and enforce within their
jurisdictions;
(b) share best practice between provinces and regions, and between larger and smaller facilities;
(c) promote consistency in the physical layout of Canadian facilities, thereby increasing operational
efficiency and helping to reduce the risk of error by newly hired or visiting staff from other facilities;
(d) enhance facility operational efficiency, optimize quality of service delivery, and maintain high levels of
worker and patient health and safety; and
(e) provide a common terminology and design approach, to improve communication between the
organizations and individuals involved in HCF design and construction, to reduce construction errors,
and to facilitate the movement of knowledge and skilled tradespeople between regions.
0.3
This Standard was developed to complement existing standards and codes by providing a set of
overarching requirements for HCFs, and referencing out to specific standards and codes as appropriate. In
this way, it can serve as a central resource for planners, architects, engineers, health care administrators,
and contractors.
0.4
This Standard contains a comprehensive and coordinated set of requirements, references, and guidelines
that apply to all aspects of the built environment for health care service delivery. Because of the complexity
of HCFs, the requirements that apply to a particular element of the HCF can appear in different places
within the document. Therefore this Standard is meant to be used in its entirety, and not as a step-by-step
manual.
0.5
As a design and construction standard, this Standard does not specify requirements for operational
models, policies, procedures, etc. Those elements are addressed in other standards, guidelines, and
accreditation tools provided by CSA and other organizations such as Accreditation Canada,
Provincial/Territorial governments, and the professional colleges and licensing bodies. This Standard
complements these other standards, guidelines, and tools by providing an environment that supports the
operational model and management structure that will be used in the HCF. The following principles and
objectives were considered throughout the development of this Standard:
(a) alignment with Provincial, Federal, or Territorial Ministries of Health and their specific governmental
policy directives;
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(b) promotion of patient and family-centred care and the elements of respect, information sharing,
participation, and collaboration;
(c) integration of guiding principles into the development of technical and functional programs;
(d) ensuring feasibility and flexibility to meet future trends and changes in services and technologies;
(e) promotion of environmentally responsible design including acoustics, lighting, air quality,
bio-hazardous waste removal, and energy usage alterations that do not compromise patient care or
needs;
(f) incorporation of ergonomics and human factors into all aspects of the HCF as it relates to the patient,
clinical providers, other staff, and the general public at large (there is particular emphasis on privacy,
confidentiality, safety, supportive workplace features, and effective operational requirements);
(g) inclusivity for people of different values, beliefs, and cultural backgrounds, as well as those who face
physical, psychological, or other health-related challenges; and
(h) facilitation of long-term, sustainable service delivery for capital and operational expenditures using
life cycle costing.
0.6
This Standard is structured to follow a consistent, modular approach to HCF design. It can apply to the
development of an entire HCF or to components within an HCF that are undergoing renovation or new
construction. This Standard is organized as follows:
(a) Clauses 1 to 3 — Scope, reference publications, and definitions.
(b) Clause 4 — Provides the overarching principles, general requirements, and guidance that apply to all
areas of an HCF that is being developed or renovated, such as general program considerations,
operations, environment of care, safety and security, infection prevention and control, and
sustainability.
(c) Clause 5 — Planning process, outlines the key planning considerations early in the
design/construction process recognizing the variability of factors that would impact the service
delivery models. This Clause specifically addresses pre-design planning, design, construction, building
commissioning, and operational commissioning.
(d) Clause 6 — Site and facility development, reviews the key generic external considerations for site
development and building development. It also highlights the critical functional adjacencies within
an HCF, both for clinical and support services.
(e) Clause 7 — General functional service requirements, outlines the generic design and construction
considerations as they relate to the overall functioning of an HCF, including building services
requirements, environmental considerations, infection prevention and control, materials and finishes,
occupational health and safety, safety and security, technology considerations, furniture, fittings, and
equipment.
(f) Clause 8 — Inpatient and related services, highlights the specific key requirements for inpatient areas,
and in some cases for outpatient facilities that are part of a continuum of care. These areas include
(i) critical care;
(ii) maternal and newborn;
(iii) medical surgical inpatient;
(iv) mental health services;
(v) pediatric and adolescent inpatient; and
(vi) rehabilitation care.
The list of functional service areas is not meant to be exhaustive.
(g) Clause 9 — Diagnostic and treatment functional service requirements, highlights specific key
requirements for diagnostic/treatment functional services. These areas include
(i) ambulatory care — general;
(ii) ambulatory care — renal dialysis;
(iii) ambulatory care — oncology;
(iv) emergency care;
(v) procedures;
(vi) allied health;
(vii) laboratory services;
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(viii) electrodiagnostics;
(ix) respiratory services;
(x) medical imaging; and
(xi) pharmacy.
(h) Clause 10 — Support functional service requirements, highlights supporting services within an HCF
including biomedical engineering, environmental services, nutrition and food services, materials
management, plant maintenance, security and parking, and medical device reprocessing.
(i) Clause 11 — Common requirements, provides a table of common spaces across an HCF and, where
appropriate, it provides minimum sizes for these areas.
(j) Clause 12 — Building services and environmental design, gives an overview of the engineering and
architectural systems that are specific to HCFs.
0.7
This Standard includes notes for additional support and guidance to users, and to provide further detail or
rationales on requirements where needed.
The goal of this Standard is to ensure that the outcomes of those under the care of an HCF are improved
where design and construction can assist with these outcomes. To achieve this requires a focus not only on
safety and efficiency, but also on the impacts of the physical environment and atmosphere on the care
outcome. Using the available knowledge in evidence-based design as outlined in this Standard, HCFs can
create a physical environment that promotes positive health outcomes, quicker recovery, a reduction in
medical errors, and the recruitment and retention of valued caregivers.
1 Scope
1.1 General
1.1.1
This Standard describes essential elements and specific requirements for the planning, design, and
construction of health care facilities (HCFs), both public and private. It applies to all facilities providing
health care services regardless of type, size, location, or range of services, including
(a) acute care hospitals;
(b) inpatient continuing care hospitals;
(c) long-term care facilities;
(d) community-based providers;
(e) leased/rental suites in office buildings;
(f) ambulatory care clinics; and
(g) outpatient care (e.g., clinics, dentists’ offices, and doctors’ offices).
Canadian Electrical Code, Part I
(CEC), National Building Code (NBC), National Plumbing Code (NPC), National Fire Code (NFC)
1.1.2
This Standard applies to new facilities and to existing facilities undergoing addition or renovation.
1.1.3
This Standard includes requirements for
(a) planning and design principles, and the planning process;
(b) site and facility development;
(c) general functional service;
(d) inpatient functional service;
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(e) diagnostic and treatment functional service;
(f) support functional service;
(g) common requirements for all facilities; and
(h) building services and environmental design.
1.2 Exclusions
1.2.1
This Standard does not apply to veterinary facilities, funeral homes, or mobile health units.
1.2.2
This Standard does not address clinical practice.
1.2.3
This Standard does not include requirements for operation and maintenance of an HCF.
1.2.4
This Standard does not specify requirements for operational models, policies, and procedures.
1.3 Terminology
In CSA standards, “shall” is used to express a requirement, i.e., a provision that the user is obliged to
satisfy in order to comply with the standard; “should” is used to express a recommendation or that which
is advised but not required; and “may” is used to express an option or that which is permissible within the
limits of the standard.
Notes accompanying clauses do not include requirements or alternative requirements; the purpose of a
note accompanying a clause is to separate from the text explanatory or informative material.
Notes to tables and figures are considered part of the table or figure and may be written as
requirements.
Annexes are designated normative (mandatory) or informative (nonmandatory) to define their
application.
2 Reference publications
This Standard refers to the following publications, and where such reference is made, it shall be to the
edition listed below. Additional resources not directly referenced in this Standard are listed in Annex A.
ASME A112.19.2-2008/CSA B45.1-08
CAN/CSA-B64 Series-07
ASME A17.1-2007/CSA B44-07
CAN/CSA-B651-04 (R2010)
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C22.1-09
C282-09
CAN/CSA-ISO 14971-07
CAN/CSA-ISO 26722-11
PLUS 317-2000
S478-95 (R2007)
Z32-09
Z275.1-05
CAN/CSA-Z305.8-03 (R2008)
Z305.12-06
Z305.13-09
CAN/CSA-Z314.2-09
Z314.3-09
CAN/CSA-Z314.8-08
CAN/CSA-Z314.9-09
Z314.10.2-10
Z314.14-10
Z314.15-10
Z316.5-04 (R2009)
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Z316.6-07
Z317.1-09
CAN/CSA-Z317.2-10
Z317.5-98 (R2007)
Z317.10-09
CAN/CSA-Z317.11-02 (R2007)
CAN/CSA-Z317.13-07
Z318.0-05 (R2010)
Z320-11
Z386-08
Z412-00 (R2005)
CAN/CSA-Z614-07
CAN/CSA-Z902-10
CAN/CSA-Z1000-06
Z1004 (under preparation)
Z1600-08
Z7396.1-09
CAN/CSA-Z10083-08
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CAN/CSA-Z60601 Series
ANSI/AAMI ST79:2010
Steel Design Guide Series 11 (1997)
2208:1996
(2002)
BS 6206:1981
(1998)
(1996)
(2007–08)
(2008)
GD-52 (2010)
2010)
SC 2000, c. 5
RSC 1985, c. p-21
RSO 1990, c. H. 2
RR. 1990, Reg. 543
RSO 1990, c. F. 31
(1999)
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62366:2007
802.1 series of Standards
802.3-2008
ANSI/IES RP-28-07
(2004)
Report No. 49 (1976)
Report No. 102 (1989)
10 (2010)
13 (2010)
14 (2010)
96 (2010)
99 (2005)
101 (2009)
701 (2010)
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2010
2010
2010
NSF/ANSI 49-2010a
(2006)
(2001)
(1998)
3rd ed. (2004)
“Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care”,
vol. 25S4(1999)
(2009 ed.)
TIA/EIA-568-B.1 (2001)
TIA/EIA-568-B.2 (2001)
TIA/EIA-568-B.3 (2000)
TIA/EIA-569-B (2004)
TIA-606-A (2007)
TIA-942 (2005)
ANSI/TIA-942-1 (2008)
TIA-942-2 (2010)
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CAN/ULC-S524-06
CAN/ULC-S537-04
3 Definitions and abbreviations
3.1 Definitions
The following definitions shall apply in this Standard:
— describing a site, building, and its facilities that can be approached, entered, and used by
all people, including those with physical, sensory, or cognitive disabilities.
— the use of extra measures for contact with a patient known to or suspected
to be infected or colonized with certain micro-organisms and based on the potential for transmission of
the micro-organism.
— a small room or space at the entrance to an AIR that is separated by doors from both
the outside and the main space in the AIR.
— a room that is designed, constructed, and ventilated to limit the
spread of airborne micro-organisms from an infected occupant to the surrounding areas of the HCF.
— clinical support services that work in conjunction with clinical care teams to
contribute to the patient’s health and well-being.
— a mode of delivering health care services on a same-day basis, not requiring
overnight hospitalization.
— a designation applied to an area in a health care facility to distinguish between
varying levels of risk.
— a patient care area where the invasiveness of procedures, the level of risk of morbidity and
mortality to the patient, and the level of risk of adverse outcomes to the care providers dictate that
more stringent HVAC and environmental parameters be met.
— a patient care area or an area that is intended for the provision of services that provide
direct support to patient care services (e.g., labs, central supply).
— all other support services not designated as Type I or II.
— a machine designed for the sole purpose of cleaning
and disinfecting endoscopes.
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— of or relating to persons with a body mass index greater than 30 or a weight above 182 kg.
— as applied to an area or service, having characteristics that allow it to be approached,
entered, and used by persons with physical or sensory disabilities.
— material that is potentially contaminated with viable micro-organisms (including prion
protein material) or toxins that under certain circumstances can cause disease or illness.
— waste generated within a health care that requires special handling and disposal
because it presents a particular risk of disease transmission.
— the sum of all building floor areas measured to the outside
face of exterior walls for all stories or areas having floor surfaces.
— persons who are normally present inside an HCF.
— a laboratory measured rating that describes the sound
transmission loss properties of a suspended ceiling system when installed in rooms with a common
plenum.
— a room, not associated with a single inpatient bedroom, containing a tub
or shower for the bathing of patients.
— a systematic verification, documentation, and training process applied to all activities
during the design, construction, static verification, start-up, and functional performance testing of
equipment and systems in an HCF to ensure that the HCF operates in conformity with the owner’s project
requirements and the basis of design in accordance with the contract documents.
— an organizational unit with a defined role within the health care facility.
— that portion of a building assigned to a specific
component, including net areas, internal circulation, partitions, building structure, and small mechanical
shafts.
— the building and/or completing of the structure and supporting elements of an HCF.
— construction to produce all or part of an HCF that did not exist prior to the
project.
— construction to modify or upgrade an existing HCF to be used for similar purposes.
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— a patient care area where the induction and maintenance of general anaesthesia
routinely occurs in connection with the examination or treatment of patients, or where cardiac contact
between a patient and medical electrical equipment is frequent or normal.
Canadian Electrical Code, Part I
— see .
— any degree of physical disability, infirmity, malformation, or disfigurement that is caused by
bodily injury, birth defect, or illness and includes, but is not limited to, diabetes mellitus, epilepsy, a brain
injury, any degree of paralysis, amputation, lack of physical coordination, blindness or visual impairment,
deafness or hearing impairment, muteness or speech impairment, or physical reliance on a guide dog or
other animal or on a wheelchair or other remedial appliance or device.
— see .
— one or more in-house electrical generator sets
intended to be available if all other supplies fail, and capable of supplying all of the essential loads.
— HCF services, e.g., general housekeeping, waste management, pest control,
and hazardous material cleanup.
— an electrical system that has the capability of restoring and sustaining a
supply of electrical energy to specified loads if the normal supply of energy is lost.
— the perimeter space around a building as well as naturally ventilated and lit atriums and
courtyards.
— an area within the HCF that is described by its function within the facility or by the
activities that take place there as part of the operation of the facility, e.g., inpatient bedrooms, critical care
units, ambulatory care areas.
— a planning document that defines the desired outcome for a building project,
informing both operating and capital cost estimates and providing the functional and spatial specifications
that provide the primary guide for the subsequent architectural design of a building.
— a sink dedicated exclusively for use by health care workers for the
purposes of hand hygiene only.
—
(a) physical injury or damage to the health of people; or
(b) damage to property or the environment.
— combination of the probability of occurrence of harm and the severity of that harm.
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— any material or substance that if handled improperly has the potential to harm
people, property, or the environment.
— a set of physical infrastructure elements supporting the delivery of
health-related services.
— an HCF in which patients are
(a) accommodated on the basis of medical need;
(b) provided with continuing medical care; and
(c) provided with supporting diagnostic and therapeutic services that can extend beyond 12 h.
Class A-1 HCFs fall into one of the following categories:
— HCFs designated by the authority having jurisdiction as a mission critical facility
including those HCFs designated as essential in infectious diseases outbreak management.
— HCFs that meet two of the following conditions:
(a) the HCF is an academic centre providing tertiary or quaternary services such as
transplantation, oncology, or trauma services;
(b) the HCF provides regional programs such as oncological, trauma, cardiac, dialysis,
pediatric, maternal, or newborn services;
(c) the expected travel time to a Class A-2 facility exceeds 1.0 h under normal driving
conditions; or
(d) the HCF is the sole provider of acute care health services to populations in excess of
500 000 people.
— HCFs that meet one of the requirements listed in Category 2 and
(a) provide programs or services that are not generally provided by other nearby HCFs; and
(b) include at least one of the following:
(i) rehabilitation hospital;
(ii) chronic patient care for hospitals with at least 200 licensed beds;
(iii) mental health facilities;
(iv) special rehabilitation services for persons with a disability;
(v) transplantation centres; or
(vi) continuing care centres for management of chronic diseases.
— an HCF
(a) in which patients are
(i) accommodated on the basis of medical need;
(ii) provided with continuing medical care; and
(iii) provided with supporting diagnostic and therapeutic services that can extend beyond
12 h; and
(b) that does not meet the Category 1, 2, or 3 requirements for a Class A-1 facility.
— an HCF in which patients, as a result of physical or mental disabilities, are unable to
function independently and are accommodated on the basis of medical need for constant care by
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health care professionals or the need for intensive therapies that require supervision by health care
professionals, but where interventional and other invasive procedures are not performed.
— an HCF in which ambulatory patients
(a) are accommodated on the basis of medical need;
(b) are provided with non-invasive medical services for diagnosis, treatment, or therapy; and
(c) stay for no more than 12 h (except for residential facilities in which occasional care is provided).
— the unit responsible, under the authority of an HCF governing board, for
planning, organizing, directing, and controlling the HCF in accordance with the policies and procedures of
the HCF, the policies of the HCF governing board, and applicable regulatory requirements.
— a large, floor-standing or wall-hung sink equipped with a flush valve and handle, for use in
disposing of body fluids and other substances that cannot be safely disposed of in a conventional sink or
toilet.
— a process used to identify design elements that increase
the risk of microbial transmission in the environment.
— an HCF patient who occupies a bed for at least one night in the course of treatment,
examination, or observation.
— a unit in the HCF specifically intended for the accommodation of inpatients.
— see .
— a document (or set of documents) that states how the HCF intends to move from its
current state to a desired future state as outlined in its strategic plan.
— a document (or set of documents) that translates the stated project parameters
(including key functional, physical, operational and financial parameters) into preliminary high level
physical accommodation and operational requirements.
— the activities performed to prepare a used medical device for
reuse.
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— electrical equipment that
(a) has only one connection to a particular supply main;
(b) is intended to diagnose, treat, or monitor a patient under medical supervision; and
(c) comes into physical or electrical contact with a patient, and/or transfers energy to or from a patient,
and/or detects energy transfer to or from a patient.
— the way in which pathogenic infectious particles are transmitted from the
reservoir to the host or susceptible patient, e.g., airborne contact.
— a ceiling constructed with a surface free of fissures, cracks, and crevices.
— the horizontal area of space assignable to a specific function.
— a rating that describes the sound absorptive properties of
architectural finishes and building materials.
— a patient, family member, caregiver, staff member, or visitor in an HCF.
— a medical procedure performed on an inpatient or outpatient in which at least
one incision through the skin or mucous membrane is made.
— a person who is waiting for or undergoing medical investigation, care, or treatment.
— an area used primarily for the provision of diagnosis, therapy, or treatment.
— items that when worn correctly form a barrier or shield
against hazardous materials.
— a structured approach for the evaluation of the performance of a
new or existing facility when it is fully operational and after at least 12 months of occupancy.
— a course of action, treatment, or care process.
— any liquid, gaseous, or solid material that contains a radioactive nuclear substance
as defined under applicable requirements and that the owner has declared to be waste.
— see .
— the probable rate of occurrence of a hazard causing harm and the degree of severity of the harm.
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— the approach to infection prevention and
control in which all human blood and body fluids are treated as if known to be infectious.
— an entry vestibule secured by two doors, where only one door can be opened at a time.
— a sink that is specifically intended for use by medical personnel prior to a procedure.
— a bowl and faucet permanently installed and connected to a water supply and drainpipe.
— areas that have an intended function in the design but can be used or converted
to another function in case of expansion or program changes.
— an alarm that can be activated by staff to request immediate
assistance.
— an area where patients undergo same-day diagnostic and/or surgical procedures,
which may include services for admission and post-operative care until discharge.
— a laboratory measured rating that describes the sound transmission
loss properties of a wall, floor, window, or door.
National Building Code
— water that is discharged from a surface as a result of rainfall or snowfall.
— person occupying or performing an activity in a building, area, or room intended for that purpose
(e.g., diagnosis, treatment, waiting, dining, etc.).
— a location that is equipped with a waterless (e.g., alcohol-based)
hand sanitizer dispenser.
— the use of infrastructure and design elements to help occupants
(a) orient themselves within an HCF; and
(b) get to their destinations.
3.2 Abbreviations
The following abbreviations shall apply in this standard:
ADL — activities for daily living
AFP — alternative financing and procurement
AIR — airborne isolation room
ALARA — as low as reasonably achievable
BAS — building automation systems
BE — biomedical engineering
BGSM — building gross square metres
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BPOC — bar coding to point-of-care
CAC — ceiling attenuation class
CACF — central alarm and control facilities
CBRN — chemical, biological, radiation, nuclear
CCTV — closed circuit television
CEPTR — counselling, examination, and procedure and/or treatment room
CGSM — component gross square metres
CMMS — computerized maintenance management system
CNC — computer numerical control
COW — carts on wheels
CPOE — computerized physician order entry
CPTED — crime prevention through environmental design
CRI — colour rendition index
CTAS — Canadian Triage and Acuity Scale
DBFM — design, build, finance, maintain
DI — diagnostic imaging
ECG — electrocardiograph
ECT — electroconvulsive therapy
EEG — electroencephalogram
EHR — electronic health records
ETO — ethylene oxide
FF&E — furniture, fittings and equipment
HCF — health care facility
HHS — hand hygiene sink
HVAC — heating, ventilation, and air conditioning
ICRA — infection control risk assessment
ICU — intensive care unit
LBR — labour/birthing room
LBRP — labour/birthing/recovery/postpartum
MDR — medical device reprocessing
MDRD — medical device reprocessing department
MSDS — material data safety sheet
NICU — neonatal intensive care unit
NRC — noise reduction coefficient
OH&S — occupational health and safety
OR — operating room
P3 — private partnerships
PACS — picture archiving communication system
PACU — post-anaesthetic care unit
PAS — patient administration system
PDU — photothermal detoxification unit
PET — positron emission tomography
PICU — psychiatric intensive care unit
POE — post-occupancy evaluation
PPE — personal protective equipment
QOS — quality of service
RCDD — registered communication distribution designer
RFID — radio-frequency identification
RFP — request for proposal
RO — reverse osmosis
RSO — radiation safety officer
SDCU — surgical day care unit
STC — sound transmission class
TMS — transcranial magnetic stimulation
TTY — teletypewriter
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VoIP — voice over Internet protocol
WHMIS — workplace hazardous materials information system
4 General
4.1 Planning and design principles
The health care facility (HCF) shall be planned and designed to serve its patients, families, staff, and visitors
in accordance with the following core principles:
(a) operations — creating an operating environment that promotes the efficient and effective delivery of
health care services, thereby helping to ensure positive patient outcomes;
(b) accessibility — creating an environment that facilitates the patient’s access to receiving care and the
caregiver’s ability to provide care;
(c) safety and security — creating an environment of care that is safe and secure for all occupants
(patients and their families, staff and visitors);
(d) infection prevention and control — creating an environment that is safe for all building occupants in
terms of the prevention of health care acquired infections and the control of infectious diseases; and
(e) sustainability — taking into account the sustainability of the construction process and the finished
building, and the sustainable operation of the HCF over time.
The design process for the HCF shall include activities to achieve specific objectives related to the core
(OASIS) principles, as specified in Clauses 4.2 to 4.6.
4.2 Operations
4.2.1 Clinical functionality
Planning and design shall focus on creating an operating environment that promotes the efficient and
effective delivery of health care services, thereby helping to ensure positive patient outcomes.
The planning and design of the HCF shall take into account the expected sequence of activities that will
take place in the facility and create an environment of care in which these activities can be performed
safely, effectively, and efficiently. The functional program shall be consulted at every stage of the planning
and design of the HCF (see Clause 5). The design shall incorporate balance between all flow processes
involving patients, visitors, and staff in the work environment. Clinical equipment and support services
(e.g., laundry, medication, food tray delivery) placement shall also be considered in the overall design.
4.2.2 Environment of care
4.2.2.1
The planning and design of the HCF shall support an environment of care that promotes safe and effective
treatment while respecting the personal and social needs of the patient. Design decisions shall be based
on available scientific evidence regarding patient outcomes and patient satisfaction.
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4.2.2.2
Environment of care components shall be addressed in the functional program (see Clause 5.1.6).
4.2.2.3
To promote a safe and effective environment of care, the HCF should be designed to achieve the following
objectives:
(a) reduced stress for patients and their families, visitors, and staff;
(b) maintenance of dignity, confidentiality, respect, and comfort at all levels;
(c) clustering of related services, to minimize transfers or walking between services;
(d) sensitivity to individual needs;
(e) universal access for all persons (see Clause 4.4);
(f) appropriate gender segregation;
(g) standardization of area design, furniture, fittings, and equipment where applicable to reduce the
possibility of staff errors;
(h) reduction of noise;
(i) sensitivity to the cultural beliefs and expectations of the expected patients where appropriate (e.g.,
selection of colours or materials that are associated with healing); and
(j) promotion of a healing environment through design and choice of materials for interior furnishings
and finishes.
4.3 Accessibility
4.3.1 General
4.3.1.1
The HCF shall be planned and designed to produce an environment that facilitates the patient’s access to
receiving care and the caregiver’s capacity to provide appropriate and effective care. The HCF shall be
designed so that people of all abilities are able, without modification to their normal conduct, to access
the services, work in the facility, use the facility, or assist staff in accomplishing their work.
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4.3.1.2
The HCF shall be designed so that staff can safely assist and serve patients of all abilities, including the
accommodation of assistive devices and other supporting elements.
4.3.1.3
The HCF shall be designed to adapt to the changing accessibility needs of patients and the possibility that
a patient who normally does not have a disability could experience a temporary disability because of
impairment due to an illness or to a medical or surgical condition.
4.3.1.4
The planning and design of HCFs shall comply with CAN/CSA-B651 and applicable requirements for
accessibility.
4.3.2 Functional requirements
4.3.2.1
The HCF shall be designed and constructed so as to minimize barriers to the normal activities of patients
and families, staff, and visitors with disabilities.
4.3.2.2
The HCF design should minimize hazards and the adverse consequences of accidental or unintended
actions for all occupants.
4.3.2.3
The planning process shall include a procedure to identify and resolve possible conflicts between the
accessibility needs of different user groups.
4.3.2.4
The HCF and all of its components should be simple and intuitive regardless of the user’s experience,
knowledge, language skills, or current concentration level. The HCF should be able to be used efficiently
and comfortably and with a minimum of fatigue by all users, regardless of ability.
4.3.2.5
All patient-occupied spaces should be designed for accessibility and ease of assistance by clinical staff.
Patient care equipment should allow for approach, reach, manipulation, and use regardless of the patient’s
body size, posture, or mobility.
4.3.3 Reconciliation of competing principles
Unless another health care principle can be shown to have a greater priority over making a space
accessible, accessibility should always be given priority in the planning and design of HCF spaces.
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4.4 Safety and security
The HCF shall be planned and designed to produce and environment of care that is safe and secure for
all occupants (patients, staff, and visitors). The planning and design of the HCF shall include provisions for
achieving the following objectives related to the safety and security of patients, staff, and visitors to the
HCF:
(a) security from criminal activity, such as personal assault or theft of property;
(b) safety from errors in the delivery of care (e.g., medication, needle-sticks, etc.);
(c) safety from environmental hazards (e.g., falls, mould, chemicals, etc.);
(d) protection of physical privacy and personal dignity;
(e) safety from equipment hazards (e.g., electrocution, fire, tripping hazards, bed sores);
(f) protection of staff from physical hazards (e.g., overexertion, repetitive stress, excessive bending,
reaching, or lifting);
(g) protection from psychosocial hazards;
(h) protection of personal information;
(i) emergency preparedness and management of emergency conditions; and
(j) protection of the patient by the caregiver.
4.5 Infection prevention and control
4.5.1 General
4.5.1.1
The HCF shall be planned and designed to be safe for all building occupants in terms of both the
prevention of health care acquired infections and the control of infectious diseases.
4.5.1.2
The planning and design process shall include participation by representatives of the major stakeholders
with an interest in infection prevention and control issues and practices.
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4.5.1.3
An infection control risk assessment (ICRA) shall be conducted as part of the planning process for any new
construction, addition, or renovation of an HCF. The HCF shall be designed and constructed to minimize
the potential for acquisition and transmission of infections in the health care setting, as outlined in the
infection control risk assessment.
4.5.1.4
The following infection prevention and control measures shall be incorporated into the design and
construction of the HCF:
(a) allocating sufficient space for patient care to prevent the spread of illness (i.e., adhering to minimum
clearances and area requirements as specified in this Standard);
(b) using materials in construction that are free of contaminants and excessive moisture and are able to
withstand regular use and repeated cleaning;
(c) using antimicrobial fabrics and other materials on furniture, fittings, and equipment;
(d) providing areas for localized waste management;
(e) dedicating areas for storage of supplies and equipment; and
(f) providing accessible hand hygiene sinks and waterless hand hygiene stations designed for caregiver
and patient hand hygiene.
Guidelines for Design and Construction of Health Care
Facilities
4.5.2 Objectives
The design and construction of the HCF shall support the following infection prevention and control
objectives:
(a) facilitate the use of routine infection prevention and control practices for all patients, regardless of the
diagnosis and tailored to the patient and the risk, including
(i) placement of hand hygiene sinks and waterless hand hygiene stations; and
(ii) placement of personal protective equipment used in delivery of care and/or non-patient
health-care-related functions (e.g., decontamination of reusable medical devices);
(b) provide sufficient space and number of rooms to allow the placement of patients based on mode of
transmission of infectious organisms, the existing patient population, and identifiable risks;
(c) take into account patient flow, so that the arrangement of rooms and corridors minimizes the spread
of infection through patient movement/transfer;
(d) facilitate the management of potentially infectious materials, including soiled medical devices, human
waste and body fluids, and medical waste;
(e) minimize the potential for airborne or water-borne transmission of infection; and
(f) facilitate effective cleaning and, where warranted, disinfection of the HCF.
4.5.3 Inpatient bedrooms
4.5.3.1
All inpatient bedrooms in Class A HCFs shall be single bedded rooms unless the functional program
demonstrates the necessity of a two-bed arrangement.
Justification for two-bedded or multi-bed inpatient bedroom accommodation shall include supporting
documentation validating the clinical significance of this arrangement. In this arrangement, there shall be
one washroom per patient.
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4.5.3.2
The use of single inpatient bedrooms in other facility classes should be in accordance with the HCF’s
functional program.
4.5.4 Patient treatment places
All patient treatment places, whether intended for inpatient or outpatient use, shall be single occupancy
unless the functional program demonstrates the necessity of multi-patient arrangement.
4.5.5 Construction considerations
New construction, renovations, and additions to HCFs shall be performed in accordance with
CAN/CSA-Z317.13.
4.6 Sustainability
4.6.1 General
4.6.1.1
The HCF shall be planned and designed to promote sustainability in terms of the construction process, the
finished building, and the sustainable operation of the facility over time.
Green Healthcare Construction Guidance Statement
4.6.1.2
The planning, design, and construction of the HCF shall follow a recognized structured sustainability
program.
Green Guide for Health Care
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Green Guide for Healthcare
Green Guide
4.6.1.3
The structured program should include the following elements:
(a) integrated design and commissioning process;
(b) site selection and development;
(c) waste and pollutant minimization;
(d) water quality and conservation;
(e) energy conservation;
(f) indoor environmental quality; and
(g) selection of building materials.
4.6.1.4
The plans for sustainability should help to ensure that the HCF is integrated into the surrounding
community and has a positive impact on its surroundings.
4.6.1.5
All planning decisions related to sustainability shall take into account the health and safety of patients and
staff. Where there is a conflict, patient health and safety shall be given priority.
4.6.2 Flexibility
The planning and design process for new construction, additions, and renovations shall include
consideration of potential changes in the functional requirements over time. Programs that are expected
to change should be designed with flexibility to facilitate future internal conversion. Programs that are
expected to expand should be designed to accommodate future expansions either internally by pushing
out “soft spaces”, or through external expansion. See Clause 7.10.
4.6.3 Total life cycle cost
The expected lifespan of the HCF shall be determined at the early stages of planning and a total life cycle
cost analysis shall be performed during planning and design. Capital cost versus long term operations and
maintenance costs should be examined to make informed decisions about the total cost of design.
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5 Planning process
5.1 Initial planning
5.1.1 Project process
5.1.1.1
The HCF shall be planned and designed through the use of a project process.
The project process and the working groups and committees established should be appropriate to the
size and complexity of the project.
5.1.1.2
The project process used shall conform to applicable requirements.
5.1.1.3
The project process shall include at least the following elements:
(a) initial assessment (to determine needs);
(b) role review;
(c) master program;
(d) master plan, including
(i) site and space analysis, including impact on the immediate ecosystem/environment and any
downstream ecosystems;
(ii) a physical feasibility study; and
(iii) building development plans;
(e) functional program;
(f) furniture and equipment planning;
(g) preliminary design development, including schematic design and design report;
(h) detailed design/design development;
(i) contract document development;
(j) tender;
(k) construction; and
(l) commissioning.
5.1.1.4
The project process should also incorporate planning for occupancy following construction/renovation,
and for post-occupancy evaluation.
5.1.1.5
The project process shall include a mechanism to ensure continued alignment between
(a) the project planning documents;
(b) applicable requirements for the jurisdiction; and
(c) planning, design, and reporting requirements of the agencies or organizations that are funding the
project.
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5.1.1.6
The project process shall include interdisciplinary input from the earliest stages to help ensure that the
resulting building will meet the needs and expectations of the people who will be using it.
Stakeholder consultation group(s) shall be assembled early as possible in the design process. The groups
should include representatives from the following:
(a) administrators;
(b) clinicians;
(c) infection prevention and control personnel;
(d) occupational health and safety personnel;
(e) ergonomists;
(f) materials managers;
(g) clinical and non-clinical support staff;
(h) advocates for patients and their families or caregivers;
(i) members of the surrounding community;
(j) furniture and equipment planner;
(k) facility operations and maintenance personnel;
(l) commissioning specialist;
(m) engineering specialists;
(n) construction project planner or manager;
(o) health care program and clinical planners;
(p) emergency management and security specialists;
(q) biomedical engineers; and
(r) other groups that will use, work in, or be affected by the HCF.
The stakeholder consultation group should be of a size and makeup that is appropriate to the size and
complexity of the project.
5.1.1.7
The project process for the HCF shall include the applicable elements of the commissioning process.
5.1.1.8
The planning process for the HCF should take into account the procurement model and its potential
impact on the planning and design process.
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5.1.2 Initial assessment
5.1.2.1 General
Planning shall begin with a formal assessment of the health care service needs that the project is intended
to address. For an existing facility, this part of the process shall also include a functional assessment to
determine the ability of the existing infrastructure to meet the defined needs.
5.1.2.2 Needs assessment
The needs assessment shall include the following:
(a) the scope and extent of services to be provided by each component;
(b) historic workload for each component for the past 3 years (if available) in terms of
(i) total attendances (total number served/treated);
(ii) service volumes (average and maximum numbers served/treated); and
(iii) number of beds;
(c) projected workload for each component for the next 3 to 5, 5 to 8, and 8 to 12 years in terms of total
attendances, service volumes, and beds;
(d) an initial estimate of staffing and space requirements to meet the projected workload; and
(e) disaster planning requirements.
5.1.3 Role review
The planning process shall include a role review, to determine the appropriate component, section, or (if
applicable) other facility to meet each of the identified needs within the context of the overall health
system service plan for the city or region.
5.1.4 Master program
5.1.4.1 General
5.1.4.1.1
A master program shall be developed that summarizes the identified needs, the resources available to
meet those needs (including existing infrastructure, if applicable), and the changes or additions necessary
to meet existing and future needs.
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5.1.4.1.2
The master program may be directed by a set of planning parameters that set the framework for the HCF,
including
(a) the HCF mission statement;
(b) the HCF vision;
(c) the role of the HCF as defined by funding and oversight agencies;
(d) catchment area and population needs; and
(e) definitions of existing and proposed service (by component).
5.1.4.2 Content
The master program shall include the following information for each component in the HCF:
(a) scope and extent of services provided by each component;
(b) historic workload for each component for the past 3 years, for the following:
(i) service volumes;
(ii) attendances; and
(iii) beds;
(c) projected workload for each component for the next 3 to 5, 5 to 8, and 8 to 12 years, for the
following:
(i) service volumes;
(ii) attendances; and
(iii) beds;
(d) projected staffing for each component (relative to workload);
(e) the result of the functional assessment (if applicable) highlighting appropriateness of current space,
location, organization and rooms, and general functionality of space;
(f) key room elements for the service which lead to space projections;
(g) existing space (CGSM) (to be coordinated with site and space analysis); and
(h) projected component space requirements (CGSM).
5.1.4.3 Existing facilities
If the project involves a renovation or addition to an existing HCF, each service or component in the HCF
shall be assessed for functionality (i.e., its ability to fulfill its intended purpose in terms of location,
organization and rooms, and general functionality). The master program shall report the functional
deficiencies and planning shall incorporate strategies to eliminate the deficiencies identified in these
assessments. In addition, the existing facility shall be assessed to ensure it can support the emergency
planning and business continuity plans of the HCF, both during construction and after completion of the
project.
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5.1.5 Master plan and assessment
5.1.5.1
A master plan shall be developed, based on the master program. The master plan shall
(a) specify how the functional objectives and space requirements identified in the master program can
be achieved on the existing site or on a new site;
(b) provide the HCF with the vision of how to best allocate and develop space rationally and coherently
in response to program needs, over a short, medium, and longer term; and
(c) describe the existing situation, define opportunities for development, make recommendations for
implementing the master program, summarize capital costs for development options, and illustrate
the building strategy and phasing in schematic design form.
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5.1.5.2
The master plan shall include the following in graphic and descriptive form:
(a) existing and proposed site diagrams:
(i) site services (utility locations and civil planning);
(ii) utility locations;
(iii) civil planning;
(iv) site utilization;
(v) vehicular traffic flow;
(vi) pedestrian traffic flow;
(vii) entrances and exits from building(s);
(viii) entrances and exits from site; and
(ix) parking strategy (number of spaces, layout, etc.); and
(b) existing and proposed building floor plans:
(i) all floor plans at a scale not less than 1:400 (25 mm = 1 m);
(ii) boundaries and names of all component spaces;
(iii) primary vertical and horizontal circulation spaces; and
(iv) entrances and exits from components and building.
5.1.5.3
The HCF master plan shall address the multi-faceted layers of stakeholder requirements, including the
following:
(a) the functional requirements of the particular HCF;
(b) the requirements of municipal agencies;
(c) concerns and needs other stakeholders;
(d) applicable requirements;
(e) design guidelines;
(f) the potential effect of the development on the site environment and surrounding ecosystems;
(g) sustainability targets in relation to the recognized sustainability program used (see Clause 4.6.1.2);
and
(h) standards of practice.
5.1.5.4
The master plan should be accompanied by a space table that compares the master program target areas
with the areas provided in the master plan. It should include a summary of the total building gross floor
area in the plan.
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5.1.5.5
Depending on specific requirements, the master plan may also include
(a) building gross square metres (BGSM);
(b) breakdown by component (CGSM);
(c) master plan cost estimate, including
(i) planning costs;
(ii) design fees;
(iii) design contingency;
(iv) construction costs;
(v) construction contingency;
(vi) escalation contingency;
(vii) miscellaneous construction related costs (e.g., permits, fees, insurance);
(viii) commissioning costs;
(ix) ancillary costs (e.g., furniture and equipment);
(x) facility start-up costs; and
(xi) administrative costs for the overseeing agency’s project specific staff; and
(d) project schedule, including
(i) municipal submissions, including
(1) site plan; and
(2) building permit;
(ii) ministry approval to proceed;
(iii) commissioning (extends through all stages of the project);
(iv) schematic design development and review by authorities;
(v) design development and review by authorities;
(vi) development and review of contract documents by authorities;
(vii) tender period, including closing and analysis;
(viii) approval to tender;
(ix) continuity of site service, and site preparation schedule;
(x) construction;
(xi) phasing;
(xii) occupancy, including planning, training, etc.; and
(xiii) deficiency period.
5.1.6 Functional program
5.1.6.1
A functional program shall be developed following the master plan and as a first step in preparing for the
design stage. The functional program at the preconstruction stage shall provide a detailed description of
each proposed activity, together with an estimation of the building and staff resources that will be required
to support each activity.
5.1.6.2
The functional program shall describe in detail
(a) the purpose of the project;
(b) the projected demand or utilization;
(c) operational concepts and descriptions;
(d) staffing patterns and responsibilities;
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(e) supply and materials flow;
(f) component relationships;
(g) space requirements and environment of care components (including key elements of the physical
environment);
(h) functional requirements; and
(i) other basic information related to fulfillment of the institution’s objectives.
5.1.6.3
The functional program shall be developed, taking into account the following considerations as they apply
to the HCF being designed:
(a) population analysis, to determine potential volumes (workload) that are anticipated and the
profile/characteristics of the patients;
(b) patient type based on historic services and projected needs (e.g., specialties, volumes, acuity);
(c) scope of services (i.e., the general functions performed by each service group and the additional roles
and functions they will provide in this particular HCF);
(d) critical mass/sufficient workload to sustain high quality of service;
(e) proximity to other service providers and the services provided; and
(f) availability of resources, such as
(i) physicians;
(ii) clinical and technical staff;
(iii) allied health workers (e.g., social worker, physiotherapists, etc.);
(iv) alternative medicine practitioners;
(v) materials/specialized supplies; and
(vi) clinical and general supporting services.
5.1.6.4
The functional program shall include analysis of the appropriate operating model on which to base the
planning for each service. The description of the assumptions regarding the operating model shall include
sufficient evidence to demonstrate that the HCF considered all applicable options and that it developed
the functional program in accordance with the available scientific data relating to HCF design and
construction (i.e., evidence-based design).
5.1.6.5
The functional program is the foundation for the building design and shall be the working document or
reference point for the subsequent planning process. The functional program shall
(a) provide a brief for the architect to indicate the purpose of the project is about;
(b) establish space requirements and distribution of space;
(c) document operational policies for the facilities (e.g., whether there will be central instrument
processing, central registration) that will affect operations; and
(d) establish who will do what (e.g., portering, reception functions, handing out and collecting meal
trays, IV additives) and what will affect staffing, quality of service, and in some instances, organization
of space.
5.1.6.6
The functional program may focus on a single component or area, or encompass an entire institution;
however, it shall include all services to be planned as part of the design stage.
It shall precede a capital project of any significance, as it is the link between operational planning and
construction. The process used to develop a functional program shall be interactive, including meetings
with department managers and medical staff as well as consultation with senior management and the
board.
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5.1.6.7
Depending of specific jurisdictional requirements, the functional program may include
(a) assumptions/guiding principles;
(b) functions and procedures;
(c) projected workload and required staffing;
(d) projected space requirements;
(e) equipment requirements and costs (new and replacement);
(f) updated capital costs;
(g) other costs associated with the project (decanting); and
(h) schedule update.
5.1.7 Furniture and equipment planning
A comprehensive list of necessary furnishings and equipment shall be developed to align with the
functional requirements for the HCF. The list shall provide a budget costing for planning purposes. In
addition, the list shall include the following key outputs to inform the detailed design:
(a) key dimensions;
(b) architectural requirements;
(c) structural implications;
(d) mechanical and electrical requirements; and
(e) distinction of new versus replacement.
5.1.8 Complementary plans
The planning and programming process should include the following additional plans:
(a) accessibility plan;
(b) emergency management plan that meets the requirements of CSA Z1600;
(c) project risk assessment plan; and
(d) infection prevention and control strategies.
These should complement or align with the master plan.
5.1.9 Test fit
5.1.9.1
In existing facilities, the functional program shall be tested before it is finalized to verify that the
requirements of the functional program can be accommodated within the HCF in the space available. This
testing shall include provision for the furnishings and equipment that will be used in the space to ensure
that the space is adequate for its intended use. The functional program shall be adjusted as necessary to
ensure the space will function as intended (e.g., the net-to-grossing factor could need to be increased to
account for existing circumstances).
5.1.9.2
Measurement of HCF areas shall be calculated in accordance with CAN/CSA-Z317.11.
5.1.10 Operational model
5.1.10.1
The master and functional programs shall incorporate one or more operational models appropriate to the
circumstances of the HCF. The HCF planners shall determine the appropriate model(s) in consultation with
the site clinical administration and project sponsor and according to the unique circumstances of the
project. The operational model shall be selected and developed so that HCF services are
(a) operationally efficient;
(b) accessible to ensure balanced access for patients, visitors, staff, and supplies;
(c) supportive of safety, injury prevention, and a secure environment for all occupants (patients, staff,
visitors);
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(d) consistent with the most current infection prevention and control practices;
(e) sustainable; and
(f) balanced with the services offered by other clinical team members and the model of care in effect in
these areas.
5.1.10.2
When the scope and types of services to be provided by the program have been determined, further
development of the operational model(s) shall occur, including decisions regarding the service-delivery
model, model of care, equipment selection, staffing models, etc.
Many HCFs develop operational models that combine the elements of several models. A “hybrid”
service-delivery model may balance several factors for an HCF. Each HCF shall examine the services
provided and determine their own model(s).
5.1.11 Site evaluation
5.1.11.1
The HCF shall ensure that the potential site is in compliance with applicable requirements for HCF
construction.
5.1.11.2
The HCF shall do a risk assessment on potential sites based on the site evaluation checklist.
5.1.11.3
The site evaluation shall include consideration of short and long-term requirements for parking and other
required amenities, access to the site, and access to facilities on site.
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5.1.12 Existing infrastructure assessment
5.1.12.1
Depending on the scope and the nature of the project, a physical feasibility study should be conducted for
an existing HCF. Prior to the master plan, the HCF shall determine whether this type of study is needed.
5.1.12.2
The physical feasibility study (if performed) shall include
(a) a technical assessment of the existing building and systems to identify defects in the existing HCF (see
CSA PLUS 317); and
(b) a site analysis to determine its suitability in relation to the building program, budget, and
construction schedule (see Annex C).
Planning shall incorporate strategies to eliminate the deficiencies identified in these assessments.
5.1.12.3
Based on the site evaluation report, the HCF planner shall explain how the site will be impacted by the
development. This shall include information on the impact on the immediate ecosystem/environment and
any downstream ecosystems that will be impacted.
5.1.12.4
The master plan shall define long-term strategies for current and future infrastructure.
5.2 Design
5.2.1 Schematic design
The schematic design shall
(a) include a site plan to demonstrate access to the HCF from transportation nodes (i.e., ambulance, car,
public transit, walking, or bicycle);
(b) include overall building plan(s) that demonstrate access to the program from the main and support
entrances;
(c) clearly demonstrate the separation of public and staff/support access to and from a program area;
(d) document internal circulation patterns to program areas, as well as their connection to the overall
building circulation;
(e) define individual spaces as per the functional program to show access, zoning (if required), and
internal adjacencies to support areas within the program;
(f) show placement of unique or major pieces of furniture or equipment;
(g) show the allocation of program support areas and building support areas;
(h) provide information concerning civil, structural, mechanical, and electrical building systems; and
(i) show the naming and numbering of building spaces for user orientation in relation to the numbering
of building elements for facilities management purposes.
The HCF or its representatives shall sign off on the schematic design prior to proceeding to design
development
5.2.2 Design development
5.2.2.1
Design development shall provide the HCF with the sign-off floor plans and site plan, upon which
additional details are provided and coordinated between all major consultants and users. HCF review
would include detailed elements such as
(a) furniture and equipment layouts;
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(b) location of infection prevention and control elements (e.g., hand hygiene sinks and waterless hand
hygiene stations, storage for personal protective equipment (PPE), isolation rooms);
(c) door swings and/or sliding doors (to address privacy and accessibility issues);
(d) window locations (to address privacy issues);
(e) ceiling plans to coordinate all architectural and engineering disciplines;
(f) interior elevations (including electrical outlets, data ports, terminal units, etc.); and
(g) exterior elevations.
All users or their representatives shall sign off on the design development drawings prior to proceeding to
finalized contract documents.
5.2.2.2
Unless otherwise specified, a tolerance of ±2% may be applied to each dimension presented in this
Standard.
5.2.3 Work planning
Design development shall provide the HCF with planning and scheduling information for project
implementation, including
(a) project work phasing plan if appropriate;
(b) transportation and routing plan during project construction;
(c) infection prevention and control plan, with area classifications and boundaries shown;
(d) fire and life safety exiting plan during construction;
(e) contractors site and building transportation routes;
(f) contractors’ lay-down and staging area; and
(g) master project schedule.
5.2.4 Mock-ups
5.2.4.1
Mock-ups should be used to plan areas with multiple interrelated activities, complex traffic flows, or
repetitive design in room types. Where mock-ups are to be used, they shall be detailed in the project
documents.
5.2.4.2
Design mock-ups should be done early enough so that design modifications can be made.
5.2.4.3
Mock-up exercises should include participation by health care workers and representatives from key
components and disciplines (e.g., infection prevention and control, health and safety).
5.2.4.4
Mock-ups should be subjected to practical trials that include the equipment and furniture needed for tasks
and simulations of critical and emergency tasks. Walls and objects can be outlined with tape or objects
placed on the floor.
5.2.4.5
Systematic evaluation of the practical trials (e.g., through check lists, debriefings, talk-aloud techniques)
should be performed to collect data from which to base modifications.
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5.2.4.6
Construction mock-ups should also be done for complex projects and for projects working within or
adjacent to existing facilities to ensure that construction can take place as planned, with minimal impact
on surrounding services.
5.2.5 Contract documents
5.2.5.1
Contract documents shall be prepared after the design process is complete and they shall specify what is
to be constructed in the project.
5.2.5.2
The contract document process should not include activities such as the negotiation of changes or the
continuation of the design development process. If there are significant design changes at this stage of the
process, the designers and the HCF shall return to the earlier stages of design for new sign–off by all the
users. For the purposes of this Standard, significant design changes are changes that impact directly on
how the services in the functional program are delivered in the design.
5.2.5.3
Contract documents shall include
(a) any special conditions arising from a construction risk assessment conducted in accordance with
Clause 5.3.2; and
(b) any special phasing requirements arising from the phasing planning in accordance with Clause 5.3.3.
5.2.6 Classification of areas
The HCF administration shall be responsible for determining the classification of areas within the HCF, e.g.,
patient care areas.
5.3 Procurement and construction
5.3.1 General
5.3.1.1
The physical systems and installations in the HCF shall be designed, constructed/installed, and
commissioned in accordance with the following standards:
(a) (CSA C22.1);
(b) CSA C282 (emergency electrical power supply systems);
(c) CSA Z32 (electrical systems and installations);
(d) CSA Z317.1 (plumbing);
(e) CAN/CSA-Z317.2 (HVAC);
(f) CSA Z317.10 (handling of waste);
(g) CAN/CSA-Z317.11 (area measurement);
(h) CAN/CSA-Z317.13 (infection control during construction);
(i) CSA Z318.0 (HCF commissioning);
(j) CSA Z320 (building commissioning);
(k) CSA Z7396.1 (medical gas systems); and
(l) CAN/CSA-Z10083 (oxygen concentrators for use with medical gas systems).
Equivalent standards from other nationally recognized standards development organizations may be used
if they have a similar scope and provide an equivalent level of detail. Any additional CSA standards (or their
equivalent) applicable to HCFs shall also be followed.
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5.3.1.2
The HCF should designate a facility project director to act as the owner’s representative in negotiations
and communications with the design and construction teams. The facility project director should have the
experience necessary and be given sufficient authority to make decisions on behalf of the owner or to
expedite the owner’s decisions.
5.3.2 Risk management planning and mitigation
A risk assessment should be developed to review all the potential risks posed by a construction project on
the operation of the current HCF and/or the impact on the future occupied facility.
5.3.3 Phase planning
5.3.3.1
If phased work is required, the construction shall be planned to include staged activity to minimize
disruption of existing services. This phasing is essential to ensure a safe environment in occupied areas
including required precautions for infection prevention and control. This plan shall be incorporated into
the contract documents so that the contractor can include the appropriate cost and schedule for the work.
5.3.3.2
The phasing plan shall provide detailed information to address
(a) areas of work and separation barriers between areas;
(b) sequence of work;
(c) security of site for building occupants;
(d) building services shutdowns;
(e) requirements for control of noise and vibration that result from construction activities;
(f) temporary services (e.g., electrical, plumbing);
(g) technical elements that have to be completed and checked prior to reoccupation (e.g., electronic
systems);
(h) safety elements that have to be completed and checked prior to reoccupation (e.g., infection
prevention and control and cleanliness provisions); and
(i) reoccupation procedures, including the necessary documents (e.g., occupancy permit) and
signatures.
Re-occupation of the area shall not occur until the construction is complete and the necessary permits
and signatures have been obtained to confirm the safety of the area for reoccupation.
5.3.3.3
The phasing plan for work on existing active facilities shall include allowances for work stoppage in
situations where a procedure or patient condition could be immediately endangered by the construction
work. See Clause 5.3.11. Contractors working on existing active facilities shall be made aware that
additional time might be needed for stoppages to protect patient safety.
5.3.4 Qualification of contractors and construction personnel
Contractors and construction personnel should have the necessary qualifications and experience to
perform their assigned duties as they apply to the construction of HCFs. Contractors should be
prequalified before being considered for projects. The criteria for prequalification should include an
assessment of
(a) the company’s quality practices, including its policies and procedures for working in HCFs;
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(b) documented qualification, training, and education of workers in the tasks to be performed, including
necessary tickets or licenses to conduct specialized work (e.g. medical gas system installation);
(c) workers’ understanding and evidence of formal training in the principles and practices of infection
control during construction and renovation of HCFs;
(d) the quality of previous projects; and
(e) the recommendations of previous customers.
5.3.5 Contractor orientation
5.3.5.1
Contractors shall be oriented to the particulars of the HCF, with site specific risks being identified.
5.3.5.2
Contractors shall submit protocols for safely conducting work in the HCF for review by the HCF.
5.3.5.3
The project documents shall outline any special training requirements for contractors. If such special
training is required, it should be detailed in the project documents.
5.3.6 Infection prevention and control
All construction work in HCFs shall meet the requirements of CAN/CSA-Z317.13.
5.3.7 Noise and vibration management
In existing active facilities, maximum noise and vibration criteria shall be specified in the contract
documents.
A protocol to halt/reschedule construction activity shall be determined in advance of construction start
(see Clause 5.3.11).
Provision shall be made to temporarily relocate clinical activity during times when noise and vibration
cannot be suppressed sufficiently.
5.3.8 Dust and odour mitigation
Dust and odour mitigation measures shall be specified in the contract documents.
5.3.9 Service tie-ins and shutdown coordination
All connections and shutdowns of services supplying existing areas of the HCF, either directly or indirectly,
shall be coordinated with the owner’s representative.
The HCF shall outline a procedure for contractors to coordinate any tie-in or shutdown of building
services.
Operation of existing services shall be coordinated with the HCF
5.3.10 Site access management
Access to the site shall be planned to minimize the impact on existing functions of the HCF.
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5.3.11 Stop work process
For renovations or additions to existing active HCFs (i.e., where patient care is taking place), there shall be
procedures to enable the temporarily stopping of construction work in situations where a medical
procedure or patient condition could be immediately endangered by this work. The contractor shall stop
work immediately when notified by any person that such a situation exists as an apparent result of
construction activity.
Any such work stoppage shall result in a thorough investigation and follow-up communication between
the HCF and the contractor. Resumption of construction activity shall be at the discretion of the HCF.
5.3.12 Signage
A temporary signage and wayfinding plan shall be developed where construction activities modify normal
paths of travel. The temporary signage and wayfinding plan shall be implemented to reroute patients, staff
and families prior to starting construction work.
5.3.13 Temporary provisions for life safety and emergency response
In cases where construction work changes the normal life safety systems or emergency response systems
of the HCF, special provisions shall be implemented during construction to maintain life safety and
emergency response.
5.3.14 Coordination and interferences
Coordination and interference drawings should be modelled in three dimensions prior to the start of
construction.
5.3.15 Change management
A process should be developed whereby changes can be reviewed, costed, analyzed, and approved
without unnecessary impact on the project.
5.3.16 As-built documentation
As-built drawings, operating manuals, maintenance manuals, and equipment cut-sheets shall be provided
to the HCF in accordance with CSA Z318.0.
5.4 Commissioning
5.4.1 General
The HCF building and site shall be commissioned in accordance with CSA Z318.0, CSA Z320, and the
applicable commissioning requirements in the standards specified in Clause 5.3.1.1.
5.4.2 Operational commissioning
Following the construction or renovation of building systems, the installation and commissioning of
owner-supplied systems and equipment shall take place in accordance with CSA Z318.0, CSA Z320, and
applicable commissioning requirements in the building systems standards specified in Clause 5.3.1.1.
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5.5 Take-over and occupancy
5.5.1 General
The commissioning process shall define the specific tasks related to turnover and final space occupancy of
the health care facility to be completed at the end of construction or renovation.
5.5.2 Take-over
Take-over activities shall be planned so that all necessary non-construction components of the project are
considered, in addition to the construction components.
The take-over activity plan should address the following components:
(a) occupancy permit;
(b) building commissioning (see Clause 5.4.1) completed, including correction of deficiencies;
(c) signage and wayfinding elements (i.e., installed and complete);
(d) communication plan, including general notices and specific information to the facility occupants;
(e) move-in date(s) (i.e., dates are established and occupants are notified);
(f) keying of doors and millwork (i.e., these are complete and individual keys have been assigned to the
approved staff);
(g) communications systems — end devices (e.g., telephone, fax, computer, printer, whether relocated
or new);
(h) new furnishings and loose equipment (i.e., delivered and set-up in the specific locations);
(i) respiratory therapy (i.e., flow meters, regulators, etc. — fittings are installed and tested for use);
(j) miscellaneous wall-mounted items (i.e., scopes, blood pressure cuff holders, sharp disposal containers
are installed); and
(k) staff orientation sessions and manuals for staff occupying the new/renovated facility.
5.5.3 Occupancy
Occupancy activities shall be planned to ensure that the occupancy of the new facility is organized and
complete.
The following components should be considered:
(a) moving activities arranged in phases or as a single event, depending on the project;
(b) disconnection, relocation, and reconnection of reused equipment;
(c) cleaning and, if necessary, disinfection of areas prior to occupancy;
(d) building commissioning (see Clause 5.4.1) completed, including correction of deficiencies; and
(e) process for users/occupants to record post-occupancy issues:
(i) deficiencies;
(ii) warranties; and
(iii) shortcomings (i.e., problems that exist but are not due to deficiencies in the execution of the
project).
5.6 Post-occupancy evaluation (POE)
5.6.1
The initial functional planning for the HCF shall include provisions for post-occupancy evaluations (POE).
The first POE should be conducted between 12 and 15 months following occupancy. POEs shall involve a
range of stakeholders.
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5.6.2
POE shall examine
(a) whether the HCF, as built, is meeting current requirements (especially where service objectives have
deviated from the original functional program brief); and
(b) the extent to which the original design is meeting current user expectations.
5.6.3
POE shall include identification of indicators that can be used and tracked to determine unique
performance aspects of the built environment.
5.6.4
POE should assess the ability of the building to meet anticipated future requirements (i.e., its management
of current use and capacity, and its flexibility in meeting future needs), based on experience to date.
6 Site and facility development
6.1 Site requirements
6.1.1 General
The HCF shall be located to
(a) accommodate the needs of its users within the clinical catchment area;
(b) be within reach of utilities and other essential services;
(c) be easily accessed from major transportation routes; and
(d) fit the master plan requirements.
6.1.2 Site design criteria
The design site evaluation shall include examination of the following
(a) climate (including possible microclimate effects at the proposed site);
(b) topography;
(c) geotechnical/soils;
(d) utilities;
(e) immediate surroundings;
(f) general services;
(g) site history;
(h) land use, ownership, and control;
(i) economic value;
(j) applicable requirements regarding zoning;
(k) sub-division, site plan review, and other local requirements;
(l) convenience and accessibility for users arriving by all means of transportation;
(m) applicable environmental protection requirements;
(n) snow and wind studies;
(o) sun and shade studies;
(p) environmental site assessments;
(q) flood risk analysis;
(r) other hazards (e.g., natural hazards, transportation systems, nearby industry); and
(s) other applicable requirements.
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6.1.3 Site entry points
6.1.3.1
The HCF should be clearly visible from all directions. Vehicular and pedestrian entrances shall be clearly
marked.
6.1.3.2
The site shall provide easily located and intuitive access routes to the following, as applicable to the HCF:
(a) the main entrance;
(b) emergency entrance;
(c) fire routes;
(d) parking areas for patients and staff;
(e) services entrances and loading docks;
(f) staff entrance(s); and
(g) ambulatory entrance(s).
6.1.3.3
The site shall be selected and designed to be consistent with the principles of wayfinding, including the
creation and location of landmarks.
6.1.4 Site circulation
6.1.4.1
The facility shall design site access routes so that staff, physicians, volunteers, and visitors can safely and
easily approach, enter, and leave the facility.
For accessibility, pedestrian signals and other components should be reviewed, along with applicable
requirements.
6.1.4.2
All types of site access, traffic, and circulation shall be identified, including
(a) pedestrian;
(b) bicycle; and
(c) vehicular, including
(i) priority/emergency (land and air);
(ii) public transit; and
(iii) service vehicles.
6.1.4.3
Access and traffic design shall be developed, including
(a) convenient and efficient and access routes for all users;
(b) accommodation of different access types to avoid congestion, interference, and conflict; and
(c) separation of traffic types were necessary.
6.1.5 Pedestrian circulation
6.1.5.1
Pedestrian routes to and between buildings shall be as direct as practicable to reduce the temptation to
use or create unnecessary routes.
6.1.5.2
Pedestrian routes shall be
(a) easily identifiable;
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(b) clearly separated from vehicular routes;
(c) free of obstacles at all times of the year; and
(d) well-lit, with clear sight lines.
6.1.5.3
All pedestrian routes to the main entrance and/or other accessible entrances shall provide a safe, direct,
level, and obstacle free path of travel for persons with mobility or visual limitations.
6.1.5.4
A pedestrian pathway shall be provided at the primary parking entrances/exits, that is separate from the
traffic lanes and provides a safe pedestrian crossing within parking lot areas.
6.1.5.5
Detectable (visual and tactile) warnings shall be provided at curb-less walks that cross vehicle traffic lanes.
6.1.5.6
Protective concrete sealers shall be applied to concrete walks located in prominent areas where de-icing
agents will be used.
6.1.5.7
Barrier free access walkways, entrances, and parking spaces shall be provided and shall have surfaces that
do not restrict the mobility of people with disabilities.
6.1.5.8
The design shall allow for the necessary circulation between the ambulatory care centre and other areas
(e.g., cancer centre, dialysis).
6.1.6 Vehicular circulation
6.1.6.1
The design for vehicle circulation should include a main circulation road to provide vehicular linkage to the
HCF’s entrances and parking facilities.
6.1.6.2
Drop-off locations shall be at each major point of public entry. The entrances should be designed and
located to provide shelter, while remaining uncluttered and accessible.
6.1.6.3
Separate routes and/or waiting areas should be provided near the main entrance for taxis and public
transit service vehicles. Bike paths should be provided and these should be distinct from automotive and
pedestrian routes to minimize the risk of collisions.
6.1.6.4
Separate waiting areas should be provided near the emergency entrance for police and ambulance
vehicles.
6.1.6.5
A direct route for emergency vehicle access should be used. Conflicts with other vehicular or pedestrian
traffic shall be minimized.
6.1.6.6
Appropriate clearances shall be provided at ambulatory and emergency entrances (if emergency services
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are provided) for simultaneous drop off and pick-up of patients and visitors without blocking the
entrances.
6.1.6.7
Public access to emergency care (if emergency services are provided) shall be distinct from emergency
vehicle access and shall be well marked to facilitate entry from public roadways. Public parking lots shall be
provided near the emergency entrance and for entrances to ambulatory care services (e.g., cancer centre,
dialysis).
6.1.7 Building entrance criteria
6.1.7.1 General
6.1.7.1.1
The building entry and approach paths shall be clearly identified. Entries should be appropriate to the
scale of the HCF and the services offered.
6.1.7.1.2
The building, the entrance canopy, and other entry sequence elements shall effectively draw attention to
the main entrance and guide patients and visitors to it without total reliance on signage.
6.1.7.1.3
The entrances to the HCF shall be
(a) consistent with the clinical planning and layout of the HCF;
(b) coordinated with both pedestrian and vehicular access to the site or building;
(c) coordinated with public transportation access points on and near the site;
(d) effectively integrated with the landscape and site design;
(e) designed so as to protect patients, staff, and visitors from inclement weather conditions; and
(f) provided with the necessary lighting and illuminated signage at entrances from dusk to dawn to
ensure visual prominence and safety.
6.1.7.2 Main and emergency entrances
6.1.7.2.1
The main entrance and emergency walk-in entrances (if emergency services are provided) shall be in
locations where they can be quickly and easily identified.
6.1.7.2.2
The design of the entrances should consider taking advantage of the natural topography of the site to
ensure entries have at-grade points of access.
6.1.7.2.3
Entrance canopies shall
(a) address both pedestrian and vehicular drop-off conditions;
(b) be visually identifiable upon approaching the building;
(c) be provided with prominent and legible signage;
(d) be provided with a vehicular pull-in area with passenger side at the curb for dropping-off and
picking-up patients and visitors without obscuring the entrance area or traffic;
(e) be outside waiting areas and provided with appropriate landscaped amenities;
(f) provide for visual monitoring of forecourt by HCF staff;
(g) provide for accessible parking nearby; and
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(h) provide for suitable night lighting and safe wayfinding.
Each entrance canopy should have a clear and distinct design with appropriate signage.
6.1.7.3 Ambulance bay
6.1.7.3.1
The emergency ambulance bay (in HCFs with emergency services) shall be located and designed to
accommodate the average number of incoming ambulances expected on site. Consideration should be
given to the possible need for additional accommodation for ambulances kept on site for dispatch to
outgoing assignments.
6.1.7.3.2
The emergency ambulance bay shall be designed so that the ambulances can unload the patient in an
environmentally controlled space.
6.1.7.3.3
A direct route for emergency vehicle access should be used. Conflicts with other vehicular or pedestrian
traffic shall be minimized.
6.1.7.3.4
Public access to the emergency care service shall be distinct from emergency vehicle access and shall be
well marked to facilitate entry from public roadways.
6.1.7.3.5
If a helipad/heliport is included in the design, it shall comply with applicable requirements. The location of
the helipad/heliport shall allow quick and direct access to emergency care.
Canadian Aviation Regulations
6.1.8 Parking
6.1.8.1
The site shall have sufficient parking for the projected volumes of patients, visitors, staff, volunteers, and
physicians.
6.1.8.2
Public parking lots shall be located near the HCF entrance.
6.1.8.3
Parking lots should be designated for patients, visitors, and volunteers with consideration for ease of access
to emergency and main entranceways.
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6.1.8.4
Parking areas shall be well lit with clear sightlines.
6.1.8.5
Consideration should be given to integrating physician parking with general staff parking, with the
exception of “on call” spaces for physicians and other medical staff, to maximize the utilization of all lots at
peak periods.
6.1.8.6
The following criteria should be considered as part of any decision whether to use surface parking or to
build a parking structure:
(a) availability of land;
(b) rate of return on investment of all options;
(c) summer and winter weather conditions;
(d) proximity of parking land to HCF buildings and site access roads;
(e) accessibility for persons with disabilities; and
(f) current demand and anticipated future demand for parking spaces.
6.1.8.7
Parking spaces for persons with disabilities shall be provided in accordance with the anticipated level of
need based on the functional program and the demographic base (i.e., patients, staff, and visitors). The
parking area design, including signage, shall be in compliance with CAN/CSA-B651.
6.1.8.8
Emergency call stations linked to the HCF’s security services should be provided in large parking lots, in
garages, and along pedestrian walkways that are isolated or pass between buildings.
6.1.8.9
The provision of electrical outlets should be considered, to supply block heaters (depending on
geographical climate conditions) and to charge electric vehicles.
6.1.8.10
Parking lots and related services shall be designed to facilitate snow removal and to prevent damage by
snow moving equipment. Snow dumping areas should be provided in areas of significant snowfall and
where siting conditions permit. Protective concrete sealers shall be used on concrete walks in prominent
areas where de-icing agents will be used.
6.1.8.11
Parking lots and roadways shall be designed to shed and properly dispose of storm water (e.g., to the
municipal storm water system).
6.1.8.12
For parking lots and roads where heavy trucks are anticipated, pavement structure should be designed to
accommodate the projected traffic and load.
6.1.8.13
Finishing materials used in parking garages should be durable and easy to maintain and clean.
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6.1.8.14
Light fixtures in parking garages or on large parking lots should be located to enhance the safety and
security of users.
6.1.9 Wayfinding
6.1.9.1
A clear and comprehensive wayfinding system for the site shall be developed and implemented.
6.1.9.2
Site access and circulation routes (roads, parking lots, parking structures, and pathways) shall be designed
to be understandable and to allow for easy and intuitive wayfinding/navigation through the site.
6.1.9.3
The site design, signage, and other wayfinding aids shall
(a) provide clear direction to primary HCF destinations, specifically
(i) entrances to the site from main thoroughfares;
(ii) accessible parking and entrances;
(iii) specific buildings, if it is a multi-building site;
(iv) main building entrances;
(v) access to building levels;
(vi) service access points; and
(vii) emergency access points;
(b) identify primary circulation routes, as follows:
(i) emergency;
(ii) pedestrian;
(iii) vehicular; and
(iv) service;
(c) identify restricted and/or unsafe areas; and
(d) identify areas and facilities that are part of the HCF disaster plan (e.g., muster stations).
6.1.9.4
Priority routing for wayfinding shall be in the following order:
(a) emergency vehicles;
(b) patients;
(c) staff, physicians, and volunteers; and
(d) service.
6.1.9.5
Site signs shall be located and illuminated with due regard for vehicular and pedestrian sightlines.
6.1.9.6
Landscape design shall support the wayfinding strategy and provide supporting cues.
6.1.10 Outdoor spaces
6.1.10.1
Where required by the functional program, outdoor amenity spaces shall be provided.
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6.1.10.2
The design and planning of outdoor areas shall be integrated with the interior floor plan layouts. Access
doors to outdoor amenity areas shall be located in close proximity to the HCF programs most likely to use
the space.
6.1.10.3
Outdoor spaces shall be designed to allow natural light into the building and provide views to natural
features from within the building.
6.1.10.4
The design of outdoor spaces shall ensure privacy for interior spaces.
6.1.10.5
Outdoor spaces shall be accessible for individuals with a disability.
6.1.10.6
Consideration should be given to spaces needed for cultural and spiritual practices that need to take place
out of doors.
6.1.10.7
Where outdoor spaces are provided, they should be designed to provide the following conditions:
(a) microclimate with consideration to extending seasonal use;
(b) protection from winds; and
(c) creating optimal high and low sun exposures.
6.1.10.8
Landscaping should be designed so that trees and shrubs do not block views from the building when they
mature.
6.1.10.9
Outdoor spaces shall be designed to meet the needs of multiple users, such as staff, patients, physicians,
volunteers, and visitors, as well as use by all ages and all levels of ability.
6.1.10.10
The design shall ensure opportunities to maximize the interaction of the HCF building occupants with
outdoor areas.
6.1.10.11
Landscaping should be designed so that exterior building maintenance activities (e.g., window washing)
can be safely and effectively performed.
6.1.11 Utility services
6.1.11.1
Facilities shall be located to provide reliable utilities (e.g., water, gas, sewer, electricity). Where reliable
utility services are not available, local or onsite backup services shall be provided.
6.1.11.2
If the HCF is planning to connect to existing utility infrastructure, it shall confirm with the relevant
municipalities and utility companies that their systems are adequate to service the site.
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6.1.11.3
Early in the design process, the HCF shall consult with the municipality to determine
(a) the adequacy of the water pressure and the possible need for on-site boosting for the fire sprinkler
system;
(b) the existence of restrictions on storm water discharge to their storm water drainage system; and
(c) the adequacy of the sewer system to manage the anticipated usage level.
6.1.11.4
Where utilities are to be connected to an existing on-site system, the HCF shall advise the regional health
authority and confirm that the existing on-site system can accommodate the additional loads.
6.1.11.5
Capped connections for portable or temporary services shall be provided for use in an emergency or an
utility outage.
6.1.11.6
Utility plans shall be consistent with the HCF’s sustainability program.
6.1.11.7
Consideration should be given to the security of the facility’s supply systems (e.g., water, electricity,
medical gases, natural gas).
6.1.12 Emergency exterior decontamination area
Where required by the emergency plan, an area on the exterior perimeter of the emergency service shall
be designated as an emergency exterior decontamination area. In smaller facilities, an existing exterior
space, such as an ambulance bay, may be used. Emergency exterior decontamination areas shall meet the
following requirements:
(a) The emergency exterior decontamination area should be approximately 45 m from the ambulance
bay (depending on the constraints of the structures involved). The distance between the
decontamination area and the ambulance entrance shall be at least 9.5 m.
(b) The decontamination area shall be in a location where no windows or doors abut the defined area or
where all doors are securable from the outside and all windows are capable of being shuttered.
(c) The decontamination area shall be equipped with semi-permanent or portable/collapsible structures
(curtains, tents, etc.) that will provide shelter from the environment, privacy, and some containment
of the contaminant/infectious agent.
(d) Boundaries of this area shall be defined on the paved ground surface with a yellow paint line and the
word “DECON” painted within these boundaries.
(e) The decontamination area shall be provided with
(i) two or more temperature-controlled shower heads, installed at least 2 m apart;
(ii) a duplex electrical outlet corresponding to each of the installed shower heads, but located at
least 1.25 m from any shower;
(iii) a separate spigot for attachment of a hose;
(iv) secured access to the HCF telephone system; and
(v) exterior lighting that meets applicable requirements for wet areas.
Canadian Electrical Code, Part I
(f) There shall be a ventilation system that maintains negative airflow with relation to the HCF perimeter
wall. This system shall draw air within the confines of the decontamination structure and exhaust it
directly to the outdoors, not less than 15.25 m away from the decontamination site with no
recirculation of air. This system shall be turned off when the decontamination structure is not in use.
(g) If a temporary facility is used, it shall be capable of maintaining negative pressure to the HCF
perimeter wall.
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(h) Water runoff shall be contained and disposed of safely to ensure that it does not enter community
drainage systems. This shall be accomplished either by graded floor structures leading to a drain with
a collection system separate from that of the HCF or by the use of plastic pools or specialized
decontamination stretchers.
6.1.13 Environmental controls
6.1.13.1
Environmental controls shall be used to minimize the impacts of the HCF (e.g., sound, waste, air quality,
and water) on surrounding areas, including natural areas.
6.1.13.2
Planning of environmental controls shall include consideration of
(a) waste holding management, recycling, incineration;
(b) hazardous materials (both existing on site and contributed by the operating HCF);
(c) servicing issues;
(d) location of loading dock, waste holding management, recycling, service yard, oil tanks, bulk oxygen,
flammable stores, power plant, incineration;
(e) potential impact on site of the energy plant; and
(f) alternative energy sources (e.g., district energy, solar power, biofuel, wind power, heat from waste).
6.1.13.3
The central plant and loading dock locations shall be planned to prevent transmission of noise, vibration,
and exhaust contaminants.
6.1.13.4
Recreation rooms, exercise rooms, equipment rooms, and similar spaces where impact noises could be
generated shall not be located directly over patient bed areas or delivery and operating suites, unless
special provisions are made to minimize such noise. The noise reduction criteria shown in Table 12.1 shall
apply to partitions, floors, and ceiling construction in patient areas.
6.1.13.5
Rooms containing heat producing equipment, such as boiler or heater rooms or laundries, shall be
insulated and ventilated to prevent the floor surface above and/or the adjacent walls of occupied areas
from exceeding a temperature of 6 °C above ambient room temperature.
6.1.14 Future expansion
6.1.14.1
The site (or space in the case of a leased/rental suite) shall be designed to accommodate various forms of
HCF expansion to the suite, buildings, or campus.
6.1.14.2
The location and design of site access and circulation routes shall take into consideration future
incremental building growth.
6.1.14.3
Site design shall take into consideration a replacement strategy for parking displaced by facility expansion.
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6.1.14.4
Site design shall take into consideration the potential effects of future development on the public image
and identity of the HCF.
6.1.14.5
The HCF entrances shall be designed to be consistent with strategies for future expansion.
6.2 Facility requirements
6.2.1 Building form and function
6.2.1.1 General
6.2.1.1.1
The building form or facility space shall be designed to provide sufficient space and infrastructure support
for the functional program, and to offer a positive building experience to occupants.
6.2.1.1.2
The building form or facility space shall accommodate internal component layouts based on
functional/clinical requirements
6.2.1.1.3
The building form or facility space shall be massed and composed in such a way as to maximize the use of
daylight into the interior of the building (unless specific clinical functions require otherwise).
6.2.1.1.4
The building form or facility space shall be integrated with the surrounding site in terms of vehicular traffic
patterns, pedestrian circulation, existing context, site servicing, and landscape.
6.2.1.1.5
The building form or facility space and its position shall be designed to allow for future expansion.
6.2.1.2 Entries and access
6.2.1.2.1
The main entrance area shall facilitate the following primary functions:
(a) arrival and departure;
(b) dropping off, meeting, and collection;
(c) security, information, and internal communication;
(d) wayfinding; and
(e) waiting.
6.2.1.2.2
The design of the main entrance shall include the following;
(a) located in sight of the information and enquiry desk;
(b) small seating groups with potential for wheelchair users to sit adjacent;
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(c) sufficient space for users manoeuvring in wheelchairs or with walking frames;
(d) facilities for children;
(e) information point for leaflets and multi-media; and
(f) natural light and views to landscaped outdoor areas;
6.2.1.2.3
All entrances shall incorporate features that limit the tracking of dirt and debris (e.g., built-in dirt traps).
6.2.1.3 Internal environments
Internal environments shall
(a) provide sufficient space in appropriate configurations to support patient care in accordance with the
functional programs;
(b) provide for the necessary patient throughput and circulation; and
(c) provide for adequate patient and building security, and facilitate ease of wayfinding.
6.2.1.4 Workflow
6.2.1.4.1
The HCF design shall
(a) ensure that the routes within and between tasks and procedures are as efficient as possible;
(b) avoid cross-flows in corridor traffic; and
(c) optimize the planning and systems support for logistical services, such that
(i) the movement of patients, staff, and visitors is appropriately planned in relation to the
distribution of supplies, storage, and waste disposal, and separated as necessary;
(ii) circulation routes are clear and well-organized for each type of traffic; and
(iii) the manual lifting and transportation of supplies, equipment, waste, etc., is minimized.
6.2.1.4.2
The HCF shall conduct a thorough analysis of anticipated internal traffic and movement and the design
shall be developed to support efficient movement and to mitigate conflicts among incompatible traffic
types.
6.2.1.4.3
Circulation routes should be designed to accommodate motorized and/or mechanized movement of
goods and people.
6.2.1.4.4
The design of circulation routes should be flexible to accommodate future changes in the modes of goods
and material movement.
6.2.1.5 Views
The design of the HCF shall provide patients, staff, and the public with external views wherever possible.
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6.2.1.6 Internal circulation
6.2.1.6.1 Principal circulation system
The principal internal circulation systems shall support the functional program for the HCF and shall be
appropriate to the category and or type of HCF.
Circulation systems for staff, inpatients, support services, and equipment shall be designed for
convenience and accessibility, and there shall be minimal overlap between these systems and the common
circulation paths for ambulatory patients and visitors.
6.2.1.6.2 Patient privacy and dignity
Secondary pathways should be available for transporting patients with dignity and privacy.
There shall be separate elevator groupings for inpatient services, and separation of HCF service functions
from those for visitor or outpatient use in order to maintain infection control and protect patient dignity.
6.2.1.6.3 Addresses
The design of the internal circulation system shall provide recognizable addresses for clinical services,
non-clinical support programs (e.g., transportation), and additional services (e.g., gift shop) in
coordination with building organization and navigation.
The design shall provide for connection of key visitor destinations. For example, outpatient services shall
be provided with the opportunity for a “front door” on the main public corridor and a “back door” from
an inpatient/service corridor.
6.2.1.7 Public areas
6.2.1.7.1
The principal visitor circulation route shall be designed as a major public entrance space providing
communication and circulation within the HCF.
6.2.1.7.2
The principal visitor circulation route shall include natural lighting strategies (i.e., day lighting). The design
of the main public concourse should take into consideration the following key points:
(a) clear connections to primary circulation routes;
(b) location of concourse in relation to other HCF services;
(c) generous floor-to-ceiling height;
(d) high spatial quality and efficient design;
(e) interesting natural and artificial lighting;
(f) views out to landscape areas; and
(g) incorporation of artworks and interior planting.
The design and planning of the building and site shall provide an appropriate environment for public
and retail activities to benefit and support HCF functions.
6.2.1.7.3
The HCF design shall provide
(a) services at the front of the HCF and/or along the main public circulation paths for primary use by the
public and outpatients;
(b) community access to facility retail components such as pharmacy and gift shops through the use of a
securable storefront address that is not on the principal visitor circulation routes;
(c) places for social interaction for patients, staff, and public;
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(d) a sufficient number of public facilities (e.g., shops, cafeterias, information points, etc.); and
(e) public washroom facilities, located in logical, visible places, which include accessible facilities and
family friendly facilities (e.g., baby change table).
6.2.2 Wayfinding
6.2.2.1 General
6.2.2.1.1
The HCF shall develop a documented wayfinding strategy that addresses the following elements:
(a) building design (i.e. architecture and interior spaces that facilitate wayfinding);
(b) people (i.e., design to position staff or volunteers in appropriate locations to provide verbal
orientation); and
(c) signage (i.e., orientation by means of words and symbols).
The wayfinding strategy shall be fully integrated into the HCF design. A wayfinding system manual shall
be developed and training in its use shall be provided so that the consistency of wayfinding information is
maintained.
6.2.2.1.2
The wayfinding system should frequently repeat the names of key facility destinations (such as main lobby,
information desk, cafeteria, etc.) and should provide detailed and comprehensive wayfinding information
such as directories and maps at these locations.
6.2.2.1.3
Wayfinding systems and signage shall use generic descriptions rather than donor nomenclature for the
identification of key elements.
6.2.2.1.4
The facility life safety plan shall be designed and displayed as part of wayfinding information. Details of
emergency procedures shall be provided, especially where egress could be restricted. Muster points for
emergency situations should be clearly marked.
6.2.2.2 Architecture and interior design
6.2.2.2.1
The architectural and interior design wayfinding features shall identify
(a) primary destinations;
(b) information services;
(c) major HCF entrances and exits; and
(d) physical levels within the HCF.
6.2.2.2.2
The following provisions for wayfinding shall be implemented into the building design:
(a) clearly defined entry points and all entry levels;
(b) clearly identified emergency exits and routes;
(c) clearly defined major circulation elements (e.g., corridors, elevators, and stairs);
(d) minimal number of decision making points;
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(e) clear lines of sight for both public and staff/inpatient circulation systems;
(f) easily comprehended organization that facilitates navigation throughout the HCF;
(g) main interior public circulation route connecting the public entry points and parking;
(h) use of icons and commonly recognized symbols as navigational elements;
(i) use of colour, pattern, and texture to reinforce circulation routes and destination points;
(j) use of other building elements to enhance orientation;
(k) use of exterior views to provide orientation and to act as “landmarks”; and
(l) selection of exterior building materials and textures to provide wayfinding cues.
6.2.2.2.3
The following provisions for wayfinding should be implemented into the building design:
(a) design of building entrances, HCF components, clinics, information desks, and specific destinations
(e.g., reception counters, nursing stations, self-checking kiosks, washrooms) to be easily seen and
accessible as priority destinations;
(b) use of daylight in the main corridors to assist in orientation at intersections to assist in navigation
through the building and enhance the HCF environment;
(c) provision of views to the exterior along circulation paths to help reduce stress and provide
orientation;
(d) use of interior landmarks to serve as points of reference for occupants, both for their own mental map
and for the giving or receiving of directions; and
(e) consideration of using components that are more than 1 storey high to provide visual connection
between the levels in spaces around major public entrances and vertical connection points.
6.2.2.3 People — Verbal orientation
6.2.2.3.1
The wayfinding strategy shall include the provision of a dedicated location(s) for wayfinding information.
Depending on the scale of the HCF and the services offered, information may be provided using staff or
volunteers, or through the use of maps and directories.
6.2.2.3.2
Adequate space shall be provided to accommodate and support the needs of staff and volunteers, if used.
6.2.2.3.3
An information kiosk or information board shall be provided at or near key entry points.
6.2.2.3.4
Convenient self-help information shall be provided for times when an information desk is not staffed.
6.2.2.4 Signage — Written and symbol orientation
6.2.2.4.1 General
The HCF shall develop and use signs in accordance with a comprehensive sign programme. The sign
programme shall detail the appearance, location, and content of signs, with the intent to provide clear,
coordinated, and consistent guidance to occupants of the HCF. Signs shall
(a) follow established protocols (i.e., the sign programme and additional requirements as specified by
the HCF’s policies);
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(b) follow an established sign hierarchy as detailed in the sign programme;
(c) provide the necessary information at decision points, without using more signs than are absolutely
necessary;
(d) provide only essential information; and
(e) provide clear information in a visually consistent format.
6.2.2.4.2 Sign programme
The sign programme shall be structured to provide orientation to
(a) major facility entrances and all levels (emergency, main, service, staff);
(b) buildings and parking;
(c) information services provided by staff and volunteers;
(d) components and rooms; and
(e) prohibited areas and cautions in accordance with applicable requirements and HCF policies.
Cardinal directions (north, east, south, and west) should not be used as the primary orientation device,
but may be used to supplement orientation information.
6.2.2.4.3 Sign design criteria
The design for signs shall
(a) provide maximum visual accessibility;
(b) ensure that they can be easily seen from major circulation routes;
(c) differentiate signs from surrounding architectural environment;
(d) provide consistent sign design features;
(e) provide unambiguous and clearly structured information; and
(f) include provisions for consistent and predictable sign placement.
6.2.2.4.4 Sign hierarchy
Signs shall be designed to indicate their function and level of importance within the established hierarchy.
The hierarchy should be based on the following five general categories of information:
(a) directional — directs to destinations;
(b) identification — identifies destinations;
(c) informational — provides orientation to destinations;
(d) advisory — provides operational and procedural information; and
(e) regulatory — provides restrictions, prescriptions, and warnings.
6.2.2.4.5 Names and symbols
Consistent and user-friendly nomenclature shall be provided for consumer services.
Symbols (pictographs or icons), when used, should be widely recognized and easy to understand.
6.2.2.4.6 Numbering systems
A consistent and simple building numbering system shall be provided.
6.2.2.4.7 Directories
Directories of names should be limited to the most important destinations and names of services should
consistently follow commonly agreed standards. Directory names shall be organized so they are easy to
find (e.g., alphabetically). The use of systems that force multiple steps in finding information (e.g.,
organizing names by a map code number or by floor) should be avoided.
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6.2.2.4.8 Maps
Maps shall be kept as simple as possible, and consistent orientation shall be maintained (e.g., orienting the
map to match the actual building orientation as closely as possible). Horizontally mounted maps or low
relief maps should be used where possible. Exterior orientation cues shall be included on building maps
(e.g., location of parking, entrances, and exterior landscape features).
6.2.2.5 Other building elements and systems
6.2.2.5.1
The designation and identification (or labelling) of building systems shall be part of the wayfinding plan,
and the principles of wayfinding shall be incorporated into designation and identification activities early in
the design process.
6.2.2.5.2
Identification of systems and components required for building operations and record keeping (e.g.,
mechanical and electrical systems, IT, communications and security systems, and doors and hardware)
shall be provided.
6.2.2.5.3
Identification of spaces and systems for facilities management procedures, including maintenance and
repairs, life cycle replacement, and inventory shall be provided.
6.2.2.5.4
The design, location, and information content provided by other building systems (e.g., public
telephones, public address systems, emergency communications systems, and self-serve kiosks) should
support the wayfinding system.
6.2.2.5.5
Construction signage and other temporary signs shall be treated as part of the wayfinding system, and
their design and placement should receive similar care.
6.2.3 Future expansion — Internal
6.2.3.1
All planning processes for new construction of, or renovations or additions to, HCFs shall include a
statement of expectations regarding future expansion needs. Provisions shall be made for such expansion
where possible without compromising the current safety, efficiency, or effectiveness of the HCF.
6.2.3.2
The building shall have a clear site placement strategy in order to leave sufficient space for future renewal
on site, without compromising the established facility layout.
6.2.3.3
The design and planning shall illustrate coherent future expansion scenarios that are in harmony with the
design and planning concepts of the prime building.
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6.2.3.4
The HCF shall be designed to be adaptable, to respond to change of use, type, and extent of building
systems and services. Decisions regarding the placement of programs in the HCF shall take into account
the possible future expansion of the building (see Clause 7.10).
6.2.3.5
The HCF shall be designed to be flexible, so that therapeutic, technological, organizational, and formal
innovations can be introduced with minimum disruption to ongoing operations.
6.2.3.6
Structured parking shall be located in areas that will not hinder incremental expansion of the facility.
6.2.3.7
The central plant and loading dock locations shall be located and designed such that they do not impede
future incremental and structured expansion of the HCF.
6.2.3.8
The organization of the HCF plan shall allow the future continuation of principal circulation routes to
connect with incremental HCF expansions.
6.2.3.9
Strategies shall be formulated for potential expansion for the facility or portions of the facility. Plans should
include the possibility of horizontal or vertical expansion. If vertical expansion is considered, the plan shall
include provisions to ensure that the necessary structure, life safety provisions, and sufficient capacity of
vertical transportation are established.
6.2.3.10
The HCF should consider the potential opportunities associated with registration to a structured
sustainability program.
6.2.3.11
Expansion plans shall include provisions to enable future access for construction activities and for the
expansion of parking space.
6.3 Key relationships and dependencies
6.3.1 General
The planning process shall include consideration of relationships between services in the HCF, and
prioritization of the key relationships and dependencies, so that the necessary adjacencies are achieved.
Table 6.1 summarizes typical key relationships and Tables 6.2 to 6.30 establish requirements, permissible
alternatives, and recommendations regarding adjacencies.
The adjacencies noted in these Tables are listed as either
(a) essential to the performance of the HCF (i.e., required); or
(b) important to the performance of the HCF (recommended).
It is recognized that in the operation of the HCF, all components are linked in the function of patient
care.
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Table 6.1
Key relationships and dependencies
Pediatric and adolescent inpatient care
Ambulatory care — renal dialysis
Medical/surgical inpatient care
Ambulatory care — oncology
Exterior garden/therapy area
Ambulatory care — general
Medical device reprocessing
Maternal and newborn care
Nutrition and food services
Building entry and parking
Main hospital entry/lobby
Specialized inpatient care
Inpatient continuing care
Electrodiagnostic services
Biomedical engineering
Materials management
Environmental services
Allied health services
Security and parking
Respiratory services
Laboratory services
Mental health care
Plant maintenance
Rehabilitation care
Medical imaging
Emergency care
Critical care
Procedures
Pharmacy
Heliport
Critical care
Maternal and newborn care
Medical/surgical inpatient care
Mental health care
Pediatric and adolescent inpatient care
Rehabilitation care
Specialized inpatient care
Ambulatory care — general
Ambulatory care — renal dialysis
Ambulatory care — oncology
Emergency care
Procedures
Allied health services
Laboratory services
Electrodiagnostic services
Respiratory services
Medical imaging
Pharmacy
Biomedical engineering
Environmental services
Nutrition and food services
Materials management
Plant maintenance
Security and parking
Medical device reprocessing
Building entry and parking
Heliport
Exterior garden/therapy area
Main hospital entry/lobby
Inpatient continuing care
Essential relationships (required)
Relationships that are critical to patient safety and clinical performance
Important relationships (recommended)
Relationships that are important, but of normal base-level importance to
patient safety and clinical performance
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6.3.2 Medical/surgical inpatient care
The key relationships between the medical/surgical inpatient care program and the related programs in
Table 6.2 should be considered during planning, and created or maintained when possible.
Table 6.2
Medical/surgical inpatient care — Important relationships
Critical care Patient bedroom Rapid transfer of patient Provide step-up care on
requiring higher level care inpatient unit
Mental health care Physicians Rapid access to medical
specialists for consultations
Emergency care Patient treatment Rapid transfer of admitted
cubicles patient
Laboratory services Accessioning Rapid transfer of specimens Provide an automated
for processing conveyance system (e.g.,
pneumatic tube) to transport
specimens directly or provide
point-of-care testing within
the clinical area
6.3.3 Critical care
6.3.3.1
In new construction, the programs in Table 6.3(a) shall be linked to the critical care program, either by
proximity or the use of a specified alternative. For additions or renovations to existing facilities, these links
shall be created and maintained whenever possible.
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Table 6.3(a)
Critical care — Essential relationships
Maternal and Birthing (LBR/LBRP/CS OR) Direct transfer of infants Provide access to a
newborn care Nursery following delivery to neonatal controlled-access elevator to
intensive care directly connect these services
Pediatric and Patient bedroom Direct transfer of acute patients Provide adjacency to a
adolescent to pediatric intensive care controlled-access elevator
inpatient care that directly connects these
services
Emergency care Trauma/resuscitation room Direct transfer of critically acute Provide dedicated elevator in
patients from trauma requiring emergency care to directly
admission to critical care connect these services
Procedures Stage one recovery (PACU) Transfer of acute patients after Provide adjacency to a
stage one recovery (PACU) controlled-access elevator to
requiring admission to critical directly connect these
care services
Procedures Operating rooms and Direct transfer of some patients Provide access to an elevator
interventional imaging post-surgery/procedures to directly connect the
rooms (bypassing stage one services. Elevator may include
recovery) full services available in a
recovery cubicle
6.3.3.2
The key relationships between the critical care program and the related programs in Table 6.3(b) should
be considered during planning and created or maintained when possible.
Table 6.3(b)
Critical care — Important relationships
Medical/surgical Patient bedroom Transfer of patient following Create step-down (or step-up)
inpatient care discharge from critical care beds on the inpatient units
Respiratory services Respiratory therapy Access to respiratory therapy A satellite RT service may be
equipment (i.e., ventilators) and included in critical care
spare parts plus cleaning area
Laboratory Specimen accessioning Urgent access to patients and Provide point of care testing
laboratory results; staff access to equipment within critical care
patients
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6.3.4 Maternal and newborn care
6.3.4.1
In new construction, the programs in Table 6.4(a) in shall be linked to the inpatient component of the
maternal and newborn care program, either by proximity or the use of a specified alternative. In additions
or renovations to existing facilities, these links shall be created and maintained whenever possible.
Table 6.4(a)
Maternal and newborn care — Essential relationships
Critical care Neonatal intensive care Rapid transfer of patient Provide dedicated NICU within
unit (NICU) to more intensive care if unit or provide dedicated corridor
needed to NICU and delivery room
6.3.4.2
The key relationships between the inpatient component of the maternal and newborn care program and
the related programs in Table 6.4(b) should be considered during planning, and created or maintained
when possible.
Table 6.4(b)
Maternal and newborn care — Important relationships
Procedures Birthing operating room Rapid transfer of patient Provide dedicated birthing
(caesarean section) requiring surgery operating room within maternity
Medical device Decontamination sterile Transport sterile materials Provide dedicated clean and
reprocessing (MDR) storage efficiently, quickly, and soiled elevators linking maternity
without contamination, and with MDR
bypassing public areas
6.3.5 Mental health and addiction services
6.3.5.1
In new construction, the program in Table 6.5(a) shall be linked to the mental health and addiction
services, either by proximity or the use of a specified alternative. In additions or renovations to existing
facilities, these links shall be created and maintained whenever possible.
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Table 6.5(a)
Mental health and addiction services — Essential relationships
Emergency care Secure/observation room Rapid transfer of patient
following admission
6.3.5.2
The key relationships between the mental health and addiction services and the related programs in
Table 6.5(b) should be considered during planning, and created or maintained when possible.
Table 6.5(b)
Mental health and addiction services — Important relationships
Pharmacy Dispensary Clinical pharmacists Clinical pharmacists located
consultation service and as member of interdisciplinary
medications delivery care team in medical/surgical
inpatient care, and
Automated conveyance
system (e.g., pneumatic tube)
to transport medications
Exterior garden/therapy Garden/therapy area Controlled movement of
area patients to secured exterior
area for leisure or
therapeutic activities
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6.3.6 Pediatric and adolescent inpatient care
6.3.6.1
In new construction, the programs in Table 6.6(a) shall be linked to the pediatric and adolescent inpatient
care program, either by proximity or the use of a specified alternative. In additions or renovations to
existing facilities, these links shall be created and maintained whenever possible.
Table 6.6(a)
Pediatric and adolescent inpatient care — Essential relationships
Critical care NICU and PICU Rapid transfer of patient Provide step-up care on
requiring higher level care inpatient unit
6.3.6.2
The key relationships between the pediatric and adolescent inpatient care program and the related
programs in Table 6.6(b) should be considered during planning, and created or maintained when
possible.
Table 6.6(b)
Pediatric and adolescent inpatient care — Important relationships
Maternal and newborn Postpartum inpatient care Provide rapid access for
care access to pediatric specialists
for consultation
Exterior garden/therapy Garden/therapy area Provide direct patient/family Provision of secured roof
area access to exterior play/ top areas
therapy areas for leisure and
mobilization activities
6.3.7 Rehabilitation care
6.3.7.1
In new construction, the programs in Table 6.7(a) shall be linked to the rehabilitation care program, either
by proximity or the use of a specified alternative. In additions or renovations to existing facilities, these
links shall be created and maintained whenever possible.
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Table 6.7(a)
Rehabilitation care — Essential relationships
Exterior garden/therapy Provide direct access to Provision of secured roof
area exterior for therapy top areas
activities
6.3.7.2
The key relationships between the rehabilitation care program and the related programs in Table 6.7(b)
should be considered during planning, and created or maintained when possible.
Table 6.7(b)
Rehabilitation care — Important relationships
Building entry and Building entry and Provide ease of access for Provide direct vertical access
parking adjacent parking patients with limited from elevators from a
mobility building entry and parking
6.3.8 Inpatient continuing care
The key relationships between the inpatient continuing care program and the related programs in
Table 6.8 should be considered during planning, and created or maintained when possible.
Table 6.8
Inpatient continuing care — Important relationships
Rehabilitation care All therapy areas Support efforts to Provide satellite therapy
rehabilitate to return home services within continuing care
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6.3.9 Ambulatory care — General
The key relationships between a general ambulatory care program and the related programs in Table 6.9
should be considered during planning, and created or maintained when possible.
Table 6.9
General ambulatory care — Important relationships
Allied health services Treatment of ambulatory Majority of services are
patients provided in an
ambulatory care setting
Electrodiagnostic services Patient testing rooms Access to ECG and EEG Provide satellite services in
services ambulatory care
Laboratory services Specimen accessioning Rapid testing of specimen Provide ‘point-of-care’ testing
in ambulatory care
Include automated
conveyance system (e.g.,
pneumatic tube to transport
specimens directly to the
laboratory for testing
Pharmacy Dispensary Provide medications and Provide satellite or retail service
counselling in ambulatory care
6.3.10 Ambulatory care — Renal dialysis
The key relationships between the renal dialysis ambulatory care program and the related programs in
Table 6.10 should be considered during planning, and created or maintained when possible.
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Table 6.10
Renal dialysis ambulatory care — Important relationships
Ambulatory care — The area as a whole Provide access to clinical
General specialists and expansion during
peak periods
Sharing of selected support
services
Building entry and Building entry and Provide ease of access for Provide direct vertical
parking adjacent parking patients utilizing services 3 to 4 access from elevators
times per week for extended from a building entry and
periods until eligible for a parking
kidney transplant
Exterior garden/therapy Garden/therapy area Provide direct patient/family Provision of secured roof
area access to exterior top areas
garden/therapy areas for leisure
and mobilization activities
6.3.11 Ambulatory care — Oncology
6.3.11.1
In new construction, the programs in Table 6.11(a) shall be linked to the oncology ambulatory care
program, either by proximity or the use of a specified alternative. In additions or renovations to existing
facilities, these links shall be created and maintained whenever possible.
Table 6.11(a)
Oncology ambulatory care — Essential relationships
Pharmacy Sterile products To provide direct delivery A satellite pharmacy may be
of chemotherapeutic drugs included with oncology
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6.3.11.2
The key relationships between the oncology ambulatory care program and the related programs in
Table 6.11(b) should be considered during planning, and created or maintained when possible.
Table 6.11(b)
Oncology ambulatory care — Important relationships
Ambulatory care — The area as a whole Provide access to clinical
General specialists and expansion
during peak periods
Sharing of selected support
services
Emergency care Patient treatment Transfer of patient requiring
cubicles emergency intervention
Building entry and Building entry and Provide ease of access for Provide direct vertical
parking adjacent parking patients utilizing services for access from elevators
extended periods over from a building entry and
multiple visits parking
Exterior garden/therapy Garden/therapy area Provide direct patient/family Provision of secured roof
area access to exterior garden/ top areas
therapy areas for leisure and
mobilization activities
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6.3.12 Emergency care
6.3.12.1
In new construction, the programs in Table 6.12(a) shall be linked to the emergency care program, either
by proximity or the use of a specified alternative. In additions or renovations to existing facilities, these
links shall be created and maintained whenever possible.
Table 6.12(a)
Emergency care — Essential relationships
Critical care Inpatient beds Rapid access to critical care Provide dedicated elevator in
services for patients arriving emergency care to directly
in emergency care connect the services
Procedures Operating rooms Access to OR for patients Provide dedicated OR within
requiring emergency emergency care or provide
surgery dedicated elevator in
emergency care to directly
connect the services
Laboratory services Specimen accessioning Rapid testing of specimen Provide point-of-care testing in
emergency care
Include automated conveyance
system (e.g., pneumatic tube to
transport specimens directly to
the laboratory for testing)
Medical imaging MRI, CT, X-ray, Stat imaging for Create satellite imaging area in
ultrasound unscheduled patients emergency care
arriving
Security and parking 24-hour/fully staffed To provide support to Where possible, this should be
security area emergency care staff on located close to emergency care
evenings; and to provide should be designed so that the
controls to access to the rest security services have clear
of the facility visual access of the waiting
spaces and public entry to the
HCF
Building entry and Separate walk-in entrance Easy controlled access for
parking and ambulance entrance patients separated from
other traffic types
Heliport Easy access for helicopter to Provided dedicated elevator in
deliver a patient to trauma/ emergency care to directly
resuscitation room connect the roof-based heliport
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6.3.12.2
The key relationships between the emergency care program and the related programs in Table 6.12(b)
should be considered during planning, and created or maintained when possible.
Table 6.12(b)
Emergency care — Important relationships
Ambulatory care — Renal Dialysis equipment and Access to dialysis equipment Provide dedicated dialysis
dialysis nephrology clinical and maintenance, and equipment and plumbing
services specialized specialist in emergency care
consultation
Ambulatory care — Clinical specialists and Ready access to specialists for
Oncology chemotherapeutics consultation and the
chemotherapeutics for patients
presenting in off-hours
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6.3.13 Procedures
6.3.13.1
In new construction, the programs in Table 6.13(a) shall be linked to program performing procedures,
either by proximity or the use of a specified alternative. In additions or renovations to existing facilities,
these links shall be created and maintained whenever possible.
Table 6.13(a)
Procedures — Essential relationships
Critical care Inpatient beds Direct transfer of patients Provide direct, restricted access to
requiring surgery or other an elevator to connect these
procedures services
This arrangement shall be avoided
if possible, as the transport of
critically ill patients by elevator can
create substantial risks. See
Clause 12.2.6.3 for elevators for
patient transfer.
Emergency care Patient treatment Direct transfer of patient Provide dedicated OR within
cubicles requiring emergency emergency care or provide
surgery dedicated elevator in emergency
care to directly connect the
services
Laboratory services Specimen accessioning Rapid testing of Provide point-of-care testing in
specimens ambulatory care
Include automated conveyance
system (e.g., pneumatic tube to
transport specimens directly to the
laboratory for testing)
Medical device Sterile core Transport sterile materials Provide dedicated clean elevator
reprocessing efficiently, quickly, linking OR/sterile core and sterile
and without risk of storage area within MDR
contamination bypassing
public areas
Soiled holding For removal of Provide dedicated soiled elevator
contaminated linking soiled collection area in
instruments/for direct OR’s with decontamination area in
transfer to contamination MDR
area in MDR
Supplies For non-sterile supplies, Create small stores area within
linen, etc. MDR
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6.3.13.2
The key relationships between programs performing procedures and the related programs in
Table 6.13(b) should be considered during planning, and created or maintained when possible.
Table 6.13(b)
Procedures — Important relationships
Maternal and newborn Birthing operating Rapid access to anaesthesia Dedicated anaesthesia in
care rooms services maternal program
Medical imaging Clinical specialists for Rapid access to clinical and Dedicated radiologists and
reading films and technical resources technicians in procedures
consultation area
Respiratory services Respiratory therapy Rapid access to anaesthesia and A satellite RT service may
critical care equipment be included in critical care
(i.e., ventilators, anaesthesia
systems and spare parts plus
cleaning area) in procedure area
6.3.14 Allied health services
The key relationships between allied health services and the related programs in Table 6.14 should be
considered during planning, and created or maintained when possible.
Table 6.14
Allied health services — Important relationships
Ambulatory care — Patient Provide ease of access for Include specific allied health
General exam/consultation room ambulatory patients for professionals as part of the
allied health services ambulatory care program
6.3.15 Laboratory services
6.3.15.1
In new construction, the programs in Table 6.15(a) shall be linked to the laboratory services program,
either by proximity or the use of a specified alternative. In additions or renovations to existing facilities,
these links shall be created and maintained whenever possible.
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Table 6.15(a)
Laboratory services — Essential relationships
Emergency care All clinical areas Rapid testing of specimens Provide point-of-care testing
from patients arriving in equipment within the clinical
emergency care area or include automated
conveyance system (e.g.,
pneumatic tube) to transport
specimens directly to the
laboratory for testing
Procedures Operating rooms Rapid testing of pathology Provide dedicated frozen section
and blood specimens testing area in the OR and
(testing should be point-of-care testing or include
performed while patient is automated conveyance system
in still in OR) (e.g., pneumatic tube) to
transport specimens directly to
the laboratory for testing
Provide dedicated personnel to
transport the specimens directly
6.3.15.2
The key relationships between the laboratory services program and the related programs in Table 6.15(b)
should be considered during planning, and created or maintained when possible.
Table 6.15(b)
Laboratory services — Important relationships
Critical care Patient cubicles Staff access for specimen Nursing staff collect specimens
collection and forward to lab for processing
by automated conveyance system
Maternal and newborn Patient bedroom, LBRP, Specimen testing for Provide point-of-care testing
care LBR, triage/assessment inpatients equipment within the clinical area
Include automated conveyance
system (e.g., pneumatic tube) to
transport specimens directly to the
laboratory for testing
Emergency care New trauma room Direct movement of drugs Dedicated satellite pharmacy in
to urgent care area emergency care
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6.3.16 Electrodiagnostic services
The key relationships between the electrodiagnostic services program and the related programs in
Table 6.16 should be considered during planning, and created or maintained when possible.
Table 6.16
Electrodiagnostic services — Important relationships
Ambulatory care — Patient Provide ease of access for Include electrodiagnostic
General exam/consultation room ambulatory patients for services as part of the
electrodiagnostic services ambulatory care program
6.3.17 Respiratory services
The key relationships between the respiratory services program and the related programs in Table 6.17
should be considered during planning, and created or maintained when possible.
Table 6.17
Respiratory services — Important relationships
Critical care Patient cubicle RT access to provide Include a satellite RT
respiratory therapy services service in critical care
Procedures Operating room/interventional RT access to provide Include a satellite RT
procedure room respiratory therapy services service in procedures
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6.3.18 Medical imaging
6.3.18.1
In new construction, the programs in Table 6.18(a) shall be linked to the medical imaging program, either
by proximity or the use of a specified alternative. In additions or renovations to existing facilities, these
links shall be created and maintained whenever possible.
Table 6.18(a)
Medical imaging — Essential relationships
Emergency care Trauma/resuscitation Imaging staff access with Provide overhead rail in
room portable equipment to take trauma room and dedicated
images portables in emergency
Procedures Operating Clinical and technical staff Provide dedicated clinical
room/interventional access for consultation, and technical resources in
procedure rooms provide service procedures area
6.3.18.2
The key relationships between the medical imaging program and the related programs in Table 6.18(b)
should be considered during planning, and created or maintained when possible.
Table 6.18(b)
Medical imaging — Important relationships
Procedures Operating room/ Clinical and technical staff Provide dedicated clinical
interventional procedure access for consultation, and technical resources in
rooms provide service procedures area
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6.3.19 Pharmacy
In new construction, the programs in Table 6.19 shall be linked to the pharmacy program, either by
proximity or the use of a specified alternative. In additions or renovations to existing facilities, these links
shall be created and maintained whenever possible.
Table 6.19
Pharmacy — Essential relationships
Ambulatory care — Chemotherapy area Direct movement of short life Dedicated satellite pharmacy in
Oncology chemotherapeutics to oncology
patients
Procedures Operating rooms Medication delivery and Include automated conveyance
storage of anaesthetics and system (e.g., pneumatic tube)
controlled drugs to transport medications
Critical care Patient cubicle Clinical pharmacists Provide a satellite pharmacy
consultation service and in critical care. Include
medications delivery automated conveyance system
(e.g., pneumatic tube) to
transport medications
Emergency care Patient cubicle Clinical pharmacists Provide a satellite pharmacy in
consultation service and emergency care. Include
medications delivery automated conveyance system
(e.g., pneumatic tube) to
transport medications
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6.3.20 Biomedical engineering
The key relationships between the biomedical engineering department and the related programs in
Table 6.20 should be considered during planning, and created or maintained when possible.
Table 6.20
Biomedical engineering — Important relationships
Procedures Operating rooms, Biomedical staff access to Provide dedicated staff and a
procedure rooms service equipment satellite biomedical
Anaesthesia equipment, engineering (BE) in
life support equipment procedures; or
Provide access to an elevator
to directly connect the
services
Laboratory services Lab equipment not Biomedical staff access to Provide dedicated staff and a
maintained by outside service equipment satellite BE in laboratory; or
vendors
Provide access to an elevator
to directly connect the
services
Medical imaging Medical imaging Biomedical staff access to Provide dedicated staff and a
equipment not service equipment satellite BE in medical
maintained by outside imaging; or
vendors
Provide access to an elevator
to directly connect the
services
Critical care Patient monitoring, Biomedical staff access to Provide dedicated staff and a
critical care, and service equipment satellite BE in procedures, or
respiratory care
Provide access to an elevator
equipment
to directly connect the
services
Dialysis Patient cubicles Biomedical staff access to Provide dedicated staff and a
service equipment satellite BE in procedures
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6.3.21 Environmental services
The key relationships between the environmental services department and the related components in
Table 6.21 should be considered during planning, and created or maintained when possible.
Table 6.21
Environmental services — Important relationships
Materials management Bulk stores area Ease of access to
housekeeping supplies
on a daily basis
Building entry Waste, laundry, and Ease of access to external Separation of waste and
supplies loading dock laundry in dedicated corridors
6.3.22 Nutrition and food services
The key relationships between the nutrition and food services department and the related component in
Table 6.22 should be considered during planning, and created or maintained when possible.
Table 6.22
Nutrition and food services — Important relationships
Materials management Non-perishable food Ease of access to supplies Provide non-perishable stores
stores on a daily basis in nutrition and food services
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6.3.23 Materials management
6.3.23.1
In new construction, the related element in Table 6.23(a) shall be linked to the materials management
department, either by proximity or the use of a specified alternative. In additions or renovations to existing
facilities, these links shall be created and maintained whenever possible.
Table 6.23(a)
Materials management — Essential relationships
Building entry and parking Loading dock Provide ease of access for
truck and other deliveries
6.3.23.2
The key relationships between the materials management department and the related components in
Table 6.23(b) should be considered during planning, and created or maintained when possible.
Table 6.23(b)
Materials management — Important relationships
Environmental services Housekeeping closets Ease of supply and
and service rooms equipment delivery
Nutrition and food Food production area Ease of supply and
services equipment delivery
Medical device Supplies Ease of supply and
reprocessing equipment delivery,
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6.3.24 Plant maintenance
The key relationships between the plant maintenance department and the related component in
Table 6.24 should be considered during planning, and created or maintained when possible.
Table 6.24
Plant maintenance — Important relationships
Security and parking Office area Ease of staff access for
general management
Building entry Maintenance shops and Ease of supply and
offices equipment delivery
6.3.25 Security and parking
6.3.25.1
In new construction, the related element in Table 6.25(a) shall be linked to security and parking, either by
proximity or the use of a specified alternative. In additions or renovations to existing facilities, these links
shall be created and maintained whenever possible.
Table 6.25(a)
Security and parking — Essential relationships
Emergency care Office area Monitoring Satellite security station to
monitor emergency care
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6.3.25.2
The key relationship between security and parking and the related component in Table 6.25(b) should be
considered during planning, and created or maintained when possible.
Table 6.25(b)
Security and parking — Important relationships
Plant maintenance Office area Ease of staff access for
general management
6.3.26 Medical device reprocessing
6.3.26.1
In new construction, the program/components in Table 6.26(a) shall be linked to the medical device
reprocessing department, either by proximity or the use of a specified alternative. In additions or
renovations to existing facilities, these links shall be created and maintained whenever possible.
Table 6.26(a)
Medical device reprocessing — Essential relationships
Procedures Sterile core Transport sterile materials Provide dedicated clean
efficiently, quickly, elevator linking OR/sterile
and without risk of core and sterile storage
contamination bypassing within MDR
public areas
Soiled holding For removal of contaminated Provide dedicated soiled
instruments for direct elevator linking soiled
transfer to decontamination collection area in OR’s with
area in MDR decontamination area in
MDR
Materials management Supplies For non-sterile supplies, Create small stores area
linen, etc. within MDR
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6.3.26.2
The key relationships between the medical device reprocessing department and the related programs in
Table 6.26(b) should be considered during planning, and created or maintained when possible.
Table 6.26(b)
Medical device reprocessing — Important relationships
Maternal and Birthing operating rooms Transport sterile materials Provide dedicated clean
newborn care efficiently, quickly and without elevator linking OR and MDR
risk of contamination
bypassing public areas
Soiled holding For removal of contaminated Provide dedicated soiled
instruments for direct transfer elevator linking soiled
to decontamination area in collection area in OR’s with
MDR decontamination area in MDR
6.3.27 Building entry and parking
6.3.27.1
In new construction, the program/areas in Table 6.27(a) shall be linked to the building entry and parking
area, either by proximity or the use of a specified alternative. In additions or renovations to existing
facilities, these links shall be created and maintained whenever possible.
Table 6.27(a)
Building entry and parking — Essential relationships
Emergency care Separate walk-in entrance Easy controlled access for Add CCTV in triage and
and ambulance entrance patients separated from reception areas with rapid
other traffic types; visible response system for security
security desk to monitor and services
screen traffic
Materials management Loading dock Service access for trucks and Central materials
vans to make deliveries management off site
Main lobby Admitting/registration Public access from parking Decentralized admitting/
for patients and family registration
Environmental services Waste, laundry, and Ease of access to external Separation of waste and
supplies loading dock laundry in dedicated corridors
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6.3.27.2
The key relationships between the building entry and parking areas and the related programs/components
in Table 6.27(b) should be considered during planning, and created or maintained when possible.
Table 6.27(b)
Building entry and parking — Important relationships
Rehabilitation care Patient care area Direct access from parking
for patients and family
Ambulatory care — Renal Patient care area Direct access from parking
dialysis for patients and family
Ambulatory care — Patient care area Direct access from parking
Oncology for patients and family
Ambulatory care — Patient care area Easy access from parking Elevator
Procedures for patients and family
Plant maintenance Supply Ease of supply and Service elevator
equipment delivery
6.3.28 Heliport
In new construction, when the demand for a heliport has been determined, the program in Table 6.28
shall be linked to the heliport, either by proximity or the use of a specified alternative. In additions or
renovations to existing facilities, these links shall be created and maintained whenever possible.
Table 6.28
Heliport — Essential relationships
Emergency care Trauma/resuscitation Rapid access for critical
room patient delivery
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6.3.29 Exterior garden/therapy area
6.3.29.1
In new construction, the programs in Table 6.29(a) shall be linked to the exterior garden/therapy area,
either by proximity or the use of a specified alternative. In additions or renovations to existing facilities,
these links shall be created and maintained whenever possible.
Table 6.29(a)
Exterior garden/therapy area — Essential relationships
Inpatient care Private space for patients Accommodate patients and
and family families needing privacy, exercise,
change in environment
Rehabilitation Rehabilitation exercise Accommodate patients who
require outdoor space for walking
or for looking at gardens or
landscaping.
6.3.29.2
The key relationships between the exterior garden/therapy area and the related programs in Table 6.29(b)
should be considered during planning, and created or maintained when possible.
Table 6.29(b)
Exterior garden/therapy area — Important relationships
Mental health and Area for patients to walk Require dedicated garden Secure outdoor space
addiction services outdoors as part of area for patient/family Secure garden space inside
rehabilitation; private space access building (can also be used
for patients and family when weather is
inclement)
Ambulatory care — Renal Private space for patients Accommodate patients and Internal garden space
dialysis and family facilities needing privacy,
exercise, change in
environment
Ambulatory care — Private space for patients Accommodate patients and Internal garden space
Oncology and family facilities needing privacy,
exercise, change in
environment
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6.3.30 Main entry and lobby
The key relationships between the main entry and lobby and the related programs in Table 6.30 should be
considered during planning, and created or maintained when possible.
Table 6.30
Main entry and lobby — Important relationships
Building entry and Clear access from
parking surrounding streets to front
door and parking
7 General functional service requirements
7.1 Planning
7.1.1
All interior and exterior spaces in the HCF shall be designed and constructed in a way that is consistent
with
(a) the functional requirements of the space; and
(b) OASIS principles (i.e., operations, accessibility, safety and security, infection prevention and control,
and sustainability. See Clause 4).
7.1.2
Consistent with the functional requirements and OASIS principles, the HCF shall be designed to enhance
the satisfaction of patients, families, visitors, and staff. Representatives of the major groups (e.g., clinical
staff, infrastructure and support staff, and patients and their families) who will use or work in the HCF shall
be included in the planning and construction process.
7.1.3
Consistent with the functional requirements and OASIS principles, the design and construction of patient
care areas, work areas, and public areas shall take into account common human needs for natural light,
controllable artificial light, exterior views, and privacy.
7.1.4
The design and construction of the HCF shall be consistent with
(a) current, relevant scientific information on clinical design (i.e., evidence-based design); and
(b) principles and practices of human factors engineering.
7.1.5
All clinical areas shall make provision for a family and patient support lounge.
7.1.6
The HCF plan shall include space for general administrative offices (e.g., human resources, finance,
purchasing) and for support functions (e.g., patient transportation, volunteers).
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7.1.7
The HCF plan for each service shall include space for the administrative and support functions that will be
required in each service, including the necessary storage to support those functions.
7.1.8
Appropriate staff areas shall be provided for administrative, reference, and educational activities (e.g.,
teaching, library, office, support, education, and conference).
7.1.9
Provisions for sustainable design, construction, and operation of the HCF shall be made in accordance with
Clause 4.6.
7.1.10
HVAC systems shall be designed, constructed, installed, commissioned, controlled, operated, maintained,
and managed in a manner that prudently and effectively utilizes energy, water, and other associated
resources. Consideration should be given to
(a) the availability and sustainability of energy sources;
(b) effective and efficient system design;
(c) maintainability and control of systems;
(d) initiatives that reduce energy usage; and
(e) minimizing the negative impact on the environment.
7.2 Materials and finishes
7.2.1 General
7.2.1.1
Materials and finishes shall be appropriate to the location and use (e.g., ORs with seamless, integral
surfaces on the ceilings, walls and flooring; covered flooring in all areas with potential for water
infiltration.)
7.2.1.2
Materials and finishes shall be moisture impervious and compatible with facility-approved disinfectants
used for environmental cleaning. Surfaces in high-risk treatment areas (e.g., ORs, ICU, obstetrics unit,
MDRD, and neonatal special care nurseries) shall be smooth and durable enough to withstand the
additional cleaning and disinfection that is required in these areas. Only non-cellulose building materials
shall be used.
7.2.1.3
The flame-spread and smoke-developed ratings of finishes shall comply with applicable requirements. The
use of materials known to produce large amounts of noxious gases when burned shall be avoided.
7.2.1.4
Colours, patterns, and finishes shall be appropriate to the anticipated age and type of patient, including
features that relate to cognitive abilities and mobility issues. Colours and textures in staff work areas and
staff lounge areas should be conducive to the activities in those areas.
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7.2.2 Surfaces
7.2.2.1
Surfaces shall have the following characteristics, consistent with their functional purpose:
(a) easy to maintain, repair, and clean;
(b) resistant to microbial spread and growth;
(c) non-porous or smooth;
(d) durable;
(e) easy to install, demolish, and replace;
(f) if installed on a substrates or structural assembly, it is simple, durable, and stable;
(g) seamless;
(h) resilient and impact resistant;
(i) available with options for colour, pattern, texture;
(j) non-toxic/non-allergenic;
(k) presenting minimal glare;
(l) constructed in such a way that they do not soak up or harbour moisture; and
(m) water impermeable in areas where water or dampness can occur.
7.2.2.2
Antimicrobial surfaces, if used, shall meet the surface characteristics listed in Clause 7.2.2.1.
7.2.2.3
Ceilings shall be constructed to
(a) prevent contamination of treatment areas by falling dust and debris;
(b) present a finished surface in areas where aesthetics are important;
(c) allow access to equipment, where necessary; and
(d) limit the transmission and/or reflection of sound, where necessary for patient, visitor, or staff
well-being.
See Clause 12 for detailed technical requirements for ceilings.
7.2.2.4
Floors shall
(a) be seamless and coved at all walls;
(b) be cleanable and maintainable without toxic stripping and finishing;
(c) provide the necessary stability and traction for foot traffic and wheeled traffic as appropriate;
(d) resist damage by water, chemicals, and use; and
(e) limit the transmission or reflection of sound and vibrations where noise control is needed.
See Clause 12 for detailed technical requirements for floors.
7.2.2.5
Walls shall
(a) be cleanable;
(b) prevent the movement of dust, debris, and moisture into the room;
(c) resist damage due to normal wear;
(d) resist damage due to collision in high-traffic areas;
(e) be equipped with base protection where needed to prevent damage from wheeled items (carts,
trolleys, wheelchairs, etc.);
(f) present minimal glare; and
(g) limit the transmission and/or reflection of sound, where necessary for the well-being of patients, staff,
or visitors.
See Clause 12 for detailed technical requirements for walls.
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7.2.3 Doors and door frames
Doors and door frames shall
(a) be large enough to accommodate equipment and patients;
(b) be equipped with hardware that does not present a hazard to patients or staff;
(c) resist damage due to normal wear (including collision);
(d) be cleanable; and
(e) limit the transmission and/or reflection of sound, where necessary for the well-being of patients, staff,
or visitors.
See Clause 12 for detailed technical requirements for doors.
7.2.4 Windows
7.2.4.1
Windows and frames shall be
(a) impact-resistant (e.g., using tempered safety glass or equipped with features that protect against
impact);
(b) made with materials and methods that resist moisture and mould (see Clause 12.2.4);
(c) equipped with hardware that does not present a hazard to patients or staff; and
(d) cleanable (i.e., without crevices that can trap dirt).
7.2.4.2
Windows should be clear of obstructions for optimal viewing to the outside for patients who are seated or
in bed.
See Clause 12 for detailed technical requirements for windows.
7.3 Furniture, fittings, and equipment
7.3.1
Furnishing, fittings, and equipment (FF&E) selection for each service shall be appropriate to the service
delivery model and the model of care used in the area. Careful consideration should be given to
determining what FF&E best suits the intended function, the environment, and the approach to care.
7.3.2
FF&E selection shall be made early in the pre-design planning to mitigate the risk of later decisions on the
building design. In the initial stages, this may be done by selecting FF&E based on a generic list of devices.
Specific manufacturer, model, options, and accessories might not be necessary in preliminary design.
However, in detailed design stages, the planning team shall confirm specific manufacturers to obtain
relevant information.
7.3.3
FF&E shall be consistent with the functional requirements of the area, including
(a) type of patient, visitor, staff;
(b) anticipated wear and tear;
(c) hours of use;
(d) chemicals in use at the site that could impact finishes/fabrics of the furniture;
(e) flooring in the area; and
(f) ease of cleaning and (where necessary) the use of disinfectants on materials.
7.3.4
FF&E selection shall include space planning to determine
(a) how items will fit in the space and their effect on the use of space;
(b) proximity of storage locations for items to their point of use;
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(c) the size of items in relation to clearances in their surroundings (e.g., whether a patient bed of a given
size will fit within the necessary clearances to nearby walls, equipment, and other beds); and
(d) the relationship of items to the building envelope (e.g., the impact of day lighting on the item, ability
to access equipment for replacement, the need for venting of humidity or vapours, etc.).
7.3.5
The equipment selection process shall include evaluation of the following factors:
(a) the effect on building structure in terms of weight and vibration;
(b) the effect on the surrounding environment of heat and light generated by the equipment;
(c) electrical design and power requirements; and
(d) the need for other utilities or services for equipment to properly function.
7.3.6
Throughout the selection process, criteria for decision making regarding FF&E shall include
(a) alignment with service-delivery model;
(b) flexibility and adaptability of devices, furniture, etc.;
(c) staff activities (e.g., workstation requirements that accommodate specific tasks);
(d) ergonomics;
(e) structural integrity of the furniture and covering;
(f) antibacterial cleanability over the long term;
(g) ease of getting in and out of the seating;
(h) patient types (e.g., mental health, bariatric, access challenged, hearing impaired, sight impaired);
(i) consistency with proposed environment (e.g., family-centred, home-like in some areas);
(j) safety considerations for staff (e.g., weight, force affecting manual handling) and patients and visitors
(e.g., load tolerances);
(k) standardization and adaptability for use in other components;
(l) budget;
(m) life cycle cost analysis (initial cost, ongoing maintenance, durability, etc.);
(n) serviceability/vendor support, availability of parts;
(o) potential to achieve cost savings through purchase and maintenance agreements (e.g., economies of
scale and strategic alliances with suppliers for advantageous life cycle replacement of items such as
medical equipment); and
(p) compatibility with electronic health records, other networked devices, and the IT infrastructure.
7.3.7
Furniture and equipment shall be non-permeable, non-shedding, cleanable, and compatible with the
disinfectants approved for environmental cleaning in the HCF. Surfaces shall be chosen to minimize glare.
7.3.8
When the final FF&E selection has been made, a comprehensive list and detailed specifications shall be
developed for each device (sorted by room name) to
(a) identify each device and its dimensions;
(b) classify the equipment with respect to type:
(i) fixed medical;
(ii) mobile medical;
(iii) fixed non-medical; or
(iv) mobile non-medical;
(c) summarize the implications on architectural, structural, mechanical, and electrical systems;
(d) show the FF&E on the floor plans to clarify location within the room and to confirm the space will
accommodate the list of necessary devices; and
(e) assign responsibility in a matrix that clearly identifies who purchases, receives, installs, and verifies the
device.
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7.3.9
Due to the type and cost of contents stored within refrigerators and freezers and the potential risk to
patient safety, the HCF shall have a classification system that identifies refrigerators and freezers needing
additional monitoring and safeguards to protect their contents.
30 min
30 min
7.4 Technology and communications systems
7.4.1
The technology and communications systems for the HCF and the selection of the individual systems
within each service/component shall be appropriate to the services provided, the service delivery model,
and the model of care used in the component.
7.4.2
Technology and communications system planning shall be performed early in the design process so that
provision for these enabling technologies can be incorporated in the building design.
7.4.3
The selection process for technology and communications systems shall include the following elements:
(a) space planning — some systems can increase the demand for specific rooms;
(b) block building planning — systems can require distribution hubs/closets within a maximum distance;
(c) schematic building design — some technologies can increase or decrease the need for adjacencies
between components and can enable the use of alternative layouts within some areas;
(d) structure — weight, shielding requirements, and vibration;
(e) mechanical design — services needed for the technology (e.g., cooling the processors); and
(f) electrical design — networking and power requirements.
7.4.4
Throughout the selection process, criteria for decision making regarding technology and communications
shall include
(a) alignment with the service-delivery model;
(b) flexibility and adaptability, to permit implementation of future applications;
(c) staff activities (e.g., workstation requirements that accommodate specific tasks);
(d) patient types (e.g., mental health, bariatric, access challenged, hearing impaired, sight impaired,
etc.);
(e) consistency with proposed equipment, electronic health records, and other networked devices;
(f) standardization for use across all components;
(g) budget;
(h) cost-benefit analysis (initial cost, ongoing maintenance, durability, etc.);
(i) potential to achieve cost savings by means of economies of scale, and through strategic alliances with
suppliers for advantageous life cycle replacement, upgrade, or update of hardware and software, as
well as numbers of licenses for using applications; and
(j) serviceability, vendor support, and availability of parts.
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7.4.5
Unless specified under individual program areas, technology planning for all functions shall address the
following:
(a) electronic health records (EHR);
(b) point of care equipment;
(c) picture archiving communication system (PACS);
(d) patient administration system (PAS);
(e) data entry including scripts and investigation requests;
(f) bar coding for supplies (e.g., drugs, other pharmaceuticals, small equipment such as renal, etc.);
(g) bar coding for X-rays/and records;
(h) wireless network for EHR, telemetry and monitoring; RFID asset tracking, patient equipment, voice
over IP (VoIP);
(i) personal distress alarms;
(j) hand-held computers and smart phones;
(k) confidential receipt of information (e.g., fax, email);
(l) alarm systems where necessary (e.g., unauthorized drug cabinet opening);
(m) access to cellular phone networks (repeaters in HCF);
(n) building controls and building automation systems (BAS);
(o) computerized maintenance management system (CMMS);
(p) security systems, egress locks, infant abduction system, and patient wandering monitors; and
(q) wireless public internet.
7.5 Infection prevention and control
7.5.1 General
7.5.1.1
The HCF shall be designed to minimize the potential transmission of micro-organisms, and to provide the
necessary equipment and spaces to support the use of routine infection prevention and control practices.
7.5.1.2
The HCF shall conduct an infection control risk assessment during the planning phase of a project. This
shall include consideration of the facility’s patient population and programs. Based on the risk assessment,
the HCF shall be designed to include infection prevention and control measures that minimize the
potential for acquisition and transmission of infections in a health care setting.
7.5.1.3
Planning shall make provisions to facilitate
(a) implementation of routine practices for all patients regardless of the diagnosis;
(b) appropriate spacing and placement of patients based on mode of transmission of infectious
organisms, including assessment of the need for single inpatient bedrooms and airborne isolation
rooms;
(c) adequate control of patient flow through the HCF;
(d) mechanical requirements for proper ventilation;
(e) adequate hand hygiene facilities;
(f) processes for proper reprocessing of medical devices and equipment;
(g) segregation of soiled and clean items; and
(h) HCF responses to catastrophic events, e.g., pandemic disease.
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7.5.1.4
The HCF design shall be consistent with best practice for infection prevention and control, including
(a) promotion and facilitation of the use of routine infection prevention and control practices, including
convenient access to personal protective equipment;
(b) placement of hand hygiene sinks (HHS) and waterless hand hygiene stations;
(c) single inpatient bedrooms, unless otherwise specified in the functional program with supporting
justification (see Clause 7.5.2.2);
(d) properly designed HVAC, plumbing, and water systems;
(e) the use of cleanable materials for furnishings, fittings, and finishes;
(f) management of human and other waste streams to prevent aerosolization of fluid and contamination
of the environment;
(g) segregation of sterile, clean, and soiled items, including traffic patterns of clean and soiled transport
within an HCF;
(h) safe reprocessing of reusable medical devices;
(i) information systems to support surveillance of infectious symptoms and information sharing
throughout the HCF; and
(j) adequate space allocation to each clinical patient location and separation of patients in areas where
multiple patients occupy the same space (waiting areas, holding etc.).
7.5.1.5
The planning and design process shall include stakeholder participation as specified in Clause 4.5.1.2.
7.5.2 Separation of patients
7.5.2.1 General
7.5.2.1.1
The HCF design shall provide for patient separation as needed for infection prevention and control
purposes.
7.5.2.1.2
The HCF design shall provide sufficient space in clinical areas so that the necessary distances can be
maintained between patients.
7.5.2.2 Single inpatient bedrooms
All inpatient bedrooms in Class A HCFs shall be single bedded rooms unless the functional program
demonstrates the necessity of a two-bed arrangement.
Justification for two-bedded patient bedroom accommodation shall include supporting documentation
validating the clinical significance of this arrangement. See Clause 4.5.2.
7.5.2.3 Multi-patient bedrooms
A multi-patient bedroom shall accommodate no more than two patients. In this arrangement, there shall
be one washroom per patient.
7.5.2.4 Single patient treatment places
All patient treatment places whether intended for inpatient or outpatient use shall be single occupancy
unless the functional program demonstrates the necessity of multi-patient arrangement.
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7.5.2.5 Multi-patient treatment places
If a multi-patient arrangement is used, there shall be at least 1200 mm between beds and/or treatment
chairs. For recovery rooms, the minimum distances in Table 7.1 shall apply.
7.5.2.6 Bed clearances
The space provided for each clinical patient area shall comply with Table 7.1 for minimum clearances of
space at the sides, headwall, and foot of the patient bed/treatment area. In situations where between-bed
and centreline-to-centreline distances do not match, the larger distance of the two shall be used.
Table 7.1
Minimum distances for inpatient and critical care beds
Minimum distances for inpatient beds:
1000 mm on the non-transfer side (wall) and to fixed surface from the side of the bed
1200 mm at the foot of the bed
1200 mm between beds (in rooms where there is more than one bed)
1800 mm centreline to centreline (in rooms where there is more than one bed)
Minimum distances for critical care beds:
1200 mm on the non-transfer side (wall) and to fixed surface from the side of the bed
1500 mm at the foot of the bed
1800 mm between beds (in rooms where there is more than one bed)
2400 mm centreline to centreline (in rooms where there is more than one bed)
1000 mm 1200 mm
7.5.2.7 Waiting area clearances
Waiting rooms and holding areas, where multiple patients occupy the same room, shall comply with the
following precautions and minimum distances for separation:
(a) unscreened patients — minimum of 1000 mm or physical barrier (e.g., using a pod design);
(b) screened patients (i.e., symptoms have been assessed through triage or self-screening) — distance
between chairs may be less than 1000 mm, depending on facility type, patient population, and
degree of risk; and
(c) symptomatic patients (e.g., coughing) — minimum distance of 2000 mm or physical barrier.
7.5.3 Mechanical systems and equipment
Mechanical systems and equipment shall be designed with the following features:
(a) easy access and maintenance, especially with systems needing frequent maintenance, or where
infection control is a concern (e.g., airborne isolation rooms, for which particular requirements for
HVAC and plumbing systems apply);
(b) ability for staff to safely use, maintain, and repair systems and equipment;
(c) ability to maintain and repair systems and equipment with minimal disturbance of patients;
(d) provision for zones of care with the capability to isolate HVAC systems to respond to emerging
infectious diseases;
(e) HVAC performance for specific areas in accordance with CAN/CSA-Z317.2;
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(f) measures to prevent the propagation of legionella in plumbing systems, in accordance with
CSA Z317.1; and
(g) specific water quality measures as per manufacturer’s instructions for use for dedicated equipment,
e.g., medical device reprocessing equipment (see CAN/CSA-Z314.8 and CSA Z314.3) and water for
dialysis (see CAN/CSA-ISO 26722).
7.5.4 Materials and finishes
Materials and finishes shall comply with Clause 7.2.
7.5.5 Airborne isolation rooms
7.5.5.1
Class A HCFs shall provide at least one airborne isolation room (AIR) for each of the following services or
areas:
(a) emergency care;
(b) clinics in areas servicing high risk populations (e.g., tuberculosis or infectious diseases clinics,
pulmonary/respiratory clinics, dialysis);
(c) diagnostic imaging (in HCFs servicing high-risk populations);
(d) endoscopy;
(e) ICU; and
(f) general medicine floors.
7.5.5.2
There shall be a minimum of one AIR per inpatient unit unless the functional program can demonstrate an
AIR will not be required based upon a risk assessment.
If the functional programming process indicates that additional AIRs might be needed, a needs
assessment capacity study shall be completed.
7.5.5.3
An AIR shall have a pressure monitoring system and an alarm in accordance with CAN/CSA-Z317.2.
7.5.5.4
AIR anterooms, if present, shall comply with the requirements of CAN/CSA-Z317.2 for HVAC systems and
relative pressurization.
7.5.6 Waste management
Waste management practices shall include segregation of wastes into an appropriate dedicated holding
area in the unit of care or work environment and shall be in compliance with CSA Z317.10. Provisions for
human waste management shall be in accordance with Clause 7.5.7.
7.5.7 Human waste management
7.5.7.1
There shall be a washroom with a toilet and sink for each inpatient. Toilets shall not be located in inpatient
bedrooms.
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In services where patients will not use a toilet (e.g., ICUs and nurseries), the washroom may be omitted;
however, each room with inpatient beds shall have a means for staff to dispose of human waste,
comprising either
(a) a separate closed toilet room with hand hygiene sink; or
(b) a separate closed waste management mechanism with an adjacent hand hygiene sink.
7.5.7.2
Each inpatient service shall be equipped with at least one closed waste management system where staff
can decant or discard human waste, solid and liquid, and other potentially contaminated fluids. The
number and location of these systems shall be determined based on the need to maintain proximity to the
point of care and the risks and acuity of the patient population.
7.5.7.3
Waste management systems shall be designed to prevent aerosolization of fluids during the decanting or
discarding of waste. If toilets are used, they shall be installed in a room dedicated for use of the toilet.
Spray wands shall not be used for rinsing waste receptacles.
7.5.8 Segregation of sterile, clean, and soiled items
7.5.8.1
The HCF shall be designed to facilitate and maintain the separation of sterile, clean, and soiled items as
follows:
(a) Areas for the management of soiled, reusable medical devices and textiles shall be designed in
accordance with CAN/CSA-Z314.8 and CSA Z314.10.2.
(b) Separate dedicated lifts for clean and soiled items should be provided.
(c) Sterile storage (i.e., storage under the control of the MDR service) shall be in compliance with
CSA Z314.3.
(d) Storage in warehouses or other areas not in control of the MDR service shall comply with
CSA Z314.15.
(e) Areas for the sorting and separation of items shall be given the appropriate space allocations based on
the ICRA and the functional program.
7.5.8.2
The HCF planning process shall include a description of the movement of materials, traffic patterns, and
the flow of clean and soiled devices within the HCF. Design provisions shall be included to maintain
separation of sterile, clean, and soiled items at all times.
7.5.9 Medical device reprocessing
The HCF planning for MDR services shall be based on the following principles:
(a) MDR services shall be located so as to minimize transportation of soiled devices within the HCF.
(b) MDR shall be performed only in areas that have a dedicated space for these activities, and that
comply with
(i) CAN/CSA-Z317.2 regarding exchanges and relative pressurization; and
(ii) CAN/CSA-Z314.8 regarding the design of reprocessing areas.
(c) MDR areas and transportation systems shall be designed to maintain separation between clean and
sterile items and soiled items, with clear markings of the respective areas.
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7.5.10 Surveillance and information systems
Information systems to support surveillance of infectious symptoms and sharing of information
throughout the HCF shall include the following:
(a) provision for assessment of inpatients entering the HCF for the presence of symptoms indicative of an
infectious disease; and
(b) provision of systems for documentation and communication of these symptoms to other areas within
the HCF whether electronically or by other means as identified by the needs of the facility.
7.5.11 Hand hygiene facilities
7.5.11.1 General
7.5.11.1.1
The location and design of hand hygiene facilities shall be developed in consultation with infection
prevention and control personnel and shall be consistent with the ICRA. The HCF design shall specify
(a) the room location of hand hygiene sinks in the HCF, and the placement of the sink(s) within each
room location and in relation to counters and other related fixtures;
(b) hand hygiene sink design; and
(c) the location of waterless hand hygiene stations.
7.5.11.1.2
Hand hygiene sinks shall be dedicated to that purpose and not used for any other purpose.
7.5.11.1.3
Sinks used for cleaning of equipment and the disposal of waste fluids (e.g., IV fluids, lipids, used
antiseptics) shall not be used for hand hygiene.
7.5.11.2 Hand hygiene sinks
7.5.11.2.1
A hand hygiene sink shall be installed in each of the following locations:
(a) inside each inpatient bedroom, adjacent to the entrance;
(b) in any space where treatment is provided or procedures or physical exams are performed, as follows:
(i) in a location designed for one patient to be present at a time: one sink; or
(ii) in a location designed to accommodate three or more patients at a time: a minimum of one sink
for every three patients, with no more than 6 m distance between any patient station and the
nearest sink;
(c) inside or adjacent to each diagnostic MRI room;
(d) in each soiled utility/soiled holding room (in addition to sinks or hoppers that are used for
contaminated material);
(e) in any room in which food or patient care items (e.g., tray) are prepared. This includes but is not
limited to clean utility rooms used for patient tray preparation, nourishment centres, rooms where
infant formula is prepared, etc.;
(f) inside each nursing station or within 6 m of the station;
(g) inside each staff lounge or within 6 m of the lounge;
(h) within 6 m of each laboratory workstation and within each work room;
(i) in each room in which medication is prepared (including in pharmacies);
(j) in each area where unbagged soiled linen is handled;
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(k) other areas where hands are likely to be contaminated, such as in goods receiving areas, chemical
storage, and waste storage and disposal areas; and
(l) in airborne isolation rooms, as follows:
(i) one hand hygiene sink in the anteroom, if present; and
(ii) one in the room itself.
7.5.11.2.2
The design and installation of hand hygiene sinks and their surroundings shall be in compliance with
Clause 11.
7.5.11.3 Waterless hand hygiene stations
7.5.11.3.1
Waterless hand hygiene stations shall be provided in each of the following locations:
(a) at all entrances and exits to the HCF;
(b) on the external wall immediately adjacent to the entrance to every inpatient bedroom;
(c) on a wall immediately adjacent to the entrance to every patient care area (e.g., exam rooms and
procedure rooms in out-patient settings, medical imaging procedure rooms, etc.);
(d) adjacent to the bedside (point of care) in all situations except where patient safety could be put at risk
(e.g., mental health unit);
(e) in locations where PPE is donned or doffed; and
(f) in locations where they are needed to facilitate compliance with routine practices.
7.5.11.3.2
Waterless hand hygiene fixtures shall be mounted at a height of approximately 1 m from the floor.
Adjacent floor and wall surfaces should be protected from the hand hygiene fluid.
7.5.11.3.3
Placement and storage of alcohol-based waterless hand hygiene products, fixtures, and supplies shall be in
compliance with the HCF’s fire prevention guidelines and applicable requirements.
7.5.11.3.4
Where the optimal placement of a waterless hand hygiene station (i.e., for staff compliance) appears to
conflict with applicable fire safety requirements, the fire marshal and the infection prevention and control
team shall be consulted to resolve the issue.
7.5.12 Scrub sinks
A scrub sink (as distinct from a hand hygiene sink) shall be provided in any area where operative
procedures are performed including ORs, delivery rooms, endoscopy suites, interventional radiology, and
cardiac catheterization suites.
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7.6 Occupational health and safety
7.6.1 General
7.6.1.1
The HCF shall be planned, designed, and constructed to provide a safe workplace for all staff and to enable
and support the application of occupational health and safety (OH&S) principles and practices. Planning
for OH&S should be consistent with the requirements of CAN/CSA-Z1000 and OSACH
.
7.6.1.2
OH&S planning shall involve input from employees and relevant experts, and shall be aimed at
recognizing, assessing, controlling, and evaluating hazards as they relate to the HCF building, work areas,
mechanical and electrical systems, and environment.
7.6.1.3
Provision shall be made to protect the health and safety of staff, consistent with the clinical and safety
needs of patients. Mitigation of risks shall include, but not be limited to the prevention of
(a) slips and falls;
(b) injuries due to hazardous materials (chemical, biological, radiological, nuclear, and explosive);
(c) fire;
(d) electrical shock;
(e) musculoskeletal injuries due to patient handling/lifting;
(f) musculoskeletal injuries due to manual materials handling or workplace and workstation design; and
(g) workplace violence including aggressive behaviour by patients and/or others.
7.6.1.4
The elimination of hazards or reduction in risk should be achieved as much as possible through
engineering solutions (i.e., as a part of design and construction) rather than through administrative
solutions.
7.6.1.5
Engineering features that promote OH&S should be considered early in the design process so they can be
well integrated into the overall design.
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7.6.1.6
OH&S plans shall include provisions to protect the health and safety of maintenance workers and other
HCF engineering staff. The following should be considered:
(a) For buildings with roof-mounted equipment, stairs should be provided for maintenance staff access.
(b) Means should be provided to facilitate the safe lifting of heavy tools and equipment to the roof or
other high spaces (e.g., anchor points for portable hoisting equipment).
(c) There should be easy access to maintenance points on equipment. Low ceiling crawl spaces should
be avoided.
7.6.1.7
Space for the storage of PPE shall be provided near the point of use.
7.6.2 Biologics safety
7.6.2.1
HCFs shall be designed with the intent to reduce the potential for adverse health effects from biologic
agents through the application of routine infection prevention and control practices. See Clause 7.5.
7.6.2.2
Space for sharps disposal containers shall be provided at the point of use. Sharps disposal containers
should also be provided centrally within the HCF. Sharps disposal containers should be mounted a
maximum of 1250 mm above floor level for standing use or a maximum of 510 mm above floor level for
seated use. There should be a maximum of 460 mm horizontal reach to the centre of the container
opening.
7.6.2.3
Adequate local exhaust ventilation shall be provided when hazardous biological materials are involved in a
process that can cause the material to be aerosolized (e.g., in laboratories or medical device
decontamination areas).
7.6.2.4
Eyewash stations shall be installed in areas where there is a risk of exposure to a biological splash (e.g.,
blood or body fluids).
7.6.2.5
Areas where lasers are used shall comply with CSA Z386. Surgical plume scavenging systems shall be
installed in locations where laser and electrocautery procedures are performed.
7.6.2.6
Space shall be provided for designated refrigerators to store biological materials/specimens, as required by
the functional program.
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7.6.3 Chemical safety
7.6.3.1
HCFs shall be designed with the intent to reduce the potential for illness or injuries caused by chemicals,
and to keep overall exposures as low as reasonably achievable (ALARA). The designer should be aware of,
and design for, the types of chemicals expected and the design should permit additional controls in the
future if needed.
7.6.3.2
The use of, and storage for, hazardous chemicals shall be in conformance with material safety data sheets
(MSDS) and manufacturers’ instructions. Examples of hazardous chemicals include ethylene oxide,
formaldehyde, glutaraldehyde, anti-neoplastic drugs, and anaesthetic gases. Care should be taken in the
use of chemicals for cleaning, disinfecting, and sterilizing.
7.6.3.3
When chemicals or pharmaceuticals are being poured, mixed, or otherwise handled, adequate ventilation,
including local exhaust ventilation, shall be provided in accordance with the MSDS and manufacturers’
instructions.
7.6.3.4
Adequate space shall be provided for chemical storage and PPE near the point of use. Storage shall be
appropriate for the chemicals used (i.e., separation of incompatible types of chemicals, vented versus
non-vented cabinets, etc.).
7.6.3.5
Adequate space shall be provided for chemical disposal. Space should be provided in a central location for
use as a staging area for consolidation prior to removal of the chemicals from the site.
7.6.3.6
Storage space for spill cleanup materials shall be provided in a location convenient to the point of use.
Provision should be made for spill containment and (if necessary) drainage.
7.6.3.7
Eyewash stations and emergency deluge showers shall be provided adjacent to chemical use locations
where hazardous spills or splashes could occur.
7.6.3.8
Exhaust vents for fume hoods, and other vents that carry chemical exhaust, shall be placed as specified in
CAN/CSA-Z317.2 to avoid recirculation of chemicals.
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7.6.4 Safety from physical hazards
7.6.4.1
HCFs should be designed to eliminate or decrease the risk of injury or occupational illness caused by
physical agents such as electricity, noise, radiation (including laser, ionizing, and non-ionizing), high or low
temperatures, and poor lighting.
7.6.4.2
Equipment that produces ionizing radiation (e.g., diagnostic imaging and radiation therapy machines)
shall be installed in accordance with applicable requirements.
7.6.4.3
Radiation protection for X-ray and gamma ray installations shall comply with NCRP Report No. 49 and
NCRP Report No. 102 and all applicable requirements. Testing should be coordinated with local
authorities to prevent duplication of test observations or construction inspections. Provision shall be made
for testing completed installations before use. All defects shall be corrected before approval.
7.6.4.4
Adequate lighting for the task being performed shall be provided all work locations.
7.6.4.5
Proper temperature control shall be provided in workstations in accordance with CAN/CSA-Z317.2. The
position of workstations and the comfort of staff should be considered in the selection and location of
ventilation diffusers.
7.6.4.6
Provision shall be made to protect patients, HCF staff, and emergency response crews from the hazards
related to cryogenic materials and magnetic fields around MRI machines.
7.6.4.7
Provision shall be made to protect staff and visitors from excessive and damaging noise (e.g., in boiler
rooms).
7.6.5 Safety from nuclear agents
7.6.5.1
HCFs shall be designed to reduce the potential for illness or injury caused by nuclear agents.
7.6.5.2
The space provided for the use of and storage for nuclear agents shall be in conformance with radiation
safety standards.
7.6.5.3
Work and treatment areas shall be designed to prevent the escape of radioactive particles.
7.6.5.4
Adequate space shall be provided near the point of use for
(a) storage of radioactive materials;
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(b) equipment and supplies for cleanup and decontamination following a spill or other exposure;
(c) containers for disposal of radioactive materials;
(d) PPE as needed for use when handling materials; and
(e) PPE for the cleanup of spills.
Space shall also be provided centrally as a staging area for consolidation prior to removal.
7.6.5.5
Eyewash stations and showers shall be provided adjacent to locations where spills and splashes could
occur.
7.6.6 Ergonomics
7.6.6.1 General
7.6.6.1.1
HCFs shall be designed to reduce the potential for illness or injury caused by ergonomic risks.
7.6.6.1.2
Floor surfaces, including transition areas, shall be designed to minimize the risk of injury from pushing
stretchers, beds, supply carts, or wheelchairs.
7.6.6.1.3
Surfaces and areas shall be designed to reduce the risk of slips and falls.
7.6.6.1.4
Transition areas shall minimize the effort required for staff to push stretchers, beds, supply carts, or
wheelchairs across doorways.
7.6.6.1.5
Sufficient space should be provided for flexible workstations that allow the worker to either sit or stand.
Spaces shall allow staff to move without constraint and maintain neutral body postures for manual work
and patient handling activities.
Working heights, reaches, and clearances in all work areas (labs, pharmacy, reception, etc.) should
accommodate the range of staff sizes and allow for work from a standing posture or a seated posture
through adjustable work surfaces. Workstation designs should be independently reviewed by an
ergonomist.
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7.6.6.1.6
Adequate space shall be provided around workstations to allow the user to enter and exit with ease.
7.6.6.1.7
Adequate space shall be provided at workstations for the storage and use of manuals, documents, charts,
records, and other material. Secure storage shall be provided where needed for confidential or
difficult-to-replace material.
7.6.6.1.8
The HCF design shall provide adequate space so that users can maintain optimal postures and safely
perform tasks at critical areas such as the bedside, in patient washrooms, or in emergency bays. Space
should allow for movement of stretchers, wheelchairs, portable equipment, additional staff, etc.
7.6.6.1.9
Adequate space shall be provided at a workstation for a telephone and for the placement of the keyboard
tray and computer mouse. The workstation design should avoid sharp edges or gaps that could pinch at
the wrists of the user.
7.6.6.1.10
Functional space for the use of equipment and sufficient storage space for all equipment shall be provided
in close proximity to the location of use.
7.6.6.1.11
Grab bars and handrails should be installed for patient mobility where necessary in patient bedrooms,
bathrooms, tub rooms, activities for daily living (ADL) suites, dining areas, assessment rooms, lounges, and
corridors.
7.6.6.1.12
Storage space shall be provided for manual handling aids such as patient lifts, commodes, wheelchairs,
walking belts, slider boards, and patient scales.
7.6.6.1.13
Area design should minimize the need for manual movement of materials and supplies through the use of
careful layout and the inclusion of non-manual movement systems such as horizontal and vertical lifts and
motorized devices.
7.6.6.2 Patient mechanical lift devices
7.6.6.2.1
In Class A HCFs, all inpatient bedrooms for the following patient groups shall have a rail for a patient
mechanical lift device installed in the ceiling:
(a) acute medical or surgical patients;
(b) critical care;
(c) pediatric;
(d) inpatient continuing care; and
(e) rehabilitation.
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The lift rail may be omitted if the functional program demonstrates that there is not a justified
cost/benefit need for ceiling mounted patient lifts.
The HCF shall have the means to provide mechanical lifting for patients in all other clinical areas (e.g.,
physiotherapy, diagnostic imaging).
Ceiling lift rails shall be installed with the necessary structural, mechanical, and electrical systems, and
these shall be designed so that the lift system does not interfere with other inpatient support services
located in the ceiling (e.g., lighting, HVAC, life safety). Proper fasteners shall be provided for
ceiling-mounted patient lifting devices.
7.6.6.2.2
Ceiling lifts shall have minimum vertical and horizontal lift capacities of 200 kg. Rooms that are designed
for bariatric patients (see Clause 7.8.8.1) shall have a lift with a capacity of at least 453 kg.
7.6.6.2.3
Class A HCFs shall determine the number of lifting slings and associated equipment to be installed at time
of initial construction based on the functional program. Class A HCFs shall also determine the number of
lifting slings and associated equipment to be kept in storage and readily available in each patient
functional area. Where the functional program demonstrates that lifting slings and associated equipment
will be stored within each area, dedicated space for such storage shall be provided.
7.6.6.2.4
Class B HCFs shall have patient lift rails and electrical systems installed in all inpatient bedrooms at the time
of construction.
7.6.6.2.5
Class C HCFs should consider the installation of lift rails, electrical systems, and lifting slings as required by
the functional program.
7.6.6.2.6
In all cases, where lift rails are installed, the HCFs should consider if any of the ceiling-mounted lifts are
required to transport the patient from the bed to the ensuite washroom in accordance with the functional
program.
7.6.6.2.7
Patient lifts shall be installed above treatment tables and above assessment tables in rehabilitation units
and other areas where lifting is likely to be required.
7.6.6.2.8
Patient transfer devices (in addition to, or instead of lifts) shall be provided in accordance with the
functional program.
7.6.6.2.9
Patient lifts and transfer systems, when provided, shall be installed, inspected, and tested in accordance
with the manufacturer’s instructions.
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7.7 Safety and security
7.7.1 General safety and security considerations
7.7.1.1
The HCF shall be designed to optimize the safety and security of patients, staff, and visitors. The planning
and design process shall include a threat, risk, and vulnerability analysis and the HCF shall be designed to
address the risks identified in the analysis.
7.7.1.2
Systems and features to promote safety and security should not create unnecessary inconvenience or
inefficiency for staff and patients.
7.7.1.3
The HCF shall be planned, designed, and built to incorporate the following safety and security features:
(a) passive design measures to enhance security (e.g., by providing clear sight lines to entry points);
(b) adequate space and appropriate strategic locations for active security elements such as security
services or security systems;
(c) passive design measures to enhance physical safety; and
(d) physical layout and systems that
(i) support the HCF’s emergency management plan, consistent with the requirements of
CSA Z1600;
(ii) support the HCF’s occupational health and safety management systems, consistent with the
requirements of CAN/CSA-Z1000; and
(iii) preserve patient privacy, confidentiality, and dignity to the greatest extent possible, consistent
with security and clinical considerations.
7.7.1.4
The design shall address the following aspects of security:
(a) personal security of patients, family members, and staff;
(b) security of property of patients, visitors, and staff;
(c) security of HCF equipment and stores items;
(d) drug security;
(e) access and egress/unauthorized intrusion;
(f) night staffing conditions;
(g) security lighting;
(h) the potential need for site lockdown and the control of access or egress during
(i) pandemics and other disasters; and
(ii) code responses, e.g., for missing patients; and
(i) provision of secure storage for personal items belonging to patients or staff.
7.7.1.5
Standardized design should be used where applicable within the HCF to promote patient and staff
familiarity with the layout, design, and systems.
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Inpatient bedrooms should be designed and built identically throughout the HCF including left/right
orientation, so that staff can orient themselves immediately upon entering any room.
7.7.1.6
Equipment storage shall be provided in every service. The storage area shall be determined in accordance
with the functional program, but in no case shall the storage be less than 2% of the total area of the
service. Circulation areas shall not be used for storage.
7.7.2 Design elements to enhance security
7.7.2.1
The HCF shall be designed to enhance the security and personal safety of patients, staff, and visitors
through the use of passive design elements, as follows:
(a) the floor layout in both clinical and public areas shall provide clear sight lines from control points
(e.g., a nurses’ station or reception desk) to entrances, waiting areas, and circulation routes; and
(b) clinical staff shall be able to easily monitor movements and activity of patients and visitors in their
departments through direct visual contact (e.g., from reception, staff station, etc.).
7.7.2.2
In locations where visitors or patients could present a risk of violence, the layout and choice of materials
shall be designed to mitigate the risks to staff, other patients, and building systems. Depending on the
type and extent of the risk, the following should be considered:
(a) design of reception counters to minimize staff vulnerability through
(i) protective barriers; and
(ii) choice of glazing and other materials;
(b) resistance of building materials to assault;
(c) choice of furniture; and
(d) location of service panels to prevent unauthorized access, tampering, or attack.
7.7.2.3
The design should provide the staff with an easy method to obtain help. The planning should include the
following:
(a) location and installation of staff emergency assistance alarms;
(b) location and installation of intercom systems; and
(c) location of security office.
7.7.2.4
The design should provide staff with a means for egress from potentially harmful circumstances.
7.7.2.5
The design should make it easy for staff to support each other in maintaining safety and security, especially
when the day shift operational areas are closed down.
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7.7.2.6
The design should provide the staff with a way to observe a space before entry into potentially harmful
circumstances, as follows:
(a) Bedrooms doors shall have observation panels in doors, sized and positioned so that staff can view
the room (i.e., through a high panel), as well as being able to see a small child on the other side of
the door (low panel).
(b) Convex mirrors shall be used on all blind corners.
(c) Door swings shall be planned and arranged so that there is no danger of hitting a patient on the
other side and so that a patient cannot block access into a room.
7.7.2.7
The design should maximize security by incorporating features for staff to have direct observation of all
persons entering an area when security is required. The design features may include the following:
(a) minimizing the number of entry and exit points;
(b) incorporating an access control system (e.g., electric strike and card readers to all perimeter doors);
and
(c) locating the main access door so that it does not impede access to rooms outside.
7.7.3 Electronic and staff security elements
7.7.3.1
The HCF design shall incorporate electronic and/or staff-based security elements as appropriate to address
the hazards identified in the threat, risk, and vulnerability analysis. Depending on the type of HCF and the
identified risks, this may include
(a) closed circuit television cameras (CCTV) or a comparative monitoring system;
(b) motion detectors;
(c) intruder alarm systems and/or staff emergency assistance alarm systems and staff handsets;
(d) patient tracking systems;
(e) identification and tracking systems for infants; and
(f) provision for lock down of departments or areas in response to a security threat.
7.7.3.2
Provision shall be made for staffed security posts where appropriate.
7.7.3.3
The design of electronic security elements should be flexible to allow for future changes in the security
situation or facility staffing, and changes in electronic systems.
7.7.4 Design measures to enhance physical safety
7.7.4.1
The HCF shall be designed to minimize physical hazards to staff, patients, and visitors. This shall include
(a) the use of materials with intrinsic safety characteristics (e.g., slip-resistant flooring); and
(b) automatic shut-off for equipment and devices where appropriate (e.g., power, gases).
7.7.4.2
The design shall minimize the risks for patients who are confused, disoriented, have cognitive or sensory
impairment, or behaviourally disturbed. The design features may include the following:
(a) design of stairwells to reduce risk of falls (either accidental or deliberate);
(b) choice of flooring and patterns;
(c) design of doors (hinges) in mental health unit and dementia/aged care unit inpatient bedrooms;
(d) choice of glazing;
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(e) choice of light fittings and placement; and
(f) choice of window coverings.
7.7.4.3
The design shall minimize the risks for children and other vulnerable individuals (e.g., persons with an
intellectual disability) as patients or visitors.
The design features shall include the following:
(a) Door hardware shall be child-safe and door handles shall be out of the reach of small children.
(b) The design and layout of areas where children or other vulnerable individuals could be present shall
prevent access by these individuals to areas containing equipment or material likely to be harmful to
them, including
(i) beverage pantry and heated food trolleys;
(ii) utility rooms, cleaners’ rooms, storage rooms, linen bay;
(iii) resuscitation cart;
(iv) disposal room;
(v) treatment room; and
(vi) medication room.
(c) Barriers and balustrades shall be non-scalable by toddlers.
(d) Non-scalable safety fencing of adequate height shall be provided around external play areas.
Additional safety features should be considered for play spaces located above ground level.
(e) Play spaces, if provided, shall be in compliance with CAN/CSA-Z614.
(f) Service panels shall be out of reach of small children.
(g) Nurse and emergency call buttons shall be out of the reach of children.
(h) Electrical outlets in child-occupied areas shall be above child height and safety sealed.
7.7.5 Emergency management
7.7.5.1 General
The HCF shall be designed, built, and equipped to be able to maintain the safety and security of patients,
staff, and visitors in emergency situations, including catastrophic events. See Clause 7.9.
7.7.5.2 Facility planning
The HCF master plan shall specify the necessary mitigation measures to address hazardous conditions and
situations or conditions that could compromise the ability of the HCF to fulfill its medical service functions
during and after emergencies.
7.7.6 Privacy, confidentiality, and patient dignity
The design and planning of the HCF shall include provisions to maintain patient privacy, confidentiality,
and dignity.
The HCF should
(a) provide privacy for each patient, consistent with clinical and safety/security considerations;
(b) ensure confidentiality of personal discussions and medical records;
Personal Information Protection and Electronic Documents Act Privacy Act
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(c) provide an adequate number of rooms so that discreet discussions and treatments can occur
whenever required; and
(d) enable sufficient space within each treatment room or area to permit curtains to be easily drawn
whenever required.
Doors and windows should be positioned and designed to provide and maintain privacy.
7.8 Accessibility
7.8.1 General
The planning and design of HCFs shall comply with CAN/CSA-B651 and applicable requirements for
accessibility.
7.8.2 Site access
All accessible entrances shall have nearby accessible parking for patients, visitors, and staff. There should
be no traffic crossings between the accessible parking and the entrance.
There shall be a pedestrian pathway that is separate from the traffic lanes at each of the primary parking
entrances/exits and there shall be safe pedestrian crossings within the parking lot area.
7.8.3 Building access and circulation
7.8.3.1
Floor layouts within the building should be logical and designed to make intuitive sense to persons with
visual or cognitive disabilities. Floor layouts and the location of building services (e.g., washrooms,
drinking fountains, floor maps) should be consistent from floor to floor to facilitate orientation.
7.8.3.2
Accessible routes shall be provided throughout the HCF to connect all accessible features and services.
Wayfinding systems should incorporate the use of all the senses (i.e., sight, sound texture etc.) in the
design and layout.
7.8.3.3
Design features intended to address a specific disability should not unduly inconvenience other occupants.
7.8.3.4
Automatic doors shall be provided at all major points of entry or egress.
7.8.3.5
Emergency alarms and exit routes shall be in compliance with CAN/CSA-B651. Audible and visual alarm
systems shall be provided and exit routes shall be clearly marked and accessible.
7.8.4 Lighting
7.8.4.1
Illumination systems shall be in compliance with CSA Z317.5.
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7.8.4.2
Ambient lighting shall be consistent throughout the space and hot spots shall be eliminated to enable safe
movement through spaces for all individuals including those with visual impairments, specific visual needs,
or changing visual needs due to aging.
The distribution of light between workplaces, circulation corridors, rest and communal places, and
bedrooms shall be designed to minimize disruption from work to rest spaces.
7.8.4.3
The HCF shall be designed to provide access to controllable daylight and minimize the change to the
spectrum of incoming daylight. Design shall provide ways to reduce the glare and shadows created by
natural light such as tinted windows, exterior awnings, special films, and interior blinds. Daylight openings
shall have controllable systems of shields or coverings to minimize glare and overheating, or to allow for
full access to daylight.
7.8.4.4
Access to views to the exterior shall be provided where appropriate and available. Privacy screening and
daylight controls shall be provided. Infection prevention and control and safety needs shall be
incorporated in the design of such screens and controls.
7.8.4.5
As required by the functional program, special needs of the elderly shall be incorporated into the design,
including
(a) minimization of excessive contrast in lighting levels (which can inhibit sight adaptation);
(b) easy wayfinding;
(c) non-glare floors and non-slip floors; and
(d) colours and textures that do not provide sensory miscues.
If carpeting is used, see Clause 12.2.5.2.2.
7.8.4.6
Light sources for examination and treatment spaces shall have a minimum CRI of 85. Luminaires shall be
mounted to obscure the light source from the patient’s view or be equipped with diffusers that minimize
discomfort to the patient.
7.8.5 Furnishings and layout
7.8.5.1
Reception areas shall have multiple height transaction surfaces so that service can be provided comfortably
to a person in either a seated position or a standing position.
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7.8.5.2
Waiting areas throughout the HCF shall have open floor areas dispersed throughout the seating area for
wheelchairs, scooters, or baby carriages. Different seating types that include chairs with arms, armless
chairs, and bariatric seating shall be provided as appropriate to the expected patient population.
7.8.5.3
A colour contrast of 80%:20% shall be provided between door frames and adjacent walls to facilitate
detection of door openings, except in areas where dementia and other cognitively impaired patients are
likely to try to wander or leave secure units. In those areas, door frames and wall colour may have less
contrast than 80%:20% or may be the same colour in order to make doorways less detectable.
7.8.5.4
Floor surfaces shall be of low-slip, cushioned, durable materials. Floor materials shall be selected to make
detection of fluids easier and minimize risk of slips, trips, and fall injury. Lighting of floor surfaces to
improve visibility of trip hazards shall also control light distribution into unwanted areas.
7.8.5.5
Colour contrast within floor patterning shall be limited to the equivalent of three stations apart on the grey
scale.
7.8.5.6
Sufficient space shall be provided for the parking and/or storage of mobility aids in locations where
parking/storage will be needed. Such locations include but are not limited to waiting rooms, clinical areas,
and meeting spaces.
7.8.5.7
Charging stations shall be provided within out-patient and inpatient areas for scooters and other mobility
aids. If recharging of multiple scooters will take place in a designated area, the area shall meet the
applicable requirements for electrical safety and ventilation.
7.8.5.8
High colour contrast should be used for controls and signalling devices intended for patient use (e.g.,
nurse call cords).
7.8.5.9
Staff workspaces, including reception areas, should have sufficient space for wheelchair access.
7.8.6 Amenities and specialty areas
7.8.6.1
Where public telephones are provided, there shall be designated teletypewriter (TTY) capabilities and
graduated volume control phones. Public telephones that can be used by patients shall be visible to staff.
Heights and clearances for telephones shall be in compliance with CAN/CSA-B651.
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7.8.6.2
Consideration should be given to art installations in public areas.
7.8.7 Signage
Signage and wayfinding systems shall be in accordance with the requirements in CAN/CSA-B651 and shall
comply with applicable requirements.
7.8.8 Accommodation of bariatric persons
7.8.8.1 General
7.8.8.1.1
The HCF shall be designed to accommodate bariatric persons.
7.8.8.1.2
Accommodation of bariatric persons shall include the following:
(a) lounges and waiting areas shall include furnishings that are designed to accommodate bariatric
persons; and
(b) door widths in lounges and waiting areas shall be a minimum of 1220 mm wide.
7.8.8.1.3
The number of inpatient bedrooms for bariatric patients shall be determined based on the functional
program and the anticipated proportion of bariatric patients in relation to the total patient population.
Inpatient bedrooms for bariatric patients shall meet the requirements of Clause 7.8.8.2. For other patient
areas (e.g., diagnostic imaging, emergency care), consideration for bariatric patients should follow the
same general guidelines as listed for inpatient bedrooms.
225 kg
453 kg
7.8.8.2 Patient areas
7.8.8.2.1
Patient areas for bariatric patients shall include the following:
(a) additional floor space and clear areas to accommodate larger furnishings and equipment, and to
permit the manoeuvring of items into and out of the room;
(b) additional space to allow for care by multiple caregivers when needed; and
(c) provision of areas between obstacles to facilitate righting a person who has fallen.
7.8.8.2.2
Furniture and equipment shall be able to accommodate the weight of the bariatric patient. The
manufacturer’s specifications for space requirements shall be consulted prior to the design and
construction of patient areas for bariatric patients.
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7.8.8.2.3
Inpatient bedrooms for bariatric patients shall be constructed as follows:
(a) The room shall provide a clear area of at least 25.0 m2, exclusive of washroom, closet/locker.
(b) The minimum dimension (in any direction) should be 4500 mm.
(c) Clear space of at least 1500 mm shall be provided on three sides of the bed.
(d) Sufficient clear space shall be provided to accommodate large mobility aids and other portable
equipment (e.g., walker, wheelchair, commode).
(e) The entry door opening shall be at least 1500 mm wide.
(f) Service connections (e.g., medical gas, electrical) shall be spaced farther apart to accommodate a
wider bed.
(g) The room shall have a ceiling mounted patient lift and track system that can lift and transport at least
453 kg. The track should extend to both sides of the bed, and from the bed to the washroom. This
requirement does not apply to mental health units. If a ceiling lift is not installed, storage space and
suitable power supply shall be provided for a portable lift, and a portable or ceiling lift shall be readily
available for use in the room.
(h) The bed shall be able to accommodate a 453 kg patient.
2285 mm
2490 mm 1118 mm 1574 mm
(i) The room shall be equipped with handrails that can support at least 453 kg.
7.8.8.2.4
The following additional features should be considered for bariatric inpatient bedrooms:
(a) a privacy curtain at the entry door;
(b) patient control of room lights, temperature, and TV from bed;
(c) a fan with a patient-operated control;
(d) weigh scale integrated into the bed;
(e) a portable lift with capacity of 453 kg to use in areas not reached by ceiling mounted lift, in cases
where the patient falls outside of ceiling lift range (i.e., corridor); and
(f) water and drain connections for a portable dialysis machine.
7.8.8.2.5
Washrooms for inpatient bedrooms for bariatric patients shall have a floor area of at least 7.0 m2, and be
designed and equipped with the following features:
(a) entry door at least 1500 mm wide;
(b) a sink that can support at least a 363 kg downward force;
(c) a floor-mounted toilet that can support 453 kg;
(d) toilet position compatible with the use of a bariatric commode;
(e) distance from the toilet centre line to wall of 533 mm to 610 mm;
(f) clear space of at least 1118 mm on one side of the toilet for transfer use;
(g) toilet paper dispenser mounted in a location where it can be easily reached by a bariatric patient;
(h) finished with washable waterproof finishes throughout;
(i) equipped with grab bars that are appropriately sized and positioned for use by an bariatric person,
and that can support 363 kg downward force. Grab bars shall extend behind and beside the toilet;
(j) shower area that
(i) is open to the toilet area, with no floor lip, and with floor sloped to a drain;
(ii) has minimum dimensions of 1220 mm × 1520 mm; and
(iii) is equipped with a handheld spray nozzle on a side wall; and
(iv) is equipped with a moveable/portable shower seat.
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7.9 Catastrophic event management
7.9.1 General
7.9.1.1
The planning process for the HCF shall include emergency management and response planning as it
relates to the physical layout, equipment, and systems in the HCF. Each HCF shall develop an emergency
response plan, using CSA Z1600 as a guide, based on an all hazards approach for its particular
environment. The plan shall address the following types of hazards:
(a) natural;
(b) human-induced; and
(c) technological.
The HCF shall be planned, designed, and constructed so that it can provide essential services for a
defined period of time (i.e., as defined in the functional program) in the event of an emergency or
catastrophic event.
7.9.1.2
The HCF emergency management and response planning process shall include purpose-built emergency
response features consistent with the expected role and functional level of the HCF in an emergency (i.e.,
systems and areas designed to support emergency response and with no other specific purpose intended).
The HCF shall identify selected areas within the institution for purpose-built emergency response features.
7.9.1.3
Emergency preparedness protocols shall be developed by staff and the design team to ensure alternate
service delivery models for the HCF, including, but not limited to
(a) identification of adjacent soft areas to address the surge capacity issues;
(b) development of clinical protocols to free up beds or space necessary to assist in addressing an
emergency situation; and
(c) work collaboratively with adjacent health authorities, the respective health ministry, and local
emergency management organizations to assist in handling capacity overflow and or the loss of
essential services.
7.9.1.4
In developing its emergency plans, the HCF shall include strategies for the following key components:
(a) prevention and controls;
(b) communication/command centre;
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(c) areas of refuge;
(d) maintenance of essential systems and services (e.g., through reserve capacities, redundancies, and
backups);
(e) surge capacity;
(f) emergency care;
(g) extended periods; and
(h) integration/utilization of mobile medical units, for those jurisdictions operating one.
7.9.1.5
Emergency planning shall include provisions for crowd management and, if necessary, decontamination in
a chemical/biological/radiation (CBRN) event.
7.9.1.6
The HCF shall be designed to facilitate prompt evacuation of all or part of the patient population (e.g.,
through fire zones for elevators, width of stairs for patient handling).
7.9.2 Prevention and controls
7.9.2.1
Policies and procedures shall be in place to ensure the safety of patients, staff, and family are given the
highest priority.
7.9.2.2
All large furniture and equipment shall be securely fastened to the floor, walls, or ceiling as appropriate to
prevent movement or collapse.
7.9.3 Command centre
7.9.3.1
The HCF shall develop procedures to ensure patients, staff, families, and the broader community have
accurate, up-to-date information throughout the operational timeframe.
7.9.3.2
The HCF shall have a command centre for emergency situations. The command centre shall function as
the primary zone from which the administration will manage the disaster, make decisions, communicate
with authorities, and broadcast updates to patients, staff, families, and the broader community. The HCF
should designate another area that can be used as a backup if the primary command centre cannot be
used.
7.9.3.3
The designated command centre may either be incorporated into the staff station or in a designated space
normally used for other purposes (i.e., a space that can be quickly converted).
The command centre shall include
(a) suitable space for emergency management activities and to allow press briefings, staff meetings, and
other meetings;
(b) electrical outlets connected to the backup power system;
(c) adequate communications ports; and
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(d) direct telephone lines bypassing the main HCF switchboard for use in internal and external
emergencies or when the HCF telephone system is out of service.
7.9.4 Areas of refuge
The HCF emergency plan shall provide for areas of refuge to support evacuation strategies for vulnerable
populations [e.g., intensive care unit (ICU) or patients with dementia or acquired brain injury]. Particular
attention shall be paid to means of evacuation of infants in an emergency when there is limited time.
7.9.5 Operational timeframe
7.9.5.1
The HCF master plan shall specify the minimum timeframe for continued operation for each component
during an emergency, including the supplies and services that will need to be maintained during that
period. The following minimums shall apply:
(a) HCF Class A-1: 72 h (see CSA Z32);
(b) HCF Class A-2: plan to operate for 72 h;
(c) HCF Class B: plan to operate for 72 h if patients are continuously housed (i.e., 24 h/day); and
(d) HCF Class C: plan to operate as long as necessary to allow for the orderly winding down of services.
7.9.5.2
Disaster planning for a Class A or B HCF shall include provisions to ensure an uninterrupted supply of the
supplies necessary to sustain the operations for a period of 72 h. These include, but are not limited to,
(a) food;
(b) medications;
(c) specialized supports for clinical and diagnostic services; and
(d) PPE.
7.9.5.3
Emergency planning shall include an assessment of the utility needs of the HCF, and the contingency plans
or backups in the case of temporary loss of
(a) externally supplied power;
(b) natural gas;
(c) air conditioning and heating systems;
(d) water;
(e) sewage;
(f) communications (both wired and cellular) systems; and
(g) medical gases (either failure of internal systems or interruption in external deliveries).
7.9.6 Redundancy
7.9.6.1
The HCF shall have duplicate or back-up systems and supplies to provide the essential services listed in
Clause 7.9.5.3 in the event of failure of the primary systems.
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7.9.6.2
Additional equipment and beds should be available within component storage areas or centrally in the
HCF to help mitigate disasters.
7.9.7 Surge capacity
7.9.7.1
The emergency plan shall include provisions for surge capacity (i.e., management of situations where
there is a significant increase in the number of patients due to a disaster or other cause).
7.9.7.2
In preparation for the emergence of highly infectious patients, hospitals should have the capacity to
handle a surge of up to a fourfold increase above the current emergency care capacity for such patients.
This preparation should include the provision of adjacent space for triage and management of infectious
patients. Utility upgrades for these areas (oxygen, water, electrical) should be considered.
7.9.7.3
The following activities regarding surge capacity should be incorporated into any capital
development/redevelopment plan:
(a) development of a surge capacity plan prior to finalizing capital development or redevelopment plans;
(b) identification of public spaces or service spaces within the institution that can be part of the surge
capacity plan;
(c) consideration of additional features that would be needed in non-clinical spaces to facilitate their use
as surge capacity, including
(i) access to additional electrical outlets;
(ii) access to medical gases (e.g., by means of tanks or additional terminal units); and
(iii) installation of ceiling tracks; and
(d) additional storage of supplies and equipment that will allow the quick and easy conversion of public
and other space to provide surge capacity. Storage features should include
(i) proximity to point of use;
(ii) ease of access; and
(iii) portability.
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7.9.7.4
Planning for surge capacity shall include contingency plans for a situation where access to
ventilator-assisted beds is overwhelmed in a disaster. All areas within the institution that have
ventilator-assisted capacity as part of their normal operations shall be identified and these should be
upgraded to permit extended operation. Areas identified for surge capacity should be able to provide
augmented services for a continued period of time.
7.9.7.5
When planning for surge capacity, consideration should be given to spaces contiguous to areas that could
be overwhelmed in an emergency. Such spaces, if designed for easy conversion in an emergency, can help
to minimize disruption of the rest of the facility.
7.9.8 Emergency care
7.9.8.1
The emergency plan shall focus on strategies that can be incorporated in the design of the area for
emergency care (emergency department). Emergency care shall have sufficient space, flexibility, and
storage capacity to accommodate the large workloads, critically ill and/or infectious patients, families,
friends, and HCF staff involved in managing a disaster situation. The flexibility to expand into adjoining
areas such as outpatient clinics or the main entry should be considered.
7.9.8.2
The design of the emergency care HVAC system should allow the isolation of regions so that air containing
potentially dangerous chemical or biological agents can be contained within an area.
7.9.8.3
Emergency care areas shall be designed with relative pressurization as specified in CAN/CSA-Z317.2.
Adjacent surge areas should have provision for depressurization to help control aerosolized infectious
particles with 100% exhaust capability. If 100% exhaust cannot be achieved, appropriate proven
technology should be utilized to reduce airborne particles by > 95%. If patient care areas are to be utilized
in the HCF to house these patients, the route to the patient care unit should minimize the potential for
cross-contamination. Air-handling systems should be designed to provide required pressure differentials.
Written protocols shall be developed to ensure proper performance of the means to accomplish the
intended goals.
7.9.8.4
If outdoor spaces will be used for emergency care, the emergency plans and the design of emergency care
areas should take into the possible extremes of weather for the region.
7.9.8.5
Storage shall be provided for CBRN equipment and supplies, such that it can be easily accessed by
emergency personnel and is also secure from unauthorized access.
7.9.8.6
The emergency care area plan should also accommodate a disaster equipment store that is easily
accessible and contains sufficient supplies to fully equip the disaster team for either on-site or off-site
function.
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7.9.9 Extended periods
7.9.9.1
In locations where there is potential for hurricanes, tornadoes, flooding, earthquakes, or other natural
disasters, the HCF design shall include provisions to protect the life safety of the HCF occupants and the
continuation of services following such a disaster. Disaster plans shall address at least the following two
scenarios:
(a) a disaster takes place elsewhere and the additional patients arriving at the HCF exceed its normal
capacity; or
(b) a disaster takes place within or near the HCF and patients need to be transferred to other HCFs.
7.9.9.2
To quickly react to emergency situations and create a cell for crisis management for situations that could
last for relatively long periods, the crisis management headquarters should include an eating area and a
kitchen/kitchenette.
7.9.9.3
The plant maintenance space shall be configured to allow regular backups and easy and secure storage of
backup files for systems like the computerized maintenance management system (CMMS) and building
automation system (BAS). Redundant, non-collocated servers should be used for critical information and
for large volumes of information that would not be easily restorable.
7.10 Flexibility and adaptability
7.10.1
Each HCF service shall be planned, designed, and constructed to allow for future modification. Plans
should consider what could be reasonably expected in terms of
(a) changes in service delivery;
(b) adaptation of existing services or spaces to other uses;
(c) expansion; or
(d) contraction.
Strategies shall be developed to accommodate these needs to the extent possible without
compromising current effectiveness.
7.10.2
The HCF should be designed with the following measures to provide for future changes in use; the
long-term plan for the HCF should also be consulted in making decisions on these items:
(a) evaluating structural grid spacing and floor-to-floor heights to ensure they will be able to
accommodate changes over the life of the building;
(b) locating key areas adjacent to another soft exterior wall area;
(c) providing soft space, within and adjacent to the services, to facilitate expansion;
(d) using flexible systems furniture, cabinets, counters, and workstations rather than fixed millwork;
(e) considering the number and location of data ports that would be needed in different room
configurations;
(f) providing medical gas connections, oxygen, and medical vacuum in all patient/testing rooms;
(g) roughing in medical gas piping, electrical, plumbing, and other services during new construction for
areas where future expansion might need these services;
(h) defining routes for utility services that would be needed to serve future additions or major
renovations;
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(i) building in allowances in the sizing of equipment and distribution systems (ducts, etc.) for each
service to accommodate the potential need for increased capacity to serve newly constructed or
renovated areas;
(j) designing work areas and zones with similar layouts, configurations, furniture, equipment, casework,
and services to allow for maximum flexibility now and in the future;
(k) organizing treatment areas into pods or zones that can be modified to meet future needs;
(l) avoiding the use of fixed workstations and designing service utilities to be adaptable to different
room configurations;
(m) grouping vertical services together and locating adjacent structural elements to allow reconfiguration
of the space with minimal disruption;
(n) constructing new areas in accordance with standards for full-service or acute care areas, especially in
spaces that are adjacent to clinical areas; and
(o) considering the potential need for access by construction equipment in a functioning facility.
7.10.3
The HCF design shall provide for optimal use and sharing of equipment. The use of space should be
carefully managed and the design shall ensure that there are opportunities to adapt and expand the
facility as more services are located and added to the HCF.
7.10.4
Exam/treatment/consulting rooms should have similar layouts, configurations, and services to allow for
maximum flexibility and future flexibility in changing use.
7.10.5
Procedure rooms, prep/recovery spaces, and other repeated functions should have similar layouts,
configurations, and services to allow for a maximum number of procedure types and flexibility in future
use.
8 Inpatient and related services
8.1 Medical/surgical inpatient
8.1.1 Description
8.1.1.1
Medical/surgical inpatient units for the care of patients admitted to the HCF for general diagnosis,
observation, or treatment shall be designed and constructed in accordance with Clause 8.1. See
Clauses 8.2 to 8.8 for specialized medical/surgical inpatient units for the following programs:
(a) critical care (see Clause 8.2);
(b) maternal and newborn (see Clause 8.3);
(c) mental health and addiction services (see Clause 8.4);
(d) pediatric and adolescent (see Clause 8.5);
(e) rehabilitation care (see Clause 8.6);
(f) burn unit (see Clause 8.7); and
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(g) inpatient continuing care (see Clause 8.8).
8.1.1.2
Medical/surgical inpatient units typically address the needs of a range of medicine and surgery
subspecialties (e.g., dermatology, gastroenterology, internal medicine, nephrology, ophthalmology,
general surgery, and plastic surgery).
Medical/surgical services for inpatients can include
(a) examination;
(b) assessment and diagnosis;
(c) treatment/procedures;
(d) health education and discharge planning;
(e) palliative care;
(f) step-up care (i.e., care for patients who do not require the level of technology or care provided in a
critical care unit but still require a greater level of care than in medical/surgical units);
(g) interdisciplinary care;
(h) step-down/high-dependency care; and
(i) telemetry monitoring.
8.1.2 Functional requirements
8.1.2.1
Inpatient bedrooms shall be designed to provide a comfortable, healing environment, consistent with the
OASIS principles:
(a) operational efficiency;
(b) accessibility;
(c) safety and security;
(d) infection prevention and control; and
(e) sustainability.
8.1.2.2
Supplies for use in inpatient bedrooms shall be conveniently located and secure against theft or
tampering.
8.1.2.3
Family support and participation shall be recognized as an integral component of care and be
accommodated in the environment.
8.1.2.4
Each inpatient bedroom shall have natural light. Windows shall be positioned so that the patient has a
view to the exterior when lying in the bed.
8.1.2.5
Patients should have control of personal lighting wherever practical.
8.1.2.6
Dedicated work space should be provided within the inpatient unit for support service staff, such as clinical
pharmacists and therapists.
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8.1.3 Technical requirements
The design of the inpatient bedroom should organize the room into three separate functional zones:
patient, family, and staff and should try to minimize overlap and conflict between the activities in each
zone.
8.1.4 Space details
Table 8.1 presents the standard requirements for key spaces in the inpatient bedroom areas. Common
areas are detailed in Clause 11.
Table 8.1
Key space requirements and recommendations — Inpatient bedrooms
1 Inpatient See Clause 11 for common requirements and recommendations for an
bedroom inpatient bedroom.
Bed area 15.0 See Clause 11 for requirements and recommendations for patient washrooms.
Washroom 5.6 See Clause 7.6.6.2 for requirements for patient lifts.
Vestibule 5.0 See Clause 7.5.11 and Clause 11 for requirements relating to hand hygiene
Family zone Included in sinks.
bed area
Staff zone Included in See Clause 11 for requirements and recommendations for airborne isolation
bed area rooms.
Supply alcove 1.4
Two-bed room
(if allowed as per
Clause 7.5.2.2)
Bed area 26.0
Washroom 5.6
Vestibule 7.0
Family zone 3.0
Staff zone 3.0
Supply alcove 1.4
2 Staff workstation Varies An inpatient bedroom might be used for patients transitioning from critical
care (and therefore requiring more constant observation and monitoring).
This may be accomplished in an inpatient bedroom with temporary
enhancements such as a charting station, monitors, etc.
3 Tub room See Clause 11 for requirements and recommendations.
4 Stretcher
shower room
5 Circulation
6 Team station
7 Outdoor space
8 Storage
9 Clean supply
10 Soiled utility/
storage
11 Medication
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8.2 Critical care
8.2.1 Description
8.2.1.1
Critical care services can include medical and surgical intensive care and cardiac care for adults, children,
and infants. These services provide care to patients who have a life-threatening disease or injury. Care for
critically ill patients involves specialized multi-disciplinary staff (i.e., physicians, nurses, pharmacists,
respiratory therapists), sophisticated technologies (i.e., mechanical ventilation equipment, heart
monitoring), and specialized drugs.
8.2.1.2
Patient services provided on critical care units can include, but are not limited to,
(a) assessment and diagnosis;
(b) interdisciplinary care;
(c) examination;
(d) treatment/procedures;
(e) isolation and protective environment rooms;
(f) education and research; and
(g) discharge planning.
8.2.1.3
In addition to basic medical and surgical care services, critical care units can accommodate sub-specialty
care, for example
(a) coronary, including use of telemetry;
(b) trauma;
(c) neurology/neurosurgery;
(d) infectious diseases;
(e) burn care;
(f) post-anaesthesia — high dependency care (i.e., transplant);
(g) continuous renal replacement therapy (CRRT);
(h) dialysis (haemodialysis or peritoneal dialysis); and
(i) extended ventilatory care.
8.2.1.4
In addition to dedicated critical care services, an HCF could have a need for transitional services to
accommodate patients who are moving from the more acute services provided in critical care to those of a
typical inpatient unit. Designated rooms may be provided and equipped to facilitate the stepping down
process without creating risk to patients. By ensuring these step-down facilities are adequately equipped,
HCFs can reduce the demands on the critical care services.
Step-down units can provide certain types of sub-specialty care, for example
(a) coronary, including use of telemetry;
(b) trauma;
(c) neurology/neurosurgery;
(d) infectious diseases;
(e) post-anaesthesia — high dependency care;
(f) dialysis (haemodialysis or peritoneal dialysis); and
(g) extended ventilatory care.
Step-down facilities may be collocated with the critical care unit, created as a standalone unit or
developed as a specialized zone within the inpatient unit.
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8.2.2 Functional requirements
8.2.2.1
Critical care units shall include sufficient space and facilities to permit additional family support for
patients. The design should provide for additional space around the bed to allow for the storage of special
equipment.
8.2.2.2
All units shall be designed to provide direct, one-to-one observation from staff workstation to patient
room. Step-down facilities may be planned to increase observation as needed through the use of portable
staff work areas.
8.2.2.3
The design of the physical environment in a critical care unit shall address both the physical and
psycho-social requirements of patients and their families.
8.2.2.4
There shall be conference room/teaching room for multi-disciplinary staff education.
Additional space for research or teaching shall be provided if this is a component of the functional
program.
8.2.2.5
Each inpatient bedroom shall have natural light. Windows shall allow for an exterior view while the patient
is lying in bed.
8.2.2.6
There shall be a staff respite space, staff team room space, and staff facilities. Space shall be provided for
staff paperwork, such as charting. Office space for the intensivist shall be provided.
8.2.2.7
The security provisions shall be designed so that the public does not have free access into the unit, but
that families are accommodated (within reason) and made to feel welcomed.
8.2.2.8
There shall be a family lounge.
8.2.2.9
There shall be private room(s) for discussion between staff and patient’s families, preferably near the family
lounge.
8.2.2.10
Spaces shall be provided for PPE equipment/supplies, crash carts, and other procedure carts.
8.2.3 Technical requirements
8.2.3.1
The internal zones of staff/support, patients, and visitors should be designed to have the following key
relationships:
(a) The primary staff work zone (for example, a nursing station) should be close to the entry for control
of individuals coming into the unit.
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(b) The patient care areas should be co-located with the staff work area (nursing station) while
recognizing that satellite staff work areas will be necessary to ensure that staff have work spaces at
each patient location.
(c) AIR(s), when present, should be located close to the patient entry and away from the main corridor
and other patient cubicles to limit the travel distance into the main unit by
immunosuppressed/infectious patients.
(d) The visitor entry should be adjacent to the visitor waiting area, but external to the patient care zone.
The medication dispensing area or room shall be easily accessible from the patient care areas.
8.2.3.2
Staff areas shall be discrete from patient areas to allow for security, privacy, and confidentiality.
8.2.3.3
The design shall allow for access to personal protective equipment (PPE) adjacent to each inpatient
bedroom entrance.
8.2.3.4
Utility and clean supply rooms may be centralized or decentralized based on unit design. The design shall
provide for direct access from the unit corridor to the patient areas served.
8.2.3.5
Cleaning, testing, and storage facilities for respiratory therapy services shall be readily accessible. If RT
equipment will be cleaned, decontaminated, or maintained within the unit, the space for these activities
shall be designed in accordance with CAN/CSA-Z314.8.
8.2.3.6
Equipment storage and electrical outlets for charging of equipment shall be provided to accommodate the
expected volume of activity on the unit.
8.2.3.7
Additional storage shall be provided for large volumes of water and chemicals for dialysis.
8.2.3.8
Alcoves shall be designed to minimize the need to keep equipment in corridors and reduce staff travel
distances for commonly used supplies and equipment.
8.2.3.9
Areas for family, caregivers, and visitors shall provide a calming environment with additional space and
amenities as required to meet the needs of visitors who stay in the area for extended periods of time.
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8.2.4 Space details
Table 8.2 presents the standard requirements for key spaces in the critical care area. Common areas are
detailed in Clause 11.
Table 8.2
Key space requirements and recommendations — Critical care
1 Reception/ 4.6 per work- See Clause 11 for common requirements and recommendations for a
control desk station and reception/control area.
additional Mandatory:
circulation The reception desk shall be located at the entry to the unit so that staff can
space control access and provide information to visitors and staff. The space shall
include a workstation.
Advisory:
(a) Depending upon the physical layout of the unit, second entry should
be considered for the movement of supplies and waste, and for the
transfer of patients (i.e., new admission, to/from procedures and tests,
morgue) away from general visitors.
(b) All entry points should be secure and require controlled access. An
intercom system between the visitor area and staff work area should
be considered so that staff can interview visitors to ensure appropriate
entry into the area.
2 Staff work Varies, 4.6 for See Clause 11 for common requirements and recommendations for a
Area each work- primary staff station.
station and Mandatory:
additional (a) Work space for nursing, allied health professionals, clinicians, and
circulation clerical staff shall be provided in correlation with the activity of the
space unit.
(a) Secure drug storage shall be provided if separate medication/
pharmacy areas are not part of selected care model.
Advisory:
(a) An area should be provided close to the staff work area that has
electrical receptacles to store and charge small electrical equipment
(i.e., portable monitors).
(b) There should be a tack board for display of patient received cards,
photos, and medical information relating to the specific patient.
(c) There should be a white board for the staff to diagram information to
patient and visitors.
(d) A TV and multi-media player (wall or ceiling mounted) should be
provided.
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Table 8.2 (Continued)
3 Patient bed See Clause 11 for common requirements and recommendations for an
room suite, inpatient bedroom
adult and Mandatory:
child (a) Staff shall have the ability to view the patient from their workstation.
(b) Rooms shall have
Bed area 23.2 (i) a patient care zone of a minimum 4.5 m × 4.5 m;
(ii) a family zone with seating/sleeping/work area that does not
Washroom 4.6 interfere with patient care activities;
(2 piece) (iii) a staff zone with hand hygiene station, waste disposal system, and
computer station. The computer station shall not interfere with
Family zone included in patient care functions;
bed area (iv) space for bed, equipment (i.e., monitor, ventilator, supply cart),
Staff zone included in furnishings (i.e., side chairs, recliner chair, over bed table), staff,
bed area and visitors; and
(v) storage for patient personal belongings.
Charting area 1.4
Supply alcove 1.4
(c) Critical care beds shall not be side by side.
(d) Clearances around and between beds shall be in accordance with
Table 7.1.
Advisory:
A work space for soiled items may be added, and this space may be shared
between two to three rooms. If this room is added, the net area shall be
not less than 3.0 m2
4 Patient bed Mandatory:
room suite, All elements listed in Item no. 3 shall be provided.
AIR isolation, Clearances around and between beds shall be in accordance with
adult and Table 7.1.
child Advisory:
A three-piece washroom may be planned (in lieu of the two-piece). The
Bed area 25.0 three-piece washroom sizes shall be
(a) traditional — 7.0 m2;
Anteroom 7.5 (b) medical/surgical — 5.6 m2; and
(c) hand-held wand — 4.6 m2.
Supply alcove 1.0
Washroom 4.6
(2 piece)
Family zone included in
bed area
Staff zone included in
bed area
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Table 8.2 (Concluded)
5 Patient bed Mandatory:
room suite, (a) Each newborn infant shall have a separate and dedicated station for
infant, private the bassinette following established infection prevention and control
(neonatal guidelines for configuration of layout.
intensive care (b) There shall be one hand hygiene sink per infant station.
unit) (c) Medical gases (oxygen, vacuum, medical air, and nitrous oxide) shall
be provided for each infant station.
Bed area 18.0 11.0 (d) Lights at infant stations shall be on separate switches with dimmers.
(e) Clean and soiled utility rooms shall be provided.
Family zone included in Advisory:
above space (a) Suitable furnishings for breastfeeding/family-provided care should be
Staff zone included in provided.
above space (b) A work area should be adjacent and shared on a ratio of one work area
to two infant stations.
(c) Audio privacy should be provided.
(d) A work area should be adjacent and shared on a ratio of one work area
to two infant stations.
8.3 Maternal and newborn
8.3.1 Description
8.3.1.1
Maternal and newborn services provide care for the expectant mother (antepartum), labour and birth
(intrapartum), and recovery (postpartum), as well as the care for the healthy newborn. Services can
include inpatient care and/or outpatient care. (For guidelines related to premature or medically unstable
infants see Clause 8.2). The extent of the services can vary dependent upon the role of the HCF, the lead
caregiver involved (e.g., physician or midwife), and the needs of the mother and infant.
8.3.1.2
The antepartum service can include
(a) prenatal clinics:
(i) assessment;
(ii) patient and family education; and
(iii) perinatal bereavement counselling;
(b) diagnostic obstetrical testing:
(i) ultrasound;
(ii) biophysical profiles; and
(iii) genetics;
(c) pre-admission triage and assessment; and
(d) inpatient care for women with medical, obstetrical, or fetal complications.
8.3.1.3
Depending on the service model, patients could receive antepartum services in a Type A-1, A-2, or C
facility. Jurisdictional requirements can apply regardless of the setting. See Clause 6.3.9 for additional
requirements.
Patients might or might not be moved between rooms during the labour/delivery process, depending
on the service model. The intrapartum (labour, birthing) and recovery service could use the following
options:
(a) patient room for labour period only (i.e., use of a delivery room for the birth);
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(b) patient room for labour, birthing, and recovery period only (LBR); or
(c) patient room for labour, birthing, recovery, and postpartum period (LBRP).
8.3.1.4
The postpartum service can include
(a) combined care for women and their healthy babies;
(b) teaching opportunities, including breastfeeding and mother/baby care support (e.g., baby bathing,
mother’s physical recovery); and
(c) bereavement counselling.
8.3.1.5
The newborn service can include
(a) healthy newborn holding nursery (used to accommodate healthy newborns for short periods when
not with the mother during the postpartum period); and
(b) premature, medically unstable, or ill newborn nurseries (used to accommodate those newborns who
require observation, specific care, procedures, respiratory support, or other interventions. See
Clause 8.2).
8.3.2 Functional requirements
8.3.2.1
The design of the maternal/infant care area shall recognize the pivotal role of family members as part of
the mother and baby’s care team.
8.3.2.2
For facilities in an inpatient setting, services shall be located adjacent to each other in the following order
to allow immediate access during the course of care:
(a) antepartum;
(b) intrapartum;
(c) postpartum and newborn care;
(d) special care nursery; and
(e) neonatal ICU.
8.3.2.3
Appropriate emergency access and security elements shall be available on a 24/7 basis to address the
control and safety of patients and staff.
8.3.2.4
Within the antepartum, intrapartum, and postpartum areas, there should be additional (i.e., greater than
usual) audio separation to address the increased noise level from patients in labour and newborn babies.
See Clause 12.2.7
8.3.2.5
The unit design should allow separation between general maternity patients and patients who have had
perinatal loss (e.g., still birth, neonatal death, miscarriage, and termination).
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8.3.2.6
The unit design shall include provision for continuing access to midwifery/obstetric care for patients who
have lost or are relinquishing their babies.
8.3.3 Technical requirements
8.3.3.1 General
8.3.3.1.1
Maternal and newborn services shall include
(a) provision for overnight accommodation for the family (depending upon model of care);
(b) dedicated facilities (with a private washroom) for counselling, grieving and care planning;
(c) provisions for security and monitoring of all areas within the service to address the issue of baby
abduction; and
(d) capability to secure or restrict access to fridges and freezers used for storage of breast milk.
8.3.3.1.2
All rooms used for labour, delivery, and recovery shall have natural light and access to exterior views;
however, special care nurseries may be exempted if high levels of natural light could affect patient health
or quality of care.
8.3.3.1.3
Birthing rooms, delivery rooms, and nurseries in maternal and newborn services shall be designed to
achieve a non-clinical ambience. Medical services may be encased in joinery panels and equipment stored
in an adjoining area or behind folding doors or screens.
8.3.3.2 Intrapartum
The following elements should be provided in intrapartum care service, consistent with the functional
program:
(a) labour lounge (for use in early stages of labour);
(b) whirlpool tub (for mothers during early labour but not birthing);
(c) birthing room (LBR/LBRP);
(d) operative birthing room (caesarean delivery room); and
(e) infant resuscitation area — with stations for multi-births.
8.3.3.3 Postpartum
8.3.3.3.1
Areas for postpartum care shall include the following elements:
(a) a comfortable, quiet room for bonding, feeding and expressing milk with assistance and supervision
from staff;
(b) an infant nutrition preparation area; and
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(c) a separate, quiet room with decor appropriate for grieving. This room may be designated a SANDS
room (stillbirth and neonatal death support).
8.3.3.3.2
Sterilization of bottles should be performed in a separate specified area. Disposable bottle teats should be
used.
8.3.3.4 Newborn
There shall be a nursery area for the temporary accommodation of healthy newborns.
8.3.3.5 Acoustics
8.3.3.5.1
Birthing rooms shall be constructed with a high level of sound isolation as listed in Table 12.1.
8.3.3.5.2
Infant care rooms shall also be constructed with high level of sound isolation as listed in Table 12.1 and
have additional acoustic ceiling treatment.
8.3.3.5.3
Sound transmission for the special care nursery shall be minimized. Acoustic guidelines that promote
healthy infant development should be considered. See Table 12.1 and Clause 12.2.7.3.2.
8.3.3.5.4
The following methods to reduce noise levels should be considered:
(a) sound absorbing materials and finishes;
(b) sound isolating construction;
(c) separate quiet areas from noisy areas;
(d) operational management (personal noise level restrictions); and
(e) noise attenuating building systems.
8.3.3.6 Lighting
Lighting provisions shall be as follows:
(a) Colour-corrected dimmable lighting shall be provided in all patient areas where high dependency
care is provided. The lamp colour temperature and color rendering index should be selected based
on activities in the specific area.
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(b) Lighting levels for all inpatient bedrooms shall be zoned and separately switched for flexibility of
different functions, with procedure lighting available directly above each patient.
(c) Lights in infant care areas shall be on dimmers.
8.3.3.7 Privacy
8.3.3.7.1
Communications, charting, and staff areas of the inpatient unit should be separate from common space.
8.3.3.7.2
Windows into corridors from open nursery bays, if provided, should be double glazed with integral blinds
and controls accessible from within the nursery.
8.3.3.7.3
The design of the assessment and delivery/birthing rooms should ensure that the foot of the bed does not
face the door. Viewing panels in the delivery/birthing room door should be avoided.
8.3.3.7.4
Windows in labour rooms, if provided, shall be located, draped, or otherwise arranged to preserve patient
privacy from casual observation from outside the labour room.
8.3.3.8 Infection prevention and control
8.3.3.8.1
In addition to the general list of infection prevention and control requirements, the following provisions
shall be made in this service:
(a) Hand hygiene sinks shall be in all rooms where infants are located and in the nursing station.
(b) A common central bathroom shall contain a bath, shower, toilets, hand basin, and baby bathing
facilities provided for babies, toddlers, and younger children.
(c) Locations for baby bath demonstration shall have a hand hygiene sink.
8.3.3.8.2
Provision shall be made for the safe management of placental material. Placental material shall be treated
as contaminated waste and shall be managed in accordance with CSA Z317.10; however, provision shall
be made for the safe storage and transfer of placental material to the family if it is requested for cultural
reasons.
8.3.3.9 Occupational health and safety
The following occupational health and safety (OH&S) features shall be included in the maternal/infant unit
design:
(a) Functional space for the use of equipment and storage space for all the equipment shall be provided
in close proximity to the location of use.
(b) Functional space shall be provided for rapid patient handling.
(c) Door and corridor widths should allow for a patient’s bed to travel rather than require a transfer to a
stretcher.
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(d) Storage space shall be provided for manual handling aids, such as patient lifts, commodes,
wheelchairs, walking belts, slider boards, and patient scales.
(e) Leaning/squatting rails should be provided for active birth in birthing rooms.
(f) Eyewash stations and showers shall be provided within the unit.
8.3.3.10 Safety and security — Maternal
In addition to the safety and security requirements in Clause 7.7, the design of HCFs with a maternal and
infant care unit should
(a) allow staff to directly observe all persons entering the unit;
(b) provide visual control (including electronic surveillance) for nursing units, corridors, dining areas, and
social areas such as dayrooms and activity areas. Hidden alcoves or blind corners or areas should be
avoided;
(c) plan and arrange door swings so that there is no danger of hitting a small child on the other side;
(d) minimize entry and exit points (e.g., one entrance for patients and visitors to enter the birthing area);
(e) provide an access control system that uses card readers for all unit perimeter doors, including both
internal and external access doors; and
(f) provide secured exits, with provision for delayed release in a fire or other emergency situation.
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8.3.3.11 Safety and security — Newborn
8.3.3.11.1
The newborn infant population is recognized as especially vulnerable. In addition to the requirements in
Clause 7.7, an HCF with a newborn unit shall be secured and shall be monitored to minimize and contain
the risk of a child’s abduction from the unit and prevent interference from unauthorized persons. Safety
and security measures should include the following as appropriate to the HCF:
(a) direct staff observation;
(b) closed circuit TV;
(c) restricted window openings;
(d) high level door latches;
(e) horizontal split doors (sometimes referred to as dutch doors or stable doors);
(f) locked doors;
(g) monitoring unit access; and
(h) electronic abduction detection system.
See Clause 12.7.
8.3.3.11.2
Security and safety issues and preventative measures shall be evaluated as a whole to ensure that they do
not conflict.
8.3.3.11.3
Staff emergency assistance alarm stations shall be located at reception and staff stations and neonatal
intensive care units.
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8.3.4 Space details
Table 8.3 presents the standard requirements for key spaces in the maternal and infant areas. Common
areas are detailed in Clause 11.
Table 8.3
Key space requirements and recommendations —
Maternal and infant care
1 1-bedroom suite, See See Clause 11 for common requirements and recommendations for a
antepartum Table 11.1, patient bedroom.
Item 24
2 Triage/labour Mandatory:
lounge (a) A hand hygiene sink shall be provided.
(b) A nutrition area shall be provided.
Chair 1.9 per person Advisory:
(a) Room lights should be on dimmer switches.
Stretcher 7.5 (b) A variety of soft and hard seating should be provided.
(c) The room decor should be relaxing.
(d) A separate quiet area or quiet lounge should be provided.
3 Intrapartum Mandatory:
birthing room (a) An exterior window shall be provided.
suite (LBR/LBRP) (b) A hand hygiene sink shall be provided.
(c) Equipment storage space with doors shall be provided to house
Bed area 32.0 items specifically used during the birth.
(d) The washroom (with shower) shall accommodate both bassinet
Washroom 7.0 and parent or family member providing care.
(e) The infant area shall be on the same side of the room as the
Supply/equip. 1.5 mother.
storage Advisory:
(a) Ceiling-mounted birthing lights should be provided but portable
Staff zone Included in lights may be used.
bed area (b) Depending upon model of care, a sleeping space for one family
member should be provided.
Family zone Included in (c) A lockable storage cupboard should be provided for patient
bed area personal items.
(d) Medical gas outlets should be unobtrusive.
(e) All lights should be on separate switches.
(f) Furnishings suitable for comfortable breastfeeding should be
provided.
(g) Optional considerations may be provided, including
(i) three-piece washroom, with whirlpool tub — 8.0 m2 (in lieu
of standard washroom) (see Clause 8.3.3.2);
(ii) vestibule/entry area — 6.5 m2; and
(iii) supply/equipment area — 4.5 to 6.0 m2.
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Table 8.3 (Continued)
4 Infant 13.0 for each Mandatory:
resuscitation/ bassinet, plus (a) The area shall be adjacent to the operative birthing room(s).
stabilization area sink, counter/ (b) A hand hygiene sink shall be provided.
workspace (c) Medical gases shall be provided.
and (d) All lights shall be on separate switches.
circulation; (e) Privacy shall be provided for each patient.
may be (f) The area shall be contiguous to the operative birthing rooms and
increased the sterile core.
depending on (g) Each resuscitation area shall be sized to accommodate the staff
size of unit and equipment necessary for resuscitation and stabilization.
(h) Supplies and resuscitation equipment shall be stored in the room.
(i) An overhead infant warmer shall be provided.
(j) If multiple places are planned in a single room, each place shall be
not less than 10.5 m2 per place.
Advisory:
Facility planning should consider a 2-place resuscitation area (at a
minimum) to accommodate multiple births.
5 Holding nursery, 4.5 per infant Mandatory:
healthy newborns station (a) There shall be a separate and dedicated station for each bassinette
infants following established infection prevention and control guidelines
for configuration of layout.
(b) There shall be one hand hygiene sink per four infant stations.
(c) Medical gases shall be provided per two infant stations.
(d) Lights at Infant stations shall be on separate switches with
dimmers.
(e) Clean and soiled utility rooms shall be required.
(f) Audio privacy shall be provided.
Advisory:
(a) A work area should be adjacent and shared on a ratio of one work
area to four infant stations.
(b) Suitable furnishings for breastfeeding/family member care should
be provided.
6 Infant nutrition Varies by Mandatory:
preparation program, (a) A hand hygiene sink shall be provided.
room minimum area (b) Cleaning/sterilization of equipment shall occur in the MDR
shall be 16.5 department.
(c) Counter space shall be provided for work to prepare product with
separation of clean and soiled materials.
7 Infant support/ Varies by Mandatory:
teaching area program; (a) A hand hygiene sink shall be provided.
minimum area (b) The room layout and partitions shall permit the provision of
shall be 16.5 privacy for individual mothers, if requested.
for larger Advisory:
centres (a) There should be a cold storage facility for breast milk.
(b) The area should have a window.
(c) Smaller centres may combine this function with the Infant
nutrition preparation room (Item 6).
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Table 8.3 (Concluded)
8 Operative 60.0 Mandatory:
birthing room (a) The room shall be identical in all aspects to operating rooms in
(caesarean Clause 9.5 for equipment, medical gases, electrical outlets, HVAC
delivery) systems, and overall layout.
(b) The mother shall have a clear view to the infant resuscitation areas.
Advisory:
The infant resuscitation/stabilization area (Item 4) may be combined
with this room.
9 1-bed room suite, See to Clause 11 for standard inpatient bedroom.
postpartum (care Advisory:
by parent/family (a) A care-by-parent room may be provided for day use (not intended
member) for overnight accommodation) — minimum size: 7.5 m2.
(b) Discharged patients may be offered care-by-parent functions in a
non-inpatient room with capacity for over-night stay — minimum
size: 11.0 m2.
8.4 Mental health and addiction services
8.4.1 General
8.4.1.1 Description
Clause 8.4 outlines the specific requirements for the planning of inpatient and outpatient mental health
and addictions units for adult patients, and the planning of these units for pediatric and adolescent
patients. It addresses psychiatric intensive care units (PICU), a tertiary level service that admits acute
mental health and addictions patients requiring containment, security and intensive clinical management,
and observation. It also addresses forensic patient care units, which have specialized security requirements.
Clause 8.4 also recognizes the needs of staff providing mental health and addictions services and the
multiplicity of their roles in delivering services on a day to day basis. All proposed security measures should
be sensitive to therapeutic impact and the needs of forensic patients. All therapeutic endeavours should
consider the security implications of that endeavour.
The requirements for optimal environmental care, advances in assessment and treatment, and delivery
of mental health and addictions care are reflected in this Standard. Inpatient care can be required for
people who exhibit symptoms of acute psychosis or acute substance withdrawal, as well as those with
imminent tendencies for suicide or aggression, requiring timely assessment in order to be provided with
effective diagnosis and treatment. The programming and resulting design takes into account
psychological and emotional considerations for the patient population.
This Clause reflects the need for settings that are consistent with currently available evidence on
compassionate and effective mental health and addictions inpatient care.
Mental health and addictions patients are potentially a risk to themselves and others. It is essential that
the building design, maintenance, and built environment are based on the potential risk to the patient
population it is serving. It is important that support is offered not only to the patient with mental illness or
addictions, but to the entire family.
There are many types of mental health and addictions services to serve a range of patients with
conditions of varying levels of acuity. These services represent continuum of care, from inpatient units to
outpatient clinics. Each facility is designed for its population, and depending on its type, will provide some
or all of the services outlined in this Clause.
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8.4.1.2 General services
Services generally provided by mental health and addictions units include
(a) caring for patients referred from emergency, crisis, and other services;
(b) assessment, diagnosis, treatment (e.g., pharmacotherapy, psychotherapy, electroconvulsive therapy
[ECT], physical therapy, education, among others), and rehabilitation;
(c) providing a safe environment for patients who pose a risk of harm to self and others;
(d) stabilization and/or amelioration of acute symptoms;
(e) involving patients’ families/community in establishing the care plan;
(f) constant 24-hour observation for psychiatric intensive care patients;
(g) close observation for other acute patients;
(h) management of co-morbid medical disorders;
(i) services based on recovery principles of care; and
(j) patient-centred care.
8.4.1.3 Pediatric and adolescent services
Services that can be provided by mental health and addictions units for pediatric and adolescent patients
include
(a) normalization;
(b) assessment, diagnosis, treatment, and rehabilitation;
(c) providing a safe environment, structured but with patient control (for specialized units, this includes
the grounds and facility);
(d) stabilization and amelioration of acute symptoms;
(e) constant 24-hour observation for PICU patients;
(f) close observation of other patients;
(g) patient-centred care; and
(h) services based on recovery principles of care.
8.4.1.4 Specialized services
Mental health and addictions units can also provide one or more of the following specialized services:
(a) socialization;
(b) accommodation and treatment of forensic patients;
(c) longer term, more intensive rehabilitation;
(d) normalization; and
(e) involving families, community agencies, and other key stakeholders in care.
8.4.1.5 Other services
Subject to local conditions, some mental health and addictions units will provide additional services, such
as
(a) ECT, which can be provided, depending on volume, either in a dedicated suite or SDCU;
(b) transcranial magnetic stimulation (TMS);
(c) electrocardiograph (ECG);
(d) electroencephalogram (EEG);
(e) classroom education in collaboration with external providers, such as boards of education colleges
and universities;
(f) providing secure/observation rooms;
(g) review board or review panel hearings;
(h) research;
(i) professional education;
(j) vagal nerve or other implant;
(k) psychological testing; and
(l) occupational therapy assessment rooms including access to kitchen, computer lab, etc., in order to
complete appropriate assessments of functional skills.
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8.4.2 Functional requirements
8.4.2.1 General
8.4.2.1.1
Mental health and addiction units shall be designed to maintain separation between patients in different
age groups (i.e., pediatric, adolescents, adults, and geriatric populations [where volumes allow]). Separate
facilities should be provided for men and women. Children and adolescents may be in separate units or in
or fully integrated units only separated by activities/programming.
8.4.2.1.2
The mental health and addiction unit shall have the capability to treat patients safely who have medical
co-morbidities, including co-morbid substance abuse and medical emergencies that can arise (e.g., a
secured crash cart nearby).
8.4.2.1.3
The following strategies and principles shall be implemented in all areas for mental health and addiction
patients in HCFs:
(a) Patient safety shall be provided for in all locations (e.g., by providing anti-ligature breakaway design
features).
(b) Secure observation rooms shall be provided.
(c) Good visibility of patient activity areas (i.e., good sightlines, avoidance of blind corners) shall be
provided for staff.
(d) Anti-damage strategies shall be implemented.
(e) Anti-barricade measures shall be implemented (this applies especially to doors at bedrooms and
washrooms, but may apply to other patient treatment areas such as offices).
(f) Anti-concealment measures (e.g., for contraband and potential weapons) shall be provided.
(g) Spaces should be designed to reduce anxiety and fear.
(h) Patient containment strategies, such as “fail secure” design (e.g., maglocked doors remain locked in
event of power failure) and “moveable perimeter” concepts (i.e., variable secure perimeter location)
shall be implemented.
(i) Staff safety shall be supported (e.g., by providing a clear path to the door or two doors and by
providing a staff alarm system).
(j) Facilities shall be planned to minimize staff response time in emergencies.
(k) Furniture, fittings, and equipment shall be selected to reduce the risk of patient self-harm, harm to
other patients and staff, and property damage.
(l) The design shall include the selection of finishes and fixtures that maximize ability to reduce infection
and disease transmission and the safe placement of hand hygiene stations and clean/soiled utility
rooms.
8.4.2.1.4
ECT procedures, if performed, shall take place in a dedicated ECT suite or in a procedure room that meets
the space and technical requirements for an ECT suite as specified in Table 8.4.
8.4.2.2 Inpatient
The following standard principles for all inpatient mental health and addictions units should be included in
planning and design:
(a) The design of the unit should minimize the need for support and maintenance staff to access patient
areas.
(b) The focus and flow of support services should be designed to operate as efficiently as possible.
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(c) The flow of support services and patients and clinical staff should be separated to the greatest extent
possible.
(d) Food services should be designed to facilitate as normal a dining experience as possible.
(e) Adequate and appropriately positioned and provisioned facilities shall be provided for support
functions.
8.4.2.3 Outpatient
The following principles are standard for all outpatient mental health and addiction services and shall be
included in planning and design:
(a) Staff shall have convenient access to pharmacy and diagnostic services.
(b) Support services, staff processes, and space shall have adequate safety and security to ensure patients
cannot access harmful materials or objects.
(c) The unit shall be designed to minimize the need for support and maintenance staff to access patient
areas.
(d) Sufficient space and equipment shall be provided for support services and support services shall be
designed to operate as efficiently as possible.
(e) The flow of support services shall be separated as much as possible from patients and clinical staff.
8.4.3 Technical requirements
8.4.3.1 General
8.4.3.1.1
Mental health service shall be designed in accordance with written safety and risk mitigation guidelines,
which shall be developed by planners in consultation with staff and other experts.
8.4.3.1.2
The safety and risk mitigation guidelines shall apply to all inpatient and outpatient mental health and
addictions services (i.e., adult, pediatric, and adolescent, geriatric/older adult and acute and specialized)
and other rooms where mental health patients receive care and treatment or could be unsupervised, and
shall be addressed in planning and design that balances the need for safety and risk mitigation with
facilities that are reasonably non-institutional in appearance and finishes (i.e., scaled for human interaction
and calming in their appearance).
8.4.3.2 Safety/risk mitigation
8.4.3.2.1
Safety and risk mitigation guidelines shall be applied to all aspects of design for mental health and
addictions services. Design features and precautions shall include the following:
(a) A staff alert system shall be provided in all rooms if a personal alarm system is not provided.
(b) For exterior windows, an impact test standard (e.g., BS 6206, 100 kg sandbag, 1220 mm drop) shall
be specified for the interior glazing light and a full scale mock-up test of the proposed glazing system
shall be carried out.
(c) Exterior windows should have a restricted opening of no more than 125 mm.
(d) Secure exterior glazing and frames shall be provided in all rooms where mental health and addiction
patients receive care and treatment or could be unsupervised. Exterior and interior glazing and
frames shall be constructed and secured to withstand high impact.
(e) Solid (monolithic) ceilings shall be provided in bedrooms, washrooms, and other areas where mental
health and addiction patients receive care and treatment or could be unsupervised.
(f) Ceiling heights shall be as specified in Clause 12.
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(g) Double acting doors shall be provided for washrooms, tub rooms, and shower rooms. Doors shall
open outward by releasing a retractable stop or by other means. An exterior lock shall also be
provided to secure the room when it is out of use.
(h) Water sources (e.g., sink, toilet, shower) should have individual controls such as a tamper-proof
shutoff at valves, valves located behind lockable panels, or remotely controlled shutoff to control
hydrophilic behaviour.
(i) Ligature attachment points shall be avoided.
(j) Materials and components that could become weapons shall be avoided.
(k) Trim strips between assemblies shall be avoided or securely attached.
(l) Sharp edges shall be avoided.
(m) Fasteners shall be safe and non-removable.
(n) Sealants/caulk shall be non-removable.
(o) Durable, washable finishes shall be provided.
(p) Impact-cushioning or impact-resistant finishes shall be provided.
(q) Mental health and addiction inpatient units of HCFs should be designed to provide secure storage
space for sharps disposal and patient waste disposal. Eyewash stations shall be provided in the unit.
(r) All consult/examination rooms shall have two exit doors and a staff emergency assistance alarm
station.
(s) The unit should be on the ground floor of the HCF. Where this cannot be achieved, unauthorized
access to external spaces such as balconies or roof shall be prevented.
8.4.3.2.2
In addition to the specific requirements in Clause 8.4.3.2.1, the following building elements and systems
shall be designed in accordance with the safety and risk mitigation guidelines developed under
Clause 8.4.3.1.1:
(a) materials and finishes:
(i) floor, wall, base, and ceiling finishes and components;
(ii) window frames and glazing at exterior and interior locations;
(iii) door hinges, closers, knobs/levers, and bumpers; and
(iv) wall and corner protection materials;
(b) mechanical and electrical systems:
(i) heating systems (in particular, avoid cabinets that could provide places for concealment or
present infection control problems);
(ii) HVAC terminal devices and covers;
(iii) access doors;
(iv) fire alarm system components and sprinklers;
(v) fire extinguisher and hose cabinets;
(vi) shower heads, shower actuators, and shower curtains;
(vii) washroom sinks, faucets, and valves;
(viii) toilet seats, toilet partitions, and toilet operator valves;
(ix) plumbing traps and piping;
(x) light fixtures;
(xi) electrical outlets (tamper-proof GFI-protected outlets shall be provided);
(xii) thermostats;
(xiii) grab bars, handrails, crash rails, and rub rails;
(xiv) washroom accessories;
(xv) clothes hooks and hanger rods;
(xvi) mirrors;
(xvii) bulletin boards;
(xviii) artwork hanging systems;
(xix) window treatments; and
(xx) bed curtains; and
(c) furniture and equipment:
(i) furniture;
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(ii) cabinetry;
(iii) cabinet hardware; and
(iv) equipment, including beds.
8.4.3.3 Specialized and acute inpatient care
8.4.3.3.1
Most activities will be carried out in designated activity or group space in the inpatient unit. All
patient-accessible spaces within the unit shall be understood and designed as part of the treatment milieu.
Special consideration shall be given to the needs and care of specific populations such as geriatric and
adolescent patients.
The following planning parameters shall be incorporated into the planning and design of inpatient
mental health and addictions units.
8.4.3.3.2
To contribute to the philosophy and practice of patient-centred care, the environment should be
non-institutional, residentially-scaled (i.e., as home-like as possible), and conducive to wellness. This
includes the inclusion of elder-friendly design to address such features as signage, lighting, colours, and
floor surfaces
8.4.3.3.3
Patient bedrooms shall be arranged into groupings of 6 to 8 bedrooms with an adjacent recreational
space. Living unit areas may be divided into smaller clusters of living areas. Patients shall have single rooms
with washrooms attached.
8.4.3.3.4
The design shall provide a high level of privacy and confidentiality for patients and staff.
8.4.3.3.5
An ambulation (“wandering”) loop, with identifiable focal points, shall be provided for patients. This shall
be visible to staff and able to be monitored.
8.4.3.3.6
The organization and layout of the unit should provide choice for patients to participate in individual
activities such as sitting, reading, conversing, watching TV, or playing games.
8.4.3.3.7
The layout of the unit shall facilitate members of the care team being able to make visual contact with
each patient as required by the level of patient acuity.
8.4.3.3.8
Access to enclosed exterior environments shall be provided that contrast with the interior spaces and
extend the therapeutic environment to the outside. A variety of outdoor spaces should be provided. These
may take the form of, for example, a front porch, roof garden, terrace, courtyard, or veranda and should
be designed to promote a sense of security, serenity, and safety.
8.4.3.3.9
Access shall be provided to a patient telephone and other communications devices that can be controlled
by staff when necessary. Telephones should be located in an area that can be observed, but has privacy for
personal discussions.
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8.4.3.3.10
Informal patient seating opportunities, such as benches and sitting alcoves, shall be provided along the
corridors of inpatient spaces. Sitting alcoves should not obstruct the staff’s views nor provide nooks for
hiding from staff.
8.4.3.3.11
Privacy control at all interior and exterior glazed areas shall be provided, with no view into the patient
rooms by casual observers from outside of the building.
8.4.3.3.12
Unit planning, including both external and internal relationships, should minimize staff response time in
emergencies.
8.4.3.3.13
Safety shall be a high planning and design priority. Staff should be provided with direct views of patient
activity areas.
8.4.3.4 Psychiatric intensive care unit (PICU) — Acute care
8.4.3.4.1
The psychiatric intensive care unit (PICU) is a secure (locked) unit for patients requiring the highest level of
observation and containment. These could be patients at high risk for harming themselves, harming
others, or elopement, or patients who would be disruptive on the general inpatient ward. Patient
bedrooms shall meet the requirements for a 1-bed secure/observation room with anteroom (see Table 8.4,
Item 2).
8.4.3.4.2
There shall be direct access from the corridor into the secure (locked) psychiatric intensive care unit (PICU)
staff station.
8.4.3.4.3
There shall be direct access from the patient corridor into the PICU sub-team staff station. There should be
a separate means of egress from this station.
8.4.3.4.4
Direct access should be provided from the emergency care unit. An elevator may be used for this access.
8.4.3.4.5
The team observation centre shall have a view into all rooms.
8.4.3.4.6
The PICU staff station shall control all lighting, door locking, electrical supply to outlets, security camera
system, etc.
8.4.3.4.7
All rooms shall be single and lockable.
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8.4.3.5 Psychogeriatric care unit
8.4.3.5.1
The psychogeriatric care unit (PCU) is a secure (locked) unit for senior patients with dementia requiring a
high level of observation and containment. These could be patients at high risk for harming themselves,
harming others, or elopement, or seniors who do not mix well with young adults with psychosis on the
general inpatient ward.
8.4.3.5.2
There shall be direct access from the patient corridor into the secure PCU sub-team staff station. There
should be a second means of egress from this station.
8.4.3.5.3
Direct access should be provided from the emergency care service. An elevator may be used for this
access.
8.4.3.5.4
The team observation centre shall have a view into as many rooms as possible, but all corridors should be
observable.
8.4.3.5.5
The corridor should be without any alcoves or niches that could allow patients to hide from the view of the
staff.
8.4.3.5.6
The sub-team staff station shall control all lighting, door locking, electrical supply to outlets, security
camera system, etc.
8.4.3.6 Forensic patient care unit — Specialized care
8.4.3.6.1
If a forensic patient care unit is provided, it shall have a well-defined, secure, and controlled perimeter,
equivalent to or exceeding a “medium security” level in a correctional institution.
8.4.3.6.2
Facilities for high-security forensic patients shall meet applicable requirements.
8.4.3.6.3
The design shall allow containment of patients, a physical barrier with penetration resistance, and the
capability of locking openings. All penetrations through this perimeter, such as ductwork and shafts, shall
be protected with equivalent barriers.
8.4.3.6.4
Sally ports shall be provided at all entrances to the unit through the medium security perimeter, including
vehicular entrances and entrances from outdoor courtyards where patients from other forensic units could
be present. Doors shall be remotely controlled and camera-monitored. The sally port enclosure shall meet
“medium security” perimeter standards. Sally port enclosures for high-security forensic patients shall meet
applicable requirements.
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8.4.3.6.5
Additional secure perimeters may be provided within the unit around rooms or clusters of rooms.
8.4.3.7 Outpatient services
8.4.3.7.1
The outpatient component of HCFs mental health and addictions service can include a wide range of
specialized mental health and addiction treatment settings, including, but not limited to, the mental
health clinic, substance abuse clinic, day treatment and day hospital, which promote recovery in patients
with serious mental illness.
8.4.3.7.2
To contribute to the philosophy and practice of patient-centred care, the environment in an outpatient
mental health unit should be non-institutional, residentially-scaled (i.e., as home-like as possible),
conducive to wellness, and appealing to a broad range of patients from teenagers to the elderly.
8.4.3.7.3
The design shall provide a high level of privacy and confidentiality for patients and staff, including private
offices for patient assessment and therapy. Offices should be designed to ensure sound proofing (i.e.
through insulation and noise baffling).
8.4.3.7.4
There shall be arrival and waiting areas for patients and families. There shall be one point of entry to
enable staff monitoring of access to the areas.
8.4.3.7.5
There shall be an identifiable area for reception and registration, adjacent to the waiting area.
8.4.3.7.6
Corridors and other circulation areas should be open and easily observed from the reception area.
8.4.3.7.7
There shall be examination/treatment rooms.
8.4.3.7.8
There shall be individual and group therapy rooms.
8.4.3.7.9
Camera monitoring shall be provided at main entrances, patios, and other non-clinical areas not directly
visible by staff. All office and rooms should be equipped with staff emergency assistance alarms so that
staff can summon assistance as required.
8.4.3.7.10
Outpatient mental health and addictions services should not be located near maternal/child services or
critical care services.
8.4.3.7.11
Where community-based services are coordinated by the HCF, provision shall be made for appropriate
office spaces and conferences rooms.
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8.4.3.7.12
Where a day hospital is provided by HCFs, it shall include at least the following elements:
(a) at least two distinct waiting areas, to separate patients undergoing medically supervised withdrawal
management from patients being treated at the facility through intensive counselling;
(b) a staff station — an area adjacent to the waiting room that includes space for secretary/receptionist,
office supplies, copy machine/fax, file room storage;
(c) a full kitchen with major appliances and commonly used amenities (stove, microwave, dishwasher,
double sink, refrigerator, cabinets) as relevant to the form and focus of the day treatment provided;
(d) large multi-purpose room for multi-family therapy sessions;
(e) exam/treatment room for health screenings; and
(f) interview room/treatment room that can be used by all staff for their work.
8.4.3.7.13
Where provided, ECT suites should not be located in highly visible areas.
8.4.3.7.14
The safety and risk mitigation guidelines referenced in Clause 8.4.1.1 shall apply to all outpatient mental
health and addictions services, as well as other rooms where mental health and addictions patients receive
care and treatment or might be unsupervised. To reduce the risk of patient self harm, harm to other
patients and staff, and property damage, the safety and risk mitigation guidelines reference in
Clause 8.4.3.1.1 shall be applied as appropriate to
(a) design strategies;
(b) design principles;
(c) the selection of walls, floors, ceilings, doors, and finishes;
(d) mechanical and electrical systems;
(e) accessories;
(f) furniture; and
(g) equipment.
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8.4.4 Space details
Table 8.4 presents the standard requirements for key spaces in the mental health and addiction services
area. Common areas are detailed in Clause 11.
Table 8.4
Key space requirements and recommendations —
Mental health and addiction services
1 Inpatient See Clause 11 for common requirements and recommendations for a patient
bedroom — bedroom.
Mental Mandatory:
health and (a) Secure exterior glazing and frames shall be constructed to withstand high
addiction impact (see Clause 8.4.3.2.1).
services (b) En suite bathrooms, with double-acting and staff-lockable doors, shall be
provided.
Bed area 13.0 (c) The bed in the room shall be located to optimize patient privacy.
(d) A circulation path that is safe and direct shall be provided between the bed
area, washroom, and entry door.
(e) The following shall be provided for each patient:
(i) a desk 750 mm long (except in the psychogeriatric care unit);
(ii) storage — 1.2 m3 in specialized bedrooms; 0.6 m3 in acute bedrooms —
which shall be fully accessible in all rooms; and
(iii) a comfortable chair that can be used at the desk or for reading.
(f) Where a bedroom has access to the bed area via an entry vestibule
containing an en suite bathroom, approximately 4 m2 of additional area shall
be provided, compared to a bedroom layout with direct corridor access to
the bed area (and with washrooms located between the two bedrooms).
Advisory:
(a) A double-swing entry door should be considered.
(b) If larger beds will be provided, a 1200 mm door should be considered.
(c) Operable windows that are staff-lockable, with a removable operator,
restricted opening dimensions, and security screens shall be provided.
(d) Individual temperature control should be considered in long stay bedrooms.
(e) Walls in patient and secure rooms should be scratch and graffiti resistant.
(f) Washrooms may be planned (outside of the bed area):
(i) 2-piece washroom: 4.6 m2; and
(ii) 2-piece washroom: 5.6 m2.
(g) Depending on the washroom/bed area design, a vestibule may be added.
(h) Vestibule (assuming ‘inboard’ washroom) should be 4.0 m2.
2 1-bed Mandatory:
secure/ (a) The requirements and recommendations in Item 1 apply.
observation (b) Vertical projections and corners that could cause self-harm shall be avoided.
room with (c) All horizontal projections that could allow climbing or cause self-harm,
anteroom including window sills, shall be avoided (e.g., a flush protective glazing panel
could be provided).
Bed area 13.0 (d) The room shall have space and clearances for a full-size hospital bed. The bed
shall be secured to the floor.
Anteroom 5.5 (e) Multi-point door locking with “slam-lock” function (locks automatically when
closed) shall be provided.
(f) Washable floor and wall finishes, which shall be “repairable in the field” to
minimize downtime of rooms, shall be provided.
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Table 8.4 (Continued)
(g) An observation window shall be provided of appropriate size, sill height, and
location to allow a direct view from the sub-team communications station.
An audio-video system may be used.
Advisory:
(a) Impact-cushioning materials should be considered for wall finishes.
(b) Additional bed area may be provided (if 4-sided access is required for acute
patients): 3.0 m2.
(c) A washroom may be planned (outside of the bed area):
(i) 2-piece washroom: 4.6 m2; and
(ii) 3-piece washroom: 5.6 m2.
(d) Depending on the washroom/bed area design, a vestibule may be added.
(e) Vestibule (assuming ‘inboard’ washroom): 4.0 m2.
3 2-bed room, Mandatory:
specialized The requirements and recommendations in Item 1 apply.
(if clinical Advisory:
justification (a) Additional bed area may be added (if 4-sided access is required for acute
supports patients): 6.0 m2.
this layout (b) A second washroom may be planned (two washrooms; one for each patient):
3-piece washroom: 5.6 m2.
Bed area 24.0 to (c) Depending on the washroom/bed area design, a vestibule may be added.
27.0 (d) Vestibule (assuming ‘inboard’ washroom): 4.0 m2.
Washroom 5.6
4 Activity Minimum Mandatory:
room 13.0; (a) The room shall be located in, or adjacent to the inpatient unit.
may be (b) Activities shall be visible from a staff care desk or from adjacent circulation.
increased (c) Space shall be provided for larger recreational equipment such as table tennis
based on or pool tables.
program Advisory:
needs. The room should be available for non-programmed leisure activities.
5 Group 2.0 per Mandatory:
therapy occupant (a) The room shall be located in, or contiguous to the inpatient unit.
room (b) It shall be located next to an observation room.
(c) Acoustic separation from other areas shall be provided.
Advisory:
(a) Natural light should be provided but blackout capability shall also be
provided.
(b) Individual armchairs for seating should be included.
6 Dining Mandatory:
room See Clause 11.
Advisory:
A nourishment centre (kitchenette and table) should be included.
7 Lounge, 2.5 per Mandatory:
patient occupant, (a) The lounge shall be in the inpatient unit.
including (b) Visibility of activities from a staff care desk or other staff location shall be
circula- provided; camera observation is optional but less desirable than a direct view.
tion (c) Natural light and a view of the outdoors shall be provided.
(d) Separate areas shall be provided to isolate quiet and noisy activities; separate
rooms should be provided.
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Table 8.4 (Continued)
(e) Adequate storage space shall be provided for activity equipment and
supplies.
(f) Acoustic treatment to reduce ambient noise and acoustic separation from
other areas shall be provided.
(g) All cooking appliances (ranges, microwaves, coffee makers, etc.) shall have
key operated lock-out switches to disable the appliance.
(h) All garbage disposal units shall have a key operated lock-out switch to disable
the device.
Advisory:
If a separate quiet lounge is provided, it should be 11.1 m2 minimum.
8 Observation 5.5 Mandatory:
room (staff (assumes (a) An observation window with one-way vision (mirrored) glass of appropriate
viewing seating for size, sill height, and location shall be provided to allow standing or sitting
area) four. Add observation for up to 4 persons; 1.4 m2 shall be added for each additional
1.4 m2 for staff.
each (b) Drapes shall be provided in the observed room or other treatment room to
additional conceal the window, when required.
occupant (c) Furniture or surfaces for writing and recording equipment shall be provided.
(d) Furniture shall include task chairs or stools.
Advisory:
(a) The room may be associated with, for example, the interview/consult room,
therapeutic playroom, or group room.
(b) Using other programmed rooms, such as adjacent group rooms, should be
considered.
(c) The secure room should not be located in close proximity to an elevator,
stairs, exits, or common patient areas.
9 Multi- Minimum See Clause 11.
purpose 11.0; Mandatory:
room may be (a) Standard size assumes 4 to 6 persons — 2.0 m2 shall be added for each
increased additional person expected to be accommodated.
in accor- (b) Shall be located adjacent to the observation room (Item 8 above).
dance with (c) Drapes shall be provided to conceal the window, when required.
program
needs
10 Multi- Minimum Mandatory:
sensory 11.0; (a) The room shall be in, or adjacent to, the inpatient unit.
room may be (b) A high level of acoustic privacy shall be provided.
increased (c) If the room has windows, the window treatment shall have blackout
in accor- capability.
dance with (d) The ability to install ceiling-mounted weight-supporting equipment shall be
program provided.
needs (e) Concealed, unobtrusive storage shall be provided for large items and carts
(minimum 1200 mm deep).
Advisory:
The room can be used for relaxation or stimulation therapy and will be normally
occupied by an individual patient plus staff member(s).
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Table 8.4 (Continued)
11 Sally port Varies by Mandatory:
(forensic program; Detention-grade doors shall be provided and shall be remotely controlled and
units) assume full camera-monitored from the security office.
enclosure
of transfer
vehicle in
locked
room, with
minimum
2400 mm
circula-
tion on
two sides
and
1500 mm
on the
other sides
12 ECT 23.5 Mandatory:
procedure (a) The room shall be in close proximity to Stage 1 ECT recovery room (or day
room surgery recovery area if the space is shared).
(b) Decontamination of medical devices, if done, shall be performed in the MDR
department or in a space that meets the requirements of CAN/CSA-Z314.8.
(c) Cardiac monitoring shall be available.
(d) Space shall be provided for a crash cart for emergency resuscitation when
needed.
(e) Suction and oxygen services shall be available.
(f) Other medical gases shall be provided (cylinders or piped) as required by the
functional program.
Advisory:
(a) Use as a treatment room or for other functions, when not used for ECT,
should be planned for.
(b) Use of the room for disaster planning should be considered.
(c) There should be sufficient space for the ECT device and for anaesthetic
equipment.
(d) Visual and acoustic separation from the recovery areas is desirable.
13 ECT 9.5 Mandatory:
recovery per (a) The room size assumes open/curtained cubicle. Partial walls (on 2 sides) shall
room, stretcher be minimum 11.0 m2 and a fully enclosed room shall be a minimum of
Stage 1 13.0 m2.
(short term) (b) The room shall be in close proximity to the procedure room.
(c) The exit route shall not be through the waiting area.
(d) The inpatient return route to units shall not be through the public area of the
building.
(e) Cardiac monitoring shall be available.
(f) Suction and oxygen services shall be available.
30–60 min
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Table 8.4 (Concluded)
14 ECT 7.5 Mandatory:
recovery per (a) The exit route shall not be through the waiting area.
room, stretcher (b) There shall be meal service access to the Stage 2 recovery area.
Stage 2 (assumes (c) Recliner chairs and table and chairs for snack/beverage service shall be
(long term) recliner provided.
chair in Advisory:
open/ (a) The room should be in close proximity to the procedure room and
curtained short-term recovery.
cubicle) (b) Recovery time of approximately 6 to 7 h duration should be planned for.
15 Office/ 14.0 Mandatory:
treatment (a) The seating area and desk locations shall allow a clear path to the door for
room staff. A high level of safety shall be provided.
(b) For safety reasons, the desk, table, and chairs shall be heavy to prevent their
ready use as a weapon.
Advisory:
An exterior window should be provided, permitting natural light and, if possible,
a pleasant view.
16 TMS room 13.0 Mandatory:
(a) The room temperature control shall accommodate the TMS equipment heat
load.
(b) A chair appropriate for patient positioning shall be provided.
(c) Space shall be provided for a crash cart to be used for emergency
resuscitation when needed.
17 Classroom, Varies by Mandatory:
including program; The room shall meet applicable requirements for classrooms.
teacher minimum
space of 23.3
(pediatric Advisory:
and Access to a common computer room or multi-purpose room with a computer
adolescents) should be considered.
18 Dining 7.5 per Mandatory:
room/ person (a) The room shall provide a defined space for patients to eat at tables seating
kitchen/ four and may be used for general activities outside of meal times.
refreshment (b) A unit kitchen or servery shall be provided for meal service.
centre (c) Lockable cupboards for sharps, supplies, etc., and adequate secure storage
for food and equipment and sufficient space to store food tray and
distribution trolleys shall be provided.
Advisory:
(a) Self-serve beverage facilities including a refrigerator should be included in a
large scale dining room or in a centrally located “domestic scale” kitchenette
and may be used to promote activities of daily living (ADL).
(b) Decor should reflect a “home like” environment.
19 Medication Varies See Clause 11 for common requirements and recommendations for a medication
room according room
to delivery
model.
Not less
than 9.5
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8.5 Pediatric and adolescent
8.5.1 Description
8.5.1.1
Pediatric and adolescent inpatient services provides care for infants, toddlers, children, and adolescents up
to 16 years, specifically designed to reflect the varying physical and psychological needs of this age group.
The extent of the services can vary dependent upon the role of the HCF (i.e., dedicated or integrated care,
critical care, etc.).
8.5.1.2
The inpatient service can include
(a) patient rooms for medical/surgical/mental health sub-services;
(b) play areas;
(c) education activity area(s); and
(d) procedure/treatment room(s).
8.5.1.3
Various models can be used for treatment and for coordination with other services in the HCF. Options for
consideration include
(a) treating children in their own room;
(b) establishing a step-down unit within the unit itself;
(c) transferring to an HCF that specializes in pediatric services; or
(d) temporary transfer to an adult high dependency unit in using a neonatal emergency transport service
when there is no other option.
8.5.2 Functional requirements
8.5.2.1
The design of pediatric and adolescent services shall recognize the role of the patient’s family as part of the
care team.
8.5.2.2
The pediatric unit should be located with the adjacencies specified in Clause 6. Access and routes to the
pediatric unit should ensure minimal contact with sick or injured adult patients.
8.5.2.3
The services should be designed to support appropriate security elements so that the unit can be safely
maintained and accessed on a 24/7 basis.
8.5.2.4
Dedicated facilities (including private washroom) shall be provided for counselling, grieving, and care
planning.
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8.5.3 Technical requirements
8.5.3.1 General
8.5.3.1.1
The unit design shall allow nursing staff to have optimal observation of all patient areas and for the
children to be able to see the staff in order to feel reassured and safe. The need for observation and the
safety of children shall, however, be balanced against the need to protect the privacy and the personal
dignity of patients and their parents or family members. This can be achieved by curtains on windows and
other glazed panels and the use of bed screens.
8.5.3.1.2
Space for education activities should be provided, depending upon the expected patient length of stay.
8.5.3.1.3
Indoor play activity areas shall be provided. An outdoor activity play area should be provided.
8.5.3.1.4
The indoor play space provides an area where patients can go for play and recreation activities. There may
be more than one room so that activities suitable for children are separate from activities suitable for
adolescents. The following components should be provided:
(a) tables for sit-down activities and dining (if part of model of care);
(b) televisions and computers;
(c) reading alcoves;
(d) gross motor activities; and
(e) storage for items.
8.5.3.1.5
The outdoor play space provides an area where patients can go for play and recreation activities. The
following components should be provided:
(a) seating;
(b) hard-surface for wheeled items (e.g., wagons, bikes);
(c) soft-surface/grass for sitting; and
(d) water/sand feature (if part of model of care).
8.5.3.1.6
All electrical outlets shall be tamper-resistant.
8.5.3.1.7
If the HCF includes an emergency care service, and this service has no dedicated facilities for children who
need temporary observation or are waiting for a decision to admit, the HCF should provide an
appropriately staffed assessment unit in the pediatric care service.
8.5.3.1.8
Depending on the size of the pediatric service, consideration should be given to creating a “pediatric
precinct” that incorporates facilities for inpatient care, emergency assessment/observation, day care, and
outpatient clinics.
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8.5.3.2 Privacy and confidentiality
In the communications, charting, and staff areas of the inpatient unit, consideration shall be given to
providing separation of the area from common space (e.g., use of multi-purpose rooms for confidential
discussions with family members).
8.5.3.3 Infection prevention and control
See Clause 7.5.
8.5.3.4 Furniture, fittings, and equipment
Furniture, fittings, and equipment shall be scaled to suit a variety of patient body sizes ranging from
infants to older adolescents. Rooms shall be capable of being transformed quickly to adapt to diverse
patients’ needs within this large age range (replacement of cribs with platform beds or electric beds, and
vice-versa).
8.5.3.5 Safety and security
8.5.3.5.1
An HCF with a pediatric and adolescent inpatient unit shall be secured to minimize and contain the risk of
a child’s unaccompanied egress or abduction from the unit and prevent interference from unauthorized
persons. Safety and security measures should include the following as appropriate to the HCF:
(a) monitoring of unit access through
(i) direct staff observation;
(ii) closed-circuit TV; or
(iii) monitoring of unit access;
(b) restricted window openings;
(c) high level door latches;
(d) horizontal split doors (sometimes referred to as dutch doors or stable doors);
(e) locked doors;
(f) staff emergency assistance alarm stations located at receptions and staff stations; and
(g) child monitoring and tagging especially for young children via radio frequency identification (RFID)
systems.
Door swings shall be planned and arranged so that there is no danger of hitting a small child on other
side.
8.5.3.5.2
Consideration should be given to visual control (including electronic surveillance) on nursing units of
corridors, dining areas, and social areas such as dayrooms and activity areas. Hidden alcoves or blind
corners or areas shall be avoided.
8.5.3.5.3
If an electronic surveillance system is used, it shall comply with the following:
(a) Devices in patient areas shall be mounted in a tamper-resistant enclosure that is unobtrusive.
(b) Devices shall be located so they are not readily observable by the general public or other patients.
(c) Devices shall be supplied with power from the emergency electrical power supply system in the event
of a disruption of normal electrical power.
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8.5.4 Space details
Table 8.5 presents the standard requirements for key spaces in the pediatric and adolescent area.
Common areas are detailed in Clause 11.
Table 8.5
Key space requirements and recommendations —
Pediatric and adolescent
1 1-bed room See adult See Clause 11 for common requirements and recommendations for a
suite inpatient patient bedroom.
bedroom for Mandatory:
size All electrical outlets shall be tamper-resistant.
(11.0 common
requirements) Advisory:
(a) Internet access should be proved as separate ports for patient and
family. Space for a bassinet should be provided.
(b) The room design should accommodate the possible need for parent/
family member live-in or high dependency care (e.g., by providing
support for monitoring equipment).
(c) Provision should be made for infant bathing.
(d) A chair should be provided for breast feeding if required.
(e) A heat lamp should be provided in the washroom.
(f) Depending upon model of care, sleeping area for family should be
provided.
2 1-bed room See Item 1 See Clause 11 for requirements and recommendations.
suite, AIR (11.0 common
isolation requirements)
3 Play area, Size varies by See Clause 11.
pediatric or program
adolescents
4 Staff Size varies by See Clause 11.
education program Advisory:
room (a) Furnishings should include tables/chairs and soft seating.
(b) Internet access port(s) should be provided.
5 Pediatric Varies by See Clause 11.
education program; Mandatory:
room minimum 18.5 (a) Medical gas (oxygen/vacuum) shall be provided — two stations
depending upon room layout.
(b) The room size shall be in accordance with applicable requirements.
Advisory:
(a) Furnishings should include tables/chairs and soft seating.
(b) Internet access port(s) should be provided.
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8.6 Rehabilitation care
8.6.1 Description
8.6.1.1 General
Rehabilitation care is a program of services directed toward restoring patients to their highest level of
physical independence and emotional wellness after experiencing the effects of disease or debilitating
injury.
Rehabilitative care is typically provided as a discrete unit of an acute care HCF. Patients of rehabilitative
care could be patients residing in the HCF or else visiting the HCF on an outpatient basis.
Dedicated rehabilitation facilities, not connected to an acute care HCF, can also be established to serve
patients with specialized illnesses or disabilities. In general, dedicated rehabilitation facilities typically have
larger space requirements than similar facilities in acute care HCFs, the patients have longer lengths of stay
and the facilities are less institutional and more residential.
Children’s HCFs, or acute care HCFs with major pediatric services, generate their own specific spatial
needs for rehabilitative care.
Patients of all ages will use rehabilitation services. Almost all patients receiving rehabilitative care will be,
to some extent, physically incapacitated. Many patients will use wheelchairs or walking aids and,
increasingly, motorized chairs that have implications for parking and recharging. Some patients could be
disfigured (e.g., burns, throat surgery, etc.) and require a non-threatening, private environment.
8.6.1.2 General services
The services generally provided by rehabilitation units generally include
(a) patient assessment and establishment of an individualized treatment plan;
(b) physical therapy (e.g., exercise, massage, manipulation);
(c) occupational therapy for the improvement of daily functional capacity;
(d) speech pathology;
(e) audiology;
(f) personal care, counselling, education, and support to patients and their families or caregivers to
adapt to changes in functional ability;
(g) comprehensive discharge planning; and
(h) medication management.
8.6.1.3 Specialized services
Some rehabilitation services provide additional specialized services such as
(a) hydrotherapy;
(b) specialized treatment for uncommon conditions/diseases (e.g., burns, spinal cord injury);
(c) gait analysis;
(d) orthotics/prosthetics;
(e) specialized seating;
(f) video fluoroscopy; and
(g) chiropody services.
8.6.2 Functional requirements
8.6.2.1
The rehabilitation unit should have ready access to allied health units such as speech pathology and social
work where those units are not represented or located within the unit itself. There shall be ready access to
orthopaedic clinics by physiotherapy.
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8.6.2.2
The design shall include connections to the following services, either through proximity or by means of
convenient circulation routes:
(a) diagnostic imaging;
(b) public areas such as retail, chapel, and cafeteria, for patients, families and visitors to access; and
(c) the outpatient rehabilitation area (if it is to be used by inpatients).
8.6.2.3
The rehabilitation unit should be accessible from the inside HCF’s main entrance.
8.6.2.4
The inpatient rehabilitation unit may share some services such as rehabilitation equipment and
gymnasium with the outpatient services and have a process of tracking patients through the entire
continuum of care.
8.6.3 Technical requirements
8.6.3.1 General
8.6.3.1.1
Rehabilitation inpatients typically have longer lengths of stay in an HCF than acute care inpatients.
Rehabilitation inpatients can have a greater number of personal items than a typical acute inpatient and
consideration should be given to providing storage/locker space to accommodate such items.
8.6.3.1.2
Corridors should be designed with therapeutic as well as circulation considerations in mind. Wayfinding
landmarks and cueing devices shall be provided.
8.6.3.1.3
Outdoor spaces should be provided.
8.6.3.1.4
Sufficient space shall be provided for storage of returned loan equipment, separate from the storage for
clean equipment available for loan. Cleaning and decontamination shall take place in the MDR or in a
separate designated area in accordance with CAN/CSA-Z314.8.
8.6.3.1.5
Appropriate mechanical ventilation shall be provided for control of odours.
8.6.3.1.6
Entry/waiting provisions shall include
(a) a reception and control station that permits visual control of waiting and activities areas, including
child play area for pediatric patients (this may be combined with office and clerical space);
(b) an area for wheelchair/stretcher accommodation, which shall be provided adjacent to reception; and
(c) therapy areas, which should be directly accessible from the reception.
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8.6.3.1.7
When services are decentralized, shared meeting, conference, resource, and documentation areas shall be
centralized on the unit. Washrooms shall be conveniently located specific for staff use. Space for storing
wheelchairs and stretchers shall be out of traffic while patients are using the services. These spaces may be
separate from the service area but shall be conveniently located.
8.6.3.1.8
Furniture, fittings, and equipment selection shall balance the need for encouraging active rehabilitation
against the limited mobility of some patients. All selections shall be consistent with the accessibility needs
of patients, staff, and visitors.
8.6.3.2 Occupational therapy and physiotherapy
Workspace provisions shall include
(a) a central therapeutic recreation room, which should be located near the occupational therapy
services or, depending on program requirements, may also be associated with rehabilitation,
physiotherapy, or an inpatient continuing facility; and
(b) smaller therapeutic recreation rooms, which may be located on the inpatient floors.
8.6.3.3 Speech/language pathology
8.6.3.3.1
If the speech/language pathology section is to be located on the patient unit, it should be close to other
areas where therapy is taking place.
8.6.3.3.2
If video fluoroscopy is used, the speech/language pathology section shall have convenient access to
diagnostic imaging.
8.6.3.3.3
The speech/language pathology assessment/treatment and pediatric group room should have convenient
access to the following services:
(a) occupational therapy;
(b) ambulatory care;
(c) rehabilitation; and
(d) pediatrics.
8.6.3.4 Audiology
8.6.3.4.1
The audiology testing suite should be located near related modalities, which can include ambulatory care,
physiotherapy, occupational therapy, recreational therapy, psychology, and speech-language pathology.
8.6.3.4.2
The audiology testing room should be located in a low traffic area to minimize distraction caused by other
noises.
8.6.3.5 Gymnasium
8.6.3.5.1
If a gymnasium is provided, sound dampening measures should be used in its construction.
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8.6.3.5.2
Wall finishes shall be impact resistant to a height of 2 m from the floor. Floor materials shall be appropriate
for gymnasium use.
8.6.3.5.3
Gymnasium ceiling heights should be a minimum of 3.3 m.
8.6.4 Space details
Table 8.6 presents the standard requirements for key spaces in the rehabilitation area. Common areas are
detailed in Clause 11.
Table 8.6
Key space requirements and recommendations — Rehabilitation care
1 Speech/ 16.0 Mandatory:
language (a) The room shall have barrier-free access.
pathology (b) There shall be a hand hygiene sink at the entrance.
assessment (c) There shall be a staff workstation, small round meeting table, and
room securable file storage.
(d) Storage for personal protective equipment (PPE) shall be provided.
Advisory:
Equipment should be assessed before setting size. Equipment may include
computerized speech lab, digital stroboscope, wall-mounted TV.
2 Therapeutic Varies by Mandatory:
recreation program (a) The room shall have barrier-free access.
room (b) There shall be a hand hygiene sink at the entrance.
(c) There shall be adequate space for equipment and storage.
(d) Daylight shall be provided if a horticulture therapy program is included.
Advisory:
The size of this space may vary, based on access for
(a) physically challenged patients;
(b) bariatric patients;
(c) patients using scooters and other mobility aids;
(d) large and small groups; and
(e) personal caregivers.
3 1-bedroom See adult See Clause 11 for common requirements and recommendations for a patient
suite inpatient bedroom.
bedroom for Mandatory:
size (a) Access to at least one such room shall be provided per mid- to large-sized
(11.0 rehab unit; at least easy access shall be provided from a small inpatient
common continuing care unit, as the program dictates, to avoid, if possible,
requirements) transfer of the patient to acute care.
(b) A place to charge a wheelchair shall be provided in the room.
(c) A window shall be provided in both vestibule doors, positioned to allow
a view from the bed.
(d) A flexible sanitary window screen shall be provided to allow for privacy
when the patient’s condition allows.
(e) Individual temperature control shall be provided.
(f) The vestibule shall be pressurized.
(g) A visitor space close to the patient, for ease of visual/auditory access, shall
be accommodated.
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Table 8.6 (Continued)
(h) The ability to view the patient from a closed anteroom shall be provided.
(i) Priority shall be given to locating this room near the team station.
Advisory:
(a) Privacy and care requirements, such as visibility by staff from the corridor
vs. patient privacy, should be balanced.
(b) The wardrobe need not be close to the bed.
(c) Finishes that resemble home environments should be used.
4 Tub/shower See Clause 11 common requirements.
room Mandatory:
(a) Access to oxygen and medical vacuum shall be provided within the room.
(b) A secure limiting device shall be provided if the window is operable.
5 Dining room See Clause 11 common requirements.
6 ADL kitchen Varies by Mandatory:
program; (a) The kitchen shall be wheelchair accessible.
assume (b) Both standard and barrier-free kitchens shall be included for ease of
enclosed room transition to either at home.
minimum 9.5
(c) The kitchen shall reflect similar challenges of the home as part of the
transition.
(d) Doors shall be a minimum 860 mm, with 600 mm open side leaf.
(e) Standard kitchen counter, appliances, and fixtures shall be provided, as
well as a barrier-free kitchen counter easily accessible within rehab unit.
(f) Windows, whether direct to the outdoors or not, shall resemble the
orientation typically found in a home.
(g) Fixtures shall resemble lighting at home.
(h) Flexibility shall be provided to allow for task lighting.
(i) Multiple wall outlets shall be provided to allow flexibility in
furniture/lighting placement.
(j) Individual temperature control shall be provided.
(k) Finishes shall resemble those commonly found at home.
(l) A family/visitor space to assist the patient shall be accommodated.
(m) Nurse-call shall be provided.
Advisory:
(a) To ease orientation, the use of contrasting colours to delineate interior
wall planes and furniture should be considered.
(b) Combining the ADL laundry and kitchen in one area should be
considered.
(c) Consideration should be given to whether, based on program
requirements, a full ADL apartment is required or only a laundry and
kitchen.
(d) Contrasting colours for furniture should be used to ease orientation.
(e) Visibility by staff vs. patient privacy should be balanced.
7 ADL laundry 11.0 See Clause 11 common requirements.
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Table 8.6 (Continued)
8 ADL Varies by Mandatory:
apartment program; and (a) Space for a double bed shall be included in the bedroom area.
the range of (b) A window (whether direct to outside or not) and curtain shall be provided
components in all bedrooms.
included in (c) The apartments shall be wheelchair accessible.
the ADL (d) Slip-resistant flooring shall be provided in the bathroom.
suite (e) A standard bathroom shall be incorporated, but with easily adapted
barrier-free accessories to reflect the reality of the transition to home.
(f) Both standard and barrier-free kitchens shall be included for ease of
transition to either at home.
(g) The grab-bar, if located above the toilet, shall not be in conflict with the
commode.
(h) The apartment shall reflect similar challenges of the home as part of the
transition.
(i) A second door into the bedroom shall be provided to enable access to the
bedroom and bathroom without going through the kitchen/living room.
(j) The ability to transfer patients from a mechanical lift to the bed shall be
provided.
(k) One side of the bed shall be wheelchair accessible.
(l) Doors shall be a minimum 860 mm, with 600 mm open side leaf.
(m) Space for living room furniture, including a sofa bed, shall be provided.
(n) Medical gases shall be provided in one wall of the bedroom.
(o) A dresser and barrier-free closet shall be provided in the bedroom.
(p) Standard kitchen counter, appliances, and bathroom fixtures shall be
provided, as well as a barrier-free kitchen counter easily accessible within
the rehab unit.
(q) A place to charge wheelchairs shall be provided in the apartment.
(r) Provision shall be made for a washer and dryer, but only as secondary if
an ADL laundry room is provided elsewhere.
(s) The wardrobe shall be movable but securely fixed to the wall for safety.
(t) Windows (whether direct to outdoors or not) shall resemble orientation at
home (e.g., in the bedroom).
(u) Fixtures shall resemble lighting at home.
(v) Flexibility shall be provided to allow for task lighting.
(w) Multiple wall outlets shall be provided to allow flexibility in
furniture/lighting placement.
(x) Individual temperature control shall be provided.
(y) Finishes shall resemble those commonly found at home.
(z) Visitor space to assist patient shall be accommodated.
(aa) Nurse-on-call shall be provided.
Advisory:
(a) Combining the ADL laundry and kitchen in one area should be
considered.
(b) Consideration should be given to whether, based on program
requirements, a full ADL apartment is required or only a laundry and
kitchen.
(c) Visibility by staff vs. patient privacy should be balanced.
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Table 8.6 (Continued)
9 Small multi- Varies See Clause 11.
disciplinary
assessment/
treatment
room
10 Large multi- Varies See Clause 11.
disciplinary
assessment/
treatment
room
11 Gym Varies by See Clause 11.
program
12 Physical Mandatory:
therapy (a) Storage for equipment shall be provided nearby.
(b) Visual privacy shall be ensured (e.g., with a privacy curtain).
Single 8.5 (c) One therapy area for one patient or one patient and family member shall
treatment be accommodated.
table area (d) The area shall accommodate the treatment table plus staff work space
with a portable computer.
Double 9.5 (e) A minimum 1800 mm turning circle shall be provided for standard
treatment wheelchair accessibility on one side of the treatment table for ease of
table area therapy on both sides.
(f) Access to three sides of the treatment table shall be incorporated.
(g) A minimum 900 mm shall be provided at the foot of the treatment table
(when not a fixed partition).
(h) A minimum 900 mm shall be provided on one side and 1800 mm on
other, shared with adjacent treatment table.
(i) Allowance shall be made for space for staff equipment, including a small
work area with seat and counter, and storage above the treatment table.
(j) Space shall be provided for sitting adjacent to the patient.
(k) There shall be monolithic ceiling to accommodate adjustable poles.
(l) Provision shall be made for wall reinforcing for pulleys, etc.
(m) The ceiling structure shall accommodate the weight of therapy grids.
(n) A minimum of one hand hygiene sink shall be provided for the overall
treatment area.
(o) Lockable space shall be provided for cleaning products.
(p) Ample storage shall be provided for both small items and large
equipment.
(q) The door into the general area shall have a minimum width of 1050 mm.
(r) A light shall be provided over the treatment table area.
(s) Daylight-simulated light fixtures shall be provided.
(t) One emergency power supply shall be provided per three treatment
tables.
(u) One light switch shall be provided per treatment bed/treatment table.
(v) A high voltage outlet shall be provided per three treatment tables.
(w) A family/support person space to enable assistance shall be provided.
(x) Easily accessible and safe nurse-call, connected to nearest team station,
shall be provided.
(y) For a PT double treatment table, the area shall be a minimum of 9.5 m2,
and a bobath-sized template shall be used for the standard treatment
table area.
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Table 8.6 (Concluded)
Advisory:
(a) Privacy and care requirements, such as visibility by staff from the corridor
vs. patient privacy, should be balanced.
(b) Based on the patient population, piping easily accessible medical gases
into the wall within the overall treatment room should be considered.
(c) Zoned temperature control should be considered for the room.
13 Circulation Varies Mandatory:
(a) The importance of circulation as therapeutic space for this patient group
shall be taken into account.
(b) Mobility shall be promoted by providing focal points.
(c) Finishes that facilitate manoeuvrability shall be used.
(d) There shall be no direct visual access from the corridor to patient bathing
spaces.
(e) Patient-accessible and service space entries shall be differentiated.
(f) Direct openings and visual links to social/therapeutic/common areas shall
be created whenever possible.
(g) Opportunities for meeting and greeting shall be provided.
(h) Unobtrusive observation of patients shall be ensured where surveillance is
necessary.
(i) Adequate overall illumination shall be provided, along with accent
lighting for pictures, plants, and furnishings.
(j) Direct and indirect glare onto flooring surfaces shall be prevented.
(k) Rest areas shall be provided along corridors.
Advisory:
(a) Low-maintenance but non-institutional decor should be used in finishes
and accessories, including lighting and railings.
(b) The design of circulation areas should avoid features that could confuse
cognitively or visually impaired patients by presenting an unclear or
unreachable goal. A window with a view at the end of a destination can
be frustrating if the view is not reachable. For example, a dead end
corridor can be more successfully navigated if there is a touchable focus.
(c) Providing focal points can deter wandering (see Clause 8.8.2.4.3).
(d) Residential treatment of clinically required accessories, such as corner
guards, bumper rails, and handrails, should be considered.
(e) Finishes that reduce reflected noise on walls and ceilings increase sound
absorbency and tend to prevent agitation.
14 Team care See Clause 11
station —
Decentra-
lized
15 Outdoor See Clause 11
space
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8.7 Burn unit
8.7.1 Description
8.7.1.1
The burn unit offers a progressive program of treatment, therapy, and rehabilitation for patients who have
received the following:
(a) chemical burn;
(b) scald or thermal (fire);
(c) electrical burn, including lightning;
(d) inhalation injury; and
(e) other skin disorders (e.g., Stevens-Johnson syndrome [SJS], toxic epidermal necrolysis [TENS]).
8.7.1.2
The burn unit is physically designed to maximize the healing opportunities for patients to receive
specialized care, but not limited to the following disciplines:
(a) critical care;
(b) plastic surgery;
(c) physiotherapy;
(d) occupational therapy;
(e) speech pathology;
(f) psychiatry;
(g) nutrition;
(h) addictive medicine;
(i) spiritual care; and
(j) social work.
8.7.2 Functional requirements
8.7.2.1 Rooms
Design of burn treatment services shall include the following
(a) single inpatient bedrooms complete with
(i) washroom;
(ii) patient waste disposal; and
(iii) hand hygiene sink for staff;
(b) family/visitor room suitable for both waiting and private for consultation; and
(c) education room suitable for teaching activities for patients, families, caregivers, and staff.
8.7.2.2 Equipment and furnishings
Air fluidized therapy (AFT) beds shall be provided.
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8.7.3 Space details
Table 8.7 presents the standard requirements for key spaces in the burn treatment services area. Common
areas are detailed in Clause 11.
Table 8.7
Key space requirements and recommendations —
Burn treatment services
1 Patient See Clause 11 for common requirements and recommendations for an
bedroom suite, inpatient bedroom.
adult and child Mandatory:
Patient room shall have
Bed area 23.2 (a) clear area exclusive of washroom, closet/locker;
(b) water/drain connection for a portable dialysis machine;
Washroom 4.6 (c) a patient care zone of a minimum 4.5 m2;
(2 piece) (d) a family zone with seating/sleeping/work area that does not interfere
with patient care activities;
Family zone Included in (e) a staff zone with hand washing hygiene station, waste disposal
bed area system, computer station which shall not interfere with function;
(f) space for bed, equipment (i.e., monitor, ventilator, supply cart),
Staff zone Included in furnishings (i.e., side chairs, recliner chair, over bed table), staff, and
bed area visitors; and
(g) storage for patient personal belongings.
Charting area 1.4
The minimum distances around and between beds shall be in accordance
Supply alcove 1.4 with Table 7.1.
Advisory:
A soiled work space may be added (may be shared between two to three
rooms). If this room is added, the net area shall be not less than 3.0 m2.
2 Washroom with 6.0 See Clause 11 for common requirements and recommendations for a
shower patient washroom.
8.8 Inpatient continuing care
8.8.1 Description
8.8.1.1 General
8.8.1.1.1
Inpatient continuing care is a program of services provided by a team of health care professionals to
persons who often have very complex medical, nursing, and therapeutic needs, generally of a chronic
and/or long-term nature. The complexity of patient needs requires the intensity of staffing levels typical of
a hospital environment. The goal of the program is to optimize patients’ quality of life, maximize their
independence, and improve their function to the greatest extent possible. In most instances, discharge will
not be possible due to the complexity of patient needs.
Inpatient hospices are part of a continuum of palliative care. They have been developed as new facilities
and through renovation of existing facilities.
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8.8.1.1.2
Clause 8.8 covers the continuum of inpatient continuing care, which can be provided within freestanding
facilities or as distinct parts of a general hospital or other HCF.
The continuum of nursing services and facilities can be distinguished by the levels of care, staff support
areas, and service areas provided.
8.8.1.2 General services
The services generally provided by continuing care programs include
(a) comprehensive assessment of patient needs and establishment of patient goals by the patient, his/her
network, and the inpatient continuing care team;
(b) health care services, counselling, and education to patients and their families or caregivers by a team
of health professionals; and
(c) palliative care.
8.8.1.3 Additional services
Depending on local conditions, some continuing care programs can provide additional services (which
can require different types or organization of space), including
(a) low intensity, long duration, goal-oriented rehabilitation focusing on improvement of health and
function;
(b) complex technology supported care, such as chronic assisted ventilatory care or dialysis;
(c) specialized behavioural services focused on maximizing patients’ interpersonal and social functioning;
(d) adult daycare; and
(e) respite care.
8.8.1.4 Special care services
Special care services can include the following
(a) sub-acute care;
(b) Alzheimer’s and other dementia care; and
(c) adult day health care.
8.8.1.5 Auxiliary services
When the nursing unit is part of, or contractually linked with, another HCF, services such as dietary,
storage, pharmacy, linen, and laundry may be shared insofar as practical. In some cases, all ancillary
service requirements will be met by the principal HCF and the only modifications necessary will be within
the nursing unit. In other cases, programmatic concerns and requirements can dictate separate service
areas.
8.8.1.6 Planning operational models
8.8.1.6.1
The administration of care involves procedures, which are in line with accepted care policies and practices
for aged or otherwise incapacitated patients. The goal is to achieve an environment and program that is
suitable to each patient’s individual level of adaptability.
The importance of facilitating and maintaining a sense of “family” and place within the lives of patients
is not to be understated. Patients in this type of HCF will tend to be more mindful of their needs in respect
to internal and external support networks, social interactions and issues of choice.
There will be generally three shifts per day for care staff. The general public, management, hotel and
other ancillary services will most likely be restricted to day and evening use.
8.8.1.6.2
Depending upon the type of service and care plan to be provided, direct care staff work areas need not be
equipped with all of the provisions for a supervisory administrative staff work area. In some decentralized
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arrangements, care giving functions may be accommodated at a piece of residential furniture (such as a
table or a desk) or at a work counter recessed into an alcove off a corridor or activity space, with or
without computer and communications equipment, storage facilities, etc.
8.8.2 Functional requirements
8.8.2.1 General
8.8.2.1.1
The built environment shall be designed to maximize the dignity of patients while facilitating appropriate
levels and models of professional care culminating in the establishment of a therapeutic, supported and
homelike environment.
8.8.2.1.2
Inpatient continuing care services shall be designed to provide treatment and care over an extended
period of time to persons who display behaviours related to
(a) physical frailty;
(b) mental confusion; and
(c) sensorial disablement.
8.8.2.1.3
The HCF shall be designed to facilitate independence-oriented care, focusing on health and welfare
maintenance, rehabilitation, and the achievement of an optimized lifestyle. Sufficient and subtle support
should be provided to enable each individual patient to function at the highest level of independence.
8.8.2.1.4
Patient spaces should support a variety of activities and offer areas for individual respite.
8.8.2.1.5
The ambience of the HCF should be a close as possible to residential, consistent with the need to provide
care to as many patients as will live in this HCF for a number of years. Care and support shall be provided
in a clearly defined, identifiably domestic setting to minimize confusion. This minimizes the need for
patients to relearn a new spatial grammar within the HCF.
8.8.2.1.6
Staff work areas should be designed to minimize the institutional character, command-station appearance,
and noise associated with traditional medical nursing stations, and should foster close, open relationships
between patients and staff. Confidential or noisy staff conversations should be accommodated in an
enclosed staff lounge and/or conference area. At least part of each staff work area should be low enough
and open enough to permit easy conversations between staff and patients seated in wheelchairs.
8.8.2.1.7
Services appropriate to the individual’s past and present life patterns, involving consideration of social and
cultural factors, shall be provided.
8.8.2.2 Internal functional relationships
8.8.2.2.1
Patients shall have direct access from bedrooms to areas for socialization and activities such as the dining
room, lounge, and activity rooms.
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8.8.2.2.2
For clinical providers there should be convenient access to
(a) supply rooms from patient bedrooms;
(b) the team station from the medication room and team room; and
(c) the team station from bedrooms used for acutely ill and/or at-risk patients.
8.8.2.2.3
The staff room to store staff belongings shall be near the entrance to the unit.
8.8.2.2.4
The team station, or the reception area if a decentralized team station model is used, shall be located at
the entrance to the unit to act as a control point to the unit.
8.8.2.2.5
Optimal views should be provided from the team station to the non-bedroom patient areas on the unit,
such as the dining room, activity room, and therapy area.
8.8.2.2.6
To promote a multidisciplinary team approach, there should be a team room with a sufficient number of
workstations for the full team to complete charting and other administrative tasks. The creation of separate
team rooms/workstations for each discipline should be avoided.
8.8.2.2.7
Patient rooms shall be arranged in groups adjacent to decentralized service areas, optional satellite staff
work areas, and optional decentralized patient support areas.
8.8.2.3 Staff functional requirements
8.8.2.3.1
Optimal views shall be provided from the staff station to the patient areas.
8.8.2.3.2
A portion of the bedrooms should be positioned and designed to allow staff to monitor high acuity
patients, particularly at night or other times when staffing levels are lower. The number and position of
these bedrooms should be consistent with the expected patient population and needs as defined in the
functional program.
8.8.2.3.3
The staff station should be sized to accommodate most team members at the same time and have
efficiently designed workspaces that provide opportunities for private information sharing on a one-to-one
and group basis.
8.8.2.3.4
A shared staff lounge shall be located within close proximity to the inpatient unit to support easy access to
the unit during breaks
8.8.2.4 Patient functional requirements
8.8.2.4.1
The care environment shall be enabling and allow patients to safely achieve, from a multi-sensory
perspective, increasing levels of independence and wellness. There shall be high levels of accessibility
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within all patient areas, recognizing the interdependence between staff assisting patients and patients
achieving various levels of independence.
8.8.2.4.2
Spaces and design features shall support and facilitate patient mobility and independence while
contributing to an aesthetically pleasing environment. Where there are competing needs between
aesthetics and mobility/independence, mobility/independence shall have priority.
8.8.2.4.3
Corridors should be designed for therapeutic as well as circulation purposes, and should have wayfinding
landmarks and identifiable focal points.
In facilities with dementia patients, a secure interior circulation route shall be provided. This circulation
route shall be visible to staff to facilitate monitoring. The design shall support independence and safe
mobility.
8.8.2.4.4
The use of two-bed rooms may be considered for use by couples or by others for whom there would be a
social benefit. The need for increased socialization opportunities shall be balanced against patient
management priorities, such as patient privacy and infection prevention and control.
8.8.2.4.5
There shall be a mix of spaces outside the bedrooms, both on and off the inpatient unit, that offer
opportunities for socialization on a one-to-one and group basis.
8.8.2.4.6
All patients should have the opportunity to customize their bedroom space, which can require
accommodating of large pieces of equipment such as computers.
8.8.2.4.7
Washrooms shall have sufficient space to enable independent and/or assisted transfer from the front and
both sides of the toilet.
8.8.2.4.8
The patient shall have direct access to the washroom from the bed area (i.e., without having to travel
through the bed area of another patient).
8.8.2.4.9
Each patient should have direct access to a shower facility from his or her bedroom (i.e., without having to
travel through a public corridor).
8.8.2.4.10
To protect patient privacy, access to private consultation and examination rooms shall be provided on the
unit.
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8.8.2.4.11
Patients shall have options for dining, including congregate dining for varied sized groups and
individual/private dining.
8.8.2.4.12
Patients shall be able to access therapy areas independently if they are able. Therapy areas for this service
shall be within or adjacent to the inpatient unit.
8.8.2.4.13
All patient areas should include technology and other features to support the full range of medical services
for this patient group, to minimize transfers to other units.
8.8.2.4.14
Easy access from the inpatient unit to a therapeutic outdoor area should be provided.
8.8.2.5 Adult day health care program functional requirements
8.8.2.5.1
Each adult day program, when it is located in an HCF housing other services, shall have its own identifiable
space. When permitted by the functional program, support spaces may be shared.
8.8.2.5.2
Adult day programs shall have sufficient space, furnishings, and equipment to accommodate the range of
program activities and services for the number of participants as required by the functional program. This
space shall include designated area(s) to be utilized when the privacy of the participants requires it.
8.8.2.5.3
When possible, the adult day program shall be located at street level or shall be equipped with ramps or
elevators to allow easy access for persons with disabilities.
8.8.2.5.4
All communal activity areas shall have convenient access to a hand hygiene sink or waterless hand hygiene
station.
8.8.2.5.5
There shall be a rest area and/or a designated area to permit privacy and to isolate participants who
become ill or disruptive or who require rest.
These areas shall be
(a) permitted to be part of the medical/health treatment room or nurse station;
(b) located in a place that can be clearly monitored and that is near a toilet room; and
(c) considered part of the usable activity space.
8.8.2.6 Support services functional requirements
8.8.2.6.1
The design shall reflect the most efficient method to deliver support services (including medication
distribution) and minimize travel distances between frequently accessed support and patient areas.
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8.8.2.6.2
Provision shall be made for patients to congregate, private dining options, access to kitchen space for
patients and families to prepare and store food, and a food service system that supports a variety of dietary
requirements.
8.8.2.6.3
Spaces and systems shall allow for high levels of odour control and noise reduction.
8.8.2.6.4
Storage shall be provided for program equipment and operating supplies. Patient and public spaces shall
not be used for storage.
8.8.2.6.5
Provision should be made for the charging of electric wheelchairs/scooters in the patient’s bedroom.
8.8.2.6.6
A space shall be available for participants and family/caregivers to have private meetings with staff.
8.8.2.6.7
At least one dedicated staff toilet shall be provided.
8.8.2.6.8
The HCF shall have at least one toilet and one sink for every ten participants. This shall include a variety of
toilet room types (e.g., independent, fully accessible, one-person assist, or two-person assist) as required
by the functional program. All facilities shall include at least one toilet room that can accommodate a
two-person assisted transfer between wheelchair and toilet.
Participant toilet rooms shall be located not more than 12 m away from the activity area. Emergency
call stations shall be provided in toilet rooms to which patients have access.
8.8.2.6.9
A shower or bathtub area shall be provided in all adult day HCFs. If the functional program indicates the
need for bathing services, an assisted bathing facility shall be provided.
8.8.2.6.10
Emergency call stations shall be provided in bathing facilities used by participants
8.8.2.7 Shared services
Each nursing unit shall, as a minimum, contain the elements described within the applicable clauses of
Clause 8.8. However, when a project calls for sharing or purchasing services, there may be appropriate
modifications or deletions in space and parking requirements.
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8.8.3 Technical requirements
8.8.3.1 Environmental considerations
8.8.3.1.1
The design of inpatient continuing care services shall incorporate sufficient lighting and the use of visual
cues to facilitate patient orientation.
8.8.3.1.2
Acoustic control shall be given careful consideration in planning layouts and finishes.
8.8.3.2 Flexibility
Nursing facilities shall be designed to provide flexibility in order to meet the changing physical, medical,
and psychological needs of their patients.
Dining space(s) shall be adaptable for multi-purpose activities.
8.8.3.3 Supportive environment
The HCF design shall produce a supportive environment to enhance and extend quality of life for patients
and facilitate wayfinding while promoting privacy, dignity, and self-determination.
8.8.3.4 Accessibility
The architectural design, through the organization of functional space, the specification of ergonomically
appropriate and arranged furniture and equipment, and the selection of details and finishes, shall
eliminate as many barriers as possible to effective access and use by patients of all space, services,
equipment, and utilities appropriate for daily living.
8.8.3.5 Atmosphere of care
Design shall maximize opportunities for ambulation and self-care, socialization, and independence and
minimize the negative aspects of an institutional environment.
8.8.3.6 Materials and finishes
8.8.3.6.1 Windows
All inpatient rooms and suites shall have window(s), as follows:
(a) Operable windows or vents that open from the inside shall be restricted to inhibit passage by patients
or intruders.
(b) Windows shall have sills located above grade. The patient shall be able to see out, with the sight line
based on lower point of
(i) lying in bed; or
(ii) sitting in a chair.
(c) Exterior windows should provide views to the natural environment and light when possible, to
provide visual stimulation.
(d) Plantings and other visually interesting objects should be provided when exterior views of the natural
environment are not possible due to existing building adjacencies.
8.8.3.6.2 Screens
Windows and outer doors that can be left open shall have insect screens.
8.8.3.6.3 Glazing materials
Glazing in doors, sidelights, borrowed lights, and windows where glazing is less than 460 mm from the
floor shall be constructed of safety glass, wire glass, tempered glass, or plastic glazing material that resists
breaking and creates no dangerous cutting edges when broken.
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Similar materials shall be used in wall openings in activity areas (such as recreation rooms and exercise
rooms) if permitted by local requirements.
8.8.4 Space details
Table 8.8 presents the standard requirements for space in the inpatient continuing care service area. All
requirements also apply to palliative care, respite care, and adult daycare. Where more specific
requirements apply to these three services, those requirements are indicated.
See Clause 11 for common requirements in addition to those in Table 8.8.
Table 8.8
Key space requirements and recommendations —
Inpatient continuing care
1 1-bed room See Table 11.1, See Clause 11 for common requirements and recommendations for a
Item 24 for patient bedroom.
Bed area area Mandatory:
requirements (a) There shall be a mix of private accommodation provided, reflecting
(11.0 for differences in the patient population from one HCF to another.
common (b) A minimum of one window shall be operable.
requirements) (c) Where there are operable windows, secure limiting devices shall be
provided to withstand designated loading beyond the building code
for security.
(d) Individual temperature control shall be provided.
(e) A place to charge a wheelchair shall be provided in the room.
(f) In addition to the space requirements in Table 11.1, Item 24, the family
zone in an inpatient continuing care bedroom shall be designed, sized,
and positioned to facilitate visual/auditory access, for day and
overnight visiting.
(g) All units shall have the ability to be secured.
Advisory:
(a) A visitor chair should be able to be pulled out for sleeping.
(b) Daylight-simulated light fixtures should be considered.
(c) Indirect lighting should be considered for ease of orientation.
(d) Privacy and care requirements, such as visibility by staff from the
corridor vs. patient privacy, should be balanced.
(e) Wardrobes, if moveable rather than built-in, should be fixed to the wall
for safety.
(f) Finishes that resemble home environments should be considered.
(g) A HCF-wide security system should be considered for wandering
patients.
2 One bed AIR See Table 11.1, See Clause 11 for common requirements and recommendations for an AIR
suite Item 26 for suite.
sizes Mandatory:
The room will frequently be used by inpatients not requiring isolation and
every consideration shall be given to their needs.
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Table 8.8 (Continued)
3 Inpatient See 11.0 See Clause 11 for common requirements and recommendations for a
washroom common patient washroom.
requirements Mandatory:
(a) Patient-enabling hardware shall be provided.
(b) Allowance shall be made for dim night lighting as well as
daylight-simulated bright lighting.
(c) The washroom shall be well ventilated.
(d) Access shall be provided for family/caregiver.
(e) Readily accessible nurse-call, to be shut off only at source, shall be
provided.
Advisory:
(a) Consideration should be given to the location of grab-bars beyond
building code requirements to facilitate self-enablement (e.g., at the
sink) as well as to facilitate assistance.
(b) A swing door should be avoided, if possible.
(c) Hollow-core doors should be used to facilitate movement.
(d) Sensory lighting adjustable for brightness should be provided.
(e) Providing a heat lamp in the shower area should be considered.
4 Tub/shower 15.0 See Clause 11 for common requirements and recommendations for a
room tub/shower room.
Mandatory:
Stretcher 16.0 (a) See Part 3 Building Systems guidelines for ventilation requirements
shower room beyond the .
(b) Access to oxygen and medical vacuum shall be provided within the
room.
Advisory:
Open shelving for storage of homelike bathroom components should be
considered.
5 Laundry room See Clause 11.
6 Small multi- See Clause 11.
disciplinary
assessment/
treatment
room
7 Large multi- See Clause 11.
disciplinary
assessment/
treatment
room
8 Circulation Mandatory:
The requirements in Table 8.6, Item 13 shall apply.
9 Storage Varies See Clause 11 for common requirements and recommendations for a
storage room.
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Table 8.8 (Concluded)
10 Team station Varies; 4.6 for See Clause 11 for common requirements and recommendations for a
each work- primary communication station.
station and Mandatory:
additional (a) Based on the project-specific program, either a centralized or
circulation decentralized station shall be provided, with adequate secure storage
space for all data related to care delivery.
(b) Privacy and sitting space shall be provided for patients, family, and staff
to communicate.
(c) Adequate team conference space shall be provided.
(d) A portion of the team station shall be wheelchair-accessible as well as
acoustically and visually easy to use.
Advisory:
(a) The extent (program-dependent) to which the team station can be
used for a variety of functions should be considered.
(b) The needs for staff privacy and patient and visitor accessibility should
be balanced.
11 Outdoor space See Clause 11.
9 Diagnostic and treatment functional services requirements
9.1 Ambulatory care — General
9.1.1 Description
9.1.1.1 General
Ambulatory care clinics provide scheduled examination, treatment, and diagnostic services for acute and
chronically ill patients. Ambulatory care services can also include primary care services and health and
wellness promotion. These services can be provided by hospitals, community health centres, private
physician clinics, community-based agencies, and other health care providers.
Ambulatory care clinics provide health promotion, illness prevention, and general and specialized
outpatient services using dedicated facilities, equipment, and interdisciplinary staff. Typical goals of the
clinics include
(a) improving access to services;
(b) providing diagnosis, treatment, intervention, and care management;
(c) promoting health and prevention of illness;
(d) preventing or reducing the need for admission to hospital; and
(e) reducing the length of inpatient stay.
Services are generally elective and scheduled (versus urgent and unscheduled), occur within a length of
stay measured in hours, and can involve an interdisciplinary care team. Some ambulatory care HCFs can
require equipment or diagnostics that are only available in a hospital.
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When the ambulatory care clinic is located at a hospital, functions such as laboratory and radiology
services can be shared with the hospital to avoid duplication of spaces and equipment or to improve
efficiency. Although the majority of ambulatory care patients are outpatients, in an HCF with beds
inpatients can also be treated in the ambulatory setting to eliminate duplication of services, facilities,
and staff.
9.1.1.2 General services
Services generally provided in ambulatory care facilities include
(a) support, education and counselling services (interdisciplinary and specialty-based);
(b) clinical services (interdisciplinary and specialty-based);
(c) medical day care such as IV therapy and blood transfusions; and
(d) education for patients and their families, focused on illness prevention and disease management.
9.1.1.3 Additional services
The following additional services can also be provided, depending on the local conditions:
(a) screening and assessment;
(b) immunization (e.g., public health, physician offices);
(c) pharmaceutical management;
(d) telehealth services;
(e) integrated diagnostic testing (cardiology, preadmission clinic);
(f) support for physician coverage, academic and research missions;
(g) minor procedures under local anaesthetic;
(h) specialized medical day care (chemotherapy, plasmapheresis);
(i) specialized persistent illness management;
(j) specialized counselling and diagnostic services, such as chiropody or audiology;
(k) preadmission, including diagnostic testing and specimen collection;
(l) services offered by other providers, such as home care organizations, wound clinic and IV therapy,
Arthritis Society programs, etc.; and
(m) teaching and research.
Clause 9.1 covers facilities for general ambulatory care (e.g., community-based providers, physician
offices, clinics, medical services/procedures, and support areas). Clauses 9.2 and 9.3 address specialized
ambulatory care services for oncology and renal dialysis.
9.1.2 Functional requirements
9.1.2.1 General
The following factors should be considered when deciding on the location of ambulatory services:
(a) the anticipated volume of activity;
(b) clear and direct access to reception and registration;
(c) compatibility with other services (e.g., within a rental/commercial office space);
(d) the ability to maintain infection control in non-outbreak and outbreak situations to ensure continued
operations;
(e) universal access;
(f) adaptability, such as the use for surge/overflow during outbreaks to support increased emergency
care activity;
(g) separation of patient circulation from support services circulation;
(h) the need for screening of patients entering the service, particularly during an outbreak;
(i) access from other clinical areas (especially for multidisciplinary team members who work in different
areas of the organization); and
(j) potential for use as overflow/alternative patient care areas in an emergency (e.g., a pandemic
situation).
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9.1.2.2 Workflow
9.1.2.2.1
The reception/registration area shall be designed for efficiency to allow patients to find it on entry to the
area/suite and to move easily to and from the treatment areas and to accommodate large numbers of
patients, support persons, and mobility aids. See common requirements in Clause 11.
9.1.2.2.2
Waiting areas shall be as specified in Clause 11.
9.1.2.2.3
The service shall be designed to inform patients of the need to self-screen and to facilitate infection control
screening processes during non-outbreak and outbreak situations.
9.1.2.2.4
Adequate space shall be provided for waiting, registration, and supplies, so that infection prevention and
control principles can be adhered to.
9.1.2.3 Patient care areas
9.1.2.3.1
For patient care areas within clinics, the work area shall include counselling, examination, and procedure
and/or treatment rooms (CEPTRs), depending on the functions and scope of services and activity.
9.1.2.3.2
For patients, there should be easy access from
(a) the building entrance;
(b) the reception/registration area to the waiting area;
(c) the waiting area to the CEPTRs, including the sub-waiting areas where appropriate; and
(d) the CEPTRs to the rebooking area.
9.1.2.3.3
For providers, there should be ease of access from the teamwork area to the CEPTRs.
9.1.2.3.4
Reception and waiting areas should be designed so that clerical staff can obtain information from patients
confidentially.
9.1.2.3.5
Adequate storage area shall be provided adjacent to the waiting room. See Clause 11.
9.1.2.3.6
Changing, if required, shall occur in a change room near or in the minor procedures rooms. Private
conversations shall occur in enclosed rooms to respect patient privacy and confidentiality.
9.1.2.3.7
Space should allow for family members/support persons to accompany the patient throughout the visit.
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9.1.2.4 Staff work areas
9.1.2.4.1
The staff work area shall be designed for operational efficiency (i.e., allowing staff to easily move to and
from the treatment area, and to and from the reception/admissions area). It shall provide a degree of
privacy for staff and a quiet area where they can work away from the demands of patients and relatives.
9.1.2.4.2
The key components of design shall be flexible to accommodate different uses/service delivery at different
times of day.
9.1.2.4.3
The design shall permit direct observation from staff workstations to the patient to enable timely clinical
intervention.
9.1.2.4.4
Supplies, medication, blood products, warming cabinets, nourishment areas, etc. shall be conveniently
located in order to minimize the time away from the patient and maximize direct care.
9.1.2.4.5
ENT clinics shall be designed so that medical devices can be conveniently transferred to the medical device
reprocessing area for high level disinfection or sterilization.
9.1.2.4.6
A staff lounge should be provided in either a team room or a central shared area. Such an area should be
conveniently close to the clinic area so staff can reasonably use the room during break.
9.1.2.4.7
Staff change facilities shall be located and designed to facilitate compliance with the HCF’s policies for
uniform changing and laundering.
9.1.2.5 Treatment support areas
9.1.2.5.1
Support areas should be located to support the model of care and should be planned to be flexible with
the use of the space.
9.1.2.5.2
Diagnostics, such as imaging for orthopaedic clinics, shall be easily accessible by patients.
9.1.2.6 Endoscopy suites and work areas
Endoscopy services shall be designed so that the endoscopy suite is adjacent to a medical device
reprocessing (MDR) area. Reprocessing areas shall be designed in accordance with CAN/CSA-Z314.8. The
service shall be designed so that management of soiled scopes and storage for clean scopes and other
equipment can be in accordance with CAN/CSA-Z314.8 and relevant infection prevention and control
guidelines.
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9.1.3 Technical requirements
9.1.3.1 General
9.1.3.1.1
Ambulatory clinics shall be designed to accommodate the needs of the anticipated number of users, the
patient profile, the frequency of visits, and the typical duration for each visit.
9.1.3.1.2
Consistent with the functional program, ambulatory clinics should be designed to provide a pleasant,
therapeutic environment.
9.1.3.2 Support facilities
9.1.3.2.1
A central staff station shall include a work counter, communication system, space for supplies, and
provisions for charting.
9.1.3.2.2
There shall be a drug distribution station if medications are dispensed in the outpatient facility. This may
be a part of the central staff station and shall include a work counter, sink, refrigerator, and locked storage
for biologicals and drugs.
9.1.3.2.3
Reprocessing of medical devices, if performed, shall be done in the facility’s medical device reprocessing
area, or if done onsite, in an area that meets the following requirements for area design and environmental
controls:
(a) the area and environmental control requirements in CAN/CSA-Z314.8, if only decontamination and
disinfection is done; and
(b) the area and environmental requirements in CAN/CSA-Z314.3, if sterilization is also done.
9.1.3.2.4
A separate room or closet for storing clean and sterile supplies shall be provided. This storage shall be in
addition to that of cabinets and shelves. Appropriate, convenient, and easily accessible locations shall be
provided for cleaned equipment (e.g., crash carts, stretchers, wheelchairs, and other necessary mobile
equipment) and supplies in dedicated clean storage spaces with appropriate service support and
protection.
9.1.3.2.5
Provisions shall be made for separate collection, storage, and disposal of soiled materials.
9.1.3.2.6
General storage facilities shall be provided for
(a) supplies;
(b) equipment; and
(c) mobility aids.
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Special storage for staff personal effects with locking drawers or cabinets (may be individual desks or
cabinets) shall be provided. Such storage shall be convenient to individual workstations and shall be staff
controlled.
Storage areas shall be located out of the direct line of traffic.
9.1.3.2.7
Space providing adequate work area for business related to social service, credit, transactions, records
storage, and administrative and professional staffs shall be provided.
9.1.3.2.8
At least one housekeeping closet shall be provided. In larger HCFs, the housekeeping closet shall comply
with Clause 11.
9.1.3.2.9
Supplies and linen shall be delivered to a central location in the services for distribution by clinic staff to
the appropriate examination, treatment, and procedure rooms.
9.1.3.2.10
For an ambulatory care facility in a hospital, the medication system shall be organized under the direction
of the hospital pharmacy and shall include
(a) regular delivery of medication to the clinic;
(b) security for narcotics; and
(c) decentralized/satellite pharmacy, where appropriate and supported by activity volumes.
9.1.3.2.11
Areas for storing and preparing medications shall have
(a) sufficient storage space and work space for appropriate storage, handling, preparation, and disposal
of medications; and
(b) sufficient electrical outlets, and Ethernet or wireless access to permit use of automated drug
dispensing cabinets, computerized physician order entry (CPOE), carts on wheels (COWs), bar coding
to point-of-care (BPOC), wireless med carts, etc.
9.1.3.2.12
Areas and storage facilities (including refrigerators) for blood components and blood products shall be
consistent with CAN/CSA-Z902 and the supplier’s label or circular information.
9.1.3.3 Support areas for patients
9.1.3.3.1
Toilet(s) for patient use shall be provided separate from public use toilet(s) and located to permit access
from patient care areas without passing through publicly accessible areas.
9.1.3.3.2
Toilet(s) for public use shall be conveniently accessible from the waiting area without passing through
patient care or staff work areas or suites.
9.1.3.3.3
The outpatient service shall be designed to permit timely access to health records at all times during its
operations. The design shall
(a) facilitate efficient transportation;
(b) support the use of electronic health records where appropriate; and
(c) provide the necessary support for picture archiving and communication systems.
Provision shall be made for securing health records.
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9.1.3.3.4
Interview space shall be provided for private interviews and private conversations (social services, credit,
etc.).
9.1.3.3.5
Nourishment will be delivered by the food services as required.
9.1.3.3.6
The provision of fixed wall-mounted and ceiling-mounted equipment such as televisions and other
building services should be coordinated with the placement of key medical equipment.
9.1.3.3.7
Ceiling design should be taken into account, particularly in areas such as procedure rooms and recovery
areas where patients are on their backs for long periods of time.
9.1.3.3.8
Examination rooms shall be designed in accordance with Clause 11.
9.1.3.3.9
Functional and storage space shall be provided for chemicals used in the unit. Eyewash facilities shall be
provided when chemicals are being used.
9.1.3.4 Furniture, fittings, and equipment
Furniture, fittings, and equipment in the ambulatory care clinic setting shall be selected to ensure their
adaptability to a series of clinic/treatment uses. This selection shall balance the needs for quick
turnaround/throughput of outpatients with more medically complex treatments.
24 h
9.1.3.5 Lighting
Lighting in examination/treatment rooms shall be in accordance with Clause 11.
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9.1.4 Space details
Table 9.1 presents the standard requirements for key spaces in the general ambulatory care area. Common
areas are detailed in Clause 11.
Table 9.1
Key space requirements and recommendations —
Ambulatory care — General
1 Examination 12.0 See Table 11.1, Item 24 for common requirements and recommendations
room, standard for an examination/procedure/treatment room.
Mandatory:
With scooter 13.0 If there is a need for scooter access, clearance shall also be provided for a
access scooter turning circle. Depending on the clinic model conceived for the
HCF, consideration should be given to two points of entry: from a patient
corridor/waiting zone and from a staff/clinical work zone.
2 Minor 16.5 for See Clause 11 for common requirements and recommendations for an
procedure room 3-sided access examination/procedure/treatment room.
Mandatory:
23.0 for As in Item 1, but access and clearance shall also be provided to two sides
4-sided access and the foot of the patient.
3 Examination 12.0 See Clause 11 for common requirements and recommendations for an
room, examination/procedure/treatment room.
ophthalmology Mandatory:
(a) Clearances and access to specialty equipment shall be in accordance
with the manufacturer’s recommendations.
(b) Minimum clearances of 800 mm at the sides and 600 mm behind
the patient chair, when in fully reclined position, shall be provided.
(c) Control of room lighting shall be provided at the physician work
area.
(d) If the room is to be used for multiple testing, space shall be provided
for related testing equipment.
Advisory:
The physician work area should include storage for lenses and supplies.
4 Examination 15.5 See Clause 11 for common requirements and recommendations for an
room, examination/procedure/treatment room.
ENT Mandatory:
(a) Minimum clearance around the treatment chair shall be 800 mm.
(b) Space to transfer a patient from a stretcher shall be provided.
(c) An efficient and safe method of scope reprocessing shall be provided,
separated from, but in close proximity to the ENT examination
room.
(d) If cleaned scopes are to be stored in the room, they shall be stored in
closed, ventilated cupboards.
5 Ophthalmology, 12.0 Mandatory:
laser room (a) Clearances and access to specialty equipment shall be in accordance
with the manufacturer’s recommendations.
(b) Control of room lighting shall be provided at the physician work
area.
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Table 9.1 (Continued)
Advisory:
(a) A stretcher may be provided as an alternative to the chair treatment
space.
(b) Guest chairs are not required, but sub-waiting for a patient’s
companion should be provided nearby.
6 Cast room 16.5 for Mandatory:
3-sided access (a) Access to the table shall be provided on three sides, with the
potential to reposition the table for four-sided access.
(b) The layout shall provide proximity for clinical staff and casting
materials and tools.
(c) The minimum clearance around the patient stretcher shall be
800 mm.
(d) Services for safe disposal of casting products (fibreglass and plaster)
shall be provided.
Advisory:
Viewing should be located so the patient and physician can review the
image together.
7 Treatment area 12.0 Mandatory:
(chemo, IV (a) The staff workstation, hand hygiene sink, and supplies shall be
therapy, etc.), convenient, provided at a ratio of one per maximum four patient
open treatment spaces, and be uniformly distributed for equivalent access.
(b) Additional supports (warming cabinet, nourishment station,
medication cabinet, procedure carts, clinical scale, linen hamper,
mobile lights, patient washrooms, and clean supply and soiled utility
rooms) shall be convenient to the overall treatment area.
Advisory:
(a) Patient amenities (TV, music, natural light, and view) should be
provided.
(b) If radioisotope therapy is to be conducted in the treatment space,
appropriate shielding should be provided.
(c) If a C-arm is included, the floor area shall be increased by 4.0 m2 to
accommodate the additional requirements.
8 Treatment area 9.5 for an Mandatory:
(chemo, IV open cubicle (a) A minimum 800 mm clearance shall be provided on both sides of the
therapy, etc.), patient to allow IV starts on either side, and 600 mm behind the
enclosed Assume patient chair, when in fully reclined position, shall be provided.
11.0 m2 (b) Glazing in the wall and door shall be provided to ensure visibility
for partial from the staff work area.
walls (on
3 sides) and Advisory:
13.0 m2 (a) Patient amenities (TV, music, natural light, and view) should be
for a fully provided.
enclosed (b) If radioisotope therapy is to be conducted in the treatment space,
room appropriate shielding should be provided.
9 Interview/ 11.0 Advisory:
counselling (a) Provision should be made for telehealth (e.g., through room colour,
room lighting, acoustics, the selection and placement of furniture, and
adequate space for telehealth equipment).
(b) Increasing size of room to 12.0 m2 to match exam room size (for
flexibility in use) should be considered.
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Table 9.1 (Continued)
10 Ophthalmology, 12.0 Mandatory:
visual fields Clearances and access to specialty equipment shall be in accordance with
room the manufacturer’s recommendations.
11 CEPTRs work 4.6 for each See Clause 11.
area workstation Mandatory:
and additional (a) The configuration of the CEPTRs work area shall
Counselling, circulation (i) accommodate varying sizes of clinics (two to 12 rooms) and
examination, space teams;
procedure, (ii) facilitate patient and staff flow; and
treatment (iii) minimize walking distances between
rooms (1) the team room and support areas and CEPTRs work area;
(2) among CEPTRs; and
(3) the CEPTRs work area and clean and soiled utility room.
(b) Changing and sub-waiting shall be located near or in the
exam/procedure rooms and the team area for observation, where
appropriate.
(c) The patient care areas in medical day care units shall include
recliners, stretchers/beds, room(s) with beds, and procedure
room(s), depending on the functions/scope of services and activity.
Advisory:
(a) Rooms sizes should be standardized and then grouped to like
functions are located in close proximity.
(b) Patients and families should have easy access to washrooms, waiting,
and ambulance transfer areas and amenities such as nourishment
areas, computer ports, short-term storage, and entertainment.
12 Special purpose 12.0 See Clause 11 for common requirements and recommendations for an
examination examination/procedure/treatment room.
rooms Mandatory:
(a) Room arrangement shall permit a minimum clearance of 810 mm at
each side and at the foot of the examination table, bed, or chair.
(b) Doors shall be a minimum width of 1050 mm.
Advisory:
Door swings should be oriented to provide patient privacy.
13 Treatment 9.5 for an See Clause 11 for common requirements and recommendations for an
room(s) open cubicle examination/procedure/treatment room.
Mandatory:
Assume There will be space provided for up to four or five people — providers,
11.0 m2 for patient, family — in the exam room at a time.
partial walls Individual and group education shall be provided in counselling rooms
(on 3 sides) and classrooms.
and 13.0 m2
for a fully Advisory:
enclosed Door swings should be oriented to provide patient privacy.
room
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9.2 Ambulatory care — Dialysis
9.2.1 Description
Renal dialysis programs are used by persons requiring haemodialysis and peritoneal dialysis services. The
programs can be located in an outpatient clinic building, a satellite centre, or within an HCF. The following
requirements apply equally to all facilities (unless otherwise noted). These programs provide evaluation,
treatment, follow-up, and support for individuals with kidney disease. Renal dialysis programs are also
known as chronic kidney disease programs, sometimes referred to just as “dialysis programs”.
The role of the renal dialysis program is to provide an easily accessible, safe, and serviced environment
in which people can undertake haemodialysis on a regular basis, and training and education for patients
treated using peritoneal dialysis (and their families).
9.2.2 Functional requirements
9.2.2.1
The service should be located for convenient and frequent access by patients. If the service is on a hospital
site, it should have easy access to other relevant HCF services such as inpatient programs and clinical
support services.
9.2.2.2
Dialysis services may be provided to inpatients
(a) in critical care programs; and
(b) designated areas in the HCF with appropriate utilities.
9.2.2.3
Dialysis service shall be designed to provide clear sight lines for staff.
9.2.2.4
The configuration of the renal dialysis program shall provide capacity to flexibly use training rooms (when
required to fulfill the program’s role) for both peritoneal dialysis and home haemodialysis training, and for
haemodialysis treatment over time.
9.2.2.5
The needs of bariatric patients shall be accommodated in treatment spaces, the weigh scale area, and
exam and procedure spaces.
9.2.2.6
An alcove shall be provided within each pod of treatment stations for storing and recharging patient
mobility devices in order to provide accessibility and preserve circulation.
9.2.2.7
The reverse osmosis (RO) water loop shall be installed in accordance with the following requirements:
(a) The layout shall minimize the length of the RO water loop.
(b) The RO water loop shall be installed by the RO water treatment system vendor or under their direct
supervision.
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(c) The RO water loop shall be accessible to allow modification or to replace the loop in the event of
contamination or failure.
(d) A method shall be provided to contain floods within the RO water treatment room.
(e) Structural support requirements for bulk supply shall be provided as needed.
9.2.3 Technical requirements
9.2.3.1 Water treatment and management plan
9.2.3.1.1
A key component of the renal dialysis program is the need to treat the water that will be used in the
haemodialysis process to remove any contaminants. Different commercial water treatment systems
undertake the water treatment activities in slightly different ways.
9.2.3.1.2
The plant room for water treatment should be located adjacent to or within the renal dialysis program.
9.2.3.1.3
Program design should ensure that tubing runs are short and make it easy for staff to monitor and service
the water treatment systems.
9.2.3.1.4
All dialysis system piping shall be readily accessible for inspection and maintenance.
9.2.3.1.5
Water treatment system and dialysis machine connections to the emergency power system shall be in
accordance with CSA Z32.
9.2.3.2 Drainage system
9.2.3.2.1
Millwork or enclosures used for the drainage of fluids from haemodialysis machines shall be ventilated to
prevent condensation and the subsequent growth of mould.
Covers or screens for the drainage systems shall be compatible with ventilation requirements.
9.2.3.2.2
Systems for the disposal of liquid waste from the dialyzing process shall be designed to prevent odour and
backflow and shall be in compliance with CSA Z317.1. All sinks and drains, including in the soiled utility
room, shall have corrosion-resistant drains.
9.2.3.2.3
Positive floor drainage with corrosion-resistant drains shall be provided.
9.2.3.3 Water treatment plant room
9.2.3.3.1
A reverse osmosis (RO) water treatment alarm panel shall be provided.
9.2.3.3.2
Noise attenuation is important to prevent any sound disturbance to treatment and other areas.
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9.2.3.3.3
This room shall be located with easy access to the external perimeter of the program while being adjacent
to the treatment area and shall have the following specific attributes:
(a) space for water treatment components, which can include booster pumps (usually two that
alternate), particle filters (approximately two), water softener, carbon filter, and reverse osmosis
system, as well as products to keep equipment operational;
(b) workable space around all sides of the equipment (at least 0.5 m) to enable routine calibration,
servicing, and maintenance;
(c) sufficient space to have soft curving of tubing to prevent right angle bends; and
(d) adequate ventilation, air-conditioning, and/or exhaust to remove the heat load generated by the
equipment.
9.2.3.4 Waste management plan
9.2.3.4.1
Waste management practices shall include
(a) conformance with CSA Z317.10;
(b) provision of suitable receptacles for all waste categories, that are convenient to use, service, and
move;
(c) provision of adequate storage areas (see Clause 11); and
(d) a disposal room on the external perimeter of the service to enable collection of used laundry and
waste without intruding into the service.
9.2.3.4.2
A means shall be provided to dispose of waste chemicals in the soiled utility room.
9.2.3.5 Infection prevention and control
9.2.3.5.1
In areas where haemodialysis or haemoperfusion are routinely performed, hand hygiene sinks shall have a
separate water supply and drainage facility that does not interfere with haemodialysis piping.
9.2.3.5.2
Preservation of access to the space shall be maintained in the event of an infectious disease outbreak.
9.2.3.5.3
Capacity shall be provided to separate infectious patients in delivering treatment and support services.
9.2.3.5.4
The single-use supply model shall be adopted.
9.2.3.5.5
Hand hygiene sinks shall be directly accessible and distributed uniformly as follows:
(a) within treatment areas at a minimum ratio of 1:3 stations;
(b) within all enclosed treatment, exam, and procedure rooms;
(c) convenient to/from medication cart space; and
(d) within clean supply rooms.
9.2.3.5.6
Hand hygiene stations shall be at the entrance of each treatment room. There shall be one hand hygiene
station for each chair or bed.
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At least one hand hygiene station shall be located in each treatment pod.
9.2.3.5.7
Each ambulatory care service for dialysis shall have a minimum of one inpatient bedroom with a
self-closing door.
9.2.3.5.8
A personal protective equipment (PPE) alcove shall be located immediately outside the precaution room to
hold gloves, goggles, face shields, masks, gowns, and a waterless hand hygiene station.
9.2.3.5.9
The PPE alcove may be shared between two single rooms used for patients on precautions.
9.2.3.5.10
The alcove shall accommodate a supply cart. A hand hygiene sink is not required in the alcove.
9.2.3.5.11
A means for providing patient privacy that can be cleaned between patient (e.g., between-glass blinds)
shall be used in precaution rooms and AIRs in lieu of cubicle curtains.
9.2.3.5.12
A separate single room to provide for separation of a patient on airborne isolation precautions should be
provided at the rate of one room to every five treatment bays (in HCF-based and satellite programs),
giving a cluster of six treatment spaces. The number and configuration of these rooms shall be consistent
with the functional program. The separate single room may be an AIR, but this is not required unless the
functional program warrants it.
If an AIR is provided, it shall be as specified in Clause 7.5.5.1.
9.2.3.5.13
Precaution rooms should be located close to open treatment bays.
9.2.3.6 Occupational health and safety
9.2.3.6.1
Functional and storage space shall be provided for chemicals used in the unit.
9.2.3.6.2
Functional and storage space shall be provided for sharps disposal containers and biohazard containers.
9.2.3.6.3
Eyewash facilities and showers shall be provided.
9.2.3.7 Safety and security
9.2.3.7.1
Patient files shall be kept in a secure environment that prevents access by unauthorized persons.
9.2.3.7.2
A drug safe shall be placed in the medication room (if present) or the clean utility room.
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9.2.3.7.3
The program shall be fully accessible for persons in wheelchairs or on a patient trolley or bed.
9.2.3.7.4
If pallet lifters will be used to deliver supplies to the storeroom, the facility design shall allow sufficient
space for manoeuvring them in and out. Floor materials and structure shall be appropriate to the loads
that will be applied by a fully loaded pallet lifter.
9.2.3.7.5
Provision shall be made for safety and security for evening and weekend services to prevent theft and to
provide a safe environment of care for staff, patients, and family.
9.2.4 Space details
Table 9.2 presents the standard requirements for key spaces in the dialysis ambulatory care area. Common
areas are detailed in Clause 11.
Table 9.2
Key space requirements and recommendations —
Ambulatory care — Dialysis
1 Treatment See Clause 11 for common requirements and recommendations for an
Station examination/procedure/treatment room.
Mandatory:
Open (chair) 7.5 (a) An alcove for wheelchair/scooter access shall be provided nearby.
(b) Acid-resistant drains shall be provided.
Open 9.5 (c) Rooms used for separation/precaution shall be enclosed and allow for
(bed-stretcher) observation (e.g., glass door). Directional air flow shall be considered.
(d) Clearance between stations shall be at least 1500 mm.
Partial walls 11.0 (e) The distance from centre to centre of beds, chairs, or bed-stretchers shall be
at least 2400 mm.
Enclosed 8.4
(chair)
Enclosed 13.0
(bed-stretcher)
2 Isolation Room See Clause 11 for common requirements and recommendations for an isolation
treatment area: 13.0 room.
room Mandatory:
Anteroom: (a) An alcove for wheelchair/scooter access shall be provided nearby.
5.0 (b) Acid-resistant drains shall be provided.
(c) An alcove shall be provided outside the room for PPE.
(d) The means used for providing patient privacy shall allow for terminal
cleaning between patients when needed (e.g., between-glass blinds).
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Table 9.2 (Continued)
Advisory:
(a) An anteroom should be provided outside treatment room area to improve
separation.
(b) A washroom should be provided for the isolated patients (assume 5.6m2).
3 Procedure 16.5 for See Clause 11 for common requirements and recommendations for an
room 3-sided examination/procedure/treatment room.
access Mandatory:
(a) Provision shall be made for portable X-ray and ultrasound equipment.
23.0 for (b) Haemodialysis services shall be provided.
4-sided
access
4 Training room 14.0 See Clause 11 for common requirements and recommendations for an
classroom/meeting room.
Mandatory:
Acid-resistant drains shall be provided.
Advisory:
(a) The room should be laid out to accommodate training in either peritoneal
dialysis or home dialysis.
(b) The room should be outfitted with services to accommodate haemodialysis.
(c) A dialysis box should be provided for teaching.
5 Technical 6–12 Mandatory:
workshop: stations (a) An RO water treatment alarm panel shall be provided.
Repair 30.0 (b) Space shall be provided for chemical storage (sodium metabisulphite).
workstation (c) Only non-cellulose building materials shall be used.
(maintenance 12–24 (d) Positive floor drainage shall be provided.
laboratory) stations (e) An extra-wide door shall be provided for equipment access. The door shall
45.0 be able to provide a minimum clear opening of 1525 mm. This may be
accomplished through the use of a side leaf. The maximum dimensions of
24–36 the dialysis equipment to be used shall be considered when designing
stations doors.
70.0 (f) Slip-resistant flooring shall be provided.
(g) Provision shall be made for wet and dry work zones.
(h) An eyewash and deluge shower shall be provided.
(i) A floor drain shall be provided.
(j) Additional workshop space shall be provided for servicing portable RO
equipment if supporting a home dialysis program.
(k) Additional technical space shall be provided if a home dialysis program is
being supported.
(l) Additional technical space shall be provided if haemodialysis is provided in
acute care areas (e.g., critical care, acute care inpatient programs,
emergency department).
(m) Additional part storage space shall be provided if more than one make/type
of dialysis machine is used.
Advisory:
Providing space for an incubator for testing bacteria levels should be considered.
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Table 9.2 (Continued)
6 Equipment 6–12 See Clause 11 for common requirements and recommendations for a storage
storage room stations room.
30.0 Mandatory:
12–24 Multiple electrical outlets shall be provided for charging equipment.
stations Advisory:
45.0 (a) Additional space should be provided if storing for home dialysis.
(b) Additional space should be provided if supporting a satellite dialysis
24–36
centre.
stations
70.0
7 Water 6–12 Mandatory:
treatment stations (a) Alarm equipment shall be provided to the technical room, staff station,
room 20.0 and building automation system.
(b) Back-up for the RO system shall be provided.
12–24 (c) Space shall be provided for salt storage.
stations (d) Space shall be provided for chemical storage (sodium metabisulphite).
25.0 (e) Only non-cellulose building materials shall be used.
(f) Positive floor drainage shall be provided.
24–36 (g) Necessary clearances (e.g., 3000 mm high ceilings) shall be provided for
stations replacing/adding carbon tanks and other equipment.
30.0 (h) An extra-wide door shall be provided for equipment access. the door shall
be able to provide a minimum opening of 1525 mm. This may be
accomplished through the use of a side leaf.
(i) Slip-resistant flooring shall be provided.
(j) Room security shall be provided.
(k) The room shall be located close to treatment areas and the technical
workshop.
(l) Effective insulation shall be provided to minimize sound transmission.
8 Weigh scale Mandatory:
(a) The scale shall be located near reception and the staff station.
Wheelchair 2.4 (b) In-floor mounted scales shall be mounted to be flush with the surrounding
floor to minimize trip hazards.
Stretcher 3.7 (c) There shall be a hand hygiene sink.
Advisory:
Provision should be made for a remote printout or data transmission.
9 Waiting Varies; See Clause 11 for common requirements and recommendations for a waiting
assume: room.
General 1.5 per Mandatory:
seat (a) Space shall be provided for family members.
Wheelchair/ 3.0 (b) The waiting area shall be directly viewable by dialysis staff (e.g., clerk,
scooter/ receptionist, etc.) or by remotely monitored by closed circuit TV or
bariatric equivalent, so that staff can be aware of patients in medical distress.
(c) Capacity to summon assistance from the treatment area shall be provided.
Stretcher 5.0 Advisory:
Provision should be made for other seating needs, depending on expected
patient community.
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Table 9.2 (Concluded)
10 Mobility aid 0.5 per Mandatory:
storage alcove chair Electrical outlets for battery charging shall be provided.
Advisory:
(a) The alcove should be located for convenient access from each
pod/grouping of treatment stations.
(b) Capacity for two wheelchairs and two rollators should be provided per six
treatment stations.
11 Soiled utility Varies See Clause 11 for common requirements and recommendations for a soiled
room according holding room.
to delivery Mandatory:
model (a) A clinical service sink/hopper for disposal of chemical waste shall be
provided.
(b) Provision shall be made for very high volumes of biomedical and regular
waste.
(c) If supplies are not broken down on delivery, provision shall be made for very
high volumes of cardboard.
12 Clean supply Varies See Clause 11 for common requirements and recommendations for a clean
room according supply room.
to delivery Mandatory:
model (a) A counter for dialysis supply preparation (150 mm × 700 mm) shall be
provided.
(b) A hand hygiene sink shall be provided.
(c) Access shall be controlled.
(d) The dialysis concentrate storage space shall be large enough to
accommodate a backup supply to cover possible delays in delivery.
Advisory:
Space for 0.03 m3 of supplies should be provided per patient treatment.
13 Chart storage Varies Mandatory:
according Space shall be allowed for one 50 mm binder per patient, with remaining
to documentation in health records (six binders per treatment station).
program Advisory:
size (a) Mobile filing/track storage should be considered.
(b) The location and organization of this space should provide for reallocation
to another function when electronic documentation system is in place.
14 Medication Varies See Clause 11 for common requirements and recommendations for a
room according medication room.
to delivery Mandatory:
model A scientific refrigerator/freezer shall be provided.
Not less
than 9.5
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9.3 Ambulatory care — Oncology
9.3.1 Description
9.3.1.1
In most jurisdictions in Canada, cancer care is publicly governed and funded by organizations generally
separate from hospital governing authorities, such as Cancer Care Ontario, BC Cancer Agency,
Saskatchewan Cancer Agency, etc. Typically these agencies are responsible for population-based cancer
control, which comprises the provision of clinical services (interventions) across a spectrum of prevention,
early detection, treatment and support, rehabilitative and palliative/end-of-life care, cancer research, and
education directed toward both the public and health professionals. In most instances, provincial cancer
control activities are linked and integrated through regional cancer centres, community cancer
centres/programs and clinics, and provincial networks.
9.3.1.2
Essential elements of a comprehensive cancer program include radiation and systemic therapy, pharmacy,
outpatient clinics, specimen collection, supportive care, amenity services, and access to diagnostic and
inpatient oncology services. An interdisciplinary care delivery approach is fundamental to achieving
patient and family-centred care and efficient operations. Adjacencies among the essential elements of the
cancer program are required to support both the interdisciplinary care delivery approach and effective
systems and processes. These requirements apply to all services, regardless of whether they are delivered
in an inpatient setting or an outpatient setting (and regardless of where the services are delivered).
9.3.1.3
Core elements of a cancer program requiring a direct connection include
(a) radiation therapy (including assessment, treatment planning, treatment and review);
(b) systemic therapy (including pharmacy support);
(c) outpatient oncology clinics;
(d) pharmacy; and
(e) rehabilitation services.
9.3.1.4
Radiation therapy is the use of ionizing radiation to treat patients with cancer and other diseases within a
radiation oncology program. The process includes
(a) assessment;
(b) treatment planning;
(c) treatment delivery; and
(d) additional services, such as
(i) magnetic resonance (MR) simulation; and
(ii) non-isocentric radiation treatment (e.g., gamma or tomotherapy).
9.3.1.5
Systemic therapy or chemotherapy is often given in cycles that include treatment periods alternating with
rest periods. The length of the patient’s cycle and the number of cycles in the treatment plan will be
determined by an oncologist.
Chemotherapy is given in several ways: intravenously (through a vein), orally, through an injection (i.e.,
intrathecal, intramuscular, subcutaneous, etc.), or topically (applied on the skin). The most common
method of delivering chemotherapy is intravenously (IV). This is done either in the form of fluid drip or as
an IV push. Procedures range from 15 min to 10 h or longer.
The range of procedures and activities carried out include, but are not limited to,
(a) chemotherapy infusions and pushes;
(b) examinations;
(c) intrathecal and subcutaneous injections;
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(d) lumbar punctures;
(e) PICC line access/dressing/removal; and
(f) patient and family/caregiver education.
Oncology pharmacy services are required in support of systemic therapy and these services are often
located integral to the chemotherapy treatment area.
9.3.1.6
Outpatient oncology clinics can provide
(a) examination, consultation, and treatment of new patients (including full history and physical exam
for initial management and determination of care pathway);
(b) follow-up assessment for medical oncology, radiation oncology, surgical oncology, and in some
instances hereditary high-risk surveillance, pain and symptom management, and palliative care; and
(c) consultation with nurses, pharmacists, social workers, psychologists, dieticians, and possibly others.
9.3.1.7
Rehabilitation or supportive services typically include a range of rehabilitation services as a component of
comprehensive cancer care, such as
(a) social workers and clinical counsellors;
(b) nutritionists;
(c) creative art and music therapy programs;
(d) psychiatric counselling;
(e) group therapy sessions; and
(f) outpatient rehabilitation services and exercise programs.
9.3.2 Functional requirements
9.3.2.1 Patient management
9.3.2.1.1
Care shall be provided in a supportive and caring environment for patient and families. The design of the
service shall
(a) create a calm, healing, and pleasing environment;
(b) support patient dignity, confidentiality, and privacy;
(c) include provisions for patient access to relevant health information and resources; and
(d) include nourishment and washroom facilities.
9.3.2.1.2
Rooms and connecting spaces shall be provided as necessary to accommodate the functional program.
9.3.2.1.3
Simulator, accelerator, and cobalt rooms shall be sized to accommodate
(a) the equipment;
(b) patient access on a stretcher;
(c) medical staff access to the equipment and patient; and
(d) service access.
Equipment manufacturers’ recommendations should be sought and followed, since space requirements
can vary from one machine to another and from one manufacturer to another.
9.3.2.1.4
The radiotherapy suite may contain electron beam therapy or radiation therapy, or both.
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9.3.2.1.5
The primary staff work zone (e.g., a team charting station) should be close to the entry for control of
individuals coming into the area.
9.3.2.1.6
The patient care areas should be co-located with the staff work area (care station), which can necessitate
sub/satellite staff work areas to ensure that staff have work spaces in close proximity to a given number of
patients.
9.3.2.1.7
The patient care isolation rooms should be located close to the patient entry and away from the main
corridor/other patient cubicles to limit the travel distance to the main area by immunosuppressed/
infectious patients.
9.3.2.1.8
The medication dispensing area/rooms shall be easily accessible from the patient care areas.
9.3.2.1.9
All chemotherapy areas shall be designed to provide direct observation from a staff workstation to the
patient chairs/stretchers.
9.3.2.1.10
Patient and family safety shall be provided through facility and equipment design, and compliance with
applicable requirements.
Healing Arts Radiation
Protection Act
9.3.2.1.11
Design decisions, selection of materials, and construction decisions shall be made in consultation with the
HCF’s radiation safety officer (RSO) or equivalent.
9.3.2.2 Workflow
9.3.2.2.1
The visitor entry should be adjacent to the visitor waiting area, but external to the patient care zone.
9.3.2.2.2
Utility and clean supply rooms shall be centralized or decentralized based on the functional program
requirements and design and have direct access from an internal corridor for ready access from the patient
areas served.
9.3.2.2.3
Staff areas shall be discrete from patient areas to allow for security, privacy, and confidentiality.
An interdisciplinary care delivery approach, involving all members of the care team (radiation, medical,
surgical oncologists, nurses, medical physicists, dosimetrists, radiation technologists, social workers,
dieticians, etc.) is a fundamental characteristic of cancer care programs and shall be embedded in all
aspects of planning and design.
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9.3.2.3 Support service delivery
9.3.2.3.1
Enclosed patient waste disposal units shall be readily accessible from patient care areas. Provisions for the
management of hazardous waste (e.g., from chemotherapy) shall be in accordance with CSA Z317.10.
9.3.2.3.2
Within rooms, enclosed flexible storage units shall be used to achieve infection control, patient-focussed
care, and flexibility.
9.3.2.3.3
Radioisotope storage shall be provided adjacent to the high dose rate (HDR) brachytherapy room and the
PET simulation suite.
9.3.2.3.4
Ease of replacement of linear accelerators and simulators shall be provided through unobstructed routes.
9.3.3 Technical requirements
9.3.3.1 Radiation treatment room millwork
9.3.3.1.1
Millwork shall be provided in radiation treatment rooms to house accessory equipment for treatment
delivery, including
(a) patient immobilization and positioning devices, such as
(i) vacuum cushions;
(ii) breast and lung boards; and
(iii) thermoplastic shells;
(b) shielding;
(c) collimating devices, such as
(i) cerrobend cut-outs and applicators for electron therapy; and
(ii) cerrobend shields for protection and treatment area shaping; and
(d) clinical supplies including linens, support pillows, and technical accessories.
9.3.3.1.2
Millwork shall not be installed in a way that impedes placement or viewing of the lateral lasers mounted
on the sidewalls of the room. If these devices are covered, there shall be a means to facilitate easy access to
the device for adjustment and maintenance. There shall also be a portal for the laser beam to exit to the
isocentre of the room.
9.3.3.1.3
A range of locally determined sizes shall be provided to support clinical processes.
9.3.3.1.4
Storage for safely mounted electron applicators shall be provided at a reasonable working height for
repeated, daily use.
9.3.3.1.5
Surfaces shall be readily cleanable with hospital grade cleaning products.
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9.3.3.1.6
The hand hygiene sink shall be located at the entry to the room and shall include a small shelf for
patient-specific denture pots.
9.3.3.1.7
The space shall have at least two linear metres of counter. Fully adjustable horizontal shelves shall be
provided.
9.3.3.1.8
Some storage of vertical devices, as determined by local staff, shall be provided. Ergonomically placed
shelves shall be provided for heavy and awkward items such as breast boards and cerrobend shielding
products. Shelves shall be deep enough for radiation therapy accessory devices such as chest and head
and neck shells. A storage system (rack or shelf) for vacuum cushions shall be provided.
9.3.3.1.9
Space shall be provided for a linen hamper against the wall.
9.3.3.1.10
Access to emergency off buttons shall not be impeded by doors in the open or closed position.
9.3.3.1.11
A space should be provided for a patient chair near the exit to the room.
9.3.3.1.12
A series of drawers shall be provided for housing of specialty products and equipment.
9.3.3.1.13
A location, with power and data available, shall be provided for placement of two flat-panel monitors, one
on either side of the room, outside the primary beam towards the maze end of the space. The exact
location shall be as specified by the user.
9.3.3.2 Radiation treatment room flooring
To minimize damage to flooring, the flooring in the maze and the treatment room should be installed after
machines have been installed and commissioned.
9.3.3.3 Radiation treatment room compressed air
A central compressed air source with heated desiccant dryer shall be used to provide instrument quality air
at 690 kPa to the radiation treatment machine.
9.3.3.4 Radiation treatment room HVAC
9.3.3.4.1
A central air supply and exhaust system shall be provided, dedicated to the treatment area and located
near the radiation treatment rooms to allow early installation of the radiation treatment machines within
the construction phases.
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9.3.3.4.2
The air-handling unit shall be 100% outdoor air with a heat recovery device that does not allow
contamination between the fresh and exhaust air streams. The exhaust should be located away from
public areas.
9.3.3.4.3
The radiation treatment room should be designed for between 12 and 15 air changes per hour delivered
through laminar flow ceiling diffusers. Air exchanges in the entrance maze shall be in accordance with
CAN/CSA-Z317.2
9.3.3.4.4
Low-level exhaust taken from the maze entrance should be incorporated into the design.
9.3.3.4.5
Air supply from the central system should be included in the modulator room and computer closet.
9.3.3.5 Radiation treatment room air balancing
9.3.3.5.1
The radiation treatment machine modulator room shall be pressurized in relation to the patient treatment
room.
9.3.3.5.2
The patient treatment room shall be pressurized in relation to the control area and corridor.
9.3.3.5.3
The computer closet shall have positive pressure in relation to the control area.
9.3.3.5.4
The supply air duct system shall be equipped with an airflow station with panels that display the air
exchanges within the room.
9.3.3.6 Radiation treatment room temperature and humidity controls
The following spaces shall have independent temperature controls and shall remain within 20 °C and
26 °C:
(a) modulator room;
(b) radiation treatment area;
(c) computer closet; and
(d) control area.
The humidity within the radiation treatment room and radiation treatment machine modulator room shall
remain between 40% and 65%, non-condensing.
9.3.3.7 Radiation treatment room plumbing
9.3.3.7.1
Floor drains shall be located, as per the radiation treatment room template, in the pit and modulator
room.
9.3.3.7.2
Floor drains shall not be connected directly to the building’s common sanitary system.
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9.3.3.7.3
Drains shall be connected to a dedicated system leading to a sump pump chamber. The sump shall
discharge into the sanitary system.
9.3.3.7.4
A backup overflow from the sump pit to the sanitary system should be included, with a non-return valve
on the line leading to the sanitary system.
9.3.3.7.5
A drip tray with a correctly sized drain shall be installed below any cooling equipment.
9.3.3.8 Radiation treatment room sprinkler system
9.3.3.8.1
A double interlocked, pre-action sprinkler system shall be provided in the radiation treatment and
modulator rooms.
9.3.3.8.2
Heat or photoelectric smoke detectors shall be located outside the primary radiation beam shielding in
order to prevent false triggering.
9.3.3.9 Radiation treatment room laser
9.3.3.9.1
Solid state owner-supplied lasers shall be attached to steel mounts affixed to structural concrete to prevent
drifting due to vibration or environmental causes.
9.3.3.9.2
Sidewall lasers shall be mounted on the room walls, left and right of the radiation treatment machine, at
the same height from the finished floor as the isocentre of the radiation treatment machine, as per the
radiation treatment room template.
9.3.3.9.3
The ceiling laser shall be mounted above the radiation machine isocentre, as per the radiation treatment
room template.
9.3.3.9.4
The sagittal laser shall be mounted on the wall, as per the radiation treatment room template.
9.3.3.9.5
The sagittal laser location shall be specified, within a range, by the owner.
9.3.3.9.6
Lasers shall be independently switched and inter-connected to the hand control.
9.3.3.10 Radiation treatment room communication equipment
9.3.3.10.1
The following communication equipment shall be provided in the control room:
(a) intercom system between the control area and the radiation treatment room;
(b) multiple local area network connections;
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(c) nurse call;
(d) two high-resolution CCTV monitors; and
(e) a telephone.
9.3.3.10.2
Multiple local area network jacks shall be provided in the computer closet.
9.3.3.10.3
The following communication equipment shall be provided for the radiation treatment room:
(a) multiple local area network jacks;
(b) nurse call system;
(c) telephone;
(d) at least two high-resolution colour, CCTV cameras, with pan, tilt, and zoom capability; and
(e) a third video jack, located at counter height, to facilitate placement of a mobile camera.
9.3.3.10.4
Radiation warning lights shall be connected to emergency power.
9.3.3.11 Radiation treatment room machine-related electrical conduits
9.3.3.11.1
With regard to conduits from the computer closet to the radiation treatment machine stand/modulator
room
(a) a minimum of six 102 mm conduits should be installed below grade from the computer closet to a
box in the floor at the back of the modulator room; and
(b) a minimum of six 102 mm conduits should be installed from the box in the floor at the back of the
treatment room in the modulator room to a box under the stand of the machine.
9.3.3.11.2
With regard to conduits dedicated to specific equipment in the radiation treatment room,
(a) respiratory gating equipment shall have a 25 mm overhead conduit from the computer closet to a
location near the sagittal laser; the conduit should be kept as short as possible;
(b) the respiratory gating system shall have a switchable electrical outlet near the sagittal laser location
for computer monitors in the radiation treatment room. Two 50 mm conduits should be installed
from the computer closet overhead. One of these conduits shall terminate into the millwork on the
right-hand side of the radiation treatment machine, outside the primary beam, the other in millwork
on the left-hand side of the radiation treatment machine, also outside the primary beam, in
compartments or shelves that can accommodate 510 mm flat-panel monitors;
(c) intercom speakers shall be located to the left and right of the machine and outside the primary beam
area in the ceiling;
(d) an intercom microphone should be positioned outside the primary beam in line with the centre of
the couch or treatment machine to facilitate the patient being heard regardless of the machine
position;
(e) 19 mm conduits shall be provided for high resolution colour, CCTV cameras, with pan and zoom
capability, in the treatment room, with high resolution colour monitors for viewing patients located
on the desk in the control area;
(f) a minimum of two CCTV cameras shall be located in the radiation treatment room, located as per the
radiation treatment room template; and
(g) a 19 mm conduit for a CCTV video jack shall be located at counter height to facilitate placement of a
mobile camera, as located on the radiation treatment room template.
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9.3.3.11.3
All lasers shall be controlled by the radiation treatment machine hand control via a relay in a relay box
located in the radiation treatment machine stand/modulator room.
9.3.3.11.4
The wall lasers shall also be controlled from a wall switch and the ceiling and sagittal laser from another
wall switch (see also generic specifications for lasers in the radiation treatment room).
9.3.3.11.5
To facilitate the installation of kilovoltage imaging devices, a 50 mm conduit should be run between the
electrical box in the floor under the radiation machine stand to the power conditioner.
9.3.3.11.6
An owner-supplied power conditioner shall be provided; depending on machine selection and
manufacturer, a variety of conduit placements will be required.
9.3.3.11.7
With regards to conduits for future technologies and infrastructure,
(a) two 102 mm conduits should be installed in the ceiling of the computer closet that run from the
computer closet ceiling to a serviceable ceiling area in the radiation treatment room; and
(b) additional 19 mm conduits should be considered for security, HVAC daytime night-time modes.
9.3.3.12 Radiation treatment room electric power specifications
9.3.3.12.1
The electric power brought into the radiation treatment machine modulator room for use in the radiation
treatment machine shall be 3-phase 600 V AC.
9.3.3.12.2
Transformation to other voltages shall occur within the treatment machine stand/modulator room by
means of a power conditioner and/or transformers.
9.3.3.12.3
The 3-phase 600 V AC electrical supply switchgear, wiring size, and conduits for the radiation treatment
machine should be rated for a minimum capacity of 117 kVA.
9.3.3.12.4
All electrical devices connected directly or indirectly to the radiation treatment machine within the
modulator room, radiation treatment room, computer closet, and control area should be connected to the
same power source as the radiation treatment machine.
9.3.3.12.5
All power to the radiation treatment machine and electrical devices connected directly or indirectly to the
radiation treatment machine within the radiation treatment machine stand/modulator room, radiation
treatment room, computer closet, and control area, shall be conditioned by means of a power conditioner.
9.3.3.12.6
To prevent ground loops, all grounding of all electrical devices connected directly or indirectly to the
radiation treatment machine within the modulator room, radiation treatment room, computer closet, and
control area should be connected in one connection on the medical equipment grounding grid.
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9.3.3.12.7
Electrical receptacles designated for housekeeping equipment use, room lights, CCTV cameras and
monitors, lasers, intercom, etc. that are not directly related to the radiation treatment machine shall be
powered from other sources.
9.3.3.13 Radiation room cooling water
9.3.3.13.1
The radiation room cooling water circuit shall have a central year-round cooling source, pump, and
distribution system.
9.3.3.13.2
The circuit shall have a 100% redundant cooling source and pump that will automatically start if the
supply temperature exceeds set-point.
9.3.3.13.3
In a system that utilizes domestic cold water as a back-up cooling source, there shall be a means to
manually restrict flow, as well as automatically control the domestic water flow, in order to maintain
set-point.
9.3.3.13.4
The domestic water used as the cooling source shall not be directly injected into the main cooling
distribution loop. A heat exchanger shall be used to maintain the separation of the systems.
9.3.3.13.5
A supply fluid temperature shall be provided that will be monitored and remain above condensing
temperatures and operate between 16 °C and 25 °C.
9.3.3.13.6
Flow rates and pressure inlet conditions to the equipment shall fall within equipment suppliers’
recommendations. If equipment selection is not known at the time of design, the pump should be
designed for equipment with maximum flow and pressure requirements.
9.3.3.13.7
A sensor device shall be in place to alert building maintenance in the event of unusual conditions.
9.3.3.13.8
Cooling fluid in the closed cooling loop shall be clean and free of particulate. Non-corrosive piping, such
as soldered or brazed copper, shall be used.
9.3.3.13.9
Gauges that monitor flow, temperature, and pressure on supply and return connections to the radiation
treatment machine shall be located inside the modulator room.
9.3.3.13.10
A dedicated water-filtering system, with five-micron filters and manual bypass, shall be located in the
modulator room.
9.3.3.13.11
A manual regulated bypass valve between supply and return is required to adjust and maintain velocity
pressure to the equipment.
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9.3.3.14 Simulation room HVAC
9.3.3.14.1
The simulator room HVAC system shall be designed in such way that it could satisfy simulator air-cooled
technologies as well as water-cooled technologies.
9.3.3.14.2
The HVAC system should be split into two components:
(a) a system that satisfies the need of air replacement for the occupants, as well as any applicable
requirements for outdoor air; and
(b) a system that recirculates air to satisfy the cooling requirements of the equipment.
9.3.3.14.3
Air balancing reports shall be collected and forwarded to the radiation safety officer.
9.3.3.14.4
The air duct system shall have a means of verifying the outdoor air exchanges within the room.
9.3.3.14.5
The HVAC system shall be designed to maintain the following environmental condition in the control
console and simulator room:
(a) temperature between 20 °C and 26 °C; and
(b) humidity between 40% and 65%, non-condensing.
9.3.3.14.6
The control console and simulator room shall have independent temperature controls.
9.3.3.15 Simulation room cooling water
9.3.3.15.1
In the dedicated mechanical room, a cooling water connection shall be installed to accommodate
water-cooled simulator systems.
9.3.3.15.2
The water-cooling circuit shall have
(a) chilled water that will not exceed the maximum static pressures prescribed by the simulator
manufacturers;
(b) temperature remote monitoring to prevent over temperature chilled water conditions (> 16 °C);
(c) sensor devices that will alert building maintenance in the event of unusual conditions;
(d) shutoff valves and valves to bypass and replace water filters in the dedicated mechanical room;
(e) gauges that monitor flow, temperature, and pressure on supply and return connections to the
simulator, located in the dedicated mechanical room;
(f) a dedicated water filtering system located in the dedicated mechanical room; and
(g) bypass-regulating valves to adjust flow and maintain velocity pressure.
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9.3.3.15.3
A water treatment system shall be installed somewhere in the chilled water system to prevent corrosion or
water quality deterioration.
9.3.3.15.4
The final connections towards the simulator or simulator heat-exchanger system shall be made while the
manufacturer’s installer is on site to overlook the installation.
9.3.3.15.5
The dedicated mechanical room shall have a floor drain as well as a domestic cold-water tap with hose bib.
9.3.3.16 Simulation room plumbing
A drip tray with a correctly sized drain shall be installed below any cooling equipment.
9.3.3.17 Simulation room sprinkler system
A dry, pre-action sprinkler system shall be located in the simulator rooms.
Heat or photoelectric smoke detectors shall be located away from any radiation sources to prevent false
triggering.
9.3.3.18 Simulation room smoke detectors
No dual ionization smoke detectors shall be used in the simulator room.
9.3.3.19 Simulation room electronic building devices
As much as possible, all electronic devices should be kept away from strong radiation sources.
Main electrical conduits supplying power to other equipment elsewhere shall not be routed through or
near the simulator suites to minimize external magnetic influences on the sensitive simulator electronic
equipment.
9.3.3.20 Simulation room medical gases
Oxygen and medical vacuum outlets shall be positioned outside the primary working area to reduce trip
hazard.
9.3.3.21 Simulation room communication equipment
9.3.3.21.1
An intercom system shall be used for communications between the control area and the simulator room.
9.3.3.21.2
Multiple local area network jacks shall be available in the control area and be operational upon machine
installation.
9.3.3.21.3
A telephone shall be provided within the simulator control area.
9.3.3.21.4
A local area network jack should be installed in the simulator room.
9.3.3.21.5
A nurse call system shall be within the simulator room and should be deployed as per HCF policy.
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9.3.3.21.6
A minimum of one CCTV camera shall be located in the simulator room. The camera shall be located
behind the donut on the wall at a 30° angle, left or right, measured from the donut isocentre, at a height
of 2150 mm from the finished floor. The camera shall be connected through a dedicated CCTV circuit to a
high-resolution colour monitor located on the simulator control desk.
9.3.3.22 Simulation room electrical conduits
9.3.3.22.1
Simulator related electrical conduits shall meet the following provisions:
(a) several 102 mm conduits from the dedicated mechanical room towards the simulator donut shall
accommodate power, signal, and water-cooling systems;
(b) several 102 mm conduits shall be located from the dedicated mechanical room towards the control
console and from the control console towards the simulator donut;
(c) three 102 mm conduits shall be located from the donut towards the photothermal detoxification unit
(PDU), if this device is located in the simulator room, and two 102 mm conduits shall be from the
PDU directly towards the dedicated mechanical room (in all generic cases, the PDU should be in the
dedicated mechanical room); and
(d) a generic electrical conduit schematic for the simulator shall be developed for clarification.
9.3.3.22.2
With regard to conduits dedicated to specific equipment in the simulator room shall meet the following
provisions:
(a) CCTV conduits shall be used to connect the camera behind the donut to the monitor in the console
area;
(b) injector conduits shall be provided from the ceiling injector location towards the console area;
(c) laser control signals conduits shall be provided from the lasers in the various locations in the simulator
room towards the control console area;
(d) “X-ray on” warning light(s) conduits shall be provided;
(e) intercom conduits shall be required;
(f) an emergency off button shall be provided; and
(g) conduits shall be used for the radiation monitor, door interlock and door remote lock, thermostats,
telephone, nurse call, and code calls.
9.3.3.22.3
With regard to conduits for future technologies and infrastructure, additional conduits in the simulator
room should be considered for
(a) security;
(b) HVAC daytime night-time modes;
(c) LAN;
(d) telecommunication; and
(e) wireless applications.
20 mm
9.3.3.23 Simulation room laser
9.3.3.23.1
Solid state owner-supplied/simulator manufacturer-supplied lasers shall be attached to steel mounts
affixed to structural concrete (concrete slab above and concrete floor) to prevent drifting due to vibration
or environmental causes.
600 mm
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9.3.3.23.2
An electric receptacle shall be located near every laser in the simulator room, as well as a signal conduit
that connects the laser to the laser movement controller on the control desk in the control area.
9.3.3.23.3
The ceiling and wall laser plates shall have a minimum dimension of 800 mm × 1400 mm × 10 mm and
require exact location and orientation as per the simulator/laser manufacturer and owner’s instructions.
9.3.3.24 Simulation room electric power specifications
9.3.3.24.1
The electric power brought into the dedicated mechanical room for use in the radiation treatment
simulator shall be 3-phase 600 V AC.
9.3.3.24.2
The switchgear, wiring size, and conduits for the simulator 3-phase 600 V AC electrical supply should be
sized for a minimum capacity of 225 kVA.
9.3.3.24.3
To prevent ground loops, all grounding of all electrical devices connected directly to the simulator shall be
to one connection on the medical equipment grounding grid.
9.3.3.24.4
All electrical devices directly connected to the simulator should be connected to the same power source as
the simulator, in accordance with the manufacturer’s installation manuals.
9.3.3.24.5
Electrical receptacles designated for housekeeping equipment use, room lights, CCTV cameras and
monitors, lasers, intercom, etc. that are not directly related to the simulator shall be powered from other
sources.
9.3.3.25 Simulation room lights and light fixtures
9.3.3.25.1
Lighting in the simulation room shall be dimmable and controlled by wall switches.
9.3.3.25.2
For patient safety, instant-on emergency lights shall be installed in the simulator room.
9.3.3.25.3
There shall be a dedicated mechanical room.
9.3.3.25.4
The light output of the light fixtures in the dedicated mechanical room should be high and on emergency
power.
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9.3.3.25.5
Lighting in the console area shall be dimmable and controlled by wall switches.
9.3.3.26 Simulation room emergency power emergency power
There shall be emergency power for room lights and the battery-powered emergency lights in the
simulator room.
9.3.3.27 Simulation room radiation safety devices
9.3.3.27.1
Radiation safety devices in the simulator room and control area shall meet applicable requirements.
9.3.3.27.2
Radiation safety devices shall include
(a) door interlock devices (e.g., door contacts, optical sensors, motion sensors, electric door strikes, and
emergency off buttons);
(b) warning lights;
(c) emergency battery-powered lights;
(d) emergency buttons, which shall be self-latching when pressed;
(e) radiation monitors, independent of the machine, which monitor radiation levels in the simulator
room and will alert the operator of high radiation levels;
(f) a dedicated CCTV system of cameras and monitors for each room, with monitors in the control area;
and
(g) emergency battery-powered lights that will turn on immediately when a power failure occurs.
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9.3.4 Space details
Table 9.3 presents the standard requirements for key spaces in the oncology ambulatory care areas.
Common areas are detailed in Clause 11.
Table 9.3
Key space requirements and recommendations —
Ambulatory care — Oncology
1 Radiation treatment room 99.4 Mandatory:
(high energy or low (a) The radiation shielding of the rooms shall be designed for a
energy linear accelerator) minimum of 18 MV photons.
including maze and (b) The radiation treatment rooms shall have a maze access
modulator room, but designed such that a heavy door is not required for energies
excluding control up to 18 MV photons.
(c) Neutron absorbing materials such as polyethylene and
boreated, polyethylene shall be installed in the maze to reduce
the neutron levels to an acceptable level.
(d) The room shall be designed to accommodate equipment from
all major vendors for high-energy treatment. Room
infrastructure shall include a removable plug that can facilitate
installation of future technologies.
(e) Density testing results for all products, such as prefabricated
illmenite or hematite blocks used in the plug area of the room,
shall be provided to the RSO for approval.
(f) An independent observer who reports to the RSO shall be
available during the concrete pour to ensure that voids,
marbling, and other problems do not occur.
(g) Concrete specifications shall meet applicable requirements.
(h) Room sizes shall meet applicable requirements.
2 Control room 14.0
3 Radiation treatment 63.0 Mandatory:
room, multi-purpose (a) The multi-purpose radiation treatment room shall be equipped
(orthovoltage, superficial, with general-purpose millwork with stainless steel countertops.
HDR brachytherapy), (b) Under-counter storage shall have solid fronts.
including maze, but (c) Over-counter storage shall have solid doors.
excluding control (d) Adjustable general-purpose shelving shall be provided.
(e) Special storage shall be provided for X-ray applicators.
(f) One paper towel dispenser, one mirror, one coat hook, one
soap dispenser, and a hook for a lead apron shall be provided.
(g) Oxygen and vacuum shall be provided.
(h) A hand hygiene sink shall be provided.
(i) Telephone, data, and emergency power connections shall be
provided.
(j) Nurse call, intercom, and CCTV systems shall be provided.
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Table 9.3 (Continued)
(k) A door interlock system shall be provided.
(l) Dimmable lighting, a warning light system, and a radiation
monitor and slave shall be installed.
(m) Room sizes shall meet applicable requirements.
4 Radiation treatment 59.0 Mandatory:
simulation room, (a) All radiation treatment simulation suites shall be designed in
excluding control such a way that the shielding and dimensions of the simulator
room and adjacent areas can accommodate emergent
radiation treatment simulation.
(b) The radiation treatment simulator room shall have a maze
access that is designed such that a shielded door is not
required between the simulator room and the control area.
(c) The room shall be designed to accommodate equipment from
all major vendors for computed or positron emission
tomography and combinations of both technologies.
(d) Concrete used for shielding shall meet all density checks and
construction specifications and other applicable requirements.
Advisory
Consideration should be given to including a washroom adjacent
to the room.
5 Machine shop Varies Mandatory:
(a) The machine shop shall be equipped with general-purpose
millwork, with stainless steel countertops.
(b) Under-counter storage shall have solid fronts.
(c) Over-counter storage shall have solid doors.
(d) Lockable, adjustable, general-purpose storage shall be
provided.
(e) One paper towel dispenser and one white board shall be
provided.
(f) Compressed air shall be equipment grade (desiccant dryer
with heating element, non-medical type).
(g) Natural gas shall be provided to the welding hood.
(h) Vacuum shall be provided at the computer numerical control
(CNC) mill.
(i) A fume hood shall be provided.
(j) A hand hygiene sink, special equipment stainless steel wash
sink, and an eyewash station shall be provided.
(k) A central vacuum system shall be provided.
(l) High-frequency fluorescent light fixtures shall be provided.
(m) Telephone and data connections shall be provided.
(n) 3-phase power at 600 V and 208 V shall be provided.
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Table 9.3 (Concluded)
6 Radioisotope room, 12.0 Mandatory:
HDR brachytherapy (a) The room shall be provided with a fully shielded door.
(b) General-purpose millwork with stainless steel counter tops
shall be provided.
(c) A stainless steel hand hygiene sink shall be provided.
(d) A paper towel dispenser and soap dispenser shall be provided.
(e) Open shelving shall be provided along one wall.
(f) An isotope safe shall be provided.
(g) Telephone and data connections shall be provided.
(h) Warning lights, radiation monitor, and slave shall be provided.
(i) Floor and work surfaces shall meet applicable requirements.
7 Radioisotope room, PET 11.0 Mandatory:
(a) Construction of this room shall meet applicable requirements.
(b) The room shall be provided with a fully shielded door.
(c) The walls shall be lead lined, as per applicable requirements.
(d) General-purpose millwork with stainless steel counter tops
shall be provided.
(e) A stainless steel hand hygiene sink shall be provided.
(f) A paper towel dispenser and soap dispenser shall be provided.
(g) An isotope safe shall be provided.
(h) Telephone and data connections shall be provided.
(i) Warning lights, radiation monitor, and slave shall be provided.
(j) Floor and work surfaces shall meet applicable requirements.
8 Recliner chair area, 7.5 per
open chair
9 Bed cubicle area, open 9.5 per
bed
10 Examination room 12.0 See Clause 11.
11 Examination room, 12.0 See Clause 11.
stretcher
9.4 Emergency care
9.4.1 Description
Emergency care refers to the assessment, treatment, and stabilization of patients who present on an
unscheduled basis seek emergency medical assistance and who could have a wide variety of conditions of
varying urgency and complexity.
Although the basic nature of the service can be the same, there are different community needs and
expectations for remote/rural facilities, major referral HCFs, community HCFs, major trauma centres, and
pediatric specialist HCFs. These requirements apply to a traditional emergency department located within
a major trauma centre and to standalone urgent care centres (which may be located within
commercial/rental properties).
Depending on community needs, the extent and type of emergency health services provided can range
from initial trauma assessment and stabilization services to comprehensive emergency health services.
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Additional emergency health care provided by some health care facilities can include
(a) provision of critical care transport to emergency health services;
(b) counselling, social work, and/or psychiatric services;
(c) diagnostic imaging, labs, and other diagnostic services;
(d) targeted care for particular populations (pediatrics; frail elderly; stroke, asthma, or chronic obstructive
pulmonary disease [COPD] patients, etc.);
(e) casting clinics;
(f) IV and other scheduled therapies;
(g) isolation rooms;
(h) observation or clinical decision units;
(i) trauma centre; and
(j) teaching and research.
The Canadian Triage and Acuity Scale (CTAS) for emergency departments is designed to assist urban
hospitals in managing their patient wait-times. Rapid triage allows hospitals to identify patients with
urgent, life threatening conditions; determine the most appropriate treatment area for patients presenting
to the emergency care service; decrease congestion in emergency treatment areas; provide a standard tool
for the ongoing assessment of patients; and provide information to patients and families regarding
services expected care and waiting times. Smaller hospitals are not always equipped to care for the more
acute cases, and these patients would be referred to other centres in the region for urgent care. For
example, a patient at CTAS Level III, II, or I who arrives at such a facility would be stabilized and transferred
to a neighbouring emergency department that is equipped for such a case.
9.4.2 Functional requirements
9.4.2.1 General
The design of the service shall provide for rapid access between functional areas with a minimum of cross
traffic. The design should support an assessment and treatment flow that includes screening, triage,
registration, initial assessment, secondary assessment areas, and pharmaceutical dispensing. The design
shall include provisions for surge capacity.
9.4.2.2 Entrance, reception, and triage
9.4.2.2.1
The entrance, reception, and triage areas should be designed to support a logical flow for patients who
present at emergency care.
9.4.2.2.2
The service should be accessible by two distinct entrances: one for ambulance patients (where applicable)
and the other for ambulatory patients.
The ambulance entrance and the walk-in entrance shall be visible to triage staff. If the entrances are not
in their direct line of sight, there shall be a means to communicate between the entrances and triage.
9.4.2.2.3
Space shall be provided for police and ambulance staff to take notes.
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9.4.2.2.4
The walk-in entrance shall be screened for sight and sound from the ambulance entrance.
9.4.2.2.5
Clear and separate traffic flows shall be provided for ambulance traffic and public traffic. These should not
interfere with other traffic patterns on the site. The ambulance area should utilize drive-through bays to
minimize accidents.
9.4.2.2.6
The registration/triage area shall be located as to have unobstructed visibility of the waiting room, the
children’s play area (if provided), and the ambulance entrance, and to control access to clinical areas.
9.4.2.2.7
The reception/triage area shall be adjacent to walk-in and ambulance entrances.
9.4.2.2.8
The triage area shall be designed and ventilated to reduce exposure of staff, patients, and families to
airborne infectious diseases (see Clause 7.5). A physical barrier shall be provided to protect staff from
infection and physical contact.
9.4.2.2.9
A triage cubicle for taking a patient’s history shall be located immediately adjacent and connected to the
reception/triage area. Provision shall be made for the segregation of patients presenting with infectious
symptoms. See Clause 9.4.3.3.
9.4.2.2.10
A decontamination area shall be provided directly accessible from the ambulance entrance without
entering any other part of the unit (see Table 9.4 and Clause 6.1.12).
9.4.2.2.11
A biohazard containment area shall be provided for infection prevention and control and decontamination
activities. This area shall have a graded and levelled anti-slip flooring with a wet sump to facilitate floor
drainage.
9.4.2.2.12
In HCFs that can only accommodate CTAS Level IV and V cases, an area shall be provided for the transfer
of emergent patients arriving independently and requiring higher acuity care (e.g., CTAS Level III, II, and I
patients that will need to be directed to neighbouring emergency departments). This transfer area shall
include provisions to accommodate an ambulance.
9.4.2.3 Public waiting areas
9.4.2.3.1
Patients waiting for triage shall be in a secure area that is clearly visible from the triage station. This area
shall be separate from the post-triage waiting area to limit the spread of contamination and/or contagion.
9.4.2.3.2
The waiting area shall be visible from the triage area and shall be located separate from treatment areas.
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9.4.2.3.3
The waiting area should have a washroom. Additional washrooms should be provided depending on
anticipated occupancy.
9.4.2.3.4
The waiting area should be adjacent to a vending area and a public telephone. Visitor and patient access
to all areas should not traverse clinical areas.
9.4.2.3.5
Public access points to the clinical areas shall be minimal in number and under direct observation by the
reception and control or security function.
9.4.2.3.6
A designated area should be available for the segregation of patients with potentially infectious respiratory
or gastrointestinal symptoms (e.g., influenza, Norwalk virus).
9.4.2.4 Clinical areas
9.4.2.4.1
Acute patient treatment spaces shall be situated where they can be observed from the nursing/staff
station.
9.4.2.4.2
Patient treatment spaces shall be convenient to the clean and soiled utility rooms, procedure room,
medication room, and patient washroom and shower.
9.4.2.4.3
Patients who need to be transferred to other areas of the HCF, such as imaging or inpatient care, should
not traverse other clinical areas of the emergency service.
9.4.2.4.4
Non-acute patient treatment spaces shall be in a central location that is visible from the nursing/staff
station.
9.4.2.4.5
At least one treatment/examination room should be designated for pelvic examinations.
9.4.2.4.6
The resuscitation/trauma room(s) shall have immediate access from the ambulance entrance with easy
access to the nursing/staff station and other parts of the acute treatment beds.
9.4.2.4.7
A bereavement/quiet room shall be provided and accessible from the waiting and resuscitation/trauma
room(s).
9.4.2.4.8
At least one airborne infection isolation room shall be provided with easy access to the nursing/station and
entry points.
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9.4.2.4.9
A safe room shall be provided for patients presenting with psychosis, delirium, suicidal, or aggressive
behaviour.
The safe room shall be adjacent to a staff area and able to be accessed without traversing other patient
zones.
9.4.2.4.10
There shall be a minimum of one patient toilet room per eight treatment spaces or fraction thereof.
9.4.2.5 Support and staff areas
A staff/nursing station(s) for staff work and charting shall be located where it allows line of sight of all
patient and visitor traffic in the emergency service.
A security station should be located with visibility of waiting areas and all entrances.
Storage for general medical/surgical emergency supplies, medications, and equipment such as
ventilator, defibrillator, splints, etc. shall be located out of traffic, under staff control, and within easy
access of treatment areas.
A staff washroom should be provided.
9.4.3 Technical requirements
9.4.3.1 Planning for emergency care/triage area impact
In recognition that in any external emergency impacting the institution, the area most immediately
impacted will be the emergency care/triage area, the planning shall include
(a) special attention or HVAC systems so as to allow expedited ability to isolate air handling system in
the emergency care if individuals exposed to noxious gases, other forms of contamination, or
infectious disease outbreaks are to be admitted in isolation in order to protect the rest of the
institution (see CAN/CSA-Z317.2);
(b) planning for use of adjacent ambulance garage/drop-off space for crowd management,
decontamination in a chemical/biological/radiation/nuclear (CBRN) event, extended triage, etc.
Consideration of climate conditions year round (i.e., temperature extremes) should be factored in to
designs; and
(c) storage for easy access to chemical, biological, radiological, and nuclear (CBRN) equipment and
supplies.
Pre-planning of temporary facilities should be done to ensure that the HCF can accommodate surge and
provide the necessary triage and decontamination.
9.4.3.2 Privacy
Patient privacy and confidentiality are important considerations to be addressed.
The HCF should be designed to
(a) ensure confidentiality of patient discussions and records and provide discrete sub-waiting areas for
patients wishing or needing to be separated;
(b) keep the reason for attendance confidential (e.g., through use of generic consultation rooms). This is
particularly important for services such as mental health, sexual health, drug and alcohol, etc.; and
(c) appropriately locate windows and doors to ensure privacy of patients.
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9.4.3.3 Infection prevention and control
In addition to the general list of infection prevention and control requirements, the following shall be
made in this service:
(a) partitions or single rooms separating patients from each other;
(b) designated waiting areas for patients and their family members presenting with infectious disease
symptoms;
(c) decontamination areas in or directly adjacent to the ambulance garage;
(d) negative and positive pressure rooms located to minimize passing traffic and appropriate HVAC
according to CAN/CSA-Z317.2; and
(e) the design and layout allowing for the movement of patients to an isolation room within the unit due
to suspected or known infectious disease.
9.4.3.4 Materials and finishes
9.4.3.4.1 General
In addition to the general list of materials and finishes requirements, the provisions in Clauses 9.4.3.4.2 to
9.4.3.4.4 shall be made in this service.
9.4.3.4.2 Decor
Decor includes furnishings, style, colour, textures, ambience, perception, and taste. Decor can assist in
relaxing patients and preventing an institutional atmosphere. However, cleaning, infection prevention and
control, fire safety, patient service, and the patient’s perception of a professional environment shall take
priority over aesthetics.
9.4.3.4.3 Wall protection
Due to the large number of users and stretcher movements in the emergency care service, particular care
shall be taken to provide appropriate wall protection.
The walls shall be resistant to damage by aggressive persons who kick, punch, or throw items against
the walls. This shall apply particularly in areas where behaviourally disturbed patients can be managed.
9.4.3.4.4 Flooring
Flooring shall be in accordance with CAN/CSA-B651 and shall be consistent with infection prevention and
control considerations.
9.4.3.5 Occupational health and safety
9.4.3.5.1
Provisions for occupational health and safety shall include the following:
(a) Functional and storage space shall be provided for chemicals used in the unit.
(b) Functional and storage space shall be provided for patient handling devices.
(c) Functional and storage space shall be provided for sharps disposal containers.
(d) Eyewash facilities shall be provided when chemicals are being used.
9.4.3.5.2
Areas should be designed to
(a) facilitate the movement of stretchers in and out;
(b) provide sufficient space for portable equipment at the bedside;
(c) minimize sharp corners; and
(d) minimize the need to lift patients (i.e., through the provision of overhead lifting devices).
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9.4.3.6 Furniture, fittings, and equipment
Provision shall be made for examination equipment, such as the following:
(a) exam table with multiple position settings;
(b) exam stretchers; and
(c) exam chair.
9.4.3.7 Technology considerations
9.4.3.7.1
The following provisions shall be made in this service:
(a) a dedicated direct phone line for referring medical practitioners;
(b) a dedicated cordless phone or phone jack for access to patients’ bedsides;
(c) public telephones with acoustic hoods in the waiting area;
(d) a direct line to a taxi company;
(e) systems for physical transfer such as pneumatic tubes are automated trolley systems; and
(f) patient emergency system.
9.4.3.7.2
The technology and communications design should be based on current best practices in health
technologies and access to electronic information for care providers.
9.4.3.7.3
To facilitate a less stressful environment, alternatives to paging systems should be used where possible.
9.4.3.7.4
An emergency care service in a large HCF shall have an electronic information system to support clinical
management, patient tracking, and services administration. Sufficient terminals for staff should be
available to ensure that queuing does not occur, even at peak times. Computers should be available for
use at each bedside.
9.4.3.7.5
Workspace design should include sufficient bench-widths or suitable suspension devices for terminals,
keyboards, drives, and printers. Additional computer terminals, software and peripheral devices should be
installed to enable other services functions. In smaller emergency care services, especially in more remote
areas, telemedicine is becoming increasingly common and important for day-to-day operation. Allowance
should be made for connection of portable telemedicine equipment in all treatment areas.
9.4.3.8 Safety and security
9.4.3.8.1
Emergency care services shall be designed to provide safety and security for patients, visitors and staff, in
order to avoid injuries, psychological trauma, and the damage or loss of property.
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9.4.3.8.2
The base for security personnel should be positioned either within or immediately adjacent to the
emergency care service, with rapid communication links.
9.4.3.8.3
There shall be an emergency call system, with actuators located as follows:
(a) in each examination and treatment area, including toilets and bathrooms;
(b) at triage and reception counters; and
(c) on mobile units for staff who do not work in a fixed location, e.g., clinicians.
9.4.3.8.4
The emergency call system shall annunciate visibly and audibly to a central module situated adjacent to
the staff station, as well as the following areas as applicable to the HCF:
(a) nursing station;
(b) staff room;
(c) tutorial room;
(d) clean workroom;
(e) soiled workroom;
(f) medication area;
(g) charting area;
(h) clean linen storage;
(i) nourishment;
(j) equipment storage; and
(k) other examination/treatment room(s).
9.4.3.8.5
Emergency care services should have a video security system. Ambulance entrances and after-hours
patient entrances should have the same level of video security protection as the main entrance.
9.4.3.8.6
Emergency care services should be designed to accommodate the special needs and concerns of pediatric
patients. There should be sufficient visitor space and facilities for parents, siblings, and caregivers, and
pediatric patients should be protected from potentially disturbing sights or sounds from other patients in
the service. In addition, the following design features should be considered:
(a) a separate waiting space, protected from the sights and sounds of the general waiting area (but still
observable by staff);
(b) a colourful and welcoming physical environment, with appropriate furniture and colour treatments;
(c) close access to separate procedure areas for simple procedures, which can be upsetting to other
children;
(d) transit routes to radiology or inpatient units that do not traverse other clinical areas; and
(e) a separate patient washroom, within or adjacent to the pediatric clinical area, with size-appropriate
toilet and bathtub.
9.4.4 Space details
Table 9.4 presents the requirements for spaces within emergency care.
The number and type of spaces shall be contingent on the type of emergency management/care based
on community needs, the availability of other services in the area, and the role delineation of the HCF.
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Table 9.4
Key space requirements and recommendations — Emergency care
1 Triage/ N/A See Clause 11 for common requirements and recommendations for an
interview/ exam examination/procedure/treatment room.
room Mandatory:
(a) Storage for personal protective equipment (PPE) shall be provided at the
triage workstation.
(b) Hand hygiene shall be provided by means of a wall-hung sink adjacent to
the triage workstation.
(c) Sharps disposal shall be provided in a safe location and near the point of
use.
(d) Acoustic privacy, both for exchange of information and critical listening
during the triage process, shall be provided.
(e) Storage for clean wheelchairs and stretchers shall be provided adjacent to
triage.
(f) Space for portable oxygen tanks shall be provided near triage, especially
for walk-in patients.
(g) While separate, both the ambulance entry and walk-in entry shall be
served by and converge at the same triage workstation.
Advisory:
(a) Accessible washrooms (with baby changing facilities and provisions for
specimen taking) should be located near triage.
(b) The design should facilitate the transporting of specimens and samples to
the lab.
2 Resuscitation/ 28.0 per bay, See Clause 11 for common requirements and recommendations for an
trauma without examination/procedure/treatment room.
radiology Mandatory:
(a) Overhead procedure lights shall be provided.
35.0 with (b) Medical gas, vacuum, and electrical outlets shall be provided.
built-in
radiology
Advisory:
(a) Ceiling-mounted radiology equipment may be provided; where
provided, the space, service, and control provisions shall be in
accordance with the equipment vendor’s installation recommendations.
(b) Provision should be made for telehealth (e.g., through room colour,
lighting, acoustics, and the placement of microphones, cameras, and
monitors).
3 All exam/ 12.0 See Clause 11 for common requirements and recommendations for an
treatment examination/procedure/treatment room.
rooms Mandatory:
(a) The door shall be sliding glass with provisions for privacy (curtain).
(b) Provisions shall be made in the room for common procedure supplies.
(c) Additional supports (i.e., warming cabinet, nourishment station,
medication cabinet, procedure carts, clinical scale, linen hamper, mobile
lights, patient washrooms, clean supply, and soiled utility rooms) shall be
convenient to the overall treatment area.
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Table 9.4 (Continued)
Advisory:
(a) Telehealth provisions should be considered, with particular attention paid
to room colour, lighting, acoustics, and the placement of microphones,
cameras, and monitors.
(b) Rooms should be laid out in similar configurations.
(c) Providing a ceiling-mounted or portable patient lift should be considered.
(d) IV may be mounted on a mobile pole or on a ceiling track.
4 Acute care 16.5 for See Clause 11 for common requirements and recommendations for an
cubicle critical 3-sided examination/procedure/treatment room.
care room access Mandatory:
At least one of the critical care rooms in the emergency care shall be equipped
with a ceiling-mounted patient lift track.
Advisory:
As noted in Item 3.
5 Examination 12.0 See Clause 11 for common requirements and recommendations for an
room examination/procedure/treatment room.
Mandatory:
As noted in Item 3.
Advisory:
As noted in Item 3.
6 Examination 11.0 See Clause 11 for common requirements and recommendations for an
cubicles — examination/procedure/treatment room.
Large (open Mandatory:
with partial As noted in Item 3, except a curtain track shall be provided in lieu of a sliding
walls) glass door.
Advisory:
As noted in Item 3.
7 Examination/ 9.5 See Clause 11 for common requirements and recommendations for an
treatment examination/procedure/treatment room.
cubicle (open) Mandatory:
(a) As noted in Item 3 for all rooms, except a curtain track shall be provided
around three sides.
(b) The staff workstation, hand hygiene sink, and supplies shall be convenient
and provided at a ratio in accordance with current infection prevention
and control guidelines.
(c) Additional supports (i.e., warming cabinet, nourishment station,
medication cabinet, procedure carts, clinical scale, linen hamper, mobile
lights, patient washrooms, clean supply, and soiled utility rooms) shall be
convenient to the overall treatment area.
Advisory:
As noted in Item 3.
8 Examination/ 7.5 See Clause 11 for common requirements and recommendations for an
treatment chair examination/procedure/treatment room.
(open) Mandatory:
Spacing between treatment chairs shall be in accordance with current
infection prevention and control guidelines.
Advisory:
As noted in Item 3.
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Table 9.4 (Continued)
9 Exam/ 15.5 See Clause 11 for common requirements and recommendations for an
treatment examination/procedure/treatment room.
eye/ENT Mandatory:
As noted in Item 3.
Advisory:
(a) As noted in Item 3.
(b) Depending on the HCF’s operational model and instrument handling
protocols, a utility sink in the work counter may be provided in addition
to the hand hygiene sink.
10 Exam/ 16.5 See Clause 11 for common requirements and recommendations for an
treatment examination/procedure/treatment room.
fracture Mandatory:
(a) As noted in Item 3.
(b) A utility sink with a plaster trap shall be provided in addition to the hand
hygiene sink.
(c) Services for the safe disposal of casting products (fibreglass and plaster)
shall be provided.
Advisory:
As noted in Item 3.
11 Exam/ 12.0 See Clause 11 for common requirements and recommendations for an
treatment with examination/procedure/treatment room.
adjacent Mandatory:
washroom (a) As noted in Item 3.
(b) This room type shall be provided for gynaecological exams and also for
2-pce. washrm 4.6 patients suspected of having non-airborne infections.
(c) A clean area for staff to put on personal protective equipment (PPE)
3-pce. washrm 7.0 before entering the procedure room shall be provided, and may be
shared by up to four rooms provided the distance to the room is not
more than 3.6 m.
Advisory:
(a) As noted in Item 3.
(b) For gynaecological exams, the layout for this room should have the foot
of the patient stretcher oriented away from the door.
(c) Consideration should be given to accommodating other needs (e.g.,
2-piece bariatric washroom [5.6 m2]).
(d) Preparation/supply alcove may be included outside exam rooms.
(e) Alcoves may be shared (by up to 4 rooms); 1.4 m2.
12 Airborne Room area: See Clause 11 for common requirements and recommendations for an
isolation room 12.0 airborne isolation room.
Mandatory:
Ante room: (a) A clean area for staff to put on PPE before entering the procedure room
5.0 shall be provided.
(b) A contained soiled area shall be provided outside the procedure room for
staff to wash up and remove PPE before entering a public corridor.
(c) At least one of the isolation rooms in the emergency care shall be
equipped with a ceiling-mounted patient lift track.
(d) Layout and service requirements shall conform to current infection
prevention and control guidelines.
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Table 9.4 (Continued)
Advisory:
(a) As noted in Item 3.
(b) An anteroom should be provided outside treatment room area to
improve separation.
(c) A washroom should be considered for the isolated patient, as follows:
(i) 4.6 m2 for 2-piece washroom; and
(ii) 5.6m2 for 3-piece washroom.
(d) Consideration should be given to accommodating other needs (e.g.,
2-piece bariatric washroom [5.6 m2]).
(e) Preparation/supply alcove may be included outside isolation rooms:
2.0 m2.
13 Exam — Safe 12.0 See Clause 11 for common requirements and recommendations for an
room examination/procedure/treatment room.
Mandatory:
(a) Mental health safety and risk mitigation guidelines shall be applied,
especially
(i) vertical projections and corners that could cause self-harm shall be
avoided;
(ii) all horizontal projections that could allow climbing or cause
self-harm shall be avoided; and
(iii) a flush protective glazing panel shall be provided at the window (if
present).
(b) Direct access from triage shall be provided, with good access for
emergency medical staff.
(c) Adjacency to the emergency entrance shall be avoided.
(d) Storage shall be provided nearby for restraints (restraint use will depend
on HCF policies and patient disorders).
(e) A patient washroom shall be provided nearby.
(f) Convenient access to a staff hand hygiene sink shall be provided, as
determined by an infection control risk assessment.
(g) An observation window with one-way vision (mirrored) glass of
appropriate size, sill height, and location shall be provided to allow
standing or sitting observation. The door shall be wide enough to allow
entry for a restraint bed (minimum 1100 mm, preferably 1220 mm).
(h) Multi-point door locking with automatic locking function when closed,
shall be provided.
(i) The stretcher position in the room shall be located to optimize patient
privacy.
(j) Acoustic separation from other emergency areas shall be provided.
(k) Examination lighting shall be provided, along with general lighting, with
level control by staff from outside the room, to provide a quiet mood.
(l) Temperature control by staff outside the room shall be provided.
(m) Special finishes shall be provided, as follows:
(i) they shall be easy to maintain and repair without generating toxic
fumes, in order to minimize downtime of rooms; and
(ii) floor and wall finishes shall be washable.
(n) A stretcher with restraint capability and locking wheels shall be provided.
(o) Medical gases shall be provided, if the room is to serve as an exam room,
and shall be located within a securable, tamper-resistant cabinet.
Advisory:
(a) Providing a second exit door should be considered.
(b) Finishes should be sound absorptive, tamper-resistant, and cleanable.
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Table 9.4 (Continued)
14 Exam/ 9.5 (2-sided See Clause 11 for common requirements and recommendations for an
treatment access examination/procedure/treatment room.
short stay-CDU Mandatory:
12.0 (a) As noted in Item 3.
(3-sided (b) A support area (i.e., chair) for the patient’s companion shall be provided.
access) Room lighting control appropriate for longer stays shall be provided.
Advisory:
(a) As noted in Item 3.
(b) The patient may be on an HCF bed or a stretcher.
15 Ambulance According to Mandatory:
garage demand and (a) Sizes may vary depending on size of vehicle, number of vehicles, required
applicable clearances, and degree of enclosure (canopy or fully enclosed).
require- (b) There shall be easy identification for separating ambulance from walk-in
ments traffic.
(c) Access directly to the triage area, separate from walk-in, shall be
Minimum 80 provided.
(d) An entrance to the decontamination room shall be provided from the
ambulance garage.
(e) Adequate ventilation for vehicle exhaust shall be provided.
Advisory:
Use of this space for mass triage and potential decontamination showers
should be considered.
16 Ambulance Vestibule Mandatory:
entrance minimum (a) An easy, visible connection to triage shall be provided, with bypass to
11.0 trauma, resuscitation, and acute care.
(b) An assessment area shall be provided near triage, with easy access for
emergency medical staff.
17 Office — EMS 9.3 Mandatory:
and police The area shall be located next to the ambulance entrance, separate from
triage.
Advisory:
Space may be used for EMS supply storage for restocking ambulance.
Capacity for storage will influence room size.
18 Walk-in Varies See Clause 11 for common requirements and recommendations for a
entrance reception/control area.
Mandatory:
(a) Sufficient vestibule size shall be provided to minimize cold air entry to the
services.
(b) Security shall be adjacent to the walk-in entrance.
(c) The reception/triage area shall be designed to protect against violence.
(d) The reception/triage area shall be designed to protect against infection.
Advisory:
Sufficient space for screening entrants to the services should be considered.
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Table 9.4 (Continued)
19 Triage waiting Varies; See Clause 11 for common requirements and recommendations for a waiting
general assume 1.5 room.
per seat Mandatory:
(a) The area shall be located to ensure visibility from the triage desk.
Wheelchair/ 3.0 (b) Triage waiting shall be separate from the main waiting area.
scooter/
bariatric Advisory:
(a) Acoustic separation for privacy and confidentiality should be considered.
Stretcher 5.0 (b) Provision should be made for other seating needs, depending on
catchment community.
20 Medication Varies Mandatory:
area depending The necessary security for narcotics shall be provided.
on delivery Advisory:
model (a) Ease of access for staff should be considered.
Not less (b) Drug dispensing systems should make use of technology (e.g., bar
than 9.5 coding) to facilitate safety and security.
21 Staff station 4.6 for each See Clause 11 for common requirements and recommendations for a primary
workstation communication station.
and Mandatory:
additional (a) Central staff areas shall be provided for each area within the services,
circulation located to accommodate visibility.
space (b) The station shall be sized to accommodate anticipated staffing
arrangements, and the requirements for confidentiality, consulting, and
charting.
(c) The station shall have a radio, telephone, and intercommunication
systems.
Advisory:
Pneumatic tubes should be considered for direct connections to the
laboratory and pharmacy.
22 Physician’s 4.6 See Clause 11 for common requirements and recommendations for a
consult room consultation room.
open/ Mandatory:
workstation The technology necessary for consultation, dictation, and picture archiving
Private office 9.3 communications system (PACS) shall be provided.
(1 physician) Advisory:
Provision should be made for telehealth, e.g., through room colour, lighting,
Shared office 12.0 acoustics, the selection and placement of furniture, and adequate space for
(2 physicians — telehealth equipment.
add 4.6 for
additional)
23 Equipment Varies See Clause 11 for common requirements and recommendations for a storage
holding room.
alcove/room Mandatory:
The alcove/room shall be located to minimize travel distance for staff
(decentralized for large services).
Advisory:
All potential equipment storage needs and service requirements should be
considered.
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Table 9.4 (Concluded)
24 Staff room 11.0 See Clause 11 for common requirements and recommendations for a
Varies departmental/staff lounge.
Minimum Mandatory:
(small centre) (a) The staff room shall be located within the services but away from the
main activity and patient areas.
Maximum (b) Kitchenette equipment shall be provided.
(larger centre)
Advisory:
Natural light should be considered.
25 Change/locker Varies Mandatory:
room (a) The room shall be located near the staff room for shift changes.
(b) Change cubicles, shower facilities, and washroom facilities shall be
Purse 0.15 provided.
Advisory:
Half-locker 0.4 (a) Security needs should be considered.
(b) Collocation of lockers and staff room/lounge should be considered.
Full height 0.7 (c) Adding washroom and shower to locker rooms should be considered.
locker
26 Bereavement 11.0 Mandatory:
room (minimum) (a) There shall be a quiet room appearance.
(b) The room shall be located near trauma resuscitation, with discrete
access/egress.
Advisory:
The potential for family viewing should be considered.
27 Crisis interview 11.0 Mandatory:
room (a) A safe staff exit path to the door shall be provided by locating the
interview table at the back of the room; the staff task chair may be used
in an interview position closest to the door.
(b) A workstation, task chair, three interview chairs, and coffee table (or no
table) shall be provided.
(c) There shall be a quiet room appearance.
(d) The room shall be located near the exam/treatment safe room.
Advisory:
A second exit door should be considered.
28 Decontamin- 7.5 Mandatory:
ation room clear floor (a) Direct access from the exterior shall be provided.
area (b) Water- and chemical-resistant surfaces and sealed doors shall be
provided.
Advisory:
(a) An anteroom accessed from within the services, for staff gowning,
should be considered.
(b) Direct access should be considered for patient transfer from
decontamination room to isolation room.
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9.5 Procedures
9.5.1 Description
Clause 9.5 provides requirements for the design and construction of environments for the conduct of a
range of inpatient and outpatient surgical and non-surgical procedures conducted under local, conscious
sedation, regional or general anaesthesia requiring medical and/or nursing support, and the pre- and
post-procedural management of patients undergoing procedures.
The range of procedures provided can include
(a) endoscopy;
(b) cystoscopy;
(c) bronchoscopy;
(d) minor surgical procedures under local or heavy sedation or general anaesthesia, e.g., plastics,
orthopaedics, ENT, gynaecology, general surgery, and ophthalmology;
(e) major surgical procedures requiring general or regional anaesthesia, such as plastics, orthopaedics,
cardiac surgery, neurosurgery, ENT, gynaecology, general surgery, urology, and ophthalmology;
(f) interventional medical imaging;
(g) interventional cardiology (cardiac catheterization/electrophysiology);
(h) pacemakers/ICD;
(i) lithotripsy;
(j) pain management procedures, diagnostic and regional blocks, implantable spinal stimulators;
(k) urodynamics;
(l) manometry; and
(m) medical day care procedures (e.g., infusions, IV therapy, PIC lines, etc.).
Facilities supporting these procedural services can include ambulatory care centres, free-standing
surgicentres, and acute and long term care HCFs. Within HCFs, all procedures may be centralized to
maximize flexibility and operational efficiency or decentralized to ambulatory care, specialized areas
(endoscopy suite, emergency care, cardiac catheterization labs, interventional imaging suites, etc.) and
within a surgical suite. These requirements apply regardless of whether the procedures are located within
an HCF (of any type), free-standing surgicentre, or in an outpatient/ambulatory centre (standalone or
combined with other clinical services).
9.5.2 Functional requirements
9.5.2.1 Patient management
9.5.2.1.1
Pre- and post-operative spaces and systems should be designed to accommodate the patient’s and family’s
needs for privacy and confidentiality, and family participation in care, while maintaining staff’s ability to
provide efficient and effective nursing care.
9.5.2.1.2
Provisions shall be made for privacy and confidentiality during the initial processing, for
consultation/discussion with families, etc.
9.5.2.1.3
A private and secure area shall be provided for patient’s belongings.
9.5.2.1.4
The pre-operative care and second stage recovery area should be designed to ensure flexibility in use
between the two areas and should consider patient privacy and confidentiality yet allow observation by
nursing staff.
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9.5.2.1.5
Where volumes permit, consideration should be given to organizing the pre-operative care and second
stage bays in clusters. The number and type of clusters should consider efficient staffing and, where
applicable, may be organized to support pre-operative care cluster(s) and post-operative care cluster(s) or
to support specific subspecialties.
9.5.2.1.6
Where possible, the design of the surgical area should minimize the interface between the patient/family
and the support services/technical areas (supporting the concept of an “on stage/off stage” design).
9.5.2.1.7
An electronic operating room (OR) scheduling/booking system should be provided, especially to address
wait times and urgent/emergent procedures.
9.5.2.1.8
All aspects of care should be consistent with the principles of family-centred care.
9.5.2.1.9
The number of patient transfers from place to place and from staff to staff should be minimized.
9.5.2.1.10
Travel distances from the operating rooms to the area where the patient will undergo first stage recovery,
including the PACU, should be minimized.
9.5.2.1.11
Patient care, services, and facilities shall support the management of infectious diseases and reduce the risk
of nosocomial infections. The number and type of isolation rooms required will depend on the volume and
scope of service and an infection control risk assessment of individual HCFs.
9.5.2.1.12
The design should allow the option of isolation during the pre-operative and recovery periods.
9.5.2.1.13
Options to provide isolation during the operative period should be considered and may include vestibules
at the entrances to the operating room(s).
9.5.2.1.14
If there is sufficient volume, a separate pediatric area for day surgery and recovery should be considered.
9.5.2.1.15
Special consideration should be made to ensure patient-centred care and infection prevention and
control, and the accommodation of families or caregivers, as it relates to the process for patient changing,
storage of clothing, and access to washroom facilities.
9.5.2.1.16
If the unit treats pediatric patients, it shall have the appropriate accommodations to meet the particular
needs of this patient group
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9.5.2.2 Workflow
9.5.2.2.1
The following services shall be provided with direct connections to operating rooms though restricted
corridors:
(a) operating room control and communications office;
(b) pre-operative inpatient holding area;
(c) stage one recovery area (PACU);
(d) regional anaesthesia block area;
(e) perfusionists’ workroom, preferably adjacent to cardiac operating rooms;
(f) anaesthesia equipment and respiratory services satellite workroom;
(g) equipment storage;
(h) sterile supply storage;
(i) housekeeping closets;
(j) orthopaedic implant storage;
(k) alcoves for medical imaging C-arm storage; and
(l) staff change facilities.
9.5.2.2.2
Services requiring a convenient connection to operating rooms though semi-restricted corridors include
(a) pre-operative/procedure preparation area/stage two recovery area;
(b) family/supporter waiting area;
(c) cardiac catheterization laboratory; and
(d) staff change facilities (which should also should provide access to the restricted corridor).
9.5.2.2.3
Services requiring a direct connection to stage one recovery (PACU) through restricted corridors include
(a) operating rooms;
(b) stage two recovery area; and
(c) endoscopy rooms.
9.5.2.2.4
Services requiring a convenient connection to stage one recovery (PACU) though semi-restricted corridors
include
(a) interventional cardiology; and
(b) interventional medical imaging.
9.5.2.2.5
Services requiring a convenient connection to the pre-operative/procedure preparation/stage two
recovery area include
(a) patient washroom; and
(b) family/supporter waiting area.
9.5.2.3 Support service delivery
9.5.2.3.1
The design shall ensure separate traffic flows for sterile and soiled materials and separate storage areas for
supplies and equipment.
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9.5.2.3.2
All reprocessing should be done in a central medical device reprocessing area (MDR).
9.5.2.3.3
There shall be direct access to the MDR with provisions to ensure separation of clean and soiled materials.
9.5.2.3.4
The holding of soiled materials should be minimized and direct/easy access should be provided to
remove/transfer material to the MDR.
9.5.2.3.5
Provision shall be made for adequate equipment storage. The size and type will vary by HCF but the
requirements for dispersed equipment, centralized equipment, and some decentralized area outside
and/or shared between operating and procedure rooms should be carefully considered.
9.5.2.3.6
The design shall provide for the flow and safe storage of all medications, including locked storage for
controlled drugs. Consideration should be given to a satellite pharmacy.
9.5.2.3.7
The design shall provide for the safe and efficient transfer of specimens, especially blood samples, to and
from the laboratory.
9.5.2.3.8
Respiratory/anaesthetic services shall be provided within the restricted area and shall be easily accessible.
9.5.2.3.9
Biomedical services should be provided, either within or adjacent, and be easily accessible.
9.5.3 Technical requirements
9.5.3.1 Operating and procedure rooms
9.5.3.1.1 General operating room(s)
The following requirements apply to all operating rooms:
(a) Each room shall have a system for emergency communication with the surgical suite control station.
(b) X-ray film viewers for handling at least four films simultaneously or a PACS workstation (digital image
viewers) shall be provided.
(c) Operating room perimeter walls, ceiling, and floors, including penetrations, shall be sealed.
(d) Medical gas terminal units shall be provided in accordance with Annex F of CSA Z7396.1.
(e) A scavenging system for medical gases shall be provided.
(f) A surgical plume scavenging system shall be provided if electrocautery or laser procedures will be
used. See CSA Z305.13.
(g) Provision shall be made for patient warming systems.
9.5.3.1.2 Special operating room(s)
For room(s) for cardiovascular, orthopaedic, neurological, and other special procedures that require
additional personnel and/or large equipment, the following shall apply:
(a) where open-heart surgery is performed, an additional room in the restricted area of the surgical suite,
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preferably adjoining the operating room, shall be designated as a pump (perfusion) room where
extra corporeal pump(s), supplies, and accessories are stored and serviced;
(b) where complex orthopaedic and neurosurgical surgery is performed, additional rooms shall be in the
restricted area of the surgical suite, preferably adjoining the specialty operating rooms, which shall be
designated as equipment storage rooms for the large equipment used to support these procedures;
and
(c) appropriate plumbing and electrical connections shall be provided in the cardiovascular, orthopaedic,
neurosurgical, pump, and storage rooms.
9.5.3.1.3 Additional requirements for orthopaedic surgery
Rooms for orthopaedic surgery shall have enclosed storage space for splints and traction equipment.
Storage may be outside the operating room but shall be conveniently located. If a sink is used for the
disposal of plaster of Paris, a plaster trap shall be provided.
9.5.3.1.4 Pediatric operating rooms
For pediatric patients,
(a) procedure rooms in pediatric facilities shall have a pre-procedure waiting area for parents and
families;
(b) the pre-procedure waiting area shall be large enough to accommodate the number of families that
could be waiting and accommodate the differing age groups that will be there;
(c) the waiting area should be comfortable and non-clinical, with AV equipment and toys appropriate to
the expected patient population. There should be a play area with the necessary storage spaces and
electrical services and provisions for the cleaning/decontamination of toys;
(d) additional space shall be provided for the donning and removal of cover gowns by parents/guardians
who will accompany their child into the operating theatre;
(e) provisions for pediatric surgical services in non-hospital facilities should be adapted to the expected
patient load and procedures that are expected in the facility; and
(f) depending on the size of the OR, there should be a washroom for the children, parents, and families
if needed.
9.5.3.1.5 Procedure room(s)
The following requirements apply to all procedure rooms:
(a) Each room shall have a system for emergency communication with the main communication and
control station.
(b) X-ray film viewers for handling at least four films simultaneously or a PACS workstation (digital image
viewers) shall be provided.
(c) Perimeter walls, ceiling, and floors, including penetrations, shall be sealed.
(d) Medical gas terminal units shall be provided in accordance with Annex F of CSA Z7396.1.
(e) A scavenging system for medical gases should be provided, according to the services used.
(f) A surgical plume scavenging system shall be provided if electrocautery or laser procedures will be
used. See CSA Z305.13.
(g) The need to maintain for patient warmth shall be considered in the design (e.g., by providing
temperature controls) and provision shall be made for patient warming systems.
(h) Direct access to a Stage 2 recovery area shall be provided.
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9.5.3.2 Pre- and post-operative/procedure holding area
9.5.3.2.1 General
In facilities with two or more operating rooms, areas shall be provided to accommodate stretcher patients
as well as seating space for ambulatory patients. These areas shall be located under the direct visual
control of the staff and may be part of the recovery area to achieve maximum flexibility in managing
surgical/procedural caseloads. Additional requirements for these areas are as follows:
(a) Provisions shall be made for patient privacy, e.g., cubicle curtains.
(b) Medical gas terminal units shall be provided in accordance with Annex F of CSA Z7396.1.
(c) Provision shall be made for the isolation of infectious patients.
(d) An infection control risk assessment shall be performed to determine the need for additional
provisions for the recovery of a potentially infectious patient with an airborne infection.
9.5.3.2.2 Stage one recovery/post-anaesthetic care units (PACUs)
At least one door to the recovery room shall provide access directly from the surgical suite without
crossing public HCF corridors. The requirements for stage one recovery or post-anaesthetic care units
(PACUs) shall be as follows:
(a) The unit shall contain
(i) a medication station;
(ii) waterless hand hygiene stations;
(iii) a nurse station with charting facilities;
(iv) a clinical sink;
(v) provisions for bedpan cleaning;
(vi) storage space for stretchers, supplies, and equipment; and
(vii) a PACS workstation for digital image viewing.
(b) Medical gas terminal units shall be provided in accordance with Annex F of CSA Z7396.1.
(c) Provisions for patient privacy such as cubicle curtains shall be made.
(d) Hand hygiene sink(s) shall be provided in a location designed
(i) for one patient to be present at a time: one sink; or
(ii) to accommodate four or more patients at a time: a minimum of one sink for every four beds,
uniformly distributed to provide equal access from each bed.
(e) A staff toilet shall be located within the working area to maintain staff availability to patients.
(f) Provisions shall be made for the isolation of infectious patients.
(g) Provisions for the recovery of a potentially infectious patient with an airborne infection shall be
determined by an infection control risk assessment.
9.5.3.2.3 Stage two recovery
Where outpatient surgeries are to be part of the surgical environment, and where outpatients receive
sedation or simply require observation following a procedure, a separate stage two or step-down recovery
room shall be provided. The requirements for this room are as follows:
(a) Where the PACU is provided on-site, at least one door shall access the PACU without crossing
unrestricted corridors of the HCF.
(b) Provisions for patient privacy such as cubicle curtains shall be made.
(c) Medical gas terminal units shall be provided in accordance with Annex F of CSA Z7396.1.
(d) The room shall contain
(i) a medication station;
(ii) waterless hand hygiene stations;
(iii) a nurse station with charting facilities;
(iv) a clinical sink;
(v) provision for bedpan cleaning; and
(vi) storage space for supplies and equipment.
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(e) Hand hygiene sinks shall be provided in a location designed
(i) for one patient to be present at a time: one sink; or
(ii) to accommodate four or more patients at a time: a minimum of one sink for every four patients,
uniformly distributed to provide equal access from each location (i.e., recovery chair/lounge or
bed).
(f) A staff toilet(s) shall be provided with direct access to the working area to maintain staff availability to
patients.
(g) A patient toilet(s) shall be provided with direct access to the stage two recovery unit for the exclusive
use of patients.
(h) Provisions shall be made for the isolation of infectious patients.
(i) Provisions for the recovery of a potentially infectious patient with an airborne infection shall be
determined by an ICRA.
9.5.3.3 Diagnostic and treatment locations
9.5.3.3.1
Provisions shall be made for examination, interviews, preparation, testing, and obtaining vital signs of
patients for outpatient surgery or other non-surgical procedures.
9.5.3.3.2
Area for preparation and examination of frozen sections (i.e., cryosection) may be part of the general
laboratory if immediate results are obtainable without unnecessary delay in the completion of surgery.
9.5.3.4 Support areas for the procedure area
9.5.3.4.1
A control station shall be located to permit visual observation of all traffic into the suite.
9.5.3.4.2
The number of offices, stations, and teaching areas shall depend upon the functional program.
9.5.3.4.3
A dictation and report preparation area should be accessible from the lounge area.
9.5.3.4.4
Two scrub positions (i.e., scrub sinks) shall be provided near the entrance to each operating room:
(a) Two scrub positions may serve two operating rooms if both positions are adjacent to the entrance of
each operating room.
(b) Means shall be provided for visual or audio communication between the scrub sinks and the
operating room.
(c) The scrub positions shall be located as follows:
(i) if located in the restricted outside corridor, the scrub positions shall be recessed into an alcove
out of main traffic areas areas; or
(ii) if located in the centre clean core, the scrub positions shall be beside the entrance door to the
OR and be separated by a barrier/wall to minimize incidental splatter on nearby personnel,
medical equipment, or supply carts in the clean core.
9.5.3.4.5
Provision shall be made for storage and distribution of drugs and routine medications.
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9.5.3.4.6
A dispensing type ice machine shall be provided. An ice machine with an open bin shall not be used.
9.5.3.4.7
In facilities with two or more operating rooms, an area shall be provided to accommodate stretcher
patients waiting for surgery. This holding area shall be under the visual control of the staff.
9.5.3.4.8
A sub-sterile service area shall be provided. This area may serve one or more operating or procedure
rooms. The sub-sterile service area shall be equipped with
(a) a warming cabinet;
(b) a sterile supply storage area; and
(c) a hand hygiene sink.
9.5.3.4.9
A restricted-access area outside of the procedure room shall be provided for emergency (flash)
sterilization. This area shall have the necessary utilities for the sterilization equipment and shall be designed
and located in accordance with CSA Z314.3. The emergency sterilization area may be arranged to service
more than one procedure room. The design for this area shall be developed in consultation with medical
device reprocessing and infection prevention and control staff.
9.5.3.4.10
Soiled and clean workrooms or holding rooms shall be separated. Storage space for sterile and clean
supplies shall be sized to meet the requirements of the functional program. The following shall apply:
(a) The storage space shall be moisture and temperature controlled and free from cross-traffic. This space
shall be separate from the clean and soiled workrooms.
(b) The clean workroom shall contain a work counter, a hand hygiene sink, and storage facilities for clean
supplies.
(c) The clean workroom, soiled workroom, and supply room shall not be used for food preparation.
(d) If the clean supply room is used only for storage and holding as part of a system for distribution of
clean and sterile supply materials, the work counter and hand hygiene sink may be omitted.
9.5.3.4.11
An enclosed soiled workroom (or soiled holding room that is part of a system for the collection and
disposal of soiled material) shall be provided for the exclusive use of the surgical suite. Requirements for
soiled workrooms or holding rooms shall be as follows:
(a) The room shall be located in the restricted area.
(b) The soiled workroom shall contain a flushing-rim clinical sink or equivalent flushing-rim fixture, a
hand hygiene sink, a work counter, and space for waste receptacles and soiled linen receptacles.
Rooms used only for temporary holding of soiled material may omit the flushing-rim clinical sink and
work counters. However, if the flushing-rim clinical sink is omitted, other provisions for disposal of
liquid waste shall be provided.
(c) The room shall not have direct connection with operating rooms or other sterile activity rooms.
(d) The soiled workroom shall include a fume hood for the handling and use of noxious cleaning and
sterilizing agents.
(e) If a case cart system will be used, there shall be sufficient space to hold carts with soiled items before
they are moved to the MDRD.
9.5.3.4.12
An anaesthesia workroom for cleaning, testing, and storing anaesthesia equipment shall be provided and
shall include
(a) a work counter and sink and racks for cylinders;
(b) a fume hood for the handling and use of noxious cleaning and sterilizing agents;
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(c) provisions for separate storage of clean and soiled items; and
(d) depending on the functional and space programs, the anaesthesia workroom shall provide space for
anaesthesia case carts and other anaesthesia equipment.
9.5.3.4.13
Provisions for refrigerated blood bank storage that meets CAN/CSA-Z902 shall be provided. Where
applicable, refrigeration facilities for harvested organs shall be provided.
9.5.3.4.14
Provisions for storage of specimens prior to transfer to pathology section shall be provided.
9.5.3.4.15
Storage room(s) shall be provided for equipment and supplies. Each surgical suite shall provide sufficient
storage area to keep its required corridor width free of equipment and supplies, but not less than
13.94 m2 or 4.65 m2 per operating room, whichever is greater.
Storage areas shall be provided for portable X-ray equipment, stretchers, fracture tables, warming
devices, auxiliary lamps, etc. These areas shall be out of corridors and traffic.
Main storage of medical gases may be outside or inside the facility in accordance with CSA Z7396.1.
Provision shall be made for additional separate storage of reserve gas cylinders necessary to complete at
least one day’s procedures in accordance with CSA Z305.12.
9.5.3.4.16
Housekeeping facilities shall be provided for the exclusive use of the procedures area. They shall be directly
accessible and shall contain a service sink or floor receptor and provisions for storage of supplies and
housekeeping equipment.
9.5.3.5 Support areas for staff
9.5.3.5.1
Separate or combined lounges shall be provided for male and female staff. Lounge(s) shall be designed to
(a) minimize the need to leave the suite; and
(b) provide convenient access to the stage one recovery/post-anaesthetic care units (PACUs).
9.5.3.5.2
Appropriate areas shall be provided for male and female personnel (orderlies, technicians, nurses, and
doctors) working within the surgical suite, as follows:
(a) The areas shall contain lockers, showers, toilets, hand hygiene stations, and space for donning
surgical attire.
(b) These areas shall be arranged to encourage a one-way traffic pattern so that personnel entering from
outside the surgical suite can change and move directly into the surgical suite.
(c) Toilets and hand hygiene stations shall be convenient to the work areas in the OR and there shall be a
sufficient number to serve the expected staff population.
(d) Lockers shall be large enough to contain staff clothing through all seasons (e.g., winter coats and
boots) and secure against unauthorized access. Additional lockers should be available for visiting
physicians, staff, and students.
9.5.3.5.3
Appropriate areas shall be provided for administrative, reference, and educational activities (e.g., teaching,
library, office, support, education, conference).
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9.5.3.5.4
Offices for active on-call staff and physicians (e.g., anaesthesiologists) shall be located to allow quick and
convenient access to procedure rooms and first stage recovery rooms.
9.5.3.6 Support areas for patients
If the functional program defines outpatient surgery as part of the surgical suite, a separate area shall be
provided where outpatients and same-day admission patients can change from street clothing into HCF
gowns and be prepared for surgery. It shall include a waiting room, locker(s), toilet(s), and clothing
change or gowning area.
9.5.3.7 Cardiac catheterization lab (cardiology)
9.5.3.7.1 General
If electrophysiology labs are also provided in accordance with the approved functional program, these labs
may be located within and integral to the catheterization suite or located in a separate functional area
proximate to the cardiac care unit.
9.5.3.7.2 Support areas for the cardiac catheterization lab
The following support areas shall be provided for the cardiac catheterization lab:
(a) scrub facilities with hands-free operable controls adjacent to the entrance of procedure rooms and
arranged to minimize incidental splatter on nearby personnel, medical equipment, or supplies;
(b) a patient preparation, holding, and recovery area or room, arranged to provide visual observation
before and after the procedure;
(c) a control room or area large enough to contain and provide for the efficient functioning of the X-ray
and image recording equipment. It shall include a view window permitting full view of the patient
from the control console;
(d) an equipment room or enclosure large enough to contain X-ray transformers, power modules, and
associated electronics and electrical gear; and
(e) a viewing room for use by the cardiac catheterization suite.
9.5.3.8 Procedure room(s)
9.5.3.8.1
Procedure rooms shall be designed for visual and acoustical privacy for the patient.
9.5.3.8.2
Station outlets for oxygen and medical vacuum shall be available in the procedure room. See Annex F of
CSA Z7396.1.
9.5.3.8.3
A separate dedicated hand hygiene sink shall be available in the room.
9.5.3.8.4
A system for emergency communication shall be provided.
9.5.3.8.5
Floor covering in the procedure suite shall be monolithic and joint free.
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9.5.3.9 Procedure room(s) instrument processing room(s)
9.5.3.9.1 Processing rooms
If reprocessing of medical devices (e.g., endoscopes) will be performed in the procedures area, dedicated
processing room(s) shall be provided and these shall comply with CSA Z314.3 and CAN/CSA-Z314.8. A
physical barrier shall be provided to prevent droplet contamination on the clean side. Clean equipment
rooms shall protect the clean equipment from contamination. Clean and sterile medical devices shall be
stored in a sterile storage area complying with CSA Z314.3. A fume hood for the use of noxious cleaning
and sterilizing chemicals shall be provided.
9.5.3.9.2 Decontamination
The decontamination area shall comply with CAN/CSA-CSA Z314.8 and be equipped with the following:
(a) utility sinks as appropriate to the method of decontamination used;
(b) one freestanding hand hygiene sink;
(c) work counter space(s);
(d) space and utility connections for automatic endoscopic reprocessor, sonic cleaner, and sterilizers
(where required by the functional program);
(e) ventilation system in accordance with CAN/CSA-Z317.2;
(f) provision for vacuum and/or compressed air, as appropriate to cleaning methods used; and
(g) a floor covering that is monolithic and joint free with a 152 mm integral cove base.
9.5.3.10 Medical gas scavenging
Adequate scavenging of medical gases shall be provided.
9.5.3.11 Patient warmth
Patient warmth is an important issue and should be provided for in the design.
9.5.3.12 Design detail
The following is a checklist of the critical items to be addressed:
(a) appropriate, convenient, and easily accessible locations shall be provided for supplies and cleaned
equipment;
(b) appropriate holding space shall be provided for soiled equipment that requires cleaning;
(c) provision for a staff lounge in either a team room or shared in a central area shall be provided;
(d) provision should be made for education (i.e., adequate space and audio-visual facilities);
(e) consideration should be given to providing a layout where staff workstations and support areas are
separated from reception, waiting, and patient care areas;
(f) positive distractions (e.g., acoustic, visual, entertainment, or daylight) should be considered,
particularly for lengthy procedures or recovery and pain management; and
(g) the ceiling design should be taken into account, especially for areas such as procedure rooms and
recovery areas where patients are on their backs for long periods of time.
9.5.3.13 Telehealth
If telehealth services are incorporated, the necessary support and services for telehealth shall be provided.
Relevant factors include room area, lighting, camera position, service requirements, acoustic
characteristics, wall colour, and furniture layout, including the following:
(a) proper illumination levels shall be attained to ensure accurate skin colour. Standard fluorescent
fixtures (usually 600 mm × 1200 mm) with colour corrected fluorescent tubes (Kelvin 4100
recommended) and clear acrylic prismatic diffusers should be used. Egg-crate diffusers should not be
used as these concentrate the light, creating hot spots;
(b) all four walls should be painted in a medium blue in order to provide accuracy in skin tone. An
eggshell or matte finish should be used, provided it can be cleaned to OR standards.
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(c) rooms used for telehealth should be located away from sources of internal and external noise and
vibration (e.g., fans, air conditioners, or plumbing) as some videoconferencing microphones can be
very sensitive to noise. Microphones should be placed in front of and close to the individuals
speaking, but at least 1200 mm away from the videoconferencing unit. Consideration should be give
to the provision of wireless microphones; and
(d) if telehealth services or procedures requiring full room darkening are incorporated, black-out shades
shall be provided.
9.5.3.14 Acoustics
A central music system shall be provided for each operating and procedure room.
9.5.3.15 Lighting
9.5.3.15.1
The nature of lighting and lighting control should be reviewed to establish level requirements, number
and type of sources, and the method and location of controls for convenient and easy operation.
9.5.3.15.2
Lighting shall be adaptable for minimally invasive surgery use, with dimmable spotlights and zoned
switching of fluorescent fixtures.
9.5.3.15.3
Lighting shall be adaptable for endoscopy use, with dimmable pot lights and zoned switching of
fluorescent fixtures.
9.5.3.15.4
For surgical suite/interventional procedure rooms,
(a) lighting shall be adaptable for minimally invasive surgery use, with dimmable pot lights and zoned
switching of all lighting fixtures;
(b) high level windows into operating rooms and the PACU from a corridor where natural light is
available should be considered. Blinds may be used for patient privacy and to control light, provided
the design is consistent with infection prevention and control considerations; and
(c) natural light, if available, should be provided with effective shading controls.
9.5.3.15.5
Natural light should be provided in corridors wherever possible.
9.5.3.15.6
Laser protection shall be provided at windows.
9.5.3.15.7
Warning lights shall be provided for lasers and X-rays.
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9.5.3.16 Infection prevention and control
9.5.3.16.1 General
Provisions for infection prevention and control in operating rooms and procedure rooms shall include the
following:
(a) There shall be no floor drains.
(b) Laminar flow diffusers shall be provided over the patient, with low level exhaust in corners of the OR.
(c) Laminar flow systems in arthroplasty joint replacement surgery operating rooms shall be provided.
(d) The design shall specify the flow of supplies and maintain separation between clean and
contaminated equipment.
(e) Hygiene sinks and supplies shall be immediately outside of an operating room or procedure room.
(f) Scrub facilities (scrub sinks) with hands-free operable controls shall be provided adjacent to the
entrance of procedure rooms and shall be arranged to minimize incidental splatter on nearby
personnel, medical equipment, or supplies.
(g) Management of soiled scopes and storage for clean scopes and other equipment shall be in
accordance with CAN/CSA-Z314.8 and infection prevention and control guidelines.
9.5.3.16.2 Isolation operating rooms
Consideration should be given to providing an isolation operating room. Such facilities may be located at
selected HCFs on a regional basis.
9.5.3.17 Occupational health and safety
Provisions for occupational health and safety shall include the following:
(a) Local thermostat controls, for measurement and control within a specific range, should be located in
the OR.
(b) Patient sliders shall be provided for the transfer of patients to the surgical table from a bed or
stretcher. Sliders should be located in each room.
(c) No electrical outlets shall be placed in the OR floors.
(d) Redundancy shall be provided in electrical plugs for normal and emergency power.
(e) Electrical outlets shall be located within medical supply units (e.g., articulating arms) as well as
distributed around the room on the walls.
(f) Functional and storage space shall be provided for
(i) chemicals used in the unit;
(ii) patient handling devices;
(iii) medical gas cylinders in compliance with CSA Z7396.1; and
(iv) sharps disposal containers.
(g) Anaesthetic gas scavenging shall comply with CSA Z7396.1.
(h) Surgical plume scavenging shall comply with CSA Z305.13.
(i) Functional space shall be provided for adjustable computer workstations.
(j) The layout of writing surfaces shall be designed according to ergonomic principles (i.e., proper height
for staff without sharp edges against the wrist).
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(k) Ergonomics of medical equipment should comply with IEC 62366.
(l) Non-slip flooring shall be provided.
(m) Local exhaust ventilation of the space used for cleaning equipment should be considered in order to
reduce exposure to chemicals.
(n) If clean supply spaces are used for setting up for procedures, those spaces shall be equipped with
hand hygiene facilities.
(o) Eyewash facilities shall be provided when chemicals are being used.
9.5.3.18 Technology considerations
In addition to the common set of technology and communication requirements for HCFs, the following
provisions shall be made:
(a) Adequate information technology and communications connections shall be provided for internal
communications to the surgical suite as well as external communications.
(b) Secure space with UPS and generator backup shall be provided for network switches at a minimum
area of 6 m2.
(c) Multiple access points to the local area network shall be provided on the anaesthesia and surgical
articulating arms.
(d) An OR tracking system may be provided, with cameras in operating rooms and a review station in the
OR control centre. There shall be means to disable the camera.
(e) Local overhead paging shall be provided in the corridors, not in the operating rooms. Alternative
communications systems may be used.
(f) A locating system for staff, with communication devices or intercom systems, shall be provided.
(g) There shall be separate telephones at the nurses’ desk and shall be at a location convenient to
anaesthesiologists from where they can see their monitoring equipment. A computer for the surgeon
should be provided. Consideration should be given to wireless VoIP phones for highly mobile staff.
(h) Asset tracking systems should be considered.
(i) A patient tracking system should be considered (e.g., radio frequency identification [RFID] or other
technology).
(j) A local cardiac arrest/staff assist call system, to include PACU, shall be provided in addition to the
HCF-wide code blue system.
(k) Picture archiving and communication systems (PACS) shall be provided in each operating room, the
PACU, and the preoperative preparation area.
(l) Videoconferencing capabilities shall be provided.
(m) Remote alarms shall be provided for the blood fridge, bone freezer, and pharmacy dispensing unit to
the OR control desk, blood bank lab, and a centrally monitored location (HCF switchboard).
(n) Workstations shall be sufficiently sized for electronic documentation and accessing digital images and
information. There shall be at least a workstation for the nursing documentation, a workstation for
the anaesthesia information system and one for the diagnostic imaging PACS system in each OR.
(o) If machines are used for OR greens distribution, HCF network access shall be provided with these
dispensing machines.
(p) A system using mobile operating room tables with integrated wireless monitoring systems may be
used in the preparation area to minimize patient transfers.
(q) Patient physiological monitoring systems (ECG, NIBP, SpO2, and temperature) should be compatible
and networked to allow easy transfer of patient between areas.
(r) Consideration shall be given for the provision of cellular phone coverage by repeaters in the
operating rooms.
9.5.3.19 Safety and security
Some of the ambulatory care procedure areas are used 24 h a day. The following safety and security
measures should be included in the design of such units:
(a) security cameras;
(b) ability to lock down the unit after hours;
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(c) provision for secure medical dispensing located in the unit or within a satellite pharmacy; and
(d) adequate storage systems for routine supplies and special materials such as implants.
9.5.4 Space details
Table 9.5 presents the standard requirements for key spaces in the procedures area. Common areas are
detailed in Clause 11.
Table 9.5
Key space requirements and recommendations — Procedures
1 Operating 55.0 Mandatory:
room, (a) Minimum ceiling height shall be 3.5 m.
general (b) Minimum shall be 3000 mm from sides of operating table and any wall or any
other fixed obstruction and minimum 2400 mm from head and 3000 mm
from foot of the operating table, exclusive of fixed casework.
(c) The anaesthetic medical gases shall be positioned so that they are on the
opposite side of the OR table from the patient entry door into the room.
(d) Patient access door openings shall be at least 1800 mm wide.
(e) Access doors to central core shall be at least 1200 mm wide.
Advisory:
(a) Standardization of room configurations should be considered to allow for
flexibility in use over time as services evolve to more technologically
advanced robotic/telesurgery and minimally invasive surgery or to
accommodate a change in the surgical specialties offered.
(b) Room configuration should be close to square.
(c) The integration of ceiling-mounted articulating surgical and anaesthesia arms
should be considered to add future flexibility.
(d) Consideration should be given to sizing and locating a storage room to OR
size and location standards to allow for future use as an OR.
2 Operating 60.0 Mandatory:
room, (a) Minimum ceiling height shall be 3.5 m.
special (b) Minimum shall be 2400 mm from head and 3600 mm from foot of operating
table exclusive of fixed casework.
(c) The anaesthetic medical gases shall be positioned so that they are on the
opposite side of the OR table from the patient entry door into the room.
(d) If an anteroom is provided for an isolation OR, the following shall apply:
(i) if the anteroom is designed as an air-lock for stretchers, internal length
shall be 2.4 m minimum;
(ii) the anteroom shall be negatively pressurized relative to the operating
room so that air flows from the OR into the anteroom;
(iii) the anteroom shall be negatively pressurized relative to the corridor so
that air flows into the anteroom and not out into the corridor; and
(iv) at the patient access location, the anteroom shall be sized adequately so
that the patient can be moved from the OR into the anteroom with both
doors closed. The room pressurization shall be rebalanced before the
corridor door is opened.
Advisory:
(a) Room configuration should be close to square.
(b) If OR is used for isolation, an anteroom should be added at each entrance
(5.0 m2 for staff access and 10.0 m2 for stretcher/air-lock).
(c) The anaesthetic medical gases should be located on the opposite side of the
OR table from the patient entry door into the room.
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Table 9.5 (Continued)
3 Operating Varies Mandatory:
room, 70.0 (a) Minimum ceiling height shall be 4 m.
hybrid (minimum) (b) If hybrid imaging room, shall also have control room for X-ray console and
plus control equipment room for electrical equipment.
and (c) The anaesthetic medical gases shall be positioned so that they are on the
equipment opposite side of the OR table from the patient entry door into the room.
rooms Advisory:
Room configuration should be close to square.
5 Scrub sink 0.8/sink See Clause 11 for common requirements and recommendations for a hand
alcove hygiene sink.
Mandatory:
(a) Alcoves shall be provided in corridors, beyond the minimum 2440 mm
corridor width, for storage of supplies.
(b) Provision shall be made to protect adjacent wall and floor surfaces from stains
or damage by scrub chemicals (e.g., through sink design, choice of surface
materials, or protective shielding).
6 Level one 9.5 See Clause 11 for common requirements and recommendations for an
recovery examination/procedure/treatment room.
(open Mandatory:
curtained) The minimum distances around and between beds shall be in accordance with
Table 7.1.
7 Level one 11.0 See Clause 11 for common requirements and recommendations for an
recovery examination/procedure/treatment room.
(partial Mandatory:
walls) The minimum distances around and between beds shall be in accordance with
Table 7.1.
8 Level one 13.0 Mandatory:
recovery The minimum distances around and between beds shall be in accordance with
(private/ Table 7.1.
separation) Advisory:
Adding family space (2.0 m2) should be considered.
9 Level one 13.0 See Clause 11 for common requirements and recommendations for an
recovery examination/procedure/treatment room.
(isolation Mandatory:
room) (a) Glass shall be provided between the recovery room and nursing area of the
non-isolation recovery room.
Anteroom 5.0 (b) A clean area for staff to put on PPE before entering the procedure room shall
be provided.
(c) A contained soiled area outside the procedure room shall be provided for staff
to wash up and remove PPE before entering public corridors.
(d) Door width shall be a minimum 1800 mm.
(e) The minimum distances around and between beds shall be in accordance
with Table 7.1.
Advisory:
Adding family space (2.0 m2) should be considered.
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Table 9.5 (Continued)
10 Sterile core Varies Mandatory:
supply area (a) Direct access to central MDRD shall be provided.
(see EPT (b) Adequate space shall be provided for
room — (i) two case carts per operating room;
Table 11.1) (ii) back-up supplies;
(iii) flash sterilizer;
(iv) anaesthetic supplies;
(v) emergency carts and supplies;
(vi) blood fridge; and
(vii) medication dispensing systems.
(c) At least 1 workstation with computer, network printer, and phone shall be
provided.
Advisory:
There should be a minimum width of 5500 mm (allows for two 1.5 m carts and
2400 mm to move them).
11 Pre- 7.5 See Clause 11 for common requirements and recommendations for an
operative examination/procedure/treatment room.
care/level Mandatory:
two (a) Door width on fully-enclosed/private room shall be a minimum 1500 mm.
recovery — (b) The minimum distances around and between beds shall be in accordance
Chair 9.5 with Table 7.1.
(open/ Advisory:
curtained) (a) An anteroom should be provided for a private room that will be used as an
isolation room.
Stretcher 11.0 (b) A 2-pce washroom should be provided when private room is used as an
(open/ isolation room (4.6 m2 or 5.6 m2 for barrier-free).
curtained)
Stretcher 13.0
(3-sided/
partial wall)
Private/
fully
enclosed
12 Decentra- Varies See Clause 11 for common requirements and recommendations for a storage
lized room.
equipment Mandatory:
storage (a) Storage room(s) shall be not less than 14.0 m2 per surgical suite or 4.6 m2
(within the per OR, whichever is greater.
services) (b) Storage areas shall be provided for portable X-ray equipment, stretchers,
fracture tables, warming devices, auxiliary lamps, etc. These areas shall be out
of corridors and traffic.
(c) Medical gas storage. Main storage of medical gases may be outside or inside
the facility in accordance with CSA Z7396.1. Provision shall be made for
additional separate storage of reserve gas cylinders necessary to complete at
least one day’s procedures.
(d) Emphasis shall be placed on decentralizing storage so that materials are close
to the OR.
(e) Linen alcoves shall be located outside operating rooms.
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Table 9.5 (Continued)
(f) Orthopaedic storage shall be provided directly beside the OR.
(g) Storage space shall be sized to be converted to an OR in the future at
55.0 m2.
Advisory:
Direct access into the OR for orthopaedic storage should be considered. This
includes storage for implants, special OR tables, image guidance systems, C-arms,
arthroscopy equipment.
13 Surgical Varies, 4.6 See Clause 11 for common requirements and recommendations for a storage
suite for each room.
control workstation Mandatory:
desk and To control access to and provide organization of the operating rooms,
additional (a) the desk shall be located on the perimeter of the operating rooms to have
circulation direct access to the restricted and semi restricted areas as well as an ability to
space receive and control access from outside the operating room core; and
(b) OR communication systems shall be located at the desk, including
(i) OR tracking system — video systems shall comply with patient privacy
legislation;
(ii) local cardiac arrest/staff assist communication system;
(iii) pneumatic tube system;
(iv) phones;
(v) computers with ergonomic workstation; and
(vi) an intercom system or similar wireless staff communication system.
14 Physician/ Varies, 4.6 Mandatory:
image for each (a) At least one workstation shall be provided for every four operating rooms.
workstation workstation (b) A 1220 mm desk shall be provided.
and (c) A telephone shall be provided.
additional (d) Access to the HCF dictation system shall be provided.
circulation (e) The workstation shall have an HCF system computer.
space (f) PACS shall be provided.
(g) Acoustic separation shall be provided.
Advisory:
The workstation should be positioned in a convenient location, such as
(a) between operating rooms and the PACU;
(b) near the OR control desk;
(c) near the staff lounge; or
(d) an alcove off the OR corridor.
15 Imaging/ Varies, 4.6 Mandatory:
equipment for each For mobile C-arm and mobile X-ray,
alcove alcove (a) equipment shall not be stored in operating rooms; and
space (b) space for lead (Pb) apron rack(s) on wheels shall be provided (at least
1400 mm × 900 mm).
16 RT/ Varies Mandatory:
anaesthesia (a) See Clause 9.9.
satellite (b) Door width shall be a minimum 1500 mm.
17 All N/A See Clause 11 for common requirements and recommendations for an
procedure examination/procedure/treatment room.
rooms and Mandatory:
recovery (a) Provision shall be made within the room for electronic charting and access to
bays health records.
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Table 9.5 (Continued)
(b) Provisions shall be made in the room for storing common procedure supplies.
(c) Sharps disposal shall be provided in a safe location and near the point of use.
Advisory:
(a) Provisions for telehealth should be considered, in particular, room colour,
lighting, acoustics, and the selection and placement of furniture and
telehealth equipment.
(b) Standardization of room configuration should be considered.
(c) Ceiling-mounted or portable patient lifts in procedure rooms should be
considered.
18 Procedure 22.5 for See Clause 11 for common requirements and recommendations for an
room, 4-sided examination/procedure/treatment room.
isolation access Mandatory:
(excluding (a) Means of visibility shall be provided between the procedure room and
anteroom) technique room in order that staff can observe the patient.
(b) Means of visibility shall be provided between the procedure room and the
corridor in order that staff can observe the patient.
(c) A clean area for staff to put on personal protective equipment (PPE) before
entering the procedure room shall be provided.
(d) A contained soiled area outside the procedure room shall be provided for staff
to wash up and remove PPE before entering public corridors.
(e) All fixed elements in the room (including keyboards if a computer workstation
is provided) shall be easy to clean.
Advisory:
Anteroom, supply alcove, and 2-pce washroom should be provided.
19 Procedure 24.0 for See Clause 11 for common requirements and recommendations for an
room 4-sided examination/procedure/treatment room.
(four-side access Mandatory:
patient (a) Procedure-related equipment shall be incorporated into planning.
access (b) Room lighting control shall be provided at the physician work area.
without (c) An efficient and safe method of scope reprocessing, separated from the
imaging) procedure room, but in close proximity, shall be provided and shall be
consistent with CAN/CSA-Z314.8 and the HCF’s infection prevention and
control strategy.
(d) If cleaned scopes are to be stored in the procedure room, they shall be stored
in closed, ventilated cupboards.
Advisory:
(a) For efficiency, scope reprocessing may be located adjacent to the procedure
room(s) with direct access, but this shall be reviewed to confirm infection
prevention and control protocols.
(b) Consideration should be given to the arrangement of medical services and
equipment management, for example, ceiling-mounted or wall-mounted
articulating arms.
(c) Where portable imaging and ultrasound is anticipated, the room size should
be increased.
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Table 9.5 (Continued)
20 Procedure 38.0 See Clause 11 for common requirements and recommendations for an
room examination/procedure/treatment room.
(four-side Mandatory:
patient (a) See Item 23.
access with (b) Room lighting control shall be provided at the control station.
fixed
imaging, Advisory:
including (a) See Item 23.
control) (b) There should be convenient access to patient washrooms.
21 Procedure 38.0 See Clause 11 for common requirements and recommendations for an
room examination/procedure/treatment room.
(ophthal- Mandatory:
mology) (a) Provisions shall be made for cataract and other ophthalmic procedures
(except retinal procedures and procedures requiring general anaesthesia).
(b) A separate clean supply room shall be provided in close proximity to the
procedure room for storage of ophthalmic procedure supplies.
(c) Provisions for procedure lighting and microscopy shall be made.
(d) Clearances around the operating table shall be minimum 1200 mm.
(e) A scrub sink shall be located in an alcove in the corridor adjacent to room
entry.
(f) Door entry into the room from the scrub area shall have hands-free
operation.
(g) Ventilation (air changes and air flow) shall meet OR standards.
(h) Patient door into procedure room shall have at least a 1.5 m width.
22 Procedure 60.0 See Clause 11 for common requirements and recommendations for an
room, examination/procedure/treatment room.
catheteri- Mandatory:
zation/pci (a) The suite shall be designed to suit the equipment layout.
lab, (b) A scrub sink shall be located in an alcove in the corridor adjacent to the room
including entry.
control (c) Door entry into the room from the scrub area shall have hands-free
operation.
(d) Ventilation (air changes and air flow) shall meet OR standards.
(e) Patient door openings into procedure room shall have at least a 1500 mm
width.
(f) Medical gases shall be available for provision of general anaesthesia.
(g) Anaesthetic medical gases shall be located on the opposite side of the OR
from the patient entry door into the room.
Advisory:
Convenient voice communication between the procedure area and control area
should be provided.
23 Control 14.0 Mandatory:
room (a) The room shall accommodate two seats; additional space shall be added if
(cardiac teaching requirements are to be accommodated.
catheteri- (b) Non-static flooring shall be used.
zation) Advisory:
The control room may be positioned between two cardiac catheterization rooms
and shared by the two rooms.
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Table 9.5 (Continued)
24 Computer 10.0 Mandatory:
room (a) The room shall be designed to suit the equipment layout.
(cardiac (b) Cooling capacity to suit the equipment shall be provided.
catheteri- Advisory:
zation) The computer room may be positioned between two cardiac catheterization
rooms and shared by the two rooms (room size shall be 20.0 m2 if positioned
between two rooms).
25 Viewing/ Varies, 4.6 See Clause 11 for common requirements and recommendations for a
dictation for each dictation/review station.
(cardiac alcove Mandatory:
catheteri- space (a) A telephone shall be provided.
zation) (b) Access to the HCF dictation system shall be provided.
(c) The workstation shall have an HCF system computer.
(d) PACS shall be provided.
(e) Acoustic separation shall be provided.
26 Soiled Varies See Clause 11 for common requirements and recommendations for a soiled
wash-up holding room.
and work Mandatory:
area (a) Ventilation (air changes and pressure) shall be in conformance with
CSA Z317.2.
(b) Usage and storage for hazardous chemicals shall be in conformance with
material safety data sheet (MSDS) criteria and occupational health and safety
requirements.
(c) Eyewash stations shall be located to meet occupational health and safety
requirements.
27 Clean Varies, each See Clause 11 for common requirements and recommendations for a clean supply
scope cupboard room.
storage not less Mandatory:
cupboards than Clean scopes shall be stored in closed, ventilated cupboard(s) in the procedure
450 mm room or in a clean supply room in close proximity to the procedure room(s) and
wide and storage shall be consistent with the organization’s infection prevention and
550 mm control strategy and guidelines.
depth
28 Sub-sterile 1.2 per cart
supply/
case cart
holding
area
9.6 Allied health services
9.6.1 Description
9.6.1.1
Allied health services refers to a range of clinical support services that complement and work in
conjunction with clinical care teams contributing to the patient’s health and well-being as part of the
multi-disciplinary team. Services may be provided in an inpatient setting or as part of a comprehensive
ambulatory care centre.
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9.6.1.2
Allied health services can include
(a) physiotherapy;
(b) occupational therapy;
(c) social work;
(d) chiropody; and
(e) spiritual care.
9.6.1.3
Services provided by allied health professionals can include
(a) preventional;
(b) assessment/evaluation;
(c) identification/diagnosis;
(d) treatment;
(e) rehabilitation/habilitation;
(f) advocacy;
(g) promotion of health and well-being; and
(h) education and research.
9.6.2 Functional requirements
9.6.2.1 General
9.6.2.1.1
Outpatient allied health services shall provide convenient access for patients from
(a) the patient parking area and entrance;
(b) the drop-off/pick-up area used by private vehicles and public transport; and
(c) spaces or bays used for scheduled ambulance arrivals, for patients from non-acute facilities.
9.6.2.1.2
The spiritual care/multi-faith room shall be easily accessible by inpatients. It shall be located close to the
visitor and patient elevators.
9.6.2.1.3
Access to the spiritual care/multi-faith room shall be direct from a main corridor and not through another
service. The entrance should be located out of the main flow of traffic in the corridor.
9.6.2.2 Patient management
The chiropody room/suite may be conveniently located within or near the ambulatory clinic (specifically,
near the diabetic clinic if the HCF provides this service) and/or the inpatient continuing care unit,
depending on the patient base and needs of various programs.
9.6.2.3 Workflow
There shall be dedicated space on the inpatient unit(s) for allied health staff and students from their
related disciplines. This shall include storage as well as workspace, in the form of dedicated office space or
via access to hotelling (touch-down) workspaces.
When services are decentralized, shared meeting, conference, resource and documentation areas shall
be centralized on the unit for staff access and to promoteinteraction between different professions.
The chiropody assessment rooms should have convenient access to the reception/waiting area, staff
workstations, photocopy room.
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The chiropody assessment rooms shall be located close to clean and soiled utility rooms in one of the
following departments:
(a) ambulatory care (if a diabetic clinic is part of this area); or
(b) inpatient continuing care with reprocessing capabilities if reprocessing is taking place within the unit.
9.6.3 Technical requirements
9.6.3.1 General
The following special requirements are particular to the allied health service areas and shall be reviewed in
the course of design:
(a) Areas used for the reprocessing of any reusable medical devices shall meet the requirements in
CAN/CSA-Z314.8 and (if steam is used) CSA Z314.3.
(b) Multi-faith room:
(i) In order to be supportive of all faiths, the multi-faith worship room shall be designated with
signage that acknowledges its open, multi-faith nature and reflects the faith needs of the
broadest possible constituency. The special needs of different cultural groups and inclusiveness
should be considered.
(ii) The multi-faith worship room shall be free of any sculptures, pictures, furniture, or other objects
associated with one particular religion or group.
(iii) The multi-faith worship room should be oriented facing east. If this is not possible, compass
points shall be indicated in the room to orient individuals wishing to pray in that direction.
(iv) According to local needs, an outside multi-faith worship space may be provided as a ritual
garden or labyrinth (e.g., for Buddhists, native Canadians, and others whose faith includes deep
connections with nature).
(v) Adjacent to the spiritual care/multi-faith worship room, a storage room and a coat/anteroom
that provides washing-up facilities shall be provided.
(c) Functional and storage space shall be provided for chemicals used in the unit.
(d) Functional and storage space shall be provided for patient handling devices.
(e) Functional and storage space shall be provided for sharps disposal containers.
(f) Eyewash facilities shall be provided when chemicals are being used.
9.6.3.2 Acoustics
Acoustic treatment is essential to allow for privacy and confidentiality in the counselling, treatment, and
assessment areas.
Potential noise from therapy areas should be minimized.
The audiology testing area shall be designed to provide acoustic privacy.
9.6.3.3 Lighting
The following lighting requirements shall apply to allied health services:
(a) Lighting levels shall be provided according to CAN/CSA-Z317.11.
(b) Natural light should be provided.
(c) Areas such as multi-faith areas should have softer lighting.
9.6.3.4 Infection prevention and control
In addition to the general list of infection prevention and control requirements, the following provisions
shall be made in this service:
(a) Provision for storing, cleaning, disinfection, and sterilization of reusable medical devices (e.g.,
podiatry instruments) shall be provided in accordance with the functional program (see
CAN/CSAZ314.2, CSA Z314.3, and CSA Z314.14).
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(b) Where disinfection and sterilization facilities are required, dedicated ventilation, cleaning sinks, and
equipment shall be provided. Centralized reprocessing MDRD shall be used for reprocessing
instrumentation.
9.6.3.5 Furniture, fittings, and equipment
Equipment furniture, fittings, and equipment (FF&E) requirements vary depending on the services
provided. However, the dimensions and design characteristics of the selected FF&E should be included in
the plans for space allocation, circulation, and infrastructure.
9.6.4 Space details
Table 9.6 presents the standard requirements for key spaces in the allied health service areas. Common
areas are detailed in Clause 11.
Table 9.6
Key space requirements and recommendations — Allied health
1 Chiropody 13.0 See Clause 11 for common requirements and recommendations for an
assessment examination/procedure/treatment room.
room Mandatory:
Space within the room shall be adequate to permit the treatment chair to
be reclined.
2 Reprocessing See Clause 11 for common requirements and recommendations for a soiled
area holding room.
Mandatory:
(a) Separate clean and soiled utility areas shall be provided for support of
reprocessing equipment.
(b) Dedicated cleaning sinks shall be provided close to the area where use
of reusable equipment is ongoing.
(c) Dedicated hand hygiene sinks shall be provided in the soiled
reprocessing room.
(d) Equipment (e.g., a counter top sterilizer unit, instrument cart, and
specialty cart) shall be provided if sterilization is not offered by the
central reprocessing area.
Advisory:
(a) Hand hygiene sink should be provided in the clean room if work and
preparation activities are taking place.
(b) Reprocessing areas may be shared by other programs.
3 Multi-faith Varies Mandatory:
worship room The room shall be sized according to the programs provided.
Advisory:
(a) A storage area for materials and artefacts associated with services
delivered should be provided in an adjacent room.
(b) A quiet room of 12.0 m2 may be utilized in lieu of a multi-faith room.
(c) Large rooms that can accommodate a range of ceremonies may be
used in some centres (assume 37.0 m2).
(d) Flexible design/layout to accommodate a wide variety of ceremonies
should be provided.
4 Activity room Varies Mandatory:
A storage area for materials associated with programs delivered shall be
provided in an adjacent room.
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9.7 Clinical laboratory
9.7.1 Description
9.7.1.1
The clinical laboratory services (medical lab) provides testing on a variety of specimens to support the
diagnosis, treatment, monitoring, and wellness assessment of patients.
9.7.1.2
The services generally provided to HCFs with or without clinical laboratory services, including mental
health, rehab, and chronic care facilities, include
(a) central processing/referral and receiving;
(b) chemistry;
(c) urinalysis;
(d) point-of-care testing;
(e) pathologist consultation;
(f) haematology;
(g) coagulation;
(h) transfusion medicine; and
(i) morgue.
9.7.1.3
depending on local conditions, some laboratory departments provide additional services, such as
(a) microbiology, including virology;
(b) histology;
(c) cytology;
(d) autopsy;
(e) special biochemistry/immunology;
(f) specimen procurement/phlebotomy — inpatient (can also be part of ambulatory care);
(g) specimen procurement/phlebotomy — outpatient (can also be part of ambulatory care);
(h) parasitology;
(i) mycology;
(j) molecular genetics;
(k) flow cytometry;
(l) molecular pathology; and
(m) cytogenetics.
9.7.1.4
Services can be provided by some laboratory departments within an ambulatory care centre (including
facilities located within rental or commercial properties). Depending on local conditions and clinical
services provided within the centre, laboratory services may include services listed in Clauses 9.7.1.2 and
9.7.1.3.
9.7.2 Functional requirements
9.7.2.1 Patient management process
The following principles related to patient management are standard for all laboratory departments and
shall be included in planning and design for laboratories:
(a) The privacy of patient specimens/information shall be maintained.
(b) The lab and receiving area shall be secure and not accessible to patients. Procurement of blood
specimens shall occur in a separate area to the main laboratory.
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9.7.2.2 Workflow
Planning and design of laboratories shall include the following provisions:
(a) There shall be an appropriate holding area for specimens that will be sent to another site for testing,
and for specimens received after hours.
(b) There should be an electronic system for reporting of results. The reporting system shall be able to
provide results and communicate them to clinical areas in a timely manner.
(c) Transportation and storage of all blood and blood products shall conform to applicable requirements
and guidelines.
(d) Planning shall take into account point of care testing (POCT) as it can affect throughput and
maintenance needs, as well as staffing and space requirements.
(e) The laboratory shall be located close to the critical care and emergency units for urgent tests and
blood products.
(f) Hand hygiene sinks shall be provided at the entrances and exits to the laboratory and shall be
distributed throughout the department.
(g) Provision shall be made for a clean space with a hand hygiene sink in the phlebotomy area for the
preparation of trays and storage of phlebotomy carts. An eyewash station should be included in
phlebotomy areas where specimen procurement occurs.
(h) Workflow, tasks and equipment should be mapped to provide the optimal layout such that manual
handling of supplies, specimens and shipments is avoided.
(i) For entry and waiting areas,
(i) the reception or control desk shall be located at the front of the lab;
(ii) there should be direct access to each of the collection and pick-up areas; and
(iii) administrative offices may be included.
9.7.2.3 Support service delivery
The following principles related to support services delivery are standard for all laboratory departments
and shall be included in planning and design for laboratories:
(a) An electronic laboratory information system (LIS) shall be integrated with the HCF’s information
system for test order entry and reporting.
(b) Appropriate storage shall be provided for general supplies and bulk reagents in materials
management.
(c) A housekeeping closet shall be equipped with a service sink or floor receptor and large enough to
accommodate equipment and supplies.
(d) Provision shall be made for biohazard materials storage prior to pick-up and disposal.
(e) Hand hygiene, eyewash stations, and safety showers shall be provided.
(f) A strategy for waste materials, such as biohazard materials, shall be developed in order to comply
with all applicable requirements.
(g) Meeting/teaching space shall be provided.
(h) Support requirements shall include
(i) storage area for general supplies and reagents;
(ii) biohazard storage area;
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(iii) meeting and teaching room;
(iv) staff area (lockers, toilet facilities); and
(v) support areas (housekeeping).
Depending on HCF activities, hours of operation, and need, the HCF should provide a staff rest area,
lunch room, or break room for after-hours staff.
9.7.3 Technical requirements
9.7.3.1 General
The following criteria for location, adjacencies, and internal organization criteria are standard for all
laboratory departments and shall be incorporated into planning and design.
9.7.3.2 Location
Laboratories should be located on or above grade. Laboratories shall be located to ensure timely and
efficient transport of specimens from the point of collection to the laboratory.
9.7.3.3 Adjacencies
9.7.3.3.1
The following requirements and recommendations shall apply to the location of laboratories:
(a) Histology/cytology shall be in close proximity to the surgical suite (if possible).
(b) Outpatient collection should be convenient to outpatient clinics.
(c) Morgue/autopsy shall be immediately accessible to a non-public exterior entrance for transfers of
bodies.
9.7.3.3.2
The following services and departments shall have a convenient connection to the laboratory through
non-public corridors:
(a) critical care;
(b) surgical suite (for frozen sections);
(c) emergency care;
(d) specimen evaluation room (in diagnostic imaging [DI]) for pathologists and cytologists;
(e) morgue/autopsy;
(f) materials management (loading dock);
(g) histology/cytology to flammable stores; and
(h) special chemistry, microbiology (e.g., gas tanks).
9.7.3.4 Internal organization
The internal organization of the laboratory shall be as follows:
(a) The receiving/processing area shall be adjacent to the outside entrance.
(b) The blood product receiving area shall be adjacent to outside entrance.
(c) There shall be a direct link between receiving areas and send-out to specimen collection areas.
(d) The core lab shall be adjacent to central processing/referral and receiving and shared services.
(e) The coagulation zone in the core lab shall be adjacent to the haematology zone.
(f) The transfusion medicine section shall be adjacent to central processing/referral and receiving, shared
services, and the core lab.
(g) There shall be a dedicated convenient entrance to transfusion medicine for HCF personnel and
courier staff.
(h) The microbiology section may be open-plan and adjacent to the core lab.
(i) The histology/cytology area should be located to provide easy access by pathologists. This area
should be integrated into the main laboratory.
(j) The tissue processing area shall be located to support both histology and cytology.
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(k) The quick section room shall remain in the lab.
(l) The administrative offices shall be located outside of the secure laboratory area.
(m) Technical specialists’ offices shall be located within the specific diagnostic area.
(n) Pathologists’ working space and offices shall be within or adjacent to their specific diagnostic area.
(o) The morgue/autopsy suite shall be accessible for internal transfer of bodies within the HCF through
non-public corridors.
(p) Central shared services area may be provided.
(q) Specimens in central receiving shall be handled in biosafety cabinets as required (e.g., for poorly
packaged, damaged specimens — pre-processing of urine specimens, etc.).
(r) Access to staff facilities shall be provided, conveniently located for staff use.
(s) Provision for the holding of clean and working lab coats at or near the laboratory entrance shall be
made.
(t) The autopsy room shall have direct access to the body storage area of the morgue.
(u) There shall be provision for escorted public access to the morgue viewing area, pathologists, and
administration area.
(v) The morgue/autopsy suite shall be designed to accommodate a bariatric person.
9.7.3.5 Adaptability and flexibility
The following standards apply to all laboratory departments and shall be addressed in the planning and
design:
(a) In order to promote adaptability and flexibility, locating the laboratory adjacent to another soft area
should be considered, allowing for its use if expansion of the lab is contemplated in the future.
(b) Laboratory areas/work zones should have similar layouts, configurations, equipment/casework, and
services to allow for maximum flexibility now and in the future.
(c) Laboratory areas should be organized in pods/zones/areas, which can be modified depending on
future needs.
(d) Fixed workstations should be minimized and service utilities should be designed for accessibility, with
emphasis upon emergency generator and UPS power (many laboratory equipment items require
non-standard voltages).
9.7.3.6 Lighting
Lighting for laboratory spaces shall be designed to facilitate the accurate reading of test results (especially
when they involve colour changes), and to promote staff comfort and safety. The following design points
shall be considered in the planning:
(a) Natural spectrum lighting should be provided for accurate colour rendition of clinical samples, as well
as to promote staff safety and reduce fatigue.
(b) Controlled natural light should be provided to provide a pleasant working environment for the staff;
however, direct sunlight onto benches and equipment should be avoided not only to minimize glare
to staff but also because some chemicals can become unstable or their properties altered if exposed
for extended periods. Some equipment can also be unstable or intolerant to direct sunlight.
9.7.3.7 Acoustics
Laboratories shall be designed to minimize unnecessary noise. Design provisions for acoustics shall include
the following:
(a) Means should be used to reduce loud and sudden noise.
(b) Areas with bench-mounted equipment that emits noise or vibrations shall have sound proof
acoustical material around the work area and benches shall be engineered to reduce the transfer of
vibration to other bench areas.
(c) Because of infection-control issues, acoustic materials, such as sound-absorbing ceiling tiles, should
be replaced, rather than cleaned, when soiled.
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9.7.3.8 Special considerations
Laboratory design shall take into account the following special considerations:
(a) Many operations in the laboratory are inherently hazardous, necessitating use-specific dedicated
ventilation and temperature control, physical separations, or safety devices such as emergency deluge
shower and eyewash.
(b) MSDS and specific hazards information should be posted at lab entry points and at workstations.
(c) There shall be provision for the storage and disposal of personal protective equipment (e.g., lab
coats, safety glasses, gloves, dedicated shoes, respirators) used within the lab.
(d) The receiving area shall have space for the electronic identification system used (e.g., bar code
reader).
(e) Planning for point-of-care testing shall utilize design input from laboratory staff, who will be
responsible for quality assurance of remote equipment and confirmation of processes conducted
there.
(f) Local and remote alarms for power failure or equipment failure should be provided for sensitive
equipment used for diagnostic processes and for refrigerators or freezers used for storage of samples.
(g) Uninterrupted power supply connections should be used for testing and analysis equipment for
which electrical interruption would be detrimental to test results.
(h) Sensitive or critical equipment in stat labs, high volume core labs, and transfusion services shall be
connected to emergency power or an uninterruptable power supply.
(i) Monitors should be suspended to preserve bench space.
(j) Work surfaces shall be self-coved, chemical and impact resistant, and washable.
(k) There should be a means for securing large equipment and instruments against shifting, especially in
earthquake zones.
(l) Process sinks shall be provided.
(m) De-ionized water shall be available in the laboratory.
9.7.3.9 Infection prevention and control
Infection prevention and control provisions in laboratories shall take into account the following:
(a) Space planning should be supported by directional airflow patterns from clean to less clean
operations, as well as clothing change and hand sanitization capability at the exit from the laboratory.
(b) Internal traffic routes should be generous and well defined; internal traffic by non-lab personnel is
discouraged; administrative areas, supply, and waste removal activities should be located at the lab
perimeter.
(c) Exposed surfaces should be impact-resistant, chemical resistant, and self-coved, minimizing
unhygienic crevices and concealed spaces.
(d) Environmental quality is fundamental to infection prevention and control, credible diagnostic analysis
and human comfort, necessitating closely monitored and controlled air change rates, temperature
and relative humidity ranges, relative “pressure” differentials between uses and dedicated vs.
recirculation ventilation systems determining ambient air quality.
(e) There shall be access to in-house or referral disposal of biological waste; handling of damaged or
unlabelled incoming specimens shall be done in a biosafety cabinet (see NSF/ANSI 49).
(f) Biosafety cabinets for specimens in central receiving shall be provided.
(g) There shall be a clean space with a hand hygiene sink in the phlebotomy area for the preparation of
trays and storage of phlebotomy carts.
(h) Appropriate provisions should be made for infection prevention/contamination control, including
anterooms and vestibules for sensitive work areas.
(i) Surfaces shall be washable, continuous, and chemical-resistant.
9.7.3.10 Occupational health and safety
Occupational health and safety provisions in laboratories shall include the following:
(a) Functional and storage space shall be provided for
(i) chemicals used in the unit;
(ii) sharps disposal containers;
(iii) spill kits used for the chemicals in the laboratory; and
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(iv) personal protective equipment (gloves, glasses, and protective garments).
(b) Storage should be between knee and shoulder height.
(c) Space for MSDS and specific hazards information should be provided at lab entry points and at
workstations.
(d) Functional space and utilities shall be provided for biological safety and fume cabinets.
(e) Fume hoods shall provide sufficient leg space for seated work.
(f) General and task lighting shall be adequate and provided over the work areas.
(g) Adjustable ergonomic workstations and chairs should be used. Eyewash facilities shall be provided
and positioned for immediate access in case of an incident.
(h) An emergency shower with floor drain shall be provided and it shall be located away from electrical
equipment and instruments.
(i) Work benches and surfaces shall have sufficient leg clearance for work from a standing or seated
posture on high stools.
(j) Biological containment cabinets and fume hoods shall meet applicable requirements.
9.7.3.11 Technology considerations
Technology considerations in laboratories shall include the following:
(a) The LIS, if present, shall be integrated with the HCF’s information system for requisitioning tests and
reporting.
(b) Any chosen LIS system shall also have the capability to interface (integrate) with known lab analyzers,
ehealth technologies (e.g., lab repository, image repositories), and other equipment and supporting
devices (e.g., scanners, faxes, copiers, printers).
(c) Refrigerators and freezers shall be classified as described in Clause 7.3.9.
9.7.3.12 Safety and security
Laboratories generally provide most of their services during the day, with reduced staffing for afternoon
and night shifts. Laboratories shall be designed to protect the safety and security of staff, particularly in the
afternoon and evening shifts. The laboratory design shall
(a) provide adequate security for staff so that unauthorized visitors are not able to enter the secure area;
(b) protect the records against loss, damage, or use by unauthorized personnel at all times;
(c) provide limited unit entry/exit points keyed or electronic;
(d) provide local and central monitored alarms for unauthorized entry or egress; and
(e) provide clear lines of sight for single entry control and observation of the waiting area(s) staff.
Reception/registration counters shall present a sufficient barrier to intruders (i.e., resistant to climbing
and entry) and shall be able to be secured when the station is not staffed.
9.7.4 Space details
Laboratories should utilize mobile, modular workstations and limit the use of fixed workstations to support
transition to and replacement of automated processors and analyzers. Workstations shall include
adaptable, modular storage; provide connectivity to accessories such as keyboard trays and cable
management; and provide adjustable height work surfaces.
A biosafety cabinet shall be provided for the handling of damaged, unlabelled, unpackaged, or
improperly packaged incoming specimens.
Table 9.7 presents the standard requirements for key spaces in the clinical laboratory area. Common
areas are detailed in Clause 11.
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Table 9.7
Key space requirements and recommendations — Clinical laboratory
1 Histology/ Varies, Mandatory:
cytology some (a) The lab shall be in close proximity to histology clinics.
pathology models (b) Adequate space shall be provided around microscopy equipment for
consultation might consultations between staff.
require
space for
occupant
and
consultant
2 Morgue and Varies Mandatory:
autopsy (a) The lab shall be located adjacent to morgue, whole body storage.
morgue (b) Entrances shall be set up for escorted entry by HCF staff from an
viewing access-controlled and monitored, secure corridor.
(c) There shall be a secure door and draped acoustic window to stretcher
parking.
(d) The area shall be acoustically-separate, with a ventilation system
independent of surrounding areas. See CAN/CSA-Z317.2.
(e) A family viewing area shall be provided adjacent to the morgue (minimum
10.0 m2).
Advisory:
The area should have cool temperature and low lighting levels.
3 Central Project- Mandatory:
processing/ specific; not (a) The area shall provide accommodations capable of 24 h/day operation in
referral and less than conjunction with transfusion medicine and core lab services.
receiving, 22.5 (b) Access to in-house or referral disposal of biological waste shall be
general zone provided.
(c) Space shall be provided for PPE and areas shall be designed to permit
compliance with applicable requirements for biosafety and the storage
and transfer of dangerous goods.
(d) Dedicated hand hygiene sinks shall be provided at all exits from the
laboratory.
(e) Eyewash fixtures and deluge showers that meet applicable requirements
shall be provided.
(f) Minimum equipment shall include biosafety and fume cabinets;
centrifuges; 4 °C and –20 °C storage; incubator; and ventilated fluid
storage. Electrical equipment shall have access to emergency power and
to uninterruptible power supply (UPS), as required.
(g) Ambient and task lighting shall stress high quality colour rendition.
(h) Critical dimensions, clearances, and tolerances shall be dictated by
equipment and safe traffic flow of staff and materials.
Advisory:
(a) Incoming materials can include biohazardous specimens, flammable and
toxic chemicals, and radio-active substances.
(b) Wireless communications networking should be considered, if information
security can be achieved.
(c) Desk height should conform to barrier-free access requirements.
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Table 9.7 (Continued)
4 Specimen Mandatory:
collection (a) Space shall include hand hygiene sink (if multiple stations, not less than
1 sink for every 4 places).
Bleeding 7.5 (b) Separate clinical technique sink shall be provided.
station (chair) (c) Space shall be provided for storage of phlebotomy supply carts and for
preparation of biopsy procedure trays.
Bleeding 9.5 (d) Patient reception and procurement areas shall accommodate wheel chair
station or bed access in accordance with the functional program.
(stretcher) (e) At least one bed shall be available in the service.
Advisory:
(a) May be configured to accommodate multiple patients, provided
appropriate privacy is provided.
(b) In central or regional hospitals, space may be provided to accommodate
wheelchair or bed access for bedridden patients who are transferred from
long-term care facilities/nursing homes.
5 Central Project- Mandatory:
processing/ specific (a) A fume cabinet and ventilated storage cabinets shall be used for
referral and management of volatiles and acid.
receiving, (b) Adequate storage for shipping containers and documentation shall be
receiving and provided.
send-out Advisory:
A pneumatic tube station at this location should be provided.
6 Central Project- Mandatory:
processing/ specific Hand hygiene facilities for both patients and staff shall be provided.
referral and
receiving
7 Central Project- Mandatory:
processing/ specific Space and equipment shall be accessible from receiving and send-out and from
referral and the general lab zone; minimum equipment shall include LIS/LAN workstation,
receiving, fume cabinet, biosafety cabinet, centrifuge, label printer, and distribution
processing bench.
Advisory:
(a) This area is a sub-set of the receiving and send-out function, where
preparation of samples is done prior to referral to a specific lab specialty.
(b) Refrigerators or freezers should be provided for pre and post specimen
storage.
8 Central Project- Mandatory:
processing/ specific Space and equipment for overnight holding of inbound specimens shall be
referral and provided; minimum equipment shall include 44 °C refrigeration and incubator.
receiving, Advisory:
specimen A –20 °C freezer should be provided.
holding
9 Central Project- Mandatory:
processing/ specific Space and equipment for post-processing/pre-pick-up of specimens shall be
referral and provided; minimum equipment shall include 44 °C refrigeration and –20 °C
receiving, freezer.
specimen Advisory:
storage An ultra freezer (–80 °C) should be provided for large facilities and specialty
labs.
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Table 9.7 (Continued)
10 Core lab, Project- Mandatory:
general zone specific (a) Easily accessible eyewash stations and emergency deluge shower shall be
provided.
(b) UPS and non-standard voltage shall be provided.
(c) Quick-connect emergency power source shall be provided.
Advisory:
(a) Oversized doors at building circulation corridors for change-out and
movement of floor-mounted equipment should be provided.
(b) Overhead servicing and quick-connect utilities should be provided.
11 Core lab, Project- Mandatory:
chemistry, specific (a) Ready access to reagent storage shall be provided.
primary, stat, (b) LIS/LAN workstation, 4 °C refrigeration, and –20 °C freezers shall be
and back-up provided.
12 Core lab, Project- Mandatory:
urinalysis specific High level of exhaust ventilation shall be provided to compensate for specimen
odour.
Advisory:
(a) The process sink should have backdraft ventilation.
(b) A biosafety cabinet for opening of capped specimen containers should be
provided.
13 Core lab, Project- Mandatory:
haematology, specific (a) Shall be situated near to central processing/referral and receiving.
primary and (b) Substantial bench space for fully automated analyzers (which can include
back-up adjacent countertop modules) shall be provided.
(c) Microscopy shall have a vibration-damping work surface.
(d) A stainer shall be provided for microscopy and storage for slides.
(e) Ventilated storage shall be provided for the methanol used by stainers. The
area shall have self coved impact and chemical resistant bench tops.
(f) Access to 4 °C refrigeration shall be provided.
(g) Fully automated analyzers shall have daily access to front, back, and side.
(h) Emergency power shall be available for sensitive and critical equipment.
Advisory:
(a) LIS connection should be considered.
(b) Special drains, e.g., self-flushing floor drains for automated analyzers,
should be considered.
14 Core lab, Project- Mandatory:
coagulation specific (a) This lab zone shall be adjacent to Haematology and be open to the
remainder of the lab; it is similar in fit-out to haematology and chemistry,
and shall be equipped with stable work surfaces for heavy and
vibration-generating equipment.
(b) The area shall have self-coved, impact- and chemical-resistant bench tops.
(c) The area shall have a land line telephone or reliable communication device
for power failures/disasters.
(d) Analyzers shall be connected to emergency power or an uninterruptable
power supply.
Advisory:
(a) The area should have a –20 °C freezer.
(b) Typical equipment includes 4 °C refrigerators, centrifuges, and analysers
requiring reagents.
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Table 9.7 (Continued)
15 Core lab, Project- Mandatory:
special specific (a) Emergency power and UPS shall be used.
biochemistry/ (b) A LIS/LAN workstation shall be provided.
immunology (c) The area shall have a land line telephone or reliable communication device
for power failures/disasters.
16 Core lab, Project- Mandatory:
chemistry, specific (a) Small benchtop analyzers, an LIS/LAN workstation, and access to 4 °C
manual refrigeration shall be provided.
(b) The area shall have a land line telephone or reliable communication device
for power failures/disasters.
17 Core lab, Project- Mandatory:
blood gases specific (a) Shall be located near to central processing/referral and receiving.
(b) Automated countertop analyzer(s) stations and an LIS/LAN workstation
shall be provided.
(c) The area shall have a land line telephone or reliable communication device
for power failures/disasters.
Advisory:
This activity is sometimes performed by other health care professionals at
point-of-care, such as emergency care and ICU. The process and equipment
remains under control of the laboratory.
18 Core lab, Project- Mandatory:
immunoassay, specific (a) Primary and back up benchtop analyzer, a microscope, and an LIS/LAN
and rapid workstation shall be provided.
microbiology (b) The area shall have a land line telephone or reliable communication device
for power failures/disasters.
19 Core lab, Project- Mandatory:
manual fluids/ specific (a) LIS/LAN workstation, microscope, bio-safety cabinet, cell counter, and
differentials process sink shall be provided.
(haematology) (b) The area shall have a land line telephone or reliable communication device
for power failures/disasters.
Advisory:
Provision should be made for a slide scanning device, for facilities that do not
have staff skills available to perform morphology, to link the site to a reference
referral laboratory.
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Table 9.7 (Continued)
20 Core lab, Project- Mandatory:
fluorescent specific (a) Space which can be darkened shall be provided.
microscopy (b) LIS/LAN workstation and a specialized microscope shall be provided.
(c) The area shall have a land line telephone or reliable communication device
for power failures/disasters.
Advisory:
De-ionized water tap should be provided.
21 Core lab, Project- Mandatory:
point-of-care specific The area shall have a land line telephone or reliable communication device for
power failures/disasters.
22 Core lab, Project- Mandatory:
documenta- specific (a) Segregated off-bench LIS/LAN workstation for core lab quality assurance
tion station shall be provided.
(b) The area shall have a land line telephone or reliable communication device
for power failures/disasters.
23 Core lab, Project- Mandatory:
storage, specific Room temperature storage capacity for pre-service and disposable material
general utilizing adjustable shelving and appropriate containers shall be provided.
24 Core lab, Project-
validation, specific
training and
evaluation
centre
25 Transfusion Project- Mandatory:
medicine, specific (a) Transfusion medicine shall be an enclosed space designed to provide a
general zone dispensing service available on a 24 h basis, provided through a dedicated
entrance/egress point, for convenient access for HCF personnel and
courier service. It shall be adjacent to central processing/referral and
receiving and core lab.
(b) Wall, floor, and ceiling surfaces, as well as fitments, shall be
chemical-resistant and self-coved, minimizing crevices and concealed
spaces; work surfaces shall be light-coloured and without pattern, which
could obscure observation of spills.
(c) Process sinks and dedicated hand hygiene sinks, as well as eyewash
appliances, shall be provided. Lighting shall reinforce colour rendition.
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Table 9.7 (Continued)
(d) Typical equipment shall include biosafety cabinets, blood refrigerators,
–20 °C and ultralow freezers, centrifuges, platelet storage shakers, and dry
ice maker. Biosafety and fume cabinets, transfusion analyzers and shakers
shall use UPS power, reagent and specimen refrigerators shall have
emergency power, refrigerators and freezers shall be alarmed and
monitored by a central station on a 24/7 basis.
(e) Operational considerations shall include ensuring identification and
separate refrigerated storage for blood products, reagents, and specimens.
(f) Inbound and outbound product streams shall be segregated.
(g) Supplies are delivered in large bins, space for storage of empty storage
bins prior to pick-up shall be provided.
26 Transfusion Project- Mandatory:
medicine, specific (a) Vestibule entrance shall be secure, permitting supplies to be deposited
receiving without entry to the Receiving area proper. This offers transfusion
medicine staff greater control over segregation of blood and blood
product materials, which are stored and handled along separate paths.
(b) LIS/LAN workstation shall be provided at the entrance area, where
receiving, break-out, recording, and transfer to processing and storage
takes place.
Advisory:
Extra-wide doors to facilitate movement of supply carts and other large
equipment should be provided.
27 Transfusion Project- Mandatory:
medicine, specific (a) The dispensing activity shall be designed to operate on a 24 h basis.
dispensing (b) 4 °C refrigerators with individual temperature recording devices shall be
provided.
(c) LIS/LAN workstation for recording transfer operations shall be provided.
Advisory:
Although the dispensing function may take place in the same physical space as
receiving, each process should have its own 4 °C refrigerators with individual
temperature recording devices.
28 Transfusion Project- Mandatory:
medicine, specific 4 °C refrigeration and –20 °C or ultra-low freezers shall be provided.
storage,
specimens and
reagents
29 Transfusion Project- Mandatory:
medicine, specific (a) 4 °C refrigeration and –20 °C or ultra-low freezers shall be provided.
storage, (b) Refrigerators and freezers shall comply with the requirements of
blood CAN/CSA-Z902.
components Advisory:
(a) A walk-in refrigerator with a glycerol temperature monitor and an alarm
for storage of blood components should be provided in larger sites.
(b) An intercom system should be provided that connects to the ORs,
emergency, and critical care areas.
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Table 9.7 (Continued)
30 Transfusion Project- Mandatory:
medicine, specific (a) An area to type and cross-match blood shall be provided.
specimen (b) Space for cell washer or centrifuge shall be provided.
testing station, (c) Task lighting at the inverted microscope, an open bench space for
manual handling of materials, LIS/LAN workstation, and a land line telephone shall
be provided.
31 Transfusion Project- Mandatory:
medicine, specific This space shall include LIS/LAN workstation plus clear bench-space to process
specimen specimens in support of the automated analyser.
testing station,
automated
32 Transfusion Project- Mandatory:
medicine, specific Bench-space for a plasma thawing device, agitator, water bath, and bio-safety
blood cabinet shall be provided.
component
preparation,
clean
33 Microbiology, Project- Mandatory:
general zone specific (a) This area contains biological hazards and flammable chemicals; therefore,
the workplace shall be easily sanitized and supported by bio-disposal
services and spill kits, and appropriate PPE shall be worn. Surfaces shall be
chemical resistant and self-coved for cleaning, minimizing crevices and
concealed spaces.
(b) Hand hygiene facilities shall be provided at the entrances and exits and
within short distances within the lab.
(c) Eyewash and emergency showers shall be within a short travel distance
from workstations, in accordance with applicable requirements.
(d) Process sinks with treated water and special drains on an activity-specific
basis shall be provided.
(e) Emergency power throughout microbiology, and UPS to equipment with
computer processors and recorders shall be provided.
(f) Typical equipment shall include biosafety cabinets, incubators, manual
and autostainers requiring equipment-specific exhaust ventilation,
microscopy with provision for vibration minimization, centrifuges, solvent
and flammable storage cabinets, 4 °C refrigeration, –20 °C and ultra-low
freezers.
Advisory:
(a) Microbiology has frequently been separated from the remainder of the
lab; however, except for a few specific cases (clean rooms, virology-,
mycobacteriology- and/or mycology-testing), it may remain open
internally for safety oversight. Enclosure of the services, and its parts, is to
be dealt with on a project-specific basis.
(b) Specialty gas, piped from a central location, is rarely required; however,
manifolded cylinders of inert gases, such as CO2, could be required for
some equipment, such as incubators.
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Table 9.7 (Continued)
34 Microbiology, Project- Mandatory:
set-up bench specific LIS/LAN workstation with barcode printer, biosafety cabinet, cytofuge;
microscope with vibration damping table, staining sink, and 4 °C refrigeration
shall be provided.
Advisory:
Automated specimen inoculators might require bench space.
35 Microbiology, Project- Mandatory:
incubation specific (a) Monitored, automated blood culture incubators, or walk-in controlled
environment chamber shall be provided.
(b) Compressed gas cylinders shall be provided for incubators.
36 Microbiology, Project- Mandatory:
staining specific LIS/LAN workstation, stainers, microscope, process sink, and 4 °C refrigeration
shall be provided.
Advisory:
Stainers use volatile organic compounds, so should be enclosed and ventilated.
37 Microbiology, Project- Mandatory:
routine specific LIS/LAN workstation with cleanable keyboard, bench space with biological
work-up waste disposal container, microscope, and high intensity task lighting shall be
provided.
Advisory:
Workstation CPU and monitors should be off-bench to maximize workspace.
Suspended monitors should be provided.
38 Microbiology, Project- Mandatory:
blood cultures specific (a) Direct line of vision to the auto-analyser to alert the user of a positive result
shall be provided.
(b) Centrifuge, biosafety cabinet, and blood culture auto-analyser shall be
provided.
Advisory:
This area produces a large amount of glass bottle waste.
39 Microbiology, Project- Mandatory:
susceptibility/ specific LIS/LAN workstation, automated susceptibility analysers, loaded with
ID inoculated media, dedicated 4 °C refrigeration, reagent storage, and clear
bench space shall be provided.
Advisory:
This area design should allow for the management and disposal of large
quantities of biological waste.
40 Microbiology, Project- Mandatory:
documentation specific Segregated off-bench LIS/LAN workstation for microbiology lab quality
station assurance shall be provided.
41 Microbiology, Project- Mandatory:
storage, specific (a) Walk-in or 4 °C refrigerators to maintain a minimum of 4 days media
general supply (over a long weekend), as well as refrigerated specimens, –20 °C
freezer, ultralow freezer, and adjustable shelving shall be provided.
(b) Work area for processing of media for quality control shall be provided.
42 Microbiology, Project- Mandatory:
media specific (a) A recording LIS/LAN workstation for logging-in shall be provided.
receiving and (b) The storage area shall include separate accommodation for pre- and
quality control post-quality control media.
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Table 9.7 (Continued)
(c) Media is temperature-sensitive; therefore, accommodation for in-process
storage shall be provided.
(d) If reusable medical devices are used, reprocessing shall be done in
accordance with CAN/CSA-Z314.8 and the appropriate sterilization
standards, preferably in the MDRD.
Advisory:
A media preparation area should be provided.
43 Microbiology, Project- Mandatory:
storage, specific Adjustable shelving shall be provided.
room
temperature
44 Microbiology, Project-
virology, specific
general
45 Microbiology, Project-
control specific
infection
control office
46 Microbiology, Project-
molecular specific
diagnostics
A separate, positive pressure, clean space for PCR sample preparation shall be
provided.
47 Microbiology, Project- Mandatory:
immunofluor- specific (a) A space that can be darkened shall be provided.
escence (b) An LIS/LAN workstation and a specialized microscope shall be provided.
48 Histology/ Project- Mandatory:
cytology, specific (a) Surfaces shall be washable or disposable; special spill kits shall be used and
general PPE (including chemical respirators) shall be worn, as is bio-disposal
services. Ceilings shall be accessible.
(b) Hand hygiene sinks and process sinks, as well as emergency shower and
eyewash stations, shall be provided.
(c) Lighting shall be selected to facilitate accurate colour rendition.
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Table 9.7 (Continued)
(d) Essential equipment (e.g., ventilated cabinets) shall be connected to
emergency power or uninterruptible power supply as appropriate to its
function and the level of risk.
(e) Ventilated reagent storage cabinets shall be provided.
Advisory:
(a) Proximity to the surgical suite is preferred.
(b) Typical equipment should include fume and biosafety cabinets, backdraft
or downdraft ventilated benches and grossing stations, solvent recyclers
for ethanol and formaldehyde, ventilated tissue storage cabinets,
cytofuge, centrifuge, and secure storage.
(c) Typical hazards include biohazard, flammables, toxic chemicals, and may
include radioactivity.
(d) Space requirements for the following laboratory-related areas or activities
depend on workflow and program requirements:
(i) pathology consultation;
(ii) specimen evaluation in diagnostic imaging; and
(iii) specimen evaluation in surgical services.
(e) A separate room for the segregation of tissue processors should be
provided.
(f) Ergonomic workstation design is important. This area is subject to air
quality issues, equipment heat dissipation, and specialized equipment
direct venting.
(g) This area should have access to water, water baths, and autostainers.
49 Histology/ Project- Mandatory:
cytology, specific (a) A minimum of 2 m wide workspace for sorting shall be provided.
histology (b) Easy access for pathologists shall be provided.
(c) A centralized bio-waste room and refrigerated storage to serve both
histology and cytology shall be provided.
50 Histology/ Project- Mandatory:
cytology, specific (a) A facility for preparation of working strength solutions shall be provided.
solution (b) Space for spill kits and safety supplies shall be provided.
preparation (c) A safety shower shall be provided.
(d) A fume cabinet, storage for bulk chemicals and acids, distilled water, and a
process sink shall be provided.
51 Histology/ Project- Mandatory:
cytology, specific (a) A biosafety cabinet, cryostat, microscope; hand hygiene sink, LIS/LAN
interoperative workstation, stainer/coverslipper, and staining sink shall be provided.
consultation (b) The stainer/coverslipper utilizes a xylol medium and, so, direct exhaust
(quick section) ventilation shall be provided.
(c) This area shall be equipped for direct communication with the OR.
52 Histology/ Project- Mandatory:
cytology, specific (a) A backdraft- or downdraft-ventilated grossing bench, ergonomic design,
grossing (adjustable height) shall be provided. The technologist shall have access to
appropriate PPE (storage required).
(b) Hand hygiene sink and eyewash shall be immediately available, and an
emergency shower in close proximity shall be provided.
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Table 9.7 (Continued)
(c) Locking storage for knives shall be provided.
(d) A process sink equipped for biological waste disposal shall be provided.
(e) A LIS/LAN shall be provided.
(f) A computer workstation with printer for cassette labelling and a scale shall
be provided.
(g) In addition to the grossing bench, additional bench space shall be
provided to lay-out specimens, storage for specimen containers, and
formalin dispensing equipment.
(h) Space for hands-free dictation, which could be part of the grossing station,
shall be provided.
(i) Where flammable solvents are used (e.g., for grossing, tissue processing,
and block storage activities), work areas shall have appropriate ventilation
to protect worker safety. These shall be adequate storage for flammable
materials.
Advisory:
Consideration should be given to evolving technology, e.g., digital cameras
and scanners and associated software for integration with laboratory
information system (this would apply to clinical labs as well such as
haematology and microbiology).
53 Histology/ Project- Mandatory:
cytology, specific (a) Ventilated tissue processing equipment shall be provided.
processing (b) Where flammable solvents are used (e.g., for grossing, tissue processing,
and block storage activities), work areas shall have appropriate ventilation
to protect worker safety. These shall be adequate storage for flammable
materials.
Advisory:
Tissue processing supports both histology and cytology functions. This might
require a fire separation.
54 Histology/ Project- Mandatory:
cytology, specific (a) Device to melt paraffin, a work surface, and a LIS/LAN workstation shall be
histology provided.
set-up (b) Automated or semi-automated microtome, water bath, and a cold plate
shall be provided.
(c) This area, at the microtome, shall be positioned away from traffic and
interruption because the work requires concentration and utilizing very
sharp knives.
(d) The area shall have ergonomically designed workstations and access to a
process sink.
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Table 9.7 (Continued)
55 Histology/ Project- Mandatory:
cytology, specific A fume hood with a sink and reagent storage shall be provided.
special Advisory:
staining/ Typical additional equipment includes
coverslipping, (a) microscope;
manual (b) balance scale;
(c) microwave;
(d) small 4 °C refrigerator;
(e) process sink; and
(f) LIS/LAN workstation.
56 Histology/ Project- Mandatory:
cytology, specific (a) Automated staining and cover-slipping equipment utilizes quantities of
special flammable solvents: appropriate increased exhaust ventilation and
staining/ appropriate storage for solvents shall be provided.
coverslipping, (b) Typical additional equipment shall include a microscope and
automated station-by-station solvent stain, 4 °C refrigerator, process sink, and
biological waste discard containers.
57 Histology/ Project- Mandatory:
cytology, specific Means shall be provided to damp vibration interference at microscope stations.
microscopy This can be accomplished through anti-vibration construction or by the use of
isolation tables.
58 Histology/ Project- Mandatory:
cytology, specific Specialized storage shall be provided.
storage, Advisory:
slide, block, (a) Slide storage cabinets, vented tissue storage cabinets, and block storage
and specimen for histology specimens are stored near the lab; long-term storage, such as
the environmentally controlled storage for blocks, may be located off-site;
long-term tissue storage is not required.
(b) Slide storage could involve heavy structural elements.
59 Histology/ Project- Mandatory:
cytology, specific A secure, room temperature storage space with locked cabinets shall be
storage, provided for the storage of ethanol.
general
60 Histology/ Project- Mandatory:
cytology, specific (a) Typical equipment shall include 4 °C refrigerator and –20 °C freezers for
storage, long term storage.
cold (b) Freezers shall be monitored and alarmed.
Advisory:
Ultra-low freezers could be required.
61 Histology/ Project- Mandatory:
cytology, specific (a) This area shall be located adjacent to histology.
cytology (b) Workflow in cytology begins with accessioning and proceeds through slide
preparation in biosafety cabinets; staining and cover-slipping utilize highly
flammable solvents. Direct venting shall be provided.
62 Histology/ Project- Mandatory:
cytology, specific (a) Equipment-specific exhaust ventilation shall be provided.
cytology set-up (b) Typical equipment shall include biosafety cabinet, centrifuge, stainer, fume
hood with reagent storage, 4 °C refrigerator, and process sink.
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Table 9.7 (Continued)
63 Histology/ Project- Mandatory:
cytology, specific (a) A quiet, separate room, equipped with ergonomically-designed
cytology workstations shall be provided.
screening (b) Typical equipment shall include LIS/LAN workstation, microscope, and
adequate horizontal surface for trays of slides, for completion of
documentation and review of reference material.
64 Histology/ Project- Mandatory:
cytology, specific This area shall be in close proximity to histology, cytology, and tissue
recycling processing.
65 Histology/ Project-
cytology, specific
immunohisto-
chemistry
4 °C
66 Histology/ Project-
cytology, specific
cytogenetics
67 Histology/ Project-
cytology, flow specific
cytometry
Mandatory:
Typical equipment shall include a flow cytometer, a biosafety cabinet,
preparation bench, and a LIS/LAN workstation.
68 Histology/ Project- Mandatory:
cytology, lab specific (a) Room for intra-services consultation and training shall be provided.
consultation/ (b) LIS/LAN workstation and a central, table-mounted multi-headed (5)
training microscope capable of digital projection shall be provided.
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Table 9.7 (Concluded)
69 Morgue and Project- Mandatory:
autopsy, specific (a) Dedicated cleaning supplies and drains shall be provided.
general zone (b) To protect privacy, the areas shall have convenient access to HCF corridors
and to a non-public exterior vehicular entrance for the discreet transfer of
bodies.
(c) All areas of the morgueshall be accessible without having to travel
through the autopsy room.
70 Morgue and Project- Mandatory:
autopsy, whole specific (a) An access-controlled, outer zone with LIS/LAN recording workstation shall
body storage be provided; this receiving/dispatch area shall have direct, secure access to
a transfer vehicle garage.
(b) A (bariatric-capable) multi-compartment cooler or cool room separating
the receiving/dispatch area from the autopsy room shall be provided.
(c) A separate containment for foetus and body part storage shall be
provided.
(d) A lifting device for bodies shall be provided.
Advisory:
Video monitoring for security should be considered.
71 Morgue and Project- Mandatory:
autopsy, specific (a) Systems and equipment for moving bodies shall be designed for
autopsy room ergonomic safety.
(b) Means shall be provided for the safe handling of infectious materials and
to prevent the transmission of infection from bodies to workers and the
public.
(c) There shall be additional security provisions appropriate to the space and
activities.
(d) Lighting shall be designed for clear viewing of autopsy procedures.
(e) Lockable storage for instruments and potential forensic evidence shall be
provided.
(f) Ventilated storage for tissue shall be provided.
(g) Adjacent change and personal protective equipment storage room with
lockers, showers, and washroom shall be provided.
(h) Downdraft autopsy table and grossing bench, weight scales, lifting device,
and access to mobile imaging equipment shall be provided.
(i) A workstation shall be provided.
Advisory:
(a) This is a specialized service that could be a requirement of the
project-specific functional program.
(b) Provision should be made for A/V recording equipment.
9.8 Electrodiagnostic services
9.8.1 Description
9.8.1.1
Electrodiagnostic services encompasses non-invasive cardiology diagnostics and neurology diagnostics
both providing testing, patient and family/caregiver education, and consultation services to inpatients and
outpatients. These services may be provided in an HCF or within an ambulatory care centre; they may be
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combined with other diagnostic services or developed as standalone centres. The requirements in
Clause 9.8 are intended to apply to all areas where electrodiagnostic services are provided, wherever
located in the HCF.
9.8.1.2
Many HCFs provide resting electrocardiography (ECG) services, but depending on local conditions, other
cardiac diagnostic services that could be provided include
(a) stress electrocardiography;
(b) continuous ambulatory (holter) monitoring/loop recorder;
(c) ambulatory blood pressure monitoring;
(d) echocardiography (including stress, pharmacological stress, and transesophageal);
(e) pacemaker implantation;
(f) nuclear cardiology;
(g) arrhythmia devices service;
(h) heart function service; and
(i) cardiac rehabilitation (see also Clause 8.6).
9.8.1.3
Many HCFs provide resting electroencephlography (EEG) services, but depending on local conditions,
other neurology diagnostic services that could be provided include
(a) ambulatory EEG;
(b) electromyography (EMG) nerve conduction;
(c) evoked potential studies (including auditory, visual, electroretinograms, somatosensory);
(d) electronystagmography (ENG); and
(e) polysomnography.
9.8.2 Functional requirements
9.8.2.1 Patient management
Patient management provisions in electrodiagnostic services shall include the following:
(a) There should be an easily understood path of travel for patients to navigate.
(b) Privacy and confidentiality for patients shall be maintained throughout a patient’s visit.
(c) The flow of inpatients and outpatients shall be separated to the highest degree possible.
9.8.2.2 Workflow
Health care practitioners shall be able to monitor testing yet undertake other activities, especially
consultations (e.g., in room workstations for reporting).
9.8.2.3 Support service delivery
The design of support services in electrodiagnostic services shall include the following:
(a) The flow of patients shall, as much as possible, be separate from the flow of materials.
(b) The space for receiving and cleaning soiled materials shall be physically separated from the space for
storage of clean equipment and supplies.
9.8.3 Technical requirements
9.8.3.1 General
The following provisions shall apply
(a) EMG and evoked potential procedures shall be located away from electro-magnetic interferences.
Electrical power lines serving EMG equipment shall be clearly separated from other electrical lines.
(b) EEG and sleep lab procedure areas should be located peripherally in less active areas and away from
interference of other machines and human traffic. A computer link between EEG and the sleep lab
shall be provided.
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(c) Medical gas connections including oxygen and medical vacuum shall be provided in all
patient/testing rooms.
(d) Wireless ECG shall be provided outside the central service.
(e) Picture archiving and communications system (PACS) capabilities shall be provided for all modalities.
(f) Hands-free intercoms or wireless communication devices shall be provided.
(g) Local emergency call function shall be provided to physicians for stress testing.
(h) Treadmills shall have UPS and emergency power.
9.8.3.2 Acoustics
Design provisions for acoustics in electrodiagnostic services shall include the following:
(a) Acoustic privacy shall be provided in interview rooms and consultation areas.
(b) EMG and EEG rooms shall be separated to provide sound isolation between rooms and reduce
vibration.
9.8.3.3 Lighting
Lighting design in electrodiagnostic services shall include the following:
(a) Generally, windows are not required for cardiac diagnostic spaces. If windows are unavoidable,
window treatments shall avoid direct sunlight and glare.
(b) Echocardiology and trans-oesophageal echocardiogram (TEE) rooms shall be capable of being
rendered completely dark (i.e., if windows are included, black-out blinds shall be used).
(c) Emergency lighting shall be located so that they do not affect procedures, but provide safe egress in
case of a power failure.
(d) Non-reflecting baffles on fixtures shall be provided.
(e) Ambient light from the door shall not reflect on monitors.
(f) As the reading of PACS images is particularly sensitive to lighting conditions, dimmable indirect
fixtures shall be provided wherever PACS images are read.
(g) Dimmable lighting shall be provided for the ultrasound room.
(h) Ceiling mounted shadowless lighting shall be provided for CT and angiography rooms.
(i) In the diagnostic rooms, the emergency lighting should be switched so that it only comes on under
emergency generator use.
(j) Windows shall not be provided in ultrasound, X-ray, fluoroscopy, mammography, and angiography
rooms or in radiologists’ reading/interpretation areas. If windows are considered; design shall take
into account privacy of operations, radiation standards, and ability to read images. Window
treatments shall be provided to avoid direct light and glare.
(k) Equipment in-use warning lights shall be provided outside MRI and X-ray rooms to prevent people
from inadvertently entering the room.
9.8.3.4 Infection prevention and control
9.8.3.4.1
A hand hygiene sink shall be provided adjacent to the entrance of each procedure room and shall be
arranged to minimize incidental splatter on nearby personnel, medical equipment, or supplies.
9.8.3.4.2
Reusable medical devices (e.g., ECG leads, TEE probes) shall be reprocessed in a centralized MDRD or a
separate designated space in compliance with CAN/CSA-Z314.8.
9.8.3.4.3
Where disinfection and sterilization facilities are required, dedicated ventilation, cleaning sinks and
equipment shall be provided.
Clean and soiled areas of disinfection and sterilization shall be physically separated from each other.
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9.8.3.4.4
The space for receiving and cleaning soiled materials shall be physically separate from the space for
storage of clean equipment and supplies.
Storage space for clean and sterile items shall comply with the storage requirements in CSA Z314.3 or
CSA Z314.15.
9.8.3.5 Materials and finishes
The selection of materials and finishes in electrodiagnostic services shall be in accordance with the
following:
(a) Due to the high volumes of inpatient and outpatient services in the area, wall impact protection in
areas of heavy stretcher and equipment traffic shall be provided.
(b) Frame/door protection should be provided in areas exposed to heavy traffic and/or carts.
(c) Only washable acoustic ceiling tiles should be used. Solid, painted wall surfaces should be used,
except in public areas.
9.8.3.6 Technology considerations
The following technology considerations should be incorporated into the design of electrodiagnostic
services:
(a) Teleconferencing and videoconferencing amenities should be used to either access information or
provide information.
(b) A decision whether to include other telehealth technology (such as access to digital radiology or
pathology systems) should be made early in the planning process.
(c) Physical transfer systems such as pneumatic tubes and automated trolley systems should be used for
HCF-based programs if part of the campus-wide communications system.
(d) Closed circuit television should be considered where the functional design of the program does not
permit staff to oversee all necessary entry and egress points.
9.8.3.7 Technology requirements
The following shall be incorporated into the design of electrodiagnostic services:
(a) Phone, data, etc., shall be compatible with existing or planned overall HCF systems including staff
and emergency call systems.
(b) A voice recognition dictation system shall be provided for patient records and clinical studies.
(c) Document scanners shall be provided.
(d) Multi-function scanner/copier/fax machines shall be provided.
(e) All treatment spaces should have access to a computer so staff can access urgent information.
(f) Wireless, handheld, and/or voice-activated devices shall be provided to all staff and physicians.
(g) Personal security systems shall be provided for night staff.
9.8.3.8 Safety and security
9.8.3.8.1
For electrodiagnostic services, Clauses 9.8.3.8.2 to 9.8.3.8.13 shall apply in addition to the requirements
in Clause 7.7.1.
9.8.3.8.2
There shall be controlled access to the electrodiagnostic service. Entry and exit doors shall be minimized
and staff areas shall permit the viewing of entry and exit points
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9.8.3.8.3
Closed circuit television to monitor external areas should be considered during the detailed design phase
of planning.
9.8.3.8.4
Provision shall be made for patient monitoring and security in patient areas.
9.8.3.8.5
Patient change areas shall permit privacy when changing into or out of HCF clothes.
9.8.3.8.6
Patient files shall be kept in a secure environment that prevents access by unauthorized persons.
9.8.3.8.7
There should be a non-removable “Asset No.” on all equipment above a predetermined value.
9.8.3.8.8
Lockers shall be provided for staff personal effects in a secure environment.
9.8.3.8.9
Sufficient space shall be provided to enable the activities in this service to be undertaken in a safe manner.
9.8.3.8.10
The service shall be fully accessible for persons in wheelchairs and for patients being moved on a patient
trolley or patient bed.
9.8.3.8.11
The service should be designed to accommodate people with mental, physical, or sensory disabilities.
9.8.3.8.12
Provision shall be made for the safe and unobstructed movement of materials into and out of the service
(e.g., palette lifters delivering supplies to the storeroom).
9.8.3.8.13
Space for a resuscitation cart shall be located within units where there is a risk of cardiac arrest during the
procedure.
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9.8.4 Space details
Table 9.8 presents the standard requirements for key spaces within electrodiagnostic services area.
Common areas are detailed in Clause 11.
Table 9.8
Key space requirements and recommendations —
Electrodiagnostic services
1 ECG testing 12.0 Mandatory:
room (a) Stretcher access shall be provided to the room.
(b) Access shall be provided to the patient’s left-hand side.
Advisory:
Should be accessible to patients that use a walker or wheelchair.
2 Holter 10.0 Advisory:
hook-up (a) Stretchers or chairs may be used.
(b) This space may be sized at 12.0 m2 (to match other testing room areas —
for flexibility).
3 Holter 4.6 Mandatory:
scanning The station shall be in an enclosed area — in a quiet space, but may be
station combined with other functions.
Advisory:
Multiple holter scanning stations may be combined in one room.
4 Echocardi- 16.0 Mandatory:
ology testing (a) The echo machine shall be located on the patient’s right-hand side (when
room the patient is lying on their back).
(b) Stretcher access to the room shall be provided
(c) The door/width shall permit bed access.
Advisory:
The room should be accessible to patients that use a walker or wheelchair.
5 Transeso- 16.0 Mandatory:
phageal (a) The echo machine shall be located on the patient’s right-hand side (when
echocardio- the patient is lying on their back).
graphy (TEE) (b) Stretcher access to the room shall be provided.
testing room (c) The door/width shall permit bed access.
Advisory:
Should be accessible to patients that use a walker or wheelchair.
6 TEE Varies — Mandatory:
equipment minimum (a) The space shall meet the design and ventilation requirements of
cleaning 4.6 CAN/CSA-Z314.8 and CAN/CSA-Z317.2 for device reprocessing areas. The
room design of this room shall be developed in conjunction with the MDRD.
(b) The need for additional safety measures (e.g., a fume hood) shall be
determined in consultation with the HCF professionals responsible for
occupational health and safety and infection control.
(c) The room shall be close to the echocardiology room and be accessible via a
departmental staff/patient, rather than a public corridor.
(d) Surfaces shall be highly cleanable.
(e) Deep sinks with integral stainless steel counters shall be provided.
(f) A separate hand hygiene sink, with eyewash, shall be provided.
(g) There shall not be any storage of clean supplies in this room.
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Table 9.8 (Continued)
Advisory:
(a) There should be convenient access to the MDR for transporting of materials
that require cleaning/sterilization.
(b) Cleaning and reprocessing of instruments may be done in the room,
consistent with CAN/CSA-Z314.8, if there are particularly delicate
instruments or if there are insufficient numbers of instruments to allow
reprocessing in a central location.
7 Stress testing 20.0, plus Mandatory:
room physician (a) The room shall be sized/configured to permit access to both sides of the
viewing patient on the treadmill.
area of (b) The door/width shall permit stretcher access to the room. See
9.2 Clause 12.2.3.
(c) There shall be direct visibility into the room from the physician viewing
area.
(d) The stress metabolic test system shall be on the patient’s left-hand side
when on the treadmill.
(e) If there are multiple rooms, they shall be same-handed.
Advisory:
Stress testing should be adjacent to the prep room.
8 Stress echo/ 24.0, plus Mandatory:
metabolic physician (a) There shall be access to both sides of the stretcher.
room viewing (b) Stretcher access to the room shall be provided.
area of (c) There shall be direct visibility into the room from the physician viewing
9.2 area.
(d) The stress metabolic test system shall be on the patient’s right-hand side.
(e) Space shall be provided for an exercise bike, which can be moved out of
the way.
(f) A resuscitation cart shall be located directly adjacent.
(g) The room shall be able to be completely darkened. Dimmers shall be
provided on lights.
(h) If the room is to be used for nuclear cardiology,
(i) it shall be adjacent to the nuclear gamma camera room; and
(ii) the garbage receptacle shall be lead lined.
Advisory:
The room should be adjacent to the prep room.
9 Arrhythmia 17.0 Mandatory:
devices clinic (a) Access to both sides of stretcher shall be provided.
room (b) The door width shall permit stretcher access to the room. See
Clause 12.2.3.
(c) Space shall be provided for pacemaker programmer cases.
10 EEG Testing 16.0 Mandatory:
Room (a) The door/width shall permit stretcher access to the room. See
Clause 12.2.3.
(b) Sufficient space shall be available at the head of the stretcher to facilitate
clinician access.
Advisory:
Should be accessible to patients that use a walker or wheelchair.
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Table 9.8 (Concluded)
11 EMG/ENG 16.0 Mandatory:
testing room (a) The room shall be sized/configured to permit access to both sides of the
patient stretcher.
(b) Door/width shall permit stretcher access to the room. See Clause 12.2.3.
Advisory:
(a) The room should be planned and configured to allow space for reporting.
(b) Should be accessible to patients that use a walker or wheelchair.
12 Evoked 16.0 Mandatory:
potential (a) There shall be access to both sides of the stretcher.
(b) Stretcher access to the room shall be provided.
(c) There shall be space at the head of the stretcher.
(d) The room shall be able to be completely darkened.
(e) Dimmers on lights shall be provided.
(f) There shall be no windows in these rooms.
(g) Rooms shall be well isolated for sound and vibration shall be mitigated, as
patients are sensitive to sound and vibration.
Advisory:
The room should be located near the EEG technology/physician review
workstation.
13 Preparation 7.5 Mandatory:
room (a) The prep room shall be located near ECG, echo, EEG, EMG, EVP, sleep, and
stress rooms.
(b) There shall be one prep room for every three sleep rooms.
Advisory:
Locations for leads for all modalities requiring them should be considered.
14 Technologist/ Varies, 4.6 Mandatory:
physician for each (a) Special care shall be taken for lighting systems.
review/ work- (b) Dimming of indirect fixtures shall be provided.
quality station (c) Black baffles shall be provided on down lights.
assessment and (d) The room light shall match monitor brightness.
workstation additional Advisory:
circulation Review workstations may be decentralized to test modality areas, based on
space volumes and configuration.
9.9 Respiratory services
9.9.1 Description
9.9.1.1
Respiratory services provides diagnostic and therapeutic services used in treating respiratory conditions
and illnesses. The type and extent of services provided can vary dependent on the role of the HCF and the
location of the service (in-centre or as a standalone ambulatory service in the community).
9.9.1.2
Respiratory diagnostic services may include
(a) pulmonary function testing, which can include
(i) lung function and mechanics testing;
(ii) methacholine challenge testing;
(iii) arterial blood gas testing;
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(iv) pre-and post-bronchodilator spirometry;
(v) 6-min walk test;
(vi) spacer device and metered dose inhaler (MDI) instruction;
(vii) capillary puncture for haemoglobin; and
(viii) pulse oximetry and heart rate testing;
(b) asthma education;
(c) chronic obstructive pulmonary disease (COPD) education;
(d) sleep disordered breathing assessment;
(e) medical pleuroscopy;
(f) fluoroscopic intervention;
(g) percutaneous tracheostomy insertions; and
(h) bronchoscopic procedures (see Clause 9.5).
9.9.1.3
Respiratory therapeutic services can include
(a) airway protection and trachea care;
(b) management of ventilation;
(c) response to critical care incidents and cardiac arrests;
(d) arterial blood gas (ABG) analysis;
(e) spirometry;
(f) nebulizer and O2 therapy; and
(g) other services as defined in the National Alliance of Respiratory Therapy Regulatory Bodies’
9.9.1.4
Subject to local conditions, additional services can be provided by some respiratory services, including
(a) pulmonary rehabilitation (see also Clause 8.6); and
(b) hyperbaric therapy services.
9.9.2 Functional requirements
9.9.2.1 Patient management
Patient management provisions in respiratory services shall include the following:
(a) if respiratory services such as testing and demonstration for outpatients are part of the program,
facilities and equipment shall be provided as necessary for the appropriate function of the service;
(b) patients could be coming for several tests, and there should be an easily understood path of travel;
(c) privacy and confidentiality for patients shall be maintained throughout their visit; and
(d) the flow of inpatients and outpatients shall be separated to the degree possible.
9.9.2.2 Workflow
The following provisions shall apply:
(a) physicians shall be able to monitor testing yet undertake other activities, especially consultations;
(b) in-room workstations and/or central ‘hubs’ for reporting, etc., shall be accommodated;
(c) respiratory therapy services shall be provided according to a hub-and-satellite approach, including a
central hub, which includes the main staff work area, offices, assembly, testing, storage, etc., and
potential satellite locations in the surgical suite, critical care units, maternal and newborn, and
emergency; and
(d) all satellite locations should also include work areas, cleaning, processing, assembly, testing, and
storage as required.
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9.9.2.3 Support service delivery
The following provisions shall apply:
(a) the flow of patients shall, as much as possible, be separate from the flow of materials;
(b) the space for receiving and cleaning soiled materials shall be physically separated from the space for
storage of clean equipment and supplies; and
(c) appropriate local exhaust ventilation shall be provided if glutaraldehyde or other noxious
disinfectants are used in the cleaning process.
9.9.3 Technical requirements
9.9.3.1 Locations for cough-inducing and aerosol-generating
procedures
The following provisions shall apply:
(a) All cough-inducing procedures performed on patients who are suspected of having infectious
Mycobacterium tuberculosis shall be performed in rooms using local exhaust ventilation devices (e.g.,
booths or special enclosures that have discharge HEPA filters and exhaust directly to the outside).
(b) If a ventilated booth is used, the air exchange rate within the booth shall be at least 12 air changes
per hour, with a minimum exhaust flow rate of 50 CFM and differential pressure of 2.5 Pa.
(c) These procedures may also be performed in a room that meets the ventilation requirements for
airborne infection control as specified in CAN/CSA-Z317.2.
9.9.3.2 Hyperbaric therapy services
The following provisions shall apply:
(a) hyperbaric service areas shall be designed in accordance with the standards of the Undersea and
Hyperbaric Medical Society (UHMS);
(b) the design shall be based on the access required by the patient population for specific hyperbaric
treatment modalities;
(c) space requirements will depend on the volume and scope of services offered by individual HCFs; and
(d) the hyperbaric services area shall be conveniently located to emergency care.
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9.9.4 Space details
Table 9.9 presents the standard requirements for key spaces within respiratory services area. Common
areas are detailed in Clause 11.
Table 9.9
Key space requirements and recommendations — Respiratory services
1 PFT Room 14.0 See Clause 11 for common requirements and recommendations for an
examination/procedure/treatment room.
Mandatory:
Good air exchanges shall be provided, as there will be nebulized aerosols in
these rooms.
Advisory:
Some older equipment can be larger and require a larger room area.
2 Spirometry/ 12.0 See Clause 11 for common requirements and recommendations for an
ABG examination/procedure/treatment room.
Mandatory:
Good air exchanges shall be provided, as there will be nebulized aerosols in
these rooms.
3 Preparation 7.5 See Clause 11 for common requirements and recommendations for an
room examination/procedure/treatment room.
Mandatory:
(a) The prep room shall be located near ECG, echo, EEG, EMG, EVP, sleep,
and stress rooms.
(b) There shall be one prep room for every three sleep rooms.
Advisory:
Locations for leads for all modalities requiring them should be considered.
4 Technologist/ Varies, 4.6 Mandatory:
physician for each (a) Special care shall be taken for lighting systems.
review/ work- (b) Dimming of indirect fixtures shall be provided.
quality station (c) Black baffles shall be provided on downlights.
assessment and (d) The room light shall match monitor brightness.
workstation additional Advisory:
circulation (a) There may be a number of these workstations — for review of tests and
space quality control — in one room, based on departmental volumes.
(b) Consideration should be given to decentralizing review workstations to
test modality areas, based on departmental volumes and configuration.
5 6-min walk Varies; Mandatory:
test location assume (a) The test area shall be comprised of a convenient and measurable route
patients away from a main public circulation corridor.
use (b) The area shall be near the respiratory therapy department.
existing (c) Patient handrails shall be provided.
hallways/ (d) Flooring material(s) shall be smooth, flat, and have a non-slip finish
routes (linoleum or sheet vinyl). Carpeted floors shall not be used.
Advisory:
The area may be located in a suitable physiotherapy gym, if one is available.
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Table 9.9 (Concluded)
6 Central Varies; See Clause 11 for common requirements and recommendations for a storage
respiratory based on room.
therapy devices Mandatory:
holding/ expected (a) The room shall be in a core/central location, as it functions as a large
receiving storeroom and assembly room for spare equipment.
equipment (b) Medical gases shall be provided, including oxygen and medical air.
Advisory:
Portions may be distributed to satellite respiratory therapy facilities and may
be collocated with cleaning and preventive maintenance.
7 Central RT Varies; See Clause 11 for common requirements and recommendations for an
preventative ensure 4.6 examination/procedure/treatment room.
maintenance for each Mandatory:
work- (a) Good lighting shall be provided.
station, (b) A stainless steel workbench shall be provided.
equipment (c) Finishes shall be cleanable.
holding (d) A bench for testing equipment shall be provided.
area and
additional
circulation
space
8 Satellite RT Varies; Mandatory:
facilities ensure 4.6 (a) Facilities shall be comprised of a workstation, preventative maintenance
for each area, and storage.
work- (b) If any reprocessing of equipment is required, it shall be sent to MDR.
station Advisory:
and (a) Workstation and storage can be collocated.
additional (b) Depending on volumes, satellite respiratory therapy facilities may be
circulation located in the surgical suite, critical care, maternal and newborn/NICU,
space and emergency.
9.10 Medical imaging
9.10.1 Description
Medical imaging provides diagnostic testing for inpatients, outpatients, and emergency patients with a
variety of modalities and technologies in order to support the assessment and determine the diagnosis of
patients. Medical imaging may also be used for treatment, including interventions. Services may be
provided in an HCF to support in-centre services, as part of an ambulatory care centre, or as a stand-alone
diagnostic service to support referrals in the community.
The services provided by medical imaging may include
(a) radiography (including general radiography, tomography, and fluoroscopy);
(b) ultrasonography;
(c) nuclear medicine (including bone mineral densitometry);
(d) mammography (diagnostic and screening);
(e) computerized tomography (CT);
(f) magnetic resonance imaging (MRI);
(g) interventional/angiography;
(h) PET/CT (positron emission tomography);
(i) single photon emission computed tomography (SPECT); and
(j) portable imaging.
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9.10.2 Functional requirements
9.10.2.1 Patient management
Patient management provisions in medical imaging services shall include the following:
(a) The service shall be designed to allow triage of infectious versus non-infectious patients at the
entrance.
(b) In an HCF with inpatient beds, inpatients shall be escorted directly to a procedure room or a separate
waiting/holding area.
(c) The service shall be designed to facilitate isolation of infectious patients, e.g., through the use of
separation bay(s) in the stretcher waiting, holding, preparation, and recovery areas.
(d) The information and control desk for outpatients shall be easily visible and set up so that staff can
direct visitors to specific modalities. The electronic imaging management area shall be close to
reception or public access.
(e) Access to patient washrooms and change rooms shall be provided for each modality.
(f) Patient washrooms shall have an emergency call system. Call systems shall be provided in other areas
according to need.
(g) Change rooms and gowned waiting areas shall be close to their respective treatment spaces so that
patients do not enter public spaces and can maintain privacy when wearing gowns.
(h) Separate waiting areas, change rooms, and washrooms shall be provided for nuclear medicine.
9.10.2.2 Workflow
Workflow design in medical imaging services shall include the following provisions:
(a) Upper and lower GI procedures may be performed in separate fluoroscopy rooms.
(b) Patient tracking systems may be used to support patient care management.
(c) Provisions shall be made for staff and patient entrances from separate corridors.
(d) Patient holding/recovery areas shall be under staff control.
(e) Images shall be captured digitally or by computed radiography and shall be archived into a picture
archiving and communications system (PACS).
(f) Workstations shall ensure quality control by technologists and sonographers.
(g) Images shall be interpreted in a quiet reading area, optimized for reading digital images.
(h) Access to staff facilities shall be provided for staff use.
(i) There shall be separation of patient access and staff access to the modalities within the department.
9.10.2.3 Support service delivery
The design of support services in medical imaging services shall include the following:
(a) Storage space for medical equipment, sterile supplies, medical/surgical supplies, office supplies,
linens, pharmaceuticals, and narcotics shall be provided.
(b) Separate provisions shall be made for contaminated handling and holding of soiled goods, including
radioisotopes and radioactive wastes.
(c) Hand wash, eyewash, and shower stations shall be provided.
(d) Provision shall be made for high level disinfection of transducers.
(e) Lifting and transfer devices might be needed.
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9.10.3 Technical requirements
9.10.3.1 General
9.10.3.1.1
The design of diagnostic imaging services shall include the following provisions:
(a) Mechanical systems, electrical rooms, and elevators that are in close proximity to imaging equipment
shall be reviewed for their potential interference.
(b) In areas where interventional procedures will be undertaken, air exchanges shall be provided in
accordance with infection prevention and control and mechanical requirements.
(c) MRI, CT, and PET/CT and special filtration of water sources or closed-loop system shall be provided
when connected to imaging equipment, in accordance with the manufacturer’s requirements.
(d) Provisions for ceiling mounted equipment shall be incorporated in accordance with the equipment
manufacturer’s specifications.
(e) Windows shall not be provided in ultrasound, X-ray, fluoroscopy, mammography, and angiography
rooms or in radiologists’ reading/interpretation areas.
(f) There shall be separate heating and cooling zones for the equipment and controls.
(g) Structural design shall be aware of the floor loading of equipment.
(h) A strategy to allow for installation of cabling, shielding, and piping during the initial equipment
installation and for future equipment installation shall be incorporated.
(i) Radiology rooms shall be designed in accordance with applicable requirements.
X-ray Safety Code
(j) The nuclear medicine services shall be designed in accordance with applicable requirements.
(k) MRI facilities shall be designed in accordance with the National Alliance of Respiratory Therapy
Regulatory Bodies’ .
(l) Images shall be interpreted in a quiet reading area, optimized for reading digital images.
(m) MRI scan rooms shall be equipped with a strobe light fire alarm notification device.
(n) MRI scan room air shall have an oxygen monitor content to detect reductions in room oxygen levels
due to helium content increasing.
(o) MRI scan rooms shall have an emergency air exhaust system that is activated by the oxygen monitors.
(p) MRI scan room RF shielding designs for a shielded room within a facility’s building room shall meet
applicable requirements for seismic restraining.
9.10.3.1.2
The design for imaging areas should include sufficient space for
(a) the movement of stretchers; and
(b) the shifting of equipment (if applicable) to allow scanning from the patient’s left and right sides.
Sufficient space should also be provided in washrooms to allow transfers.
9.10.3.2 Special workspace provisions
The organization of the medical imaging areas shall be as follows:
(a) The MRI and prep area shall be within a secure location (change rooms, patient prep area, interview
room, sub-waiting and MRI forming a MRI suite.)
(b) The patient prep and sub waiting areas shall be beside CT.
(c) There shall be a barium prep area adjacent to the fluoroscopy room.
(d) Separate waiting areas, change rooms, and washrooms shall be provided for nuclear medicine.
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(e) An injection room shall be provided adjacent to the nuclear gamma camera room and the SPECT-CT
room.
(f) There shall be a stress test area adjacent to the nuclear gamma camera room.
(g) Decentralized radiologists’ reading/interpretation areas shall be provided for the various modalities.
(h) The design may include sharing of patient recovery areas to facilitate nursing coverage.
9.10.3.3 Radiation protection
A qualified physicist or radiation specialist shall be used to specify the type, location, and amount of
radiation protection required in accordance with the final equipment selection and layout.
Where protected alcoves with view windows are required, a minimum of 1.07 m shall be provided
between the exposure control and the outside partition edge.
Radiation protection requirements shall be incorporated into the specifications and the building plans.
Radiopharmacy: Guidelines for Healthcare Facility Pharmacies
Sterile Preparation of Medicines: Guidelines for Pharmacies
9.10.3.4 Acoustics
9.10.3.4.1
Acoustic privacy shall be provided in all imaging rooms, interview rooms, and reporting areas.
9.10.3.4.2
An acoustic study shall be completed in all MRI suite designs
9.10.3.5 Internal design
The following provisions shall apply to all medical imaging areas:
(a) Surface colours shall be compatible with the low lighting levels required for PACS/image viewing.
(b) Material shall be durable and resistant to impact (this area can be subject to significant stretcher
traffic).
(c) Doors shall include frame guards to protect against bumping and impact of stretchers and other
mobility aids.
9.10.3.6 Infection prevention and control
In addition to the general list of infection prevention and control requirements, the following provisions
shall be made in medical imaging areas:
(a) An area for segregation of patients requiring airborne precautions shall be provided
(b) Hand hygiene stations shall be distributed throughout the services
(i) at point of contact with patient;
(ii) at entry/exit to/from patient rooms and in all procedure rooms; and
(iii) in areas where operative procedures are performed;
(c) where high risk invasive procedures are anticipated, scrub sinks shall be provided directly outside the
staff entry to the procedure room.
(d) In order to meet radioactivity standards, special sink materials and specifications should be followed.
Stainless steel and hands free operable controls are required for hand hygiene sinks in areas handling
radioactive materials.
(e) Provision for storing of soiled reusable medical devices (e.g., ultrasound probes) shall be provided.
Clean and soiled areas of disinfection and sterilization shall be physically separated from each other in
compliance with CAN/CSA-Z314.8.
(f) Decontamination and sterilization shall take place within the MDRD or in an area that meets the
requirements of CAN/CSA-Z314.8 and (if applicable) CSA Z314.3.
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(g) Clean supplies, including those on carts, shall not be stored in hallways.
(h) Local access to washrooms and bedpan disposal shall be determined in accordance with the infection
control risk assessment (ICRA).
9.10.3.7 Materials and finishes
9.10.3.7.1
In addition to the general materials and finishes requirements, the following provisions shall be made in
medical imaging areas:
(a) Noise transmission control measures should be provided.
(b) Copper or lead lined components shall be used where needed for radiation protection. Lining
requirements shall be reviewed and approved by a qualified radiation specialist.
(c) Flooring shall be acoustically dampening and antistatic.
(d) Magnetic shielding shall be used where required to restrict the magnetic field plot.
(e) Radio frequency shielding shall be used where required to attenuate stray radio frequencies.
9.10.3.7.2
The area around, above, and below an MRI suite shall be reviewed and evaluated for the following:
(a) possible occupancy by person(s) who could have pacemakers or other metal implants; and
(b) equipment that can be disrupted by a magnetic field (e.g., personal computers, monitors, CT
scanners, and nuclear cameras).
After reviewing and evaluating the surrounding space, appropriate magnetic shielding shall be provided.
9.10.3.7.3
Anti-static flooring should be provided.
9.10.3.8 Functional and storage space
Functional and storage space shall be provided for the following:
(a) chemicals used in the unit;
(b) patient handling devices; and
(c) sharps disposal containers.
Eyewash facilities shall be provided when chemicals are being used.
9.10.3.9 Technology considerations
In addition to the general technology and communication requirements, the following provisions shall be
made in this service:
(a) Provision shall be made for the use of voice-recognition software for dictation (to be saved directly to
electronic health records).
(b) Additional communications systems and equipment that should be provided include
(i) hands-free intercom;
(ii) wireless earpieces for booking clerks;
(iii) voice recognition dictation system over the HCF network for patient records and clinical studies;
(iv) document scanners; and
(v) film digitizers.
9.10.4 Space details
Table 9.10 presents the standard requirements for key spaces in the medical imaging area. Common areas
are detailed in Clause 11.
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Table 9.10
Key space requirements and recommendations — Medical imaging
1 Radiography 29.0 See Clause 11 for common requirements and recommendations for an
room examination/procedure/treatment room.
Mandatory:
(a) The room shall have lead lining.
(b) There shall be a lead glass window between the control room and the
radiology room to provide clear view of patient.
Advisory:
(a) Equipment should be assessed before setting size.
(b) Same handedness in multiple radiology rooms should be applied to design.
2 Control room Varies; Mandatory:
(applies to 7.5 The following shall be provided:
Items 3 and 4) (a) standing-height counter;
(b) sufficient space to accommodate equipment and infrastructure;
(c) barrier-free access;
(d) a hand hygiene sink at entrance;
(e) lead lining;
(f) a lead glass window between the control room and the radiology room to
provide clear view of patient; and
(g) cabinet for storage for personal protective equipment (PPE).
Advisory:
Shared control room should be used.
3 Dedicated 22.0 Mandatory:
chest room, If a 3050 mm focal receptor distance is required, the room shall be 610 mm
including longer.
control room
4 Fluoroscopy Mandatory:
room, (a) The barium prep area shall be located directly adjacent to the staff work area.
including (b) Washrooms shall include
control room (i) direct access;
(ii) sufficient space to accommodate two doors; and
Room 29.0 (iii) direct access to bedpan disinfection facilities.
(c) The room shall have a lead lined enclosure.
Control room 7.5
Advisory:
Washroom 4.6 If there are multiple rooms, they should be designed with the same floor and plan
and orientation.
5 Ultrasound 13.0 Mandatory:
room There shall be direct access to a washroom.
6 CT room, Mandatory:
including (a) There shall be a direct line of sight (on a slight angle of approximately 25q)
control room, from the control room into the bore of the CT room.
washroom (b) A ceiling-mounted injector shall be located on the side of the room with
supply counters.
Room 40.0 (c) There shall be direct access from the control room into the CT room.
(d) There shall be separate corridor access into control room.
Control room 11.0 (e) There shall be direct access to the washroom from the CT room.
(f) The CT room and control room shall have lead lining.
Washroom 4.6 (g) Medical gases shall be provided in CT. These shall be positioned so that they
are on the opposite side of the OR table from the patient entry door into the
room.
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Table 9.10 (Concluded)
7 Angiography, Mandatory:
including (a) Room environment shall use same standards as an operating room (i.e.,
control room, mechanical systems standards).
computer (b) Emergency power, full UPS, and emergency lighting shall be provided as
room specified in CSA C282 and CSA Z32.
(c) The room shall have lead lining.
Room 56.0
Control room 11.0
Washroom 10.0
8 MRI 1.5/3.0 Mandatory:
tesla, (a) Planning and design shall include a patient hall or transition space to manage
including patient transfers and to create allowance for the five-gauss line.
control room, (b) There shall be a desk height counter in the control room.
MRI (c) The five-gauss line shall be contained either with room configuration or with
equipment the use of magnetic shielding.
room (d) RF and magnetic shielding shall be provided.
(e) Allowance shall be made for cryogen venting to exit the facility to a safe
Room 50.0 location.
(f) A dedicated cooling system shall be provided for the computer room with an
Control room 14.0 automatic emergency backup.
(g) A back-up system for the MRI scanner’s cryogenic helium cooling system
Equipment 17.7 shall be provided.
computer (h) DC incandescent lights shall be used within the MRI room.
room (i) Non-ferrous materials only shall be used within the MRI room.
(1.5 tesla) (j) Non-ferrous materials only shall be used in the ceiling system support grids.
Equipment 19.5
computer (k) Medical gases shall be provided in MRI.
room (l) Positioning of the anaesthetic medical gases shall be so that they are on the
(3.0 tesla) opposite side of the OR table from the patient entry door into the room.
Advisory:
(a) Additional provisions should be made in the structure design to support
heavy loads of MR magnets (includes room and path of travel for moving the
magnet from the exterior of the building to the final magnet location).
(b) Other adjustments might be needed to accommodate special patient needs
(e.g., bariatric).
(c) Prior to planning, new MRI scanner installations location vibration and
magnetic influence testing should be conducted at the planned installation
location.
(d) During design of a new MRI installation an area for helium “dewar” storage
and transport to the MRI should be planned for.
9 Nuclear 39.5 Mandatory:
medicine (a) The room shall have lead lining.
(excluding (b) The room shall be adjacent to the stress testing room for nuclear cardiology
control room) studies.
10 Mammo- 14.0 Mandatory:
graphy room There shall be direct access to a washroom.
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9.11 Pharmacy
9.11.1 Description
A pharmacy provides clinical services and medications to patients to a variety of programs in acute,
inpatient continuing care or ambulatory settings. Clinical pharmacy services can include direct patient care
e.g., assessment and education.
A pharmacy orders, controls, prepares for dispensing, and dispenses medications for inpatients and
emergency patients. It may also provide the same functions for outpatients.
The services provided by pharmacy can include, but are not limited to,
(a) Inpatient and outpatient dispensing;
(b) controlled drug storage and distribution;
(c) drug information;
(d) medication safety;
(e) procurement, inventory control, and secured storage of pharmaceuticals;
(f) administrative and clinical services;
(g) direct patient care activities (e.g., assessment, education);
(h) pre-packaging, compounding, and preparing non-sterile or extemporaneous compounds such as
lotions and ointments;
(i) formulary management;
(j) preparation of sterile products including total parenteral nutrition;
(k) IV admixtures;
(l) investigational drugs and preparation of drugs for clinical trials;
(m) chemotherapy, including mixtures;
(n) methadone dispensing;
(o) home parenteral therapy service; and
(p) education for patients, their families and caregivers, and staff.
9.11.2 Functional requirements
9.11.2.1 Patient management
Patient management provisions for pharmacy services shall include the following:
(a) The administration of medications to inpatients shall occur outside the pharmacy.
(b) Patients and families shall not access the secure area of pharmacy.
(c) Accessible areas include reception, waiting and counselling areas for non-pharmacy staff, outpatients,
and the public.
(d) Outpatients may collect medications and receive counselling in a secure, dedicated, and confidential
(private) area.
9.11.2.2 Workflow
Workflow design in pharmacy services shall include the following provisions:
(a) Space provided for preparation of all medications, including IV and cytotoxic drugs, shall be planned
in accordance with applicable requirements.
(b) Security measures shall be provided to ensure the security of staff, pharmaceuticals, patients, and
patient information.
(c) Provision shall be made for the proper storage, control, and disposal of all pharmaceutical agents,
including narcotics and controlled substances, as per applicable laws and guidelines.
(d) Access to convenient staff washrooms shall be provided.
(e) The pharmacy shall have access to a teaching/education/training room, which may be shared with
other departments.
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(f) The space provided for order entry and distribution of pharmaceuticals shall adhere to all relevant
standards, guidelines, and evidence-based practices.
9.11.2.3 Support service delivery
The design of support services in pharmacy services shall include the following:
(a) Provision shall be made for the secure handling and delivery of all medications.
(b) Pharmacy shall receive, break out, and store most bulk pharmaceuticals.
(c) Provision shall be made to include pharmacy as part of the IT infrastructure plan. The information
technology plan may include interfaces for materials management, accounts payable, and
environmental services, which will support the patient care information systems.
(d) Provision shall be made for IT linkages to ensure proper receiving and delivery of pharmaceuticals to
the department.
(e) Provision shall be made for environmental services, such as garbage and hazardous waste disposal.
(f) Waste shall be sorted at the point of use by pharmacy and removed from the department by
environmental services in accordance with all applicable standards.
9.11.3 Technical requirements
9.11.3.1 General
These following special considerations are particular to the pharmacy areas and shall be reviewed in the
course of design. Responses by individual facilities and programs will vary:
(a) Emergency (protected) power shall be provided as specified in CSA C282 and CSA Z32 for
refrigerators, laminar flow hoods, freezers, computers, and consoles.
(b) Provision shall be made for telephone, fax, and computer cabling (especially if the HCF does not have
wireless computer systems).
(c) Drug storage area (stores) should be independently securable.
(d) Drug storage area (stores) shall have provision for safe storage of
(i) narcotics and controlled substances;
(ii) quarantined drugs and hazardous drugs; and
(iii) flammables and combustibles.
(e) Refrigerators and freezers shall be classified as described in Clause 7.3.9.
(f) Refrigerators used for the storage of therapeutic products (drugs, medications, etc.) shall be
calibrated. Back-up refrigerators should be available in case of overstock or failure.
(g) Refrigerators should be alarmed either independently or centrally monitored as part of the building
automation system.
(h) Biological safety cabinets and other vented safety cabinets or hoods shall be vented in accordance
with CAN/CSA-Z317.2.
(i) An area for drug information shall be provided for display and storage of journals, books, and
computerized DI access workstations.
(j) Network computer and electrical cabling shall be provided to all rooms, including
education/teaching rooms, and allow for expansion of the services.
(k) Provision shall be made for cart or cassette storage in the pharmacy.
(l) An alarm system shall be provided to monitor the pharmacy periphery (doors and windows) and
internal secure areas such as the narcotics vault.
(m) A staff emergency assistance alarm system shall be provided.
(n) Counters in preparation areas shall be disinfectant-proof.
(o) The choice of medication delivery systems shall take infection prevention and control practices into
account.
(p) Eyewash stations and emergency showers shall be provided in accordance with occupational health
and safety guidelines.
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9.11.3.2 Acoustics
Design should consider acoustic privacy at the pharmacy counter and counselling areas.
9.11.3.3 Natural light
Considerations for natural light include the following:
(a) use of natural light should be considered for the benefit of staff; however, windows should not be
located next to the public area to maintain security and privacy of operations; and
(b) some medications are sensitive to natural light. Caution should be taken in locating natural light
sources.
9.11.3.4 Infection prevention and control
In addition to the general list of infection prevention and control requirements, the following provisions
shall be made in this service:
(a) Hand hygiene sinks shall be provided in each room where open medications are prepared for
distribution.
(b) Provision shall be made to protect medications from aerosols or splashing from the hand hygiene
sink.
(c) Carts, medication delivery systems, or cassettes selected shall be able to be easily disinfected with
disinfectants that are appropriate for use in pharmacies.
(d) If intravenous (IV) solutions are prepared in the pharmacy, a sterile work area with a laminar-flow
workstation designed for product protection shall be provided. The laminar-flow workstation shall
include a nonhydroscopic filter rated at 99.97% (HEPA), as tested by dioctyl-phtalate (DOP) tests, and
have a visible pressure gauge for detection of filter leaks or defects.
(e) Air handling and exchange systems (heating and cooling) should be localized.
(f) Air handling and exchange systems shall comply with CAN/CSA-Z317.2.
Sterile Preparation of Medicines: Guidelines for
Pharmacies
9.11.3.5 Materials and finishes
In addition to the general list of materials and finishes requirements, the following provisions shall be
made in this service:
(a) finishes in the sterile preparation buffer area shall promote effective cleaning and disinfection; and
(b) ceiling, walls, floors, fixtures, work surfaces, shelving, counters, and cabinets shall be smooth,
impervious, free from cracks and crevices, non-shedding, cleanable, and resistant to disinfectants.
9.11.3.6 Technology considerations
In addition to the general list of technology and communication requirements, the following provisions
shall be made in this service:
(a) Communication systems (e.g., phone, data) shall be compatible with existing or planned overall HCF
systems, including staff and emergency call systems.
(b) The pharmacy should be included in the IT infrastructure plan regarding the development of
automated health records, prescriber order entry systems, clinical decision support systems, etc.
(c) Communications between the main pharmacy, satellite locations, and any pharmacy staff deployed
to a clinical area shall be available.
(d) Evaluation of other technologies shall be reviewed. Some equipment may be implemented at the
planning stages; but regardless, provisions should be made for adapting space to accommodate the
technology in the future.
(e) Planning should consider the following technologies:
(i) prescriber order entry;
(ii) automated delivery systems (e.g., conveyor systems, pneumatic tube, etc.);
(iii) robotics, carousels, and other automated dispensing equipment; and
(iv) IT linkages to ensure proper receiving and delivery of pharmaceuticals to the services.
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9.11.3.7 Occupational health and safety
9.11.3.7.1
Areas should be designed to
(a) minimize the need for manual lifting and handling of supplies;
(b) provide sufficient storage space in easily reachable locations (e.g., between knee and shoulder
height); and
(c) allow staff to work in different positions (e.g., standing, seated in a chair, or seated on a high stool)
with sufficient leg clearance under work surfaces and hoods.
9.11.3.7.2
Biological containment cabinets and fume hoods shall meet applicable requirements.
9.11.3.7.3
Fume hoods shall provide sufficient leg space for seated work.
9.11.3.8 Technology considerations
See Table 9.11 for specific technology considerations for each pharmacy area.
9.11.3.9 Safety and security
9.11.3.9.1
In addition to the general safety and security requirements, design shall incorporate the following specific
features:
(a) minimization of entry and exit points;
(b) maximization of control by the staff through direct observation of all persons entering the area;
(c) access control system;
(d) intruder alarm system to monitor the pharmacy periphery (doors and windows) and internal secure
areas, such as the narcotics vault;
(e) staff emergency assistance alarms and security shuttle at the outpatient dispensing counter; and
(f) drug storage room and narcotics vault should not be located on an outside wall.
Directive on Physical Security Requirements for Controlled Substances
9.11.3.9.2
The pharmacy shall be designed to limit or restrict access by non-pharmacy staff after hours, in accordance
with HCF policies.
9.11.3.9.3
A lockable pharmacy night cupboard shall be provided for storing medications to meet patient needs
when the pharmacy is closed. This cupboard may be a partitioned off section of the pharmacy or a
separate dedicated room in a readily accessible location.
9.11.4 Space details
Table 9.11 presents the standard requirements for key spaces in the pharmacy area. Common areas are
detailed in Clause 11.
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Table 9.11
Key space requirements and recommendations — Pharmacy
1 Outpatient 11.0 Mandatory:
consulting (a) Shelving shall be provided for resource materials.
(b) Computer and printer access shall be provided.
(c) Windows from adjacent pharmacy area shall be provided for security.
(d) A telephone shall be provided.
(e) Area shall be accessible to patients that use a walker or wheel chair.
Advisory:
(a) The room should be located adjacent to the public (non-secure) suite
entrance.
(b) For security, there should be separate visitor and staff entrances.
2 Satellite Varies Mandatory:
pharmacy (a) Modular picking station(s) shall be provided.
(b) Space shall be provided for utility/supply carts.
(c) A hand hygiene sink and emergency eyewash shall be provided.
(d) Room shall have positive relative pressurization ventilation.
(e) Computer workstation(s) shall be provided.
(f) Alarm monitoring and card control shall be provided.
(g) A refrigerator shall be provided.
(h) Work space shall be provided for the pharmacist.
(i) Additional work space shall be provided for pharmacy technicians
(i.e., for drug distribution activities).
3 Sterile prep Varies; Mandatory:
vestibule assume not (a) An order entry workstation, with computer, printers, etc., shall be
less than provided.
10.0 (b) The vestibule shall have a hand hygiene sink and emergency eyewash.
(c) Space shall be provided for storage carts.
Advisory:
(a) A pass-through refrigerator(s) to the anteroom should be considered.
(b) For safety, visual monitoring (glazing) from adjacent pharmacy spaces
should be considered.
(c) Coat hooks should be provided.
4 Sterile prep Varies; Mandatory:
anteroom assume not (a) Space shall be provided for utility/storage carts.
less than (b) A hand hygiene sink and emergency eyewash shall be provided.
10.0 (c) Work surfaces and cupboards shall be chemically resistant.
(d) A refrigerated pass-through to sterile prep and sterile anteroom shall be
provided.
(e) The ceiling and wall surfaces shall be easily washed and disinfected.
(f) Storage and hampers shall be provided for linen and gowns.
(g) A positive pressure HEPA filter-equipped HVAC system shall be provided
to meet applicable clean room classification.
Advisory:
(a) Visual monitoring (glazing) from adjacent pharmacy spaces should be
considered for safety.
(b) An automatic door should be considered.
(c) A freezer should be considered.
(d) An emergency shower, without floor drain, should be provided.
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Table 9.11 (Continued)
5 Sterile Varies; Mandatory:
preparation assume not (a) Laminar flow hood(s) — ISO 5 (class 100) shall be used in this room.
area less than (b) Space shall be provided for utility/supply carts and other equipment
30.0 that will be used in the area.
(c) Visual monitoring (glazing) from adjacent pharmacy spaces shall be
provided for safety.
(d) A positive pressure HEPA filter-equipped HVAC system shall be provided
to meet applicable clean room classification.
(e) An automatic door shall be provided.
Advisory:
(a) An emergency shower, without floor drain, should be considered.
(b) A pass-through to the anteroom should be considered.
(c) Consideration should be given to a door security system.
6 Chemo- 10.0 Mandatory:
therapy (a) If located in a satellite pharmacy, alarm monitoring/card control shall be
preparation provided.
anteroom (b) Computer workstations shall be provided.
(c) There shall be a hand hygiene sink and emergency eyewash.
(d) Provision shall be made for a supply cart.
(e) A refrigerator shall be provided.
(f) A HEPA filter-equipped HVAC system shall be provided. Negative
pressure shall be maintained to the exterior and positive to the chemo
prep room.
(g) The anteroom shall be adjacent to a third room such as a vestibule or
satellite pharmacy.
(h) There shall be a pass-through to the chemo prep room.
(i) Visual monitoring (glazing) from adjacent pharmacy space shall be
provided for safety and checking.
(j) An emergency shower, without floor drain, shall be provided.
Advisory:
The following should be considered for inclusion:
(a) pass-through to the exterior;
(b) automatic door; and
(c) freezer.
7 Chemo- Varies; Mandatory:
therapy prep assume not (a) Work surfaces and cupboards shall be chemically resistant.
room less than (b) Visual monitoring (glazing) from adjacent pharmacy space shall be
10.0 provided for safety and checking.
(c) An externally vented biosafety cabinet shall be provided.
(d) Space shall be provided for utility/storage carts.
(e) A HEPA filter-equipped HVAC system shall be provided. Negative
pressure shall be maintained to the anteroom.
(f) A hazardous waste receptacle shall be provided.
(g) A hand hygiene sink and emergency eyewash shall be provided.
(h) A refrigerated pass-through to sterile prep and sterile anteroom shall be
provided.
(i) The ceiling and wall surfaces shall be washable and easy to disinfect.
(j) Storage and hampers shall be provided for linen and gowns.
Advisory:
Hazardous products should be stored under negative pressure.
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Table 9.11 (Continued)
8 Narcotics vault Varies, Mandatory:
may be a (a) Security partitions and a door shall be provided.
cupboard: (b) Alarm monitoring and card control shall be provided.
not less (c) Shelving shall be provided for drug storage.
than 1.5 (d) Telephone/intercom system shall be provided.
or secure Advisory:
room not (a) A computer workstation should be considered.
less than (b) An automatic dispensing unit (ADU) should be considered.
10.0 (c) If a secure room is used, the vault should a refrigerator.
(d) The vault should be adjacent to stores, packaging, and dispensing.
9 Picking station 7.5 Mandatory:
(a) A modular storage/picking component system shall be provided.
(b) Computer workstation shall be provided.
(c) Room for medication cart shall be provided.
Advisory:
(a) Bar code reader/label system should be considered.
(b) Access to telephone should be considered.
10 Order entry Varies, 4.6 Mandatory:
for each (a) A modular multi-user workstation shall be provided.
workstation (b) A computer and telephone shall be provided.
and (c) Furniture shelving shall be provided.
additional (d) Views from the order entry to the entrance shall be provided.
circulation Advisory:
space Adjacencies to dispensing, pneumatic tube, and fax should be considered.
11 Packaging Varies Mandatory:
area (a) Work surfaces/counters shall be provided.
(b) Multiple electrical outlets shall be provided.
(c) Adequate storage shall be provided.
(d) Computers and labelling and bar-coding equipment shall be provided.
(e) Bulk stores shall be adjacent to the area.
(f) A hand hygiene sink and emergency eyewash shall be provided.
Advisory:
(a) The dispensing area should be nearby.
(b) The packaging area should be adjacent to bulk stores.
12 Compounding Varies Mandatory:
area (a) Chemical-resistant work surfaces and counters shall be provided.
(b) Computer workstations shall be provided.
(c) A utility sink, with drying area, shall be provided.
(d) Storage cabinetry shall be provided.
(e) The area shall have a hand hygiene sink and emergency eyewash.
(f) Extensive electrical outlets shall be provided.
(g) Storage shall be provided for personal protective equipment (PPE).
(h) Provision shall be made for storage and disposal of hazardous materials.
Advisory:
The area should be adjacent to stores, packaging, and dispensing.
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Table 9.11 (Concluded)
13 Purchasing/ Varies; Mandatory:
receiving/ provide (a) Work surfaces and counters shall be provided.
storage clear (b) If the area is accessed from outside the services, alarm monitoring and
circulation card control shall be provided.
aisles of not (c) A shelving system shall be provided for storage.
less than (d) Refrigerators shall be provided.
900 mm (e) A clerical workstation, with computer and shelving, shall be provided.
wide (f) Provision shall be made for a break-out area and container recycling.
(g) Telephone, fax, and printers shall be provided.
(h) A bar-code scanner shall be provided.
(i) Space shall be provided for staging and returns.
(j) A filing system shall be provided.
Advisory:
(a) Adjacencies to compounding, packaging, and the storage of narcotics
and controlled substances should be considered.
(b) A hand hygiene sink and emergency eyewash should be considered.
14 General Varies; Mandatory:
dispensing assume (a) Dispensing counters shall be provided.
area 600 mm (b) Computer, printers, and telephones shall be provided.
deep (c) Provision shall be made for supply storage.
counter (d) Access shall be provided to a hand hygiene sink and emergency
with eyewash.
minimum (e) Refrigerators and freezers shall be provided.
1500 mm Advisory:
length for (a) Area could be adjacent to picking stations, order entry, and the
each task pneumatic tube station.
(b) Secure pick-up area should be provided.
15 Night Varies; not Mandatory:
cupboard less than (a) Shall function as a small central pharmacy for access to non-stock items.
4.6, (b) Secure access shall be provided.
10.0 if an (c) A secure area with a separate lock shall be provided for storage of
automated controlled drugs within the secure space (i.e., night cupboard or
dispensing medication room).
unit is used Advisory:
(a) An automatic dispensing unit (ADU) should be considered.
(b) Cupboard should include a refrigerator.
(c) Night cupboard should be central to 24 h inpatient units.
16 Drug Varies; not See Clause 11 for common requirements and recommendations for a
information less than primary communication station.
room 10.0. Advisory:
Assume 4.6 (a) Furniture workstation carrels should be considered.
for each (b) Audio-visual equipment and videoconferencing capability should be
workstation considered.
and
additional
circulation
space
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10 Support functional services requirements
10.1 Biomedical engineering
10.1.1 Description
10.1.1.1
Biomedical services are responsible for maintaining medical equipment and providing education and
training on the correct and safe use of electromedical equipment, as well as maintaining close working
relationships with materials management, clinical staff, the information technology (IT) services, and
vendors. The size and scope of the biomedical engineering department will vary depending on the type of
facility.
Examples of the services generally provided by biomedical services within an acute care HCF include
(a) medical equipment identification, evaluation, and specifications;
(b) installation;
(c) compliance and verification of standards and codes;
(d) emergency repair;
(e) investigation of equipment problems;
(f) routine inspections calibrations and preventative maintenance;
(g) maintaining records of repairs;
(h) tracking emerging technologies;
(i) storage of impounded equipment;
(j) consultation on equipment to clinical and other services;
(k) monitoring alerts/hazards; and
(l) essential support during emergency situations such as a power failure or outbreak.
10.1.1.2
Additional services that can be provided by biomedical services in an acute HCF, depending on local
conditions, include
(a) management of contracts for outsourced service providers;
(b) education and training on the correct and safe use of equipment;
(c) transporting equipment to the biomedical services shop for repair;
(d) managing a facility-wide electronic inventory management system; and
(e) outsourcing services to other facilities.
10.1.2 Functional requirements
10.1.2.1
The services shall be in close proximity to elevators, the receiving area, and an exit to allow convenient
egress for external servicing requirements.
Decentralized workshops may be used where there are significant workload demands.
10.1.2.2
A separate storage room shall be provided for inventory and shall be located within easy access from the
workshop area.
A holding area shall be provided for both components and equipment that are not being used or are
waiting for repair.
A customer service area should be the first point of access, with a separate entrance for accepting
equipment.
An eyewash station shall be located within the services.
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10.1.3 Technical requirements
10.1.3.1 General
10.1.3.1.1
Biomedical engineering services shall be designed so that the movement of typical electromedical and
medical equipment by HCF staff and biomedical engineering staff does not interfere with the efficient and
effective operation of the HCF.
10.1.3.1.2
All biomedical engineering services rooms shall be lockable.
10.1.3.1.3
Each technologist’s workbench, including the receiving and cleaning area, shall be equipped with
(a) piped compressed air, oxygen, and medical vacuum for servicing and testing of equipment; and
(b) a scavenging system for anaesthetic equipment, chemical vapour, solder fumes, etc. (see
CSA Z7396.1).
10.1.3.1.4
Fume hoods with appropriate ventilation shall be provided at mechanical workbenches in the workshop
area.
10.1.3.1.5
Benches shall be designed to support heavy equipment loads. Work surfaces shall be highly durable and
drip- and stain-resistant.
10.1.3.1.6
Biomedical engineering workshops and satellites shall be protected from electromagnetic interference (see
CAN/CSA-Z60601 Series).
10.1.3.1.7
Task lighting shall be provided above the benches. Additional lighting shall be provided to support repair
work performed on the floor nearby.
10.1.3.1.8
A satellite service shop should be considered as part of the surgical suite department, critical care, medical
imaging, and dialysis.
10.1.3.1.9
Satellite workshops shall be equipped with a floor drain.
10.1.3.1.10
Satellite areas shall be equipped with medical vacuum, medical air, nitrous oxide, anaesthetic gas
scavenging system, and oxygen.
10.1.3.1.11
Satellite workshops should be equipped with appropriate ventilation, sinks, and compressed air.
10.1.3.2 Acoustics
The noise level shall be controlled to ensure a comfortable environment.
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10.1.3.3 Natural lighting
All workplaces should have natural lighting or easy access to natural lighting.
10.2 Environmental services
10.2.1 Description
10.2.1.1
Environmental services provide full service cleaning and waste removal for all inpatient, outpatient, and
administrative areas, and for HCF-affiliated buildings on site.
10.2.1.2
Linen and laundry services can be part of other services and may, for the most part, be outsourced.
However, on-site laundry processing areas could be required for specialty items. This service may also
provide patient laundry services. Provision for back-up/emergency supplies shall be provided.
10.2.1.3
Services generally provided by environmental services (housekeeping and linen) in an acute care HCF,
inpatient continuing care/rehabilitation centre and mental health facility include
(a) routine daily cleaning, as well as reactive cleaning to address ad hoc situations in all areas, including
isolation areas;
(b) project cleaning of all areas on a basis that is neither routine nor reactive, but where notice can be
served of special cleaning situations and timing of cleaning can remain flexible (e.g., deep cleaning of
certain items);
(c) outbreak cleaning (i.e., special cleaning duties necessary to contain and eliminate an infection
outbreak);
(d) some equipment cleaning;
(e) replenishing supplies (eyewash stations, hand hygiene sinks, cleaning chemicals, etc.);
(f) floor mat cleaning service (in-house or contract, with management of outsourced service);
(g) flood remediation;
(h) holding and managing soiled linen and all waste and waste streams, including
(i) shredding;
(ii) recyclables;
(iii) composting;
(iv) chemical;
(v) biological; and
(vi) radiation;
(i) discharge cleaning;
(j) drapery/curtain, furniture, and upholstery cleaning; and
(k) responsibility for the distribution of OR scrubs.
10.2.1.4
Depending on local conditions, environmental services (housekeeping and linen) also provide additional
services, including
(a) patient laundry;
(b) transporting waste and recyclable materials from the soiled utility rooms throughout the facilities to a
central holding area;
(c) supplying, cleaning, and hanging draperies, window coverings, and cubicle/privacy curtains;
(d) responsibility for the distribution of clean linen to the clinical areas;
(e) transporting linen and garbage;
(f) room set-up, including audio-visual set-up, furniture and office moves, and equipment storage;
(g) advice/input into all purchases of upholstered products;
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(h) management, which may include delivery and pick-up, of specialty mattresses, equipment, slings,
etc.;
(i) services for community-based providers, if they are part of the organization;
(j) furniture storage;
(k) bed storage;
(l) distribution of staff uniforms;
(m) collection of soiled linen and waste from all inpatient bedrooms and transportation to soiled holding
rooms (may also be performed by on-unit/multi-skilled person) and transportation to waste holding
areas in the soiled loading dock area;
(n) pest control (sometimes a contracted service);
(o) disposal of capital assets;
(p) stocking of disinfectants, infection control supplies, etc.;
(q) light bulb changing;
(r) window cleaning;
(s) office accommodations (room booking);
(t) preventative maintenance on housekeeping equipment;
(u) contract management;
(v) limited grounds keeping within (10 to 15 m) of the entrance (alternatively, this may be provided by
plant maintenance staff); and
(w) minor repairs (paint touch-ups, curtains, etc.).
10.2.2 Functional requirements
10.2.2.1
Because of the need for regular communications between services, consideration should be given to
keeping the following services in reasonably close proximity or at least to establish efficient means of
communications (e.g., two-way pagers, wireless handheld device communication):
(a) forwarding of lost and found articles to security services; and
(b) taking in/closing calls logged in to central help desk services.
10.2.2.2
The services should be planned to support the following workflow:
(a) receiving/holding (awaiting repair);
(b) cleaning/clean hold;
(c) work area;
(d) parts storage; and
(e) equipment holding while awaiting pick-up.
10.2.2.3
The housekeeping space shall include the following zones:
(a) the supervisor and managers offices/administrative support;
(b) staff sign-in area; and
(c) training space/workplace hazardous materials information system (WHMIS) area (if required).
Storage areas for environmental services equipment shall be easily accessible to the services and to the
service elevators.
Central linen holding areas shall be directly adjacent to the receiving dock.
The laundry processing area should be collocated with the linen room and shall include areas for cart
make-up and back-up storage.
Space should be allocated for equipment storage, and such space shall be directly adjacent to the
housekeeping services.
Space shall also be allocated to store physical or electronic copies of material safety data sheets (MSDS),
which shall be kept onsite in accordance with WHMIS and applicable requirements.
A staff washroom and staff facilities should be located directly adjacent to the administrative offices.
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10.2.3 Technical requirements
10.2.3.1
The movement of soiled, infectious, hazardous, or otherwise unsafe goods and materials by environmental
services staff shall ensure efficient and effective operation of the HCF and the safety of patients, the public,
and HCF staff.
Environmental services shall conform to the applicable requirements for the use and storage of
hazardous materials within the HCF and on the HCF site.
10.2.3.2
Housekeeping carts and chemicals shall be lockable and, when not in use, be stored in housekeeping
rooms/closets.
Decentralized housekeeping rooms shall be designed to accommodate storage of supplies and
equipment — such as cleaning carts, polishers, and vacuums — and include water supply, a hand hygiene
sink, hopper sink, space to park and plug in equipment, cupboards/shelving to store supplies, and a
pre-mixed, automatic system for dispensing chemical supplies.
Waste handling area (materials management) shall be designed to accommodate the different waste
streams: general, biomedical, recyclable, food, chemical, etc.
Safety against fire, odour, and pests shall be provided, and cross-contamination by infectious materials
shall be avoided. Biomedical waste shall be managed in accordance with CSA Z317.10.
10.2.4 Occupational health and safety
Environmental service areas shall be designed to minimize the manual movement of goods and materials.
Where manual pushing of dollies and carts is required, distances should be minimized by considering the
location of the loading docks, storage, and elevators to units.
10.3 Nutrition and food services
10.3.1 Description
10.3.1.1
The food services are responsible for all nutrition in the HCF, serving both patients and non-patients. Food
delivery models can vary significantly between organizations and the field continues to evolve with the
emergence of new delivery models. Each organization will need to determine the most appropriate
delivery model and plan accordingly. Clause 10.3.1 provides general guidance typical for all models, but
does not describe specific requirements.
10.3.1.2
Food delivery models can include
(a) room service (food delivered on demand);
(b) tray service (cold plated or hot plated);
(c) bulk; and
(d) “catering to you” (meals plated at bedside).
10.3.1.3
Services in an acute HCF, inpatient continuing care/rehabilitation centre, and mental health facility
generally include
(a) menu planning, food procurement, food preparation/production, meal assembly, and delivery to
patient units and/or on-unit dining room serveries;
(b) contract management of outsourced service providers;
(c) waste removal;
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(d) warewashing, cart washing, and food service-related waste management;
(e) nourishments to pantries throughout the HCF;
(f) catering, internal and external;
(g) clinical nutrition services (other than dietician services);
(h) late night meal service, as required; and
(i) special dietary needs.
10.3.1.4
Retail food services for visitors, outpatients, and staff in an acute HCF, inpatient continuing
care/rehabilitation centre, and mental health facility can include
(a) preparation, production, and service of food and beverage products for staff and visitors;
(b) a central cafeteria servery and seating area;
(c) a branded or unbranded food and beverage outlet(s) (may serve coffee, food, etc.); and
(d) vending area(s).
10.3.1.5
Food services in an acute HCF, inpatient continuing care/rehabilitation centre, and mental health facility
may, depending on local conditions, provide additional services, including
(a) clinical and therapeutic diets;
(b) food purchasing and receiving;
(c) food services equipment purchasing;
(d) food services equipment repairs and cleaning;
(e) cleaning of all food areas;
(f) additional vending machines in high-traffic areas including, but not limited to, emergency, outpatient
clinics, etc.;
(g) input into specifying equipment and food safety for all food areas, such as activities for daily living
(ADL) kitchens and kitchenettes;
(h) community relations/services to community groups, such as meals-on-wheels, meals to detoxification
facilities, etc.;
(i) snack/tea services to inpatient bedrooms (could be provided by volunteers); and
(j) dietician services.
10.3.2 Functional requirements
10.3.2.1
Requirements (space, internal adjacencies/planning) vary according to the HCF’s food delivery model.
Space should be planned to reflect the following workflow:
(a) food receiving;
(b) storage;
(c) pre-preparation;
(d) preparation;
(e) production;
(f) holding (refrigerated); and
(g) patient.
Office space should be provided for administration, menu planning, etc.
10.3.2.2
The receiving dock shall open directly to the bulk storage area and the refrigerated/freezer storage areas.
Deliveries shall not pass through the food production areas.
Planning for the handling of all soiled materials shall reflect the following workflow:
(a) patient;
(b) dish room (including dedicated space for waste); and
(c) cart wash.
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10.3.2.3
The pot wash and dish room areas shall be separate rooms and be designed to reduce noise within the
rooms and the migration of sound outside the rooms.
10.3.2.4
Retail outlets and vending machines shall be in a location that encourages their use.
10.3.3 Technical requirements
10.3.3.1 General
10.3.3.1.1
An eyewash station shall be provided near chemical dispensation areas.
10.3.3.1.2
Special ventilation and heat removal shall be provided for the kitchen area.
10.3.3.1.3
Space for food service carts through the entire HCF shall be provided.
10.3.3.1.4
Space shall be provided at the plate-scraping station to separate and store waste streams into organic,
recyclable, and garbage.
10.3.3.1.5
For operational efficiency, the use of an oven that accommodates roll-in carts should be considered.
10.3.3.1.6
The operational and space implications for the provision of three days’ pandemic supply of all products
should be considered. Longer periods should be planned for in remote areas or where supplies could be
delayed by weather, natural disasters (fire or flood), or terrain.
10.3.3.1.7
A locked chemical storage area with a chemical dispensing system (e.g., for dishwashing equipment),
separate from the food storage area, should be considered.
10.3.3.1.8
Personal patient food shall be stored separately from food purchased by foodservices department.
10.3.3.1.9
Decentralized food serveries shall be lockable, and locked when not in use by food service personnel.
10.3.3.2 Occupational health and safety
Occupational health and safety provisions in nutrition and food services shall include the following:
(a) Environmental control for noise and air conditioning shall be provided.
(b) General and task lighting shall be adequate and provided over the work areas.
(c) Increased ventilation and acoustical isolation shall be provided for the dishwasher and pot washing
rooms.
(d) The walls, ceilings and floors shall be washable and moisture-impervious.
(e) The floors shall be non-slip.
(f) Depending on the operation model, special ventilation, space, and electrical requirements should be
provided in accordance with CAN/CSA-Z317.2.
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(g) Functional and storage space shall be provided for chemicals used in the unit.
(h) Eyewash facilities shall be provided when chemicals are being used.
(i) Kitchen class “K” fire suppression systems shall be provided in accordance with applicable
requirements.
(j) Dishwashing areas shall be designed to minimize lifting, pushing, pulling, and carrying.
(k) Ergonomics principles shall be applied to the design of work areas (e.g., heights) and equipment
selection (e.g., size and weight of carts).
(l) Flammable storage cabinets should be included for both new and used cooking oils.
(m) Chemicals (e.g., fuel for heating trays) shall be stored separately.
10.4 Materials management
10.4.1 Description
10.4.1.1
Materials management arranges for the procurement, receipt, and supply of most goods used by the
programs and services in the HCF. Within their quality control standards, the services provides an area for
receiving, storing, and inventory control of incoming and outgoing materials used in acute, mental health,
rehabilitation, and chronic care facilities.
The services generally provided by the materials management services in an acute HCF, inpatient
continuing care/rehab centre, and mental health facility include
(a) purchasing (acquisition of capital and supplies);
(b) standardization of services and products;
(c) maintaining stock inventory or appropriate safety stock levels in the event of just-in-time (JIT);
(d) requisition and distribution of medical/surgical supplies;
(e) shipping and receiving;
(f) stores;
(g) procurement and stocking of specialty supplies, such as pandemic supplies, chemicals, and biological
and radiation materials; and
(h) storage for flammables.
10.4.1.2
Depending on local conditions, materials management provide additional services, including
(a) time-sensitive and reliable portering, including a standard schedule as well as rush/emergency
capabilities;
(b) a short-term holding area for surplus equipment;
(c) responsibility for archive storage for inactive health, finance, laboratory, diagnostic imaging, and
other records (may be outsourced);
(d) storage of back-up patient equipment, such as beds, bassinets, and wheelchairs, and management
and disposal of surplus equipment;
(e) sorting and delivery of incoming mail and internal correspondence, pick-up and metering of
outgoing mail, receiving and shipping of courier packages, and delivery of small courier packages
internally;
(f) input into furniture selection and layout;
(g) printing;
(h) transportation;
(i) courier services between sites;
(j) providing materials management services to other organizations such as physicians and community
care access centres (CCACs); and
(k) disposal of hazardous waste materials.
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10.4.2 Functional requirements
10.4.2.1
The services should be planned to support the following workflow:
(a) receiving/holding (awaiting repair);
(b) cleaning/clean hold;
(c) work area;
(d) parts storage; and
(e) equipment holding while awaiting pick-up.
10.4.2.2
The mailroom, inventory control office, and print shop should be in close proximity to the materials
management administrative offices.
10.4.2.3
The waste-handling area shall include a dock compactor, dock for general use, recycling areas, cardboard
area, a refrigerated waste holding and cart washing area, and a confidential waste holding area.
10.4.2.4
The clean receiving/shipping area shall be separated from the soiled receiving/shipping area. In clean work
areas, to avoid contamination, materials shall flow from clean to soiled.
In planning for soiled materials, the materials shall flow from soiled to a wash area, then to a clean
storage area.
10.4.2.5
A receiving/inspection work area shall be located adjacent to the clean receiving areas.
10.4.2.6
The bulk stores areas should be directly adjacent to the receiving area. Unit supplies shall be adjacent to
bulk stores.
10.4.2.7
In acute care hospitals, a separate enclosed entrance shall be provided for morgue traffic.
10.4.2.8
Space should be allocated for pandemic and CBRN planning adjacent to the receiving area.
10.4.2.9
There shall be accommodation for off-hour service deliveries, as well as a refrigerated storage area.
10.4.2.10
There shall be a receiving office/work area with a view of the docks if physical plant allows. Offices should
be consolidated in one suite within the materials management area.
10.4.2.11
Storage rooms for flammable and combustible liquids, and tanks of medical gases, shall be located
adjacent to the receiving areas.
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10.4.2.12
An area for vendor representatives and a resource area shall be provided directly adjacent to the materials
administrative offices.
10.4.2.13
The cart marshalling area shall be close to the service elevators.
10.4.3 Technical requirements
10.4.3.1 General
10.4.3.1.1
The movement of typical goods and materials, as well as large, soiled, infectious, hazardous, or otherwise
unsafe goods and materials, by building, engineering, and maintenance staff or staff associated with the
operations and functions of this services shall not put at risk the efficient and effective operation of the HCF
or compromise the safety of patients, the public, or HCF staff.
Materials management shall conform to applicable requirements for the use and storage of hazardous
materials within the HCF and on the HCF site.
10.4.3.1.2
Separate service elevators shall be provided within the HCF for the transportation of materials, promotion
of operational efficiencies, and provision of an appropriate environment for patients and the public.
10.4.3.1.3
Planning for the materials management area shall be in compliance with CSA Z314.15.
10.4.3.1.4
Each receiving bay shall be equipped with a levelling device.
10.4.3.1.5
A scissor lift or ramp, fully adjustable between ground and dock, should be provided in at least one bay to
facilitate the movement of goods.
10.4.3.1.6
A meeting room should be provided close to the receiving docks.
10.4.3.2 Occupational health and safety
Provisions for occupational health and safety shall include the following:
(a) Functional and storage space shall be provided for chemicals used in the unit.
(b) Vehicle exhaust gases shall not interfere with building ventilation system intakes in the
receiving/shipping docks area.
(c) All floors shall have a highly durable, easy-to-clean surface.
(d) There shall be storage space for spill clean-up kit storage.
(e) The dock area should be provided with climate control.
(f) The dock area should be provided with easy-to-clean, slip-resistant surface.
(g) Consideration should be given to heated floors.
(h) Functional and storage space shall be provided for patient handling devices.
(i) Eyewash facilities shall be provided when chemicals are being handled.
(j) Ergonomics shall be considered in the design of work areas (e.g., heights) and equipment selection
(e.g., size and weight of carts).
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(k) Materials management areas shall be designed to minimize the manual lifting, lowering, pushing,
pulling, and carrying of items.
10.5 Plant maintenance
10.5.1 Description
10.5.1.1
Physical plant management services provide operation and maintenance of the HCF, including the
building and all plant systems and installed equipment, and excluding electronic and sensitive medical
equipment.
The department is tasked with the governance of the physical plant assets. This encompasses the
infrastructure in its entirety and a mandate to provide a safe and healthy environment for its staff
occupants and patients.
The management team holds a membership or may lead on committees in the areas of occupational
health and safety, infection prevention and control, leadership teams, disaster planning and response,
project planning, capital development, construction, space planning, and other committees and
governance groups that could be applicable or have impact on the facility or its operation.
The department is responsible for the acquisition and conservation of utilities and other related
commodities to insure sustainment of the physical plant.
The management of the physical plant encompasses a broad range of systems and components, many
of which are covered by CSA standards and by regulatory requirements. A preventive maintenance
management system is employed to carry out the tasks required to maintain the equipment in good
operating order within the various systems. These include building envelope components and
architectural finishes, grounds, electrical distribution and infrastructure, medical gases, air, and fluid
transfer distribution and storage systems, HVAC systems, boiler, hot water, steam, and sterilization systems
and distribution, life safety systems such as fire alarm, nurse call, code blue, and auxiliary communication
systems, security systems, plumbing, elevators, refrigeration, and other related systems.
The maintenance and management of equipment within the envelope of the physical plant may include
a wide range of specialized equipment required by clinical and support departments. The plant services
department should provide input and approval of all equipment that may have an impact on the facility or
a requirement for maintenance or operation.
10.5.1.2
Services provided by the plant maintenance services can include
(a) management, maintenance, and control of
(i) site property, grounds, irrigation, drainage, fencing, signage, lighting, parking, auxiliary
buildings, utility service corridors systems, and public areas management and maintenance;
(ii) facilities exterior, building envelope, foundations, roof systems, and utility services building
connections from demarcations;
(iii) facility interior walls, architectural finishes, floors, ceilings, and structural components;
(iv) building operational services systems, building operating components, and physical plant
maintenance (e.g., doors, hardware, key control, elevators, signage, loading docks, air tube
systems, kitchen services, elevators, sterilization, rolling stock, beds, etc.);
(v) primary electrical transformation and distribution systems and secondary electrical distribution
systems;
(vi) emergency power generation, distribution, and uninterrupted power supply systems;
(vii) lighting systems and controls;
(viii) nurse call, code call, intercoms, and other audio communication systems;
(ix) life safety alarming, monitoring, and protection systems;
(x) HVAC generation, distribution, and systems;
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(xi) quality air and ventilation systems distribution, control and maintenance (i.e., HEPA, AIRs,
computer rooms, and other specially ventilated areas);
(xii) plumbing and water treatment systems (e.g., demineralization, ultraviolet, filtration systems);
(xiii) fire suppression sprinkler, stand pipe, and fire hydrant systems;
(xiv) medical gases distribution, bulk storage, and generation systems;
(xv) special and waste water collection system;
(xvi) steam and heating systems distribution and maintenance; and
(xvii) hazardous waste and flammable storage;
(b) statutory testing;
(c) fire prevention and safety;
(d) supervision/coordination of work requiring specialized training/outsourced services, such as elevators
and medical gases;
(e) organized maintenance tasks, including
(i) preventive maintenance, intended to actively reduce the risk of on-demand maintenance;
(ii) corrective (or on-demand) maintenance, which are unplanned activities to correct, repair,
replace, or refurbish the facilities; and
(iii) predictive maintenance, which uses specialized tests (vibration, thermography, etc.) to predict
the need for maintenance of certain equipment within the facilities; and
(f) life cycle replacement and refurbishment.
10.5.1.3
Depending on local conditions, plant maintenance services offer additional services, such as
(a) electrical;
(b) plumbing;
(c) carpentry (including millwork);
(d) locksmithing;
(e) IT physical infrastructure maintenance and management;
(f) call centre/help desk operations;
(g) medical gas systems maintenance;
(h) maintenance and repairs to mechanical equipment and systems for
(i) laundry;
(ii) water treatment;
(iii) kitchens;
(iv) vertical transport;
(v) refrigeration;
(vi) conveying systems;
(vii) steam generation (i.e., boilers and distribution systems);
(viii) device cleaning and sterilization equipment (e.g., sterilizers, washer-disinfectors);
(ix) nurse call systems; and
(x) monitoring systems for wandering and for infant protection;
(i) painting and minor projects;
(j) assessment and/or repair of building infrastructure, including
(i) facility fabric, internal and external;
(ii) exterior furniture and structure;
(iii) fixtures and fittings;
(iv) floor and floor covering; and
(v) decorative finishes;
(k) grounds keeping, including snow removal;
(l) window washing;
(m) project planning and capital redevelopment;
(n) flood remediation (including work on sumps, pits, and drains);
(o) parking lot maintenance and operations;
(p) furniture/non-medical equipment repairs (including holding area);
(q) welding;
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(r) maintenance of in-house wayfinding systems;
(s) construction project management;
(t) providing support to HCF emergency code response teams;
(u) assisting in planning emergency preparations;
(v) physiotherapy and occupational therapy equipment repairs and servicing (specialized aids, ceiling
lifts, etc.);
(w) maintenance and repairs to clinical equipment (e.g., wheelchairs, beds); and
(x) coordination of wheelchair and stretcher inventory.
10.5.2 Functional requirements
10.5.2.1
The design of the HCF shall provide sufficient space for the plant maintenance personnel and their
supervisors to carry out their assigned tasks, as well as storage and workshop areas to house the required
tools and equipment to carry out these tasks effectively.
10.5.2.2
The services should be planned to support the following functions:
(a) facilities management supervision and operations, including work areas for call centre/help desk,
computerized maintenance management system (CMMS), and building automation system (BAS)
operation and maintenance;
(b) contractor holding, where contractors will come in to get specific work orders, work instructions, and
receive training if performing special work or work in facility areas that require special procedures;
(c) project management for retrofit/refurbishment and life cycle work performed throughout the site,
including work areas and drawings cabinets to keep current as-built and ongoing project drawings
for the facility;
(d) work areas for mechanical, electrical, electronic, carpentry, locksmith, and hot work;
(e) training and induction of new plant maintenance staff and/or outside contractors; and
(f) disaster planning and crisis management.
10.5.2.3
Workflow should be planned as follows:
(a) receiving/holding (awaiting repair);
(b) cleaning/clean hold;
(c) parts and tools storage; and
(d) equipment holding while awaiting pick-up.
10.5.2.4
A staff washroom and staff facilities should be located directly adjacent to the plant maintenance offices.
10.5.2.5
Plant maintenance spaces shall be easily accessible for staff with disabilities.
10.5.2.6
The following provisions shall apply:
(a) The manager’s office shall be located within the plant maintenance services.
(b) The plans room shall be located within the services.
(c) The main services shall consist of a general office for clerical staff and storage, a call centre, offices,
plans rooms, specialty workshops, and storage/holding areas.
(d) A multi-use office close to the services should be provided for contractors and other service
personnel.
(e) Workshops shall be located close to the equipment holding area.
(f) The welding and/or painting area shall be situated against an outside wall.
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(g) A shower/change area should be provided close to the workshops.
(h) The maintenance garage/grounds areas should be located in a location central to the services it
provides, with satellite service boxes at every entrance.
(i) An inventory storage room for parts and materials shall be provided adjacent to the workshops or
within the workshop area.
10.5.3 Space details
10.5.3.1 General
The space requirements within the plant maintenance workspace vary according to HCF size, design
constraints, and the services that plant maintenance will provide to the HCF, but in general
Clauses 10.5.3.2 to 10.5.3.8 should be taken into account.
10.5.3.2 Facility manager’s office
The facility manager’s office shall
(a) have an area of at least 20–23 m2;
(b) provide a quiet space to work, with privacy as required for human resources and customer meeting
requirements;
(c) accommodate a group of up to 6; and
(d) be positioned to give a view of entries and protected storage areas.
10.5.3.3 Open area offices
Staff work in open area offices shall each be provided with a cubicle with a minimum of 11 m2 of
workspace.
Hotel stations shall be planned for recurring visitors, in a number that is adequate to meet the needs.
They shall be of smaller size than cubicles for regular employees, at about 6 m2 each.
An open area shall be provided, with storage and a table large enough to allow the roll out of as-built or
project drawings.
Workspace for project teams shall also be provided for use in building and equipment life cycle
planning, replacement, and upkeep. To allow for easy circulation, an area of 50–60 m2 shall be planned for
this purpose.
Additional space shall be planned to allow easy circulation around the different work areas mentioned
above.
10.5.3.4 Multipurpose room
Space shall be provided for the purposes of training, staff orientation, meetings, and (if needed) a lunch
room. The area shall be sized in accordance with anticipated use. Provision for presentations and/or video
viewing should be provided. This space may also be designated for repurposed use during crisis/disaster
management situations.
If used as a lunch room, the area should provide sufficient seating at tables and allow for minor meal
preparation and cleanup of kitchen utensils, etc. In general, an area of 20–30 m2, depending on the
number of people to house, shall be sufficient to meet these needs.
10.5.3.5 Workshops
Workshop areas will be used for equipment, material, and tools to perform repairs or to fabricate parts.
Some areas are used for all hot work and others to allow refrigeration mechanics, maintenance mechanics,
millwrights, plumbers, electricians, locksmiths, and carpenters to bring in equipment that cannot be
repaired in place.
Clean areas should be provided for work on smaller and/or dust sensitive equipment such as circuit
boards, computer equipment, electronic door opening devices, electronic/mechanical locks, etc.
Servers for the building automation system (BAS) system may be located in this area to allow controlled,
yet easy access by the appropriate plant maintenance staff.
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Approximately 80 m2 should be planned for workshops, with the general workshop area larger than the
clean workshop because of the size equipment and greater number of interventions that are usually
performed in those spaces.
10.5.3.6 Storage
Storage areas generally hold large material that the plant maintenance staff need (e.g., lengths of copper
pipe, vinyl rolls, spare doors, panes of glass, etc.). They are also used for the storage of large tools that any
of the trades might use, and service carts required by the plant maintenance staff.
Separate areas should be designed for storage of flammable items, paint, compressed gases (e.g.,
nitrous oxide, oxygen, propane), chemicals etc. These areas shall have their specific exhaust with an alarm
in compliance with BAS, as well as specific cabinets for these uses.
Depending on the size of the HCF and plant maintenance services performed, approximately 60–75 m2
should be planned for storage.
10.5.3.7 Washrooms and change room
Washrooms and change rooms shall be provided to allow plant maintenance staff to lock personal items in
a cabinet and to store coats, hats, boots, etc.
10.5.3.8 Miscellaneous areas within plant maintenance workspace
Circulation areas around each of the locations described in the previous sections shall be planned in the
design of the HCF and shall meet with the requirements of the most recent edition of CAN/CSA-Z317.11.
10.5.4 Technical requirements
10.5.4.1 General
The movement of typical goods and materials, as well as large, soiled, infectious, hazardous, or otherwise
unsafe goods and materials, by building, engineering, and maintenance staff shall not put at risk the
efficient and effective operation of the HCF or compromise the safety of patients, the public, or HCF staff.
The functions of the building, engineering, and maintenance services shall conform to applicable
requirements for the use and storage of hazardous materials within the HCF and on the HCF site.
10.5.4.2 Acoustics
The noise level shall be controlled to ensure a comfortable environment.
10.5.4.3 Lighting
Plant maintenance spaces are typically located in areas of the HCF where natural lighting or easy access to
natural lighting are difficult to achieve. Careful consideration shall therefore be given to appropriate
lighting levels, with supplementary task lighting installed where appropriate.
10.5.4.4 Odour
The following standards apply to all public areas and shall be addressed in planning and design:
(a) Odour control and adequate air for groups of people shall be provided.
(b) Directional airflow (related to the control point) shall be used to protect staff when the public areas
are used as a screening point in an outbreak situation.
10.5.4.5 Materials and finishes
10.5.4.5.1 General
In addition to the general requirements for materials and finishes as specified in Clause 7.2, the provisions
in Clause 10.5.4.5 shall be made.
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10.5.4.5.2 Concrete surfaces
Concrete surfaces shall be sealed.
10.5.4.5.3 Ceilings
In workshops, storage, and loading dock areas, ceilings shall be concrete painted.
10.5.4.5.4 Walls
Walls shall be durable and scrubbable.
10.5.4.5.5 Floors
In areas of high traffic and/or heavy load that require easy cleaning, poured epoxy or good quality sheet
vinyl should be used. These areas include contractor hosting, training/induction/lunch room, and
washrooms/change rooms.
10.5.4.5.6 Doors and door protection
Doors providing access to the plant maintenance workspace from other locations, as well as those inside
the workspace, shall be durable and impact resistant and protected by kick plates. Depending on the
configuration, consideration should be given to the use of double doors for areas that will need to house
larger equipment for repair and refurbishment, such as general storage and workshop, as well as plant
maintenance staff entrance to the plant maintenance workspace.
10.5.4.6 Occupational health and safety
Provisions for occupational health and safety shall be as follows:
(a) services shall be designed to provide appropriate ventilation and dust control;
(b) adequate general lighting and task lighting shall be provided;
(c) service switches and valves for equipment should not be located in confined spaces; and
(d) fall protection barriers should be installed around all equipment that will require servicing.
10.5.4.7 Furniture, fittings, and equipment
10.5.4.7.1
Furnishings, fittings, and equipment shall be standardized as much as possible in the support and
administrative areas.
10.5.4.7.2
Workshops shall include
(a) workbenches with ample cupboard space;
(b) a whiteboard;
(c) tools storage cabinet; and
(d) an eyewash and shower.
10.5.4.7.3
A fume hood shall be provided to capture all exhaust fumes and a curtain shall be installed to isolate the
welding area (if hot work is performed).
10.5.4.7.4
Servers shall be located in the clean section of the workshop (or separate clean workshop). A lockable,
well-vented server cabinet shall be installed.
10.5.4.7.5
Storage shall include appropriate shelving systems.
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10.5.4.7.6
Washroom and change room shall include
(a) lockers, bench seating, and hooks appropriate to the number of plant maintenance technical staff;
and
(b) the appropriate number of toilets, urinals, and showers provided with sink, soap dispenser, paper
towel dispenser, etc.
10.5.4.7.7
Depending on the anticipated types and quantities of equipment and materials that will be received,
shipped, and moved, designated areas within the plant maintenance workspace should be provided with
loading docks equipped with a shelving unit and a lift bay.
10.5.4.7.8
Hoists and lifts should be considered for selected stairwells, for the moving of heavy equipment to roof
and penthouse levels.
10.5.4.7.9
The meeting area shall have a table and chair to accommodate small meeting groups.
10.5.4.8 Technology considerations
Information desks/boards/kiosks shall be located in a direct line of sight with the entrance.
10.5.4.9 Safety and security
Safety and security provisions in plant maintenance services shall include the following:
(a) All doors providing access to the plant maintenance space shall be protected by card readers and
automatic door locking hardware, with access being restricted at each entrance according to different
time-of-day schedules. Consideration shall also be given to card reader access to functional areas
within the plant maintenance space, such as employee facilities area (change room) if located close to
unrestricted access such as the loading dock, secure storage, etc.
(b) The plant maintenance location access points, as well as each of the main areas within the workspace,
should also be supervised by CCTV cameras. The entrance to the change room shall be protected by
a camera located in the hallway monitoring entry and exit to the change room.
(c) Ways of egress shall be clearly indicated low electrical consumption exit signs.
(d) The workspace shall be adequately covered by a centralized a fire alarm system, with all necessary
components installed and maintained to meet fire alarm standards applicable to public buildings in
general and HCFs in particular.
(e) The hot work area, typically located in the general workshop area, should be protected by a panic
alarm system.
(f) The general workshop area should contain and eyewash and shower, especially if activities such as
key cutting, carpentry, and hot work are being performed.
10.6 Security and parking
10.6.1 Description
10.6.1.1
The role of security services is to provide a safe environment for all patients, visitors, and staff. This service
is also responsible for protecting HCF property and assets.
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10.6.1.2
Services generally provided by security and parking services in all facilities can include
(a) access control activities, including locking and unlocking of specific doors and patrolling the
properties, building(s), and adjacent site areas; after-hours access control;
(b) reporting hazardous or suspicious conditions;
(c) responding to alarms;
(d) assisting staff in responding to aggressive behaviour;
(e) participating in HCF emergency codes and assisting in searches for missing patients;
(f) providing escorts, as requested, to staff, medical staff, visitors, and patients travelling on the site after
dark;
(g) investigating/challenging suspicious persons;
(h) responding, investigating, and reporting on incidents of criminal activity;
(i) assisting with directions and wayfinding;
(j) fire protection and coordinating on-site fire marshals for facilities without a dedicated fire marshal;
and
(k) training/in-services for fire drills and emergency codes applicable to security, including the following
code situations:
(i) purple (hostage situation);
(ii) white (violent situation);
(iii) yellow (missing patient);
(iv) green (evacuation); and
(v) black (bomb threat).
10.6.1.3
Depending on local conditions, additional services provided by security and parking services can include
(a) escorting of cash and other valuables;
(b) photo identification integrated with access control;
(c) video surveillance;
(d) lost and found;
(e) emergency management;
(f) securing patient valuables;
(g) education (emergency alerts);
(h) locksmithing;
(i) escorting of family and access control to the morgue;
(j) liaising with police and fire services;
(k) capital/maintenance of parking lot/parking service;
(l) valet parking/concierge program;
(m) internal investigation support (for human resources, for example);
(n) providing traffic control and issuing tickets for parking violations;
(o) wandering patient responses;
(p) patient watch program; and
(q) in cases where a help desk is not locally manned 24/7, addressing walk-in help desk requests and
liaising with remote help desk operators to report such requests.
10.6.2 Functional requirements
A review of security risks shall be performed during the planning of the HCF. Proximity of security staff to
high-risk areas should be considered in the planning of the HCF.
Security should be prominently visible to the public and have convenient access to circulation routes
within the HCF.
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10.6.3 Technical requirements
10.6.3.1
HCF entrance areas shall be planned to allow screening and streaming during emergency situations and
infection outbreaks. Planning should provide for the public display of hand hygiene and masks as well as
staff access to personal protective equipment (PPE).
10.6.3.2
Staff and public parking areas should be dedicated, with separate entrances and exits such that parking
and traffic flow on the site are not impeded.
10.6.3.3
Consideration should be given to traffic flow during emergency situations.
10.6.3.4
Service vehicles should be provided with dedicated parking such that patient parking and traffic flow on
the site are not impeded.
10.6.3.5
Power outlets for engine block heaters should be considered in HCF parking areas in northern climates.
10.6.3.6
Dedicated spaces should be provided for arrest holding, separate from patient care and public spaces, to
allow holding of persons while waiting for police services.
10.6.3.7
Sufficient space should be allocated for preparation of incident reports.
10.6.4 Space details
Video surveillance equipment requires significant space allocation and should be planned in conjunction
with equipment planning. Heat loads of surveillance equipment shall be defined and accommodated in
engineering design of HVAC systems serving these spaces.
10.7 Medical device reprocessing
10.7.1 Description
10.7.1.1 General
The medical device reprocessing services (MDRD) are responsible for the decontamination, preparation
and packaging, sterilization, and storage of reusable medical devices used in provision of health care.
MDRD is an essential service that assists in the prevention of transmission of infections from reusable
medical devices used in the HCF.
The MDRD can be of various functional sizes and can be designed as either a centralized system or
decentralized system.
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The centralized system for MDRD should be the preferred design model (i.e., decontamination,
preparation, packaging, sterilization and sterile storage).
If decentralized reprocessing services are provided outside the MDRD, the principles and standards
followed shall be the same as a centralized MDRD.
10.7.1.2 General services
Core services generally provided in MDRD include
(a) receiving contaminated devices;
(b) decontamination;
(c) disinfection;
(d) preparation and packaging of decontaminated reusable medical devices;
(e) sterilization (often more than one method of sterilization); and
(f) storage of clean and sterilized reusable medical devices.
10.7.1.3 Additional services
Some MDRD, depending on local conditions, provide additional services, which can include
(a) restocking of sterile storage areas (e.g., in inpatient units, clinics, critical care, emergency care);
(b) provision of a case cart system for operating rooms;
(c) provision of a case cart system for labour and delivery;
(d) reprocessing of respiratory devices;
(e) reprocessing of flexible scopes;
(f) receive contaminated supplies from other HCFs to reprocess and return;
(g) pack making and sterilization of surgical drapes and surgeon gowns;
(h) equipment cleaning (e.g., pumps, wheelchairs); and
(i) storage and distribution of single use medical devices.
10.7.2 Functional relationships
10.7.2.1
The MDRD design shall facilitate one-way work flow (i.e., contaminated devices flow one way from the
soiled to the clean). Materials shall not move in the opposite direction at any point because this could
introduce contamination to previously uncontaminated devices. If devices need to travel vertically in the
HCF, separate dedicated elevators should be provided for soiled and clean device transport.
10.7.2.2
The decontamination receiving area shall be located at one entrance to the services. The dedicated
(soiled) elevator for carrying contaminated devices from the OR and/or other HCF areas shall off-load into
this soiled receiving area.
10.7.2.3
The MDRD shall be designed to support the following work flow:
(a) Items enter the MDRD through the decontamination receiving area.
(b) Once cleaned and disinfected, the items leave the decontamination area and move to the
preparation and packaging area.
(c) From preparation and packaging, the devices either move to a clean storage area or to sterilization.
(d) After sterilization, items move to a sterile storage area where they are dispatched to the user area(s) or
are stored until they are needed.
10.7.2.4
The dedicated (clean) elevator MDRD, if provided, should be located in or near the sterile storage area.
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10.7.2.5
The staff locker room should be readily accessible to the MDRD.
10.7.2.6
Medical device reprocessing shall only take place in dedicated reprocessing areas that comply with the
design, construction, and environmental requirements for reprocessing areas, as specified in
CAN/CSA-Z314.8 and (if applicable) CSA Z314.3.
10.7.2.7
The MDRD shall be located near the rooms where reusable medical devices are used.
10.7.2.8
Clean and soiled rooms used for reprocessing of devices shall comply with CSA/CSA-Z317.2 to ensure safe
mechanical provisions with increased air exchanges and relative pressurization are adhered to.
10.7.2.9
There shall be separate, clearly marked storage areas for clean and soiled items.
10.7.2.10
Sterile storage areas within the MDRD shall meet the requirements of CSA Z314.3. Storage for clean and
sterile items outside of the MDRD shall meet the requirements of either CSA Z314.3 (sterile storage) or
CSA Z314.15.
10.7.2.11
All rooms in which cleaning and disinfection of equipment take place, wherever located in the HCF, shall
have separate labelled storage for clean and soiled items, and shall meet the same requirements as stated
in CAN/CSA-Z314.8.
10.7.3 Space details
10.7.3.1 General
The space for MDR services shall accommodate the anticipated activities and workload for the service as
determined by the following factors:
(a) service model of the reprocessing services (i.e., centralized including case carts vs. decentralized and
number of transport carts);
(b) type and number clinical services supported;
(c) volume and type of procedures performed;
(d) medical devices used;
(e) degree of mechanization and manual reprocessing within the services; and
(f) type, size, and number of reprocessing machines.
Storage space for sterile storage areas shall be sufficient for the functional program for the MDRD.
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10.7.3.2 Estimated space requirements and recommendations
Table 10.1 presents the standard requirements for key spaces in the medical device reprocessing area.
Common areas are detailed in Clause 11. Table 10.2 provides general guidance on the space needed for
reprocessing areas, based on the number of surgical procedures performed each day.
Table 10.1
Key space requirements and recommendations —
Medical device reprocessing
1 Decontami- Varies Mandatory:
nation area The decontamination area shall be equipped with the following:
(a) waste bins;
(b) recycle bins;
(c) linen bins;
(d) collection bins for third party reprocessing;
(e) hopper/flusher (depending on infection prevention and control
recommendation, this may not be necessary);
(f) desk for receiving control and instrument tracking control;
(g) work table or counter top; and
(h) accessible storage for PPE.
2 Soiled area Varies Mandatory:
Cleaning and disinfecting shall include work surfaces that are resistant to water
and disinfecting chemicals. Stainless steel should be used. See CAN/CSA-Z314.8
for further information. The following equipment shall be provided as appropriate
to the equipment and processes that will be used:
(a) double or triple sinks for manual cleaning and disinfecting (see
CAN/CSA-Z314.8), with the size and depth to depend on expected tasks
and the sizes of the devices to be cleaned;
(b) water manifold;
(c) sinks that are adjustable and equipped with water pistols;
(d) shelves below sinks to store cleaning supplies:
(i) storage shelves/carts for cleaning chemicals in-use; and
(ii) accessory baskets for washer-disinfectors;
(e) tables for sorting, with shelves underneath for storage;
(f) sonic cleaner(s) and rinser/dryers;
(g) anaesthetic/respiratory equipment washers (if the selected instrument
washers will not reprocess these devices);
(h) washer disinfectors;
(i) cart washer, if case carts will be used;
(j) automatic endoscope reprocessor(s);
(k) pass-through drying cabinets for anaesthetic equipment, if required;
(l) multiple washer manifolds with their carriages;
(m) workstation for Instrument tracking and control; and
(n) medical air (for drying lumens).
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Table 10.1 (Continued)
3 Preparation Varies Mandatory:
and The preparation and packaging area shall be equipped with the following:
packaging (a) Return conveyors for washer-disinfectors (if applicable).
area (b) Automated unloading system (if applicable).
(c) Pass through window from soiled area.
(d) Tube dryer.
(e) Cart(s) to hold items awaiting assembly:
(i) instruments;
(ii) sets;
(iii) containers; and
(iv) utensils.
(f) Work tables, height adjustable.
(g) Task lighting and/or magnifying lighting.
(h) Racks for disposable and/or reuseable wrappers.
(i) Racks for storage of miscellaneous clean supplies, such as
(i) sterility assurance indicators; and
(ii) set assembly items (e.g., gauze, tubing, syringes).
(j) Heat sealer workstation including packaging supplies (e.g., peel pouches).
(k) Sterilizer loading carts.
(l) Workstations for instrument management system, including monitors,
keyboards, printers, and labels.
(m) Pegboards, cabinets and/or drawers for instrument inventory.
(n) Cabinets for plates and screws.
(o) Light source if using telescopes.
(p) Testing equipment for testing electrical medical devices.
(q) Magnifying glass.
4 Sterilization Varies Mandatory:
area The sterilization area shall be equipped with the following:
(a) steam sterilizers, including
(i) water saver;
(ii) dedicated service area; and
(iii) dedicated steam line with ability to produce quality steam supply;
(b) low temperature sterilizer(s), if needed;
(c) workstation for monitoring ETO, if ETO is used;
(d) separate room for ETO (ventilated, monitored);
(e) workstation for instrument management;
(f) workstation for biological monitoring system(s);
(g) sterilizer carts; and
(h) mobile shelving for loading baskets and miscellaneous sterilizer accessories,
including test packs.
5 Sterile and Varies Mandatory:
clean storage The sterile and clean storage area shall be equipped with the following:
area (a) Shelving and/or automated storage systems.
(b) Workstation for case cart picking and instrument management system.
(c) Case carts and collection bins for small items.
(d) Exchange carts.
(e) Top-up carts.
(f) Tables.
(g) Wall or ceiling-mounted monitors.
(h) Desk at dispatch.
(i) Electrical outlets for charging of scanners and operation of workstations.
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Table 10.1 (Concluded)
6 Chemical Varies Mandatory:
storage area The chemical storage area shall be equipped with the following:
(a) means for the monitoring of vapours;
(b) sink with hose bib;
(c) drain or spill catchment system;
(d) locking access door; and
(e) chemical-resistant shelving.
7 Hand Varies Mandatory:
hygiene Hand hygiene sinks shall be conveniently located at all entrances to and exits from
sinks the decontamination area. Hand hygiene sinks or waterless hand hygiene stations
shall be located in all personnel support areas, such as staff lounges and change
rooms. Accessible, adequately supplied, and properly functioning soap dispensers
and towel dispensers, or waterless hand hygiene stations shall be made available. If
a large room is used for several individuals, more than one sink or station might be
necessary. For additional information, see CAN/CSA-Z314.8.
Advisory:
(a) To avoid recontaminating hands, faucets should be supplied with foot-, wrist-,
or knee-operated handles or electronic sensors. If automated faucets are not
available, single-use towels shall be made available for use in turning off
faucets. If electronic sensors are used, there should be a back-up system for
operation during power outages.
(b) Taps should be fitted with an anti-splash-back device and should ideally be
operated without hand contact, that is, by elbow, knee, foot, or an infra-red
or similar “no touch” mechanism.
(c) Where filters (aerators) are fitted to taps in place of anti-splash devices, they
should be cleaned regularly-a cleaning regime should be in place.
(d) Hot air hand dryers should not be used in sterile storage areas and should not
be installed in staff or visitor washrooms.
8 Sinks for Varies Mandatory:
instrument (a) Sinks shall be designed with three functional requirements:
reprocessing (i) for soaking;
(ii) for cleaning; and
(iii) for rinsing of reusable medical devices.
(b) Decontamination sinks shall be designed and arranged to facilitate soaking,
washing and rinsing of medical devices with minimal movement or delay
between these processing steps. At least two adjacent sinks shall be provided.
The area around the sinks should be furnished with waterproof counter tops
and a back splash.
(c) Sinks shall not have an overflow.
(d) Sinks should be equipped with water ports for the flushing of instruments
with lumens. For additional information, see CAN/CSA-Z314.8.
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Table 10.2
Recommended size of reprocessing areas, m2
Work area 54 87 104 122 130
Receiving and case cart holding* 9 14 23 33 37
Cart wash area 13 13 20 20 48
Equipment processing area 14 15 16 17 19
Chemical storage 9 9 9 9 9
Housekeeping 4 4 4 4 4
Decontamination total 103 142 176 205 247
Work area 103 157 204 247 372
Sterilizer service area 32 39 46 50 53
Low temperature sterilizer area† 9 13 18 22 30
Personnel facilities 13 20 28 35 39
Housekeeping 4 4 4 4 4
Prep and pack total 161 233 300 358 498
Case cart holding 19 28 46 65 74
Sterile storage 139 186 232 279 325
Clean equipment storage 24 37 44 52 56
Reprocessing supply storage 21 21 21 21 21
Dispatch 17 25 34 39 40
Receiving and breakout rooms 37 37 46 466 56
Storage and distribution total 257 334 423 502 572
Conference room 10 15 17 19 20
531 724 916 1084 1337
*
†
‡
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10.7.4 Unique requirements
10.7.4.1 General
Humidity loads in reprocessing areas can be extremely high. Ceiling, walls, and work services in this area
shall be impervious to moisture. Effective load calculations shall be performed to ensure temperature and
humidity control in the space, including effective exhaust and air exchange.
10.7.4.2 Acoustics
Facilities shall be designed to control noise levels. Equipment should be selected, positioned, and installed
so that workers are not exposed to excessive or unnecessary noise.
Offices, training, and staff rooms should be located away from noisy areas.
Building finishes shall absorb and reduce noise as much as possible, consistent with infection prevention
and control considerations. These building finishes shall be easily cleanable.
10.7.4.3 Lighting
Lighting provisions in the MDRD shall include the following:
(a) Lighting shall be appropriate to the task and age of the work force. The area directly in front of the
worker shall be illuminated.
(b) In the decontamination area, additional lights shall be positioned directly above sinks and sorting
areas.
(c) In the decontamination and preparation and packaging areas, magnification inspection with lights
shall be installed at each workstation.
(d) Light fittings and control in processing and storage areas should be fully recessed and carefully
selected to avoid ledges or crevices where dust can collect.
(e) Lighting shall be appropriate and adaptable for a range of activities performed in the MDRD as
determined by a qualified engineer. See Table 10.3 for recommended illuminance levels for work
environments.
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Table 10.3
Illuminating Engineering Society of North America (IES)
recommended illuminance levels for work environments
General inspection 500 lux 750 lux 1000 lux
(50 foot-candles) (75 foot-candles) (100 foot-candles)
Detailed inspection 1000 lux 1500 lux 2000 lux
(100 foot-candles) (150 foot-candles) (200 foot-candles)
Sink areas 500 lux 750 lux 1000 lux
(50 foot-candles) (75 foot-candles) (100 foot-candles)
General work area 200 lux 300 lux 500 lux
(20 foot-candles) (30 foot-candles) (50 foot-candles)
Processed storage 200 lux 300 lux 500 lux
(20 foot-candles) (30 foot-candles) (50 foot-candles)
10.7.4.4 Natural light
Natural light should be provided in offices, the staff lounge and the training room whenever possible.
Although desirable in most spaces, it might not be possible to provide natural lighting in all other areas.
Windows shall be completely sealed and airtight. Window frames, without ledges and joints, shall be
used in clean rooms.
Where external windows cannot be provided, glazed panels between rooms should be considered.
10.7.4.5 Privacy
There shall be separate male and female locker areas and washroom facilities.
10.7.4.6 Temperature and relative humidity
Provisions for environmental control in MDR shall be as follows:
(a) Room temperature of decontamination work areas shall be within the range of 18 °C to 20 °C for
soiled areas and 18 °C to 23 °C for clean areas. See CAN/CSA-Z317.2 and CAN/CSA-Z314.8.
(b) Relative humidity of the decontamination areas shall be maintained in a range of 30% to 60% and
preferably in the range of 40% to 50%.
(c) Provision for daily monitoring shall be made.
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10.7.4.7 Infection prevention and control
In addition to the general requirements for infection prevention and control as specified in Clause 7.5, the
following provisions shall be made in medical processing:
(a) All areas used for decontamination, preparation and packaging, sterilization and storage of medical
devices shall be designed and built to minimize bioburden and particulate contamination.
(b) Adequate space shall be provided to carry out sterilization activities. Functional work areas should be
separated by walls or partitions to control traffic flow and contain contaminants generated during
processing.
(c) Whenever possible, multi-person contact with high-touch work surfaces shall be minimized through
the use of automated equipment and related design features built into the MDRD.
(d) Building and engineering maintenance/testing can compromise the integrity of the medical device
reprocessing environment. Such maintenance and testing shall not be undertaken in the assembly
and packaging area at times when devices are being produced or processed. Design considerations
that allow easy access to equipment shall minimize the effects of maintenance activities.
(e) Test and maintenance equipment, tools, and similar items, brought into the MDRD should not pose a
risk of contamination or compromise the services environment or the integrity of the items processed
in it. Where dedicated maintenance equipment is used, a suitable storage area accessible only from
the MDRD should be provided.
10.7.4.8 Materials and finishes
10.7.4.8.1 General
An assessment of the cleaning methods, frequency, and equipment required throughout the services
should be made before choosing finishes. All finishes chosen shall be compatible with the required
cleaning methods and products. In addition, the following apply to materials and finishes in MDRD:
(a) Finishes shall be suitable for frequent cleaning and tolerant to surface-cleaning agents. Wood and
laminate products shall not be used as they allow ingress of water or chemical solutions. Stainless
steel is recommended as it is easily cleanable.
(b) Joints should be avoided as they can hold moisture, encouraging the growth of micro-organisms.
Worktop sinks and similar items should be built up to walls and any gaps sealed. Where gaps are
unavoidable, they should allow enough access for cleaning.
(c) To permit flexibility, easy cleaning, and maintenance, whenever possible, workstations and storage
units should not be fixed (e.g., use work tables and mobile storage units rather than fixed counters
and cupboards).
(d) Ledges trap dust and should be avoided.
(e) Finishes of areas where heavily loaded carts are in use should provide protection (e.g., bumper pads
against damage).
10.7.4.8.2 Surface materials
The following requirements apply to surface materials used in MDRD:
(a) Where there is likely to be direct contact with blood or body fluids, floors and walls shall be surfaced
with smooth, impermeable seamless materials such as vinyl. In equipment processing areas, work
surfaces shall be non-porous, smooth, and easily cleaned.
(b) Work tables shall be constructed of non-porous materials (e.g., stainless steel).
(c) Work surfaces shall be flat, cut resistant, seamless, and composed of a non-porous material so they
can be cleaned, disinfected, and dried. Stainless steel surfaces are preferred, given their overall ease of
maintenance. Particulate materials that could shed fibres shall not be used.
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(d) Laminated materials shall not be used unless they are specified by the manufacturer as providing a
chemical-resistant surface suitable for laboratory use. For additional information, see
CAN/CSA-Z314.8.
10.7.4.8.3 Ceilings
The following requirements apply to ceilings in MDRD:
(a) Ceilings shall be resistant to humidity in spaces where steam and moisture are encountered.
(b) Ceilings shall be constructed of non-porous, non-shedding materials with recessed, enclosed pipes
and fixtures so as to create a flush surface, facilitating frequent cleaning. Appropriate access shall be
provided for maintenance of pipes and fixtures.
(c) Ceilings shall be constructed without fissures, open joints, or crevices that can retain or permit
passage of dirt particles.
10.7.4.8.4 Walls
The following requirements apply to walls in MDRD:
(a) In storage and processing areas in particular, hollow-wall constructions pose an infestation risk and
are susceptible to damage from carts. Choice of materials and construction shall eliminate these risks.
(b) Solid walls shall be rendered to a hard smooth finish to facilitate cleaning and repair. Epoxy coating or
a sprayed paint finish is appropriate in MDR areas.
(c) Where hollow walls, partitioning or boxing is used, consideration should be given to means of access
and inspection.
(d) Walls shall be protected against damage from wheeled traffic by buffer rails and corner guards, which
should be appropriately sited to reflect the specifications of carts in use.
(e) Pipes and other fixtures above work areas shall be enclosed.
10.7.4.8.5 Floors
The following requirements apply to floors in MDRD:
(a) All functional areas of the MDRD areas shall have a uniform floor level. Thresholds between rooms
shall be smooth and not elevated. Doorways between adjoining rooms are points of stress and
particular attention needs to be paid to the selection and installation of the flooring product.
(b) Floors in decontamination and cart washing areas shall be constructed of anti-skid or slip-proof
material. All floors shall be constructed of materials able to withstand wet mopping and the
application of cleaning agents.
(c) The finish, the screed (a long piece of aluminum to level cement), and sub-floor should be suitable for
heavy cart traffic. The flooring should be turned up at walls using an integral covered skirting. This
should be continuous with the floor and finished flush with the wall, so that the junction between the
skirting and the wall does not provide a ledge for the collection of dust.
(d) Carpet shall not be used.
10.7.4.8.6 Hoppers
Hoppers shall be located away from staff work areas, traffic areas, and be separated by a cleanable physical
barrier to contain the spray generated by the hopper operation. Caution shall be used in locating a hopper
in the decontamination area.
10.7.4.8.7 Doors
Automatic and semi-automatic doors should be provided to facilitate entry and exit of carts. Doors should
be fail safe to allow emergency exit in the event of fire or power failure. In addition, the following
requirements and recommendations apply to doors in MDRD:
(a) Where door interlocks are provided, the door should open towards the higher pressure side where
possible.
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(b) All emergency exits should have a means of indicating they have been opened.
(c) Vision panels (windows) should be provided in doors that are frequently used. These vision panels
shall be easily cleanable.
10.7.4.9 Occupational health and safety
Provisions for occupational health and safety shall include the following:
(a) Functional and storage space shall be provided for chemicals used in the unit.
(b) Functional space shall be provided for storing, donning, and removing protective apparel.
(c) Environmental control for noise and air conditioning shall be provided.
(d) General and task lighting shall be adequate and provided over the work areas.
(e) Space shall be provided for equipment associated with direct-read chemical or biological indicators, if
used.
(f) Functional space shall be provided to allow for the movement of carts between tasks.
(g) Automated loading and unloading equipment should be selected.
(h) The floors shall be non-slip.
(i) Depending on the operation model, special ventilation, space and electrical requirements should be
provided.
(j) Workstations shall be provided based on the number of staff that will work in that area. Workstations
shall be adjustable for working height.
(k) Counters, carts and loading devices should be at the same height for easy horizontal movement of
materials.
(l) Sufficient and accessible space for storing movable equipment and supplies shall be provided by the
work zone.
(m) Hands-free door openers should be provided.
(n) Functional and storage space shall be provided for sharps disposal containers.
(o) Eyewash facilities shall be provided when chemicals are being used.
(p) Provision should be made for anti-fatigue mats to be placed at workstations requiring prolonged
standing.
(q) Ergonomics shall be considered for workstation heights including counters, sinks, etc.
10.7.4.10 Furniture, fittings, and equipment
10.7.4.10.1
Furnishings, fittings, and equipment selection shall be based primarily on the functional workflow and the
technical requirements of the service. The size and number of furniture and fittings depend on the volume
of devices to be processed in the area.
10.7.4.10.2
In all areas, shelving and counters shall be made of materials that are non-porous on all surfaces and
non-shedding, easily cleanable, and free of burrs and sharp or rough edges.
10.7.4.10.3
The top and bottom shelves of storage carts shall be solid. In all cases, the selection of materials shall be
able to withstand cleaning and disinfection and not absorb water or cleaning solutions.
10.7.4.10.4
If open shelving units are used for storage of sterilized medical devices, the shelves should be at least
250 mm off the floor, 460 mm from the ceiling, and 50 mm from an outside wall.
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10.7.4.11 Technology considerations
10.7.4.11.1 General
Planning for medical device reprocessing services shall include the following requirements and
recommendations:
(a) Because traffic into the MDRD is restricted and doors should always be closed, a communication
system from the outside to the inside of the services shall be provided.
(b) A buzzer/intercom type of system should be located at the soiled receiving area, sterile supply
dispatch point, and the reception area of the MDRD.
(c) Main door(s) should be hands free to allow the unrestricted movement of large wheeled carts, etc., in
or out of the areas.
(d) There shall be a system to allow communication of essential information from managers to staff. The
system should be able to monitor and record when staff receive and open essential messages.
Planning should take into consideration the means by which staff will access their messages.
(e) A handsfree method for communication between decontamination and the clean side of the services
should be provided.
(f) CCTV cameras should be mounted at the identified transportation corridors and video monitors in
the appropriate MDR areas. For example, CCTV/video in clean and soiled case cart holding areas in
the OR suite can alert MDR staff to the need for pickup or delivery without direct voice
communication from the area.
(g) The number and location of electrical outlets and data connections shall be determined based on the
equipment to be used in the area.
If steam sterilizers will draw on the HCF steam system, the MDRD planning process shall specify the
quality and quantity of steam required for the sterilizers, and the ability of the system to provide this steam
shall be confirmed.
10.7.4.11.2 Automated reprocessing equipment
Whenever possible, automated reprocessing equipment rather than manual methods shall be used for
medical device reprocessing.
Planning of technology systems for automated reprocessing equipment shall include the following
requirements and recommendations:
(a) Space planning for the decontamination, preparation, and packaging and sterilization areas shall take
into account the size of the equipment to be used in those areas. The service space for the equipment
shall also be considered.
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(b) In large facilities, automated systems for loading and unloading of the reprocessing equipment
should be considered.
(c) All loading systems and mechanisms shall be easily serviceable and cleanable.
10.7.4.11.3 Instrument inventory management system(IMS)
The MDRD design shall include the necessary space and electronic infrastructure to support the
instrument inventory management system (IMS) that will be used in the HCF, if any.
Design and construction requirements for instrument and inventory management systems depend on
the system that is chosen. Provision shall be made for the following features, as appropriate to the
requirements of the system:
(a) routine data input methods:
(i) scanner (e.g., bar code or laser etching);
(ii) sensor (e.g., radio frequency identification [RFID]); and
(iii) keyboard/mouse/touch screen;
(b) routine data output methods:
(i) monitor/screen;
(ii) page printer; and
(iii) label printer; and
(c) ongoing data uploading and updating:
(i) keyboard/mouse; and
(ii) central server.
10.7.4.12 Environmental monitoring for ethylene oxide
10.7.4.12.1
When ethylene oxide (ETO) sterilization is used, the area shall be monitored for ETO to ensure the safety of
HCF staff, patients, visitors, and the public.
10.7.4.12.2
For internal monitoring of the MDRD, the HCF shall have
(a) a gas chromatograph monitor;
(b) sensors in work areas adjacent to the ETO sterilizer(s);
(c) sensors in the chemical (e.g., ETO sterilizer service area); and
(d) sensors in the chemical (e.g., ETO storage area).
10.7.4.12.3
For external monitoring, the HCF shall have an exhaust sensor for the abator or catalytic convertor.
10.7.4.12.4
The following alarm systems shall be installed:
(a) LEV system failure;
(b) ETO detection;
(c) fire; and
(d) smoke.
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All alarm systems shall have both audible (e.g., horn, klaxon) and visible (e.g., flashing coloured light)
signals.
10.7.4.12.5
Alarm sensors that indicate inadequate negative duct pressure shall be either pressure differential sensors,
sail switches, or another type of sensor selected by a competent system designer. They shall be located at
the following points:
(a) in the exhaust hood over the container storage area; and
(b) in the gas scavenging system over each sterilizer.
The sterilizer manufacturer might include an ETO scavenging sensor with the sterilization equipment.
10.7.4.12.6
The ETO alarm system shall be capable of alerting the operator when excessive ETO is present in the
ethylene oxide sterilization area. This alarm system is not intended to measure ETO worker-exposure levels.
10.7.4.12.7
Sensors for the ETO alarm system shall be placed in the following locations:
(a) above the sterilizer gas scavenging system;
(b) above the container storage exhaust hood;
(c) in the centre of the service room;
(d) in the centre of the ETO sterilization area;
(e) in other areas where the ETO concentration is likely to be high;
(f) these sensor positions allow the system to detect the presence of ETO in the workers’ breathing zone;
and
(g) the alarm system’s designer, in consultation with occupational health and safety, risk management,
and supervisory staff, should determine the exact placement of the sensors.
10.7.4.12.8
Fire alarms shall be placed in the ETO sterilization area in accordance with the applicable fire code. Alarms
from the sterilizer area shall be connected to the building management system, if applicable. If any part of
the sterilization equipment is located in an area that is separate from the ETO sterilization area (e.g., the
containers are not stored with the rest of the sterilization equipment), the separate area shall also have fire
alarms as required by the fire code.
10.7.4.12.9
Alarm systems shall be installed, maintained, and regularly tested in accordance with applicable
requirements and the facility’s risk management policy.
10.7.4.12.10
Handling, storage, and disposal of cylinders and cartridges shall be in accordance with
(a) manufacturer’s recommendations;
(b) CAN/CSA-Z314.9; and
(c) applicable requirements.
10.7.4.13 Safety and security
The MDRD shall
(a) restrict access to the MDRD within the HCF;
(b) provide an access control systems (e.g., card readers to all perimeter doors);
(c) enable direct observation of all persons entering the MDRD; and
(d) provide alarm systems and or staff emergency assistance alarms for staff security.
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11 Table of common requirements
The following list and Table 11.1 define the requirements for common areas, if these areas are required by
the functional program of the HCF:
1. assessment room — General;
2. breastfeeding room;
3. central staff station (nurse station);
4. change/locker room;
5. charting alcove;
6. chart storage;
7. classroom/meeting room/educational facilities;
8. clean supply/utility room;
9. decentralized equipment storage;
10. departmental resource library;
11. diagnostic viewing workstation;
12. dictation/review workstation;
13. dining room;
14. examination/procedure/treatment room;
15. examination/procedure/treatment room — Isolation;
16. examination/procedure/treatment room — Adjacent washroom;
17. examination/procedure/treatment room — Safe room;
18. gym;
19. hand hygiene sink;
20. waterless hand hygiene station;
21. housekeeping closet;
22. housekeeping service room;
23. hydrotherapy room;
24. inpatient bedroom;
25. inpatient washroom;
26. isolation room suite;
27. imaging/equipment alcove;
28. laundry (patient use);
29. lockers;
30. lounge, patient/visitor — General;
31. lounge, patient (pediatric or adolescents);
32. medication room;
33. nourishment centre;
34. offices (staff);
35. outdoor space;
36. play area (pediatric or adolescents);
37. reception/control desk;
38. respiratory therapy/anaesthesia support area;
39. satellite pharmacy;
40. soiled utility/holding room;
41. small multi-disciplinary assessment/treatment room;
42. large multi-disciplinary assessment/treatment room;
43. staff coat room;
44. staff room;
45. storage room;
46. sub-sterile supply/case cart holding area;
47. tub/shower room;
48. waiting area/rooms;
49. washroom (public); and
50. work area (staff/student).
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Table 11.1
Common area requirements
1. Assessment 11.0 Mandatory:
room — A hand hygiene sink shall be mounted on the wall adjacent to the door.
General Advisory:
(small group (a) A privacy curtain should be provided to shield patient from corridor view if
counselling) door is open.
(b) Depending on the program function of this room, it may be equipped with
furniture or an exam table.
(c) The room should have a mirror on one wall, mounted low, to be used by the
patient in a sitting position.
(d) A 1500 mm long base cabinet with closed cupboards above should be
provided along one wall.
(e) To provide flexibility of use, consideration should be given to increasing the
size of this room from the minimum size so that it matches the net area of a
standard exam room (12.0 m2).
2. Breastfeeding 7.5 Mandatory:
room (a) A wall-mounted hand hygiene sink shall be provided adjacent to the door.
(b) Room shall include a change table.
Advisory:
(a) Comfortable furniture including rocking chair should be included in the
room.
(b) Dimmable lights should be provided.
(c) A base cabinet of 1500 mm and wall cabinets above should be provided for
storage of supplies and equipment.
(d) Equipment for music should be provided to enable the mother to bring their
own music (i.e., CD player, MP3 player).
3. Central staff Varies Mandatory:
station (nurse according to (a) There shall be sufficient space around and within the station for the
station) HCF size and movement of chairs and people. Space for a table, chairs, and telephone
delivery should be provided.
model (b) Network and phone line services shall be provided to support telephone and
data connections.
4.6 per work- Advisory:
station and (a) The staff station should be located in an area easily accessible from all areas
additional of the department, minimizing the walking distance for the staff.
circulation (b) The station should consist of a work counter, at sit down height (about
space, 750 mm), surrounding the unit, with a short wall 1200 high providing the
storage, immediate privacy for the work space.
equipment (c) One or more computer workstations should be provided.
(d) Work counters should be deep enough for computers to be placed on them
and be able to accommodate a keyboard tray wide enough for the keyboard
and mouse to be placed side-by-side.
(e) Glass privacy screens should be provided where needed to maintain security
and confidentiality. The design should allow staff to view surrounding areas
as needed.
(f) A break in the privacy partition should be maintained to provide access for
patients in wheelchairs.
(g) Noise control and task lighting should be incorporated into the work area
design.
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Table 11.1 (Continued)
(h) A nurse call or intercom should be provided.
(i) A pneumatic tube station (if system is included in HCF) should be located
within easy access of unit clerk workstation.
(j) Storage space should be provided for the storage of forms, stationery,
professional use manuals, and educational materials.
(k) An area for a central monitoring station (if included as unit equipment)
should be provided.
(l) Additional storage space should be provided for printers, copiers, fax
machines, manuals, transmittal documents, patients’ files, and other items.
(m) The staff station for inpatient mental health should be secured with half
glass partitions on all sides of the unit, with access controlled via doors and
opening in the glass panels.
(n) Work areas may be centralized or decentralized and satellite work areas may
also be implemented.
(o) Care should be taken to ensure the appropriate number of electrical and
data outlets are required for computer or PACS applications.
(p) Height adjustable workstations should be used to accommodate a range of
user sizes and work preferences (i.e. seated posture, standing posture).
4. Change/ locker Varies; Mandatory:
room assume the (a) The room shall be located near the staff room for shift changes.
following (b) Change cubicles, shower facilities, and washroom facilities shall be provided.
space per Advisory:
locker: Security needs should be considered.
Purse 0.15/locker
Half 0.40/locker
Full 0.70/locker
5. Charting 1.0 — for Mandatory:
alcove viewing of a (a) The alcove for charting and patient observation shall be located on the
single room corridor side of, and between two inpatient bedrooms.
1.4 — when (b) Windows shall be provided at the alcove so the patients in the adjacent
space is rooms can be observed while staff performs documentation duties.
shared (c) Storage shall be provided for charts and paper.
between two Advisory:
rooms/two (a) Pull down shades should be considered on the observation window so that
staff they can be closed when staff are not observing patient.
(b) The alcove should contain a counter deep enough for a computer and be
able to accommodate a keyboard tray wide enough for the keyboard and
mouse to be placed side-by-side.
(c) Alcove should be designed to accommodate two staff.
(d) Patient supplies should not be kept at the alcove.
(e) A printer may also be provided if required.
(f) There should be sufficient clearance for movement of people and materials
behind seated users.
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Table 11.1 (Continued)
6. Chart storage Varies — Advisory:
accommo- (a) The location and organization of this space should provide for reallocation
date to another function when electronic documentation system is in place.
5 cm binder (b) Space should be allowed for one two-inch binder per patient, with
per patient remaining documentation in health records (six binders per treatment
station).
(c) Charts should be in an accessible location that is easy to reach for users (i.e.,
maximum horizontal reach of 520 mm and vertical placement between
elbow and shoulder height).
7. Classroom/ Seating for Mandatory:
meeting room/ 6: 15.0 (a) Education facilities shall be provided to meet program requirements in care
educational areas. This may include a dedicated or shared space with the consultation
facilities 12–15: room complete with computer access and audio-visual equipment.
30.0 (b) Education facilities shall be provided to meet program requirements in
support services areas (e.g., MDRD, laboratories).
20–25: (c) Inpatient continuing care centres shall review service and program focus to
42.5 define specialized teaching needs.
Mandatory teacher space (pediatric and adolescents):
25: The room shall meet applicable requirements.
42.5 plus 1.4
for every
additional Advisory:
seat (a) Additional space should be provided for podium, stage, seat storage, etc., as
necessary.
(b) Tables and chairs should be provided that provide the greatest flexibility.
(c) Whiteboards should be provided.
(d) A base cabinet should be located near the entrance to the room for storage
of equipment and supplies used in the room.
(e) A full-height cabinet for the audio-visual equipment should be provided.
(f) Provision should be made for a wall or ceiling-mounted flat screen television
or a wall-mounted projection screen should be provided at one end of the
room with a ceiling-mounted projection system.
(g) Access to a common computer room or multi-purpose room with a
computer should be considered.
(h) A dialysis box may be provided for teaching.
8. Clean supply/ Varies Mandatory:
utility room according to (a) Size varies by facility and required function. An enclosed room shall not be
delivery less than 11.0 m2 (an alcove with double doors may be smaller).
model (b) Areas for storage of clean and sterile supplies shall conform to CSA Z314.15
if located outside of the MDRD and the sterile storage requirements of
CSA Z314.3 if located within a MDRD.
(c) Clean and soiled utility rooms shall be separated spaces.
(d) All storage of medical and surgical supplies shall be in mobile shelving or
automated dispensing cabinets.
(e) All storage for linen shall be in mobile shelving and the cart shall be covered
when transported to the room.
(f) The room shall be secure with access limited to clinical and support staff.
(g) If reprocessing of medical equipment is performed, the space shall meet the
requirements of CAN/CSA-Z314.8, CAN/CSA-Z314.2, and CSA Z314.3, as
applicable.
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Table 11.1 (Continued)
(h) The room shall have designated locations for the types of item being stored,
including,
(i) clean and sterile supplies;
(ii) clean linen; and
(iii) crash carts.
(i) The room shall be conveniently located, close to the point of use for the
supplies.
(j) Decontamination, or cleaning up, of supplies shall not be permitted in the
clean utility room.
(k) Shelving units or cart surfaces shall have cleanable, smooth, and non-porous
surfaces tolerant of hospital disinfectants.
(l) Storage of equipment and supplies shall not be exposed to direct airflow
from the HVAC system in accordance with CSA Z314.15 and CSA Z314.3.
Storage should be away from the window, due to the risk of condensation.
(m) Flooring shall be of seamless impermeable, non-slip material.
(n) The principles of ergonomics shall be addressed when designing the storage
space and locations of supplies.
(o) Shelving for clean and sterile supplies shall be at least
(i) 230 mm off the floor;
(ii) 450 mm from the ceiling; and
(iii) 50 mm from outside walls.
(p) Clean utility rooms may have specific needs depending on the clinical unit.
Specific needs shall be identified in the functional plan and provided for
within the space.
(q) If supplies are not broken down on delivery, provision shall be made for very
high volumes of cardboard.
Advisory:
(a) The room should be located close to the centre of the care area.
(b) Where alcoves or bays are provided for covered linen carts, storage in
separate rooms may be waived.
(c) Clean utility rooms may be centralized or decentralized depending on the
delivery of care.
(d) Wire racks should be used for shelving to prevent dust accumulation.
(e) Access to the clean utility room may be from two sides of the care space.
(f) Wall finish materials should be smooth and impact-resistant wall board
where heavy carts are exchanged in the space.
(g) Flooring finishes should be able to withstanding rolling equipment and
provide minimal rolling resistance.
(h) Wall base and floor edges should be an integral cove base, tightly sealed
against the wall, and constructed without any gaps.
(i) Clean rooms that support inpatient critical care units should be the same
size but more rooms should be provided evenly spaced within the unit.
9. Decentralized 12.0 — small Mandatory:
equipment (size varies by (a) Each inpatient accommodation location shall have designated storage for
storage (within facility and equipment to be stored within the space.
the services) required (b) The allocated space shall be determined based on the needs identified in the
function) functional program, and in no case shall be less than 2% of the floor space
18.0 — of the service.
medium (c) Storage of equipment in corridor spaces shall not be incorporated into any
25.0 — HCF design.
large (d) Equipment storage rooms shall conform to the equipment manufacturer’s
requirements for clearance around stored equipment.
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Table 11.1 (Continued)
(e) Storage areas shall be lockable, with access restricted to clinical and support
staff. A safe working environment shall be provided.
(f) Shelving units or cart surfaces shall be cleanable, smooth and non-porous
surfaces tolerant of hospital disinfectants.
(g) Wall finishes shall be smooth and cleanable.
(h) Recharging capabilities shall be provided for all equipment (and the need to
provide excess charging capacity should be considered for flexibility.
(i) Storage space shall be provided convenient to each program/activity area.
(j) Dedicated space, subdivided or separated, shall be provided for large and
small equipment.
(k) Stored items shall be easily accessible.
(l) Easy handling of supplies and equipment shall be ensured.
(m) Storage space shall be designed (i.e., with the appropriate type, location,
and amount) to accommodate the expected equipment inventory.
(n) Shelving systems that are adjustable and easily maintained shall be
provided.
(o) The room shall be provided with open shelving along one side of the space.
(p) Equipment storage rooms shall conform to the equipment manufacturer’s
requirements for clearance around stored equipment.
Advisory:
(a) Electrical and mechanical outlets should be designed to suit the equipment
to be stored in each equipment storage room.
(b) Equipment rooms should not be used for storage of equipment in need of
repair or supplies other than those required for the safe and efficient
operation of the equipment stored in this room.
(c) Wire racks should be used for shelving to prevent dust accumulation.
(d) Wall finishes should be impact resistant where heavy devices or objects with
sharp or protruding edges and corners are stored.
(e) Flooring finishes should be able to withstanding rolling equipment and
provide minimal rolling resistance.
(f) Storage for beds not in use should be provided unless it is provided at other
locations within the HCF.
(g) Storage for clean and soiled equipment should be located for easy and
efficient access, and consistent with the anticipated circulation patterns.
(h) Storage areas may serve more than one unit.
(i) Consideration should be given to storage requirements for all care delivery
support services, building services as well as the therapeutic equipment
services, in order to determine where storage services can be combined and
what their relationship to each other can imply.
(j) Provision of overflow space to meet unexpected storage situations should be
considered.
(k) A clear door opening width of at least 1200 mm should be provided to
allow for easy movement of items.
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Table 11.1 (Continued)
(l) For an equipment holding alcove/room,
(i) the alcove/room should be located to minimize travel distance for staff
(decentralized for large services); and
(ii) all potential equipment storage needs and service requirements should
be considered.
10. Departmental Varies Advisory:
resource library according to (a) The room should provide access to information via books, periodicals, and
delivery audio video.
model (b) Computer stations should be provided against one wall.
(c) An open bookshelf should be provided along another wall for storage of
books and periodicals.
(d) Tables and chairs should be provided for laying out books and other
materials.
(e) A storage cabinet should be provided for storing audio, video, and other
equipment.
11. Diagnostic 4.6 per Mandatory:
viewing workstation (a) The diagnostic viewing alcove shall be a separate space or integrated into
workstation the other staff work areas depending upon technology used and function of
the clinical area.
(b) Workstation with film illuminators, PCs, or PACS units shall be included.
(c) The alcove shall have dimmable lights and individual task light at each
workstation.
(d) For an ECG/EEG data management workstation, the room area should be a
minimum of 16.0 m2 and it shall include the following:
(i) a sit-down counter (750 mm high) along the longer wall, for
computers; and
(ii) a wall shelf for reference material above the counter.
Computer access shall be provided in the alcove as well as systems to review
patient EEGs/ECGs in confidential space.
12. Dictation/ 4.6 per Mandatory:
review workstation (a) This station shall be located adjacent to the central staff station to ensure
workstation access to patient documents and ease of communication with the staff.
(b) The station shall be provided with a 750 mm deep counter wide enough for
two persons.
(c) A shelf, 300 mm deep, shall be provided for patients’ records and other
documentation.
(d) The alcove shall provide audio privacy for confidential information purposes.
(e) A telephone shall be provided.
(f) Access to the HCF dictation system shall be provided.
(g) The workstation shall have an HCF system computer.
(h) PACS shall be provided.
(i) Acoustic separation shall be provided.
Advisory:
Careful consideration should be given to the equipment chosen for dictation.
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Table 11.1 (Continued)
13. Dining room 2.0 per Mandatory:
occupant
(non-barrier-
free access) (a) A minimum 1800 mm-wide entryway shall be provided, whether doors are
incorporated or not.
3.0 per (b) There shall be a minimum 1800 mm clearance between tables.
occupant (c) There shall be a minimum 1100 mm clear between the backs of
(includes chairs/wheelchairs in sitting position at the tables.
barrier-free (d) Tables shall have a minimum width/diameter of 1370 mm.
access) (e) Ice/water shall be patient-accessible at all hours.
(f) Storage shall be provided for activities for daily living (ADL) equipment
(adaptive utensils, etc.).
(g) Space for stackable chairs shall be available.
(h) A hand hygiene sink shall be provided in each subdivided space.
(i) The size of tables shall assume that a minimum 50% of the population
requires assistance with feeding.
(j) Feeding stools shall be height-adjustable.
(k) Daylight and views to the outdoors shall be provided.
(l) Multiple safe, accessible outlets for specialized equipment shall be provided
near tables.
(m) Additional space shall be provided for family/visitors (percentage to be
determined), including separate family dining space per unit.
(n) Nurse-call shall be readily accessible.
(o) Planning for the space shall assume that 100% of the population is in
wheelchairs.
(p) For renovations, at least 1.5 m2 per bed shall be available for dining.
Additional space might be required for outpatient day care programs.
Advisory:
(a) ADL counter for patient use should be considered, either in the dining room
or nearby, based on the functional program.
(b) Height-adjustable tables are preferred.
(c) Tables with locking casters should be used, for ease of movement.
(d) Contrasting colours between the table edge and floor should be used for
ease of orientation.
(e) Homelike features, such as an electrical fireplace, should be provided.
(f) The design should consider the use of round tables, as these are more easily
accessible for both patients and caregivers.
(g) Additional space might be required for outpatient day care programs.
(h) There should be direct access to an outdoor area for special events.
(i) Patient areas for both larger and smaller groups should be provided.
(j) The room should be sub-divided to enable multi-purpose activities.
14. Examination/ Mandatory:
procedure/ (a) Each examination/treatment room shall have a minimum clear floor area
treatment according to the space requirements, exclusive of fixed casework.
(EPT) room, (b) A wall mounted hand hygiene sink shall be located adjacent the door along
with a hand hygiene station.
Standard exam 12.0 (c) Privacy curtain shall be located adjacent door but away from door swing;
room another curtain dividing space around exam table shall be provided.
(d) Exam table shall suit the function of the room.
Scooter access 13.0 (e) Blood pressure cuff, paper towel dispenser, sharps container, and hand
hygiene station shall be mounted next to the exam table.
(f) Mirror above sink and coat hooks shall be mounted adjacent to the door.
(g) Soiled linen hamper and soiled garbage container shall be provided.
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Table 11.1 (Continued)
Minor 16.5 for (h) Nurse call system shall be provided.
procedure 3-sided (i) The minimum door width shall be 1050 mm (with 600 mm side leaf).
room access (j) A minimum 1800 mm turning circle shall be provided for standard
wheelchair accessibility on one side of the therapy room.
Special 23.0 for (k) Multiple wall outlets shall be provided to allow flexibility in furniture/lighting
purpose exam 4-sided placement, as well as for services for splinting, etc.
room access (l) Sharps disposal shall be provided in a safe location and near the point of
use.
Exam/ 12 (m) Provision shall be made within the room for electronic charting and access
treatment to health records.
cubicle, open (n) Medical services (e.g., electrical connections, medical gases, vacuum) shall
(chair) 7.5 be provided through a medical supply unit.
Exam/ 9.5
treatment (o) The room arrangement shall provide for access and clearance (800 mm) on
cubicle, one side and at the foot of a patient accommodated on an HCF-sized
bed-stretcher, stretcher.
open (p) Medical gases including oxygen and vacuum shall be provided as specified
(bed- in CSA Z7396.1.
stretcher) (q) The room arrangement shall provide for access and clearance (800 mm) on
one side and at the foot of a patient accommodated on an HCF-sized
Exam/ 8.4 stretcher.
treatment (r) Provision should be made for telehealth, e.g., through room colour,
cubicle, lighting, acoustics, the selection and placement of furniture, and adequate
enclosed space for telehealth equipment.
(chair) (s) An exam light shall be provided over the therapy area.
(t) A room for minor procedures shall have the dimensions shown, and access
Exam/ 13 and clearance shall also be provided to two sides and the foot of the patient.
treatment (u) Treatment/examination rooms used for pelvic exams shall allow for the foot
cubicle, of the examination table to face away from the door.
enclosed (v) Where renovation work is undertaken, every effort shall be made to meet
these minimum standards. In such cases, each room shall have a minimum
(bed-
clear area of 9.0 m2, exclusive of fixed or wall-mounted cabinets and built-in
stretcher)
shelves.
(w) For special purpose examination rooms:
(i) the room arrangement shall permit a minimum clearance of 800 mm at
each side and at the foot of the examination table, bed, or chair;
(ii) minimum clearance around the treatment chair shall be 800 mm; and
(iii) space to transfer a patient from a stretcher shall be provided.
(x) For an open examination treatment area,
(i) a curtain track shall be provided around three sides;
(ii) staff workstation, hand washing facilities, and supplies shall be
convenient and provided at a ratio in accordance with current infection
prevention and control guidelines;
(iii) a hand hygiene station shall be provided in every treatment cubicle;
and
(iv) additional supports (i.e., warming cabinet, nourishment station,
medication cabinet, procedure carts, clinical scale, linen hamper,
mobile lights, patient washrooms, clean supply, and soiled utility
rooms) shall be convenient to the overall treatment area.
Advisory:
(a) Rooms should be laid out in similar configuration.
(b) Access should be provided at the left side of the stretcher.
(c) Other medical gases as required by the room function should be considered.
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Table 11.1 (Continued)
(d) Sufficient space should be provided for up to four or five people (i.e.,
providers, patient, family) in the exam/treatment room at a time.
(e) Consultation table and chairs should be provided for three people with flat
screen computer.
(f) Additional supports, including warming cabinet, nourishment station,
medication cabinet, procedure carts, clinical scale, linen hamper, mobile
lights, patient washrooms, clean supply, and soiled utility rooms, should be
convenient to the overall treatment area.
(g) Storage for staff-accessible patient supplies should be provided in the room.
(h) Counter and wall mounted cupboards for storage of supplies and linen
should be provided.
(i) Each room should contain work counter(s); cabinets; supply storage
facilities; examination lights; a desk, counter, or shelf space for writing; and
a vision panel adjacent to and/or in the door.
(j) The door may be sliding glass with provisions for privacy (curtain).
(k) For telehealth, attention should be paid to room colour, lighting, acoustics,
and the placement of microphones, cameras, and monitors.
(l) TV/media for viewing of educational material may be provided.
(m) If required for consultation, only the examination table and chairs may be
replaced with soft furniture.
(n) Dimmable light should be considered.
(o) Furniture in the room should be easily movable to accommodate a
wheelchair.
(p) Based on program needs, a computer may be provided.
15. Examination/ Mandatory:
treatment The following requirements shall apply in examination/treatment rooms
room — intended for patients requiring airborne precautions, in addition to those
Isolation specified in Item 18:
(a) A clean area shall be prepared for staff to put on PPE before entering the
Exam room 12.0 procedure room.
(b) A contained soiled area shall be provided outside the procedure room for
Anteroom 5.0 staff to wash up and remove PPE before entering a public corridor.
(c) At least one of the isolation rooms in the emergency care shall be equipped
Prep alcove 2.0 with a ceiling-mounted patient lift track.
(d) Layout and service requirements shall conform to current infection
prevention and control guidelines.
(e) An alcove for wheelchair/scooter access shall be provided nearby.
(f) An alcove shall be provided outside the room for PPE and a hand sink.
(g) A hand hygiene sink shall be provided for staff and patient use.
(h) The means used to provide patient privacy shall allow for terminal cleaning
between patients when needed (e.g., between-glass blinds).
Advisory:
Consideration should be made for adding a 2-piece washroom (4.6 m2), 2-piece
barrier-free washroom (5.6 m2), or a 3-piece washroom (7.0 m2) adjacent to the
exam room. If provided, the washroom shall be directly accessible from the
within the exam/treatment room. It shall be for the exclusive use of the isolation
exam/treatment room.
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Table 11.1 (Continued)
16. Examination/ 13.0 Mandatory:
treatment — 4.6 (a) As specified in Item 14.
Adjacent to 7.0 (2 or (b) This room type shall be provided for gynaecological exams and also for
washroom 3 piece patients suspected of having non-airborne infections.
washroom) (c) A clean area for staff to put on PPE before entering the procedure room shall
1.4 (prep) be provided, and may be shared by up to four rooms provided the distance
to the room is not more than 3600 mm.
Advisory:
(a) As specified in Item 14.
(b) If the room could be used for gynaecological exams, the room layout should
have the foot of the patient stretcher oriented away from the door.
17. Examination/ 12.0 Mandatory:
safe room The following requirements shall apply, in addition to those specified in Item 18:
(a) Mental health safety and risk mitigation guidelines shall be applied,
especially as follows:
(i) vertical projections and corners that could cause self-harm shall be
avoided;
(ii) all horizontal projections that could allow climbing or cause self-harm
shall be avoided; and
(iii) a flush protective glazing panel shall be provided at the window (if
present).
(b) Direct access from triage shall be provided, with good access for emergency
medical staff.
(c) Adjacency to the emergency entrance shall be avoided.
(d) Storage shall be provided nearby for restraints (restraint use will depend on
HCF policies and patient disorders).
(e) A patient washroom shall be provided nearby.
(f) Convenient access to a staff hand hygiene sink shall be provided, as
determined by an infection control risk assessment.
(g) An exterior window is not required, except if the room is to be used for
more than 24 h stays.
(h) The door shall be wide enough to allow entry for a restraint bed (minimum
1100 mm, preferably 1200 mm).
(i) Multi-point door locking with automatic locking function when closed, shall
be provided.
(j) The stretcher position in the room shall be located to optimize patient
privacy.
(k) Acoustic separation from other emergency areas shall be provided.
(l) Examination lighting shall be provided, along with general lighting, with
level control by staff from outside the room, to provide a quiet mood.
(m) Temperature control by staff outside the room shall be provided.
(n) Special finishes shall be provided as follows:
(i) they shall be easy to maintain and repair without generating toxic
fumes, in order to minimize downtime of rooms; and
(ii) floor and wall finishes shall be washable.
(o) A stretcher with restraint capability and locking wheels shall be provided.
(p) Medical gases shall be provided, if the room is to serve as an exam room,
and shall be located within a securable, tamper-resistant cabinet.
Advisory:
(a) A second exit door should be considered.
(b) Finishes should be sound absorptive, tamper-resistant, and cleanable.
©
Table 11.1 (Continued)
18. Gym Varies by Mandatory:
program; (a) The mandatory and advisory guidelines of the treatment table/therapy
assume not equipment shall be accommodated, as well as all related circulation space.
less than (b) Double doors shall be provided into the gym.
46.5 (c) For parallel bars, there shall be wheelchair access, with turning radius at
both ends, and space for two caregivers on any side at any one time.
Allowance shall be made for a ceiling-mounted support system for bariatric
patients.
(d) Training stairs shall have access on both sides, a wheelchair turning space at
the bottom, and proper head clearance at the top.
(e) Space shall be provided near equipment for temporary wheelchair storage.
(f) The exerciser (for lower/upper extremities) shall have accessibility on both
sides, wall pulleys, an accessible high-low table, and leg press side-access.
(g) The treadmill shall be accessible at one end.
(h) Hand hygiene sinks shall be provided.
(i) Open space for gait and mobility training shall be provided. A minimum
30 m pathway and a minimum 15% of the gym area shall be maintained as
clear space.
Advisory:
(a) The equipment and therapy program inventory should be considered to
establish parameters and the number and extent/type of equipment
required.
(b) Medical gases are assumed to be portable, but built-in could be considered
based on program need.
(c) Allowance should be made for either a free standing or wall-mounted
universal weight station, with wheelchair accessibility ensured.
(d) Impact-absorbent flooring should be considered.
19. Hand hygiene 1.0 Mandatory:
sink Hand hygiene sinks shall be constructed and installed as follows:
(a) Materials:
(i) Materials shall be non-porous, e.g., porcelain, enamel, vitreous china,
or 18 gauge (or thicker) stainless steel.
(ii) Granite or marble shall not be used.
(b) Size:
(i) Hand hygiene sink size shall be sufficient to prevent recontamination
(from splashing) during use. Minimum inside dimension should be
350 × 250 mm and a minimum depth of 225 mm.
(ii) Cup or bar sinks shall not be used for hand hygiene.
190 225 mm
Healthcare Facility Design Position Statement
(c) Construction:
(i) Hand hygiene sinks shall be shaped to prevent splashing and with a
collar directing runoff into the sink basin.
(ii) Sink shall not be capable of taking a sink plug.
(iii) Sink and spout shall be designed such that splashing and aerosolization
is minimized. The spout shall not direct water directly into drain but
should hit the basin surface in front of the drain.
(iv) Spouts shall be free of aerators\modulators\rose sprays and shall not
swivel.
(v) Strainers and anti-splash fittings at outlets shall not be used.
(vi) The outside rim shall be of minimal width and have the surface angled
down towards the inside to prevent pooling of water and placement of
objects on the rim.
©
Table 11.1 (Continued)
(vii) Traps shall be metal. Gaskets at the skin/drain connection shall be
plastic or neoprene. Rubber gaskets shall not be used.
(viii)Trap size shall be 40 mm diameter.
(ix) Overflows shall not be used.
(x) Adequate flow rate shall be provided to ensure the removal of soap
residue.
(d) Location:
(i) Sinks shall be wall-mounted and at least 1 m away from any fixed work
surface or separated by a splash barrier. Sinks shall not be inserted into
or immediately adjacent to a counter.
(ii) Hand hygiene sinks shall be installed at least 865 mm above the floor
and shall not have storage underneath (due to proximity to sanitary
sewer connections and risk of leaks or water damage).
(e) Controls:
(i) Taps and controllers shall be hands free. Electric eye, foot pedal, or
faucet blade controls may be used. Electric eye operation shall be
triggered by hand, not body, placement. A means shall be provided to
control the temperature.
(ii) Automatic temperature control shall not be used.
(iii) Electric eye technology shall have a backup that allows for operation
during power interruptions and shall have a means for users to adjust
water temperature adjacent to the sink.
(f) Backsplash:
(i) Adjacent wall surfaces shall be protected from splashes with
impermeable back/side splashes. Backsplashes shall be seam free. All
edges shall be sealed with a waterproof barrier. Backsplashes shall
include the area under the paper towel dispenser and soap dispenser.
(ii) Backsplashes shall extend a minimum 600 mm above sink level and a
minimum of 250 mm below sink level.
(g) Soap and lotion dispensers:
(i) Liquid soap and lotion dispensers shall have hands free operation and
mounted to permit unobstructed access and minimize splashing or
dripping onto adjacent wall and floor surfaces.
(ii) Liquid dispensers (soap or lotion) shall use non-refillable bottles and
shall be placed to prevent splash-up contamination.
Hand drying:
(a) Single-use paper towels shall be provided. Cloth drying towels shall not be
used.
(b) Towel dispensers shall be mounted to permit unobstructed access and
minimize splashing or dripping onto adjacent wall and floor surfaces.
©
Table 11.1 (Continued)
(c) Towel dispenser design shall be such that towels are dispensed singly. They
shall either be hands-free or designed so that only the towel is touched
during removal of towel for use.
(d) Hot-air dryers shall not be used for hand hygiene sinks.
(e) Paper waste receptacles shall be a corrosion free material and wide mouth
design.
(f) Space shall be allowed for the placement of waste bins in close proximity to
the hand hygiene sink.
(g) To avoid recontamination of the hands, paper towels should be available to
use on the exit door hardware and a trash container for used towels should
be located near the exit door.
(h) Bins, with a waste bag, shall be provided in close proximity to each hand
hygiene sink. If bins are lidded the bin shall be foot-pedal operated.
Accessible sinks:
(a) Hand hygiene sinks shall be located at a level where they can used by people
in wheelchairs and shall be available as per HCF requirements. These are in
addition to hand hygiene sinks used by staff.
(b) Hand hygiene sinks should be in accordance with ASME A112.19.2/
CSA B45.1. Wheelchair accessible sinks should be wall mounted, made of
vitreous china, 510 mm long by 685 mm wide, slab type provided with
combination centre set faucets, gooseneck spout, open drain with
perforated strainer, and 32 mm cast brass adjustable P-trap with tailpiece.
20. Waterless hand N/A Mandatory:
hygiene station Hand hygiene stations shall be installed at the point of care to improve
(alcohol- adherence to infection prevention and control principles.
based or other Advisory:
waterless hand (a) Stations should be installed outside inpatient bedrooms at the entrance.
hygiene (b) Stations should also be installed at the bedside.
dispenser)
21. Housekeeping 7.0
closet
Mandatory:
(a) A housekeeping closet shall be provided in all major care areas or a
minimum of one closet per 650 m2.
(b) Every housekeeping room shall have a floor-based 600 mm × 600 mm sink.
This sink shall be protected by an easily cleanable wall surface up to
1200 mm from the finished floor.
(c) The housekeeping room shall be large enough to store at least one
housekeeping cart.
(d) Wall protection shall be provided to prevent damage by the carts to a height
of 1200 mm.
(e) Room shall include
(i) floor sink for dumping of dirty water from pails, etc.;
(ii) fresh water source (hot and cold) for filling pails, etc.;
(iii) hand hygiene sink with paper towel dispenser and waste container;
(iv) non-fixed shelving unit for storage of supplies (i.e., paper towels, toilet
paper); and
(v) fixed shelving for storage of small quantities of cleaning products.
(f) The room shall be secure with access restricted to clinical and support staff.
©
Table 11.1 (Continued)
22. Housekeeping 11.0
service room
Mandatory:
(a) A housekeeping service room shall be centrally located between care areas
and shall be able to accommodate large power equipment and have greater
inventory for distribution to the smaller housekeeping unit rooms.
(b) Room shall accommodate the following functions:
(i) necessary electrical service for battery recharging;
(ii) space for cleaning products (and dispensers, if used); and
(iii) eyewash station with tempered water supply and floor drain to collect
run-off.
(c) The room shall be secure with access restricted to clinical and support staff.
23. Hydrotherapy Varies Mandatory:
area according to (a) Patient lifts shall be provided for transfer of patients.
HCF size and (b) Each space shall be curtained off for privacy.
delivery (c) Counters shall be provided as work and storage areas, with upper wall
model. cabinets.
(d) Floor and walls shall be of water-resistant material.
(e) A floor drain shall be provided.
(f) The room shall be secure with access restricted to clinical and support staff.
(g) The room shall have a nurse call system.
(h) The floor shall be finished with slip-resistant materials.
24. Inpatient 1-bed room Mandatory:
bedroom suite Inpatient bedrooms shall be designed with the following features:
(a) Area: Inpatient bedrooms shall be constructed to meet the needs of the
Bed area 15.0 functional program and have a minimum of 16.0 m2 of clear floor area in
single-bed rooms, exclusive of toilet rooms, closets, lockers, wardrobes,
Washroom 5.6 alcoves, or vestibules.
(b) Renovation: Where renovation work is undertaken, every effort shall be
Vestibule 5.0 made to meet the above minimum standards. If it is not possible to meet
the above requirements, inpatient bedrooms shall have not less than
Family zone Included in 12.0 m2 of clear floor area in single-bed rooms exclusive of the spaces
bed area previously noted in this section.
Staff zone Included in
bed area (c) There shall be sufficient space for bed, equipment including monitors,
ventilator, supply cart, furnishings (i.e., side chairs, recliner chair, over bed
Supply alcove 1.4 table), staff and visitors, and mobile charting station (in the event the room
is used for step-down/high-dependency care for patients transitioning from
Two-bed room the critical care unit).
(if allowed as (d) The bed area shall have a minimum clear dimension of 4000 mm ×
per Clause 4000 mm including a minimum clear dimension of 1800 mm for wheelchair
7.5.2.2) turning and stretcher access between the bed and the inside wall (staff side),
a minimum clear dimension of 1100 mm between the bed and the wall on
Bed area the opposite side (family side), and a minimum of 1500 mm from the foot
26.0 of the bed to the facing wall.
(13 per bed) (e) The minimum distances around and between beds shall be in accordance
Washroom with Table 7.1.
11.2 (f) Staff shall be able to access all sides of the patient bed.
(5.6 per
washroom)
©
Table 11.1 (Continued)
Vestibule 7.0 (g) Rooms for bariatric patient use shall have the necessary additional space and
equipment for safe, efficient, and effective management of bariatric
Family zone included in patients. See Clause 7.4.4.
bed area (h) The family side of the bed shall contain a wardrobe unit with minimum
dimensions of 450 mm × 600 mm and space for a recliner/pull-out bed or a
Staff zone included in window seat.
bed area (i) The floor finish in the bedroom shall have an integral coved base.
(j) A storage space (alcove, recess, or cabinet) for personal protection
Supply alcove 1.4 equipment shall be located in a corridor alcove outside the room, and shall
not obstruct the corridor.
Other (k) A soiled linen hamper and waste container shall be provided.
considerations: (l) A hand hygiene station shall be located in the corridor outside each
Two bedroom and at the point of care in each bed area.
washrooms, 14.0 (m) Hand hygiene facilities shall be in accordance with Clause 7.5.11 and
3 piece Item 19 in this Table.
(traditional) (n) There shall be a private washroom accessible from within the patient
cubicle. The washroom shall comply with the requirements in Clause 11.
Two (o) Provision of a patient lift shall be in accordance with Clause 7.6.6.2.
washrooms, 9.2 (p) Specialized water/drain services for portable dialysis equipment shall be
3 piece provided accordance with the functional plan.
(hand-held) (q) There shall be storage for patient personal belongings. This storage should
be lockable.
(r) Medical gases (oxygen, vacuum, and medical air) shall be provided in
accordance with CSA Z7396.1.
(s) Each bed shall have access to daylight. The amount of daylight shall be
controllable.
(t) All lights shall be on separate switches.
(u) Bed lights shall be provided and shall be controllable by the patient.
(v) There shall be a wall or ceiling-mounted clock.
(w) There shall be a telephone for patient use.
(x) Individual temperature control shall be provided.
(y) Sharp corners shall be avoided.
(z) Cubicle curtains and draperies shall be non-combustible or rendered flame
retardant and shall pass both the large and small scale tests in NFPA 701.
Cubicle curtains should be washable at a temperature that provides thermal
disinfection.
(aa) Bedrooms in selected inpatient areas shall have the capability for
non-invasive monitoring, such as telemetry, and sufficient space shall be
provided at the appropriate communication station to accommodate the
additional monitoring equipment.
(bb) A nurse-call shall be easily accessible (audibly and physically) from the bed.
(cc) The room design shall be based on minimum overall bed dimensions
(bumper to bumper) of 2250 mm long × 1050 mm wide, unless it is known
that a larger bed will be used.
(dd) Storage shall be provided for a clean bedpan either in the patient washroom
or in a discreet location in the bedroom.
(ee) Allowance shall be made for future accommodation of wireless/
multi-faceted TV/communication/laptop, etc. as portable devices at the
bedside.
©
Table 11.1 (Continued)
Mandatory for a 2-bed room, if allowed as per Clause 7.5.2.2:
(a) The need to pass through another patient’s bed space to access the
washroom or window shall be avoided.
(b) A privacy curtain shall be incorporated in all shared bedrooms.
(c) There shall be side-to-side visual privacy between patients.
Advisory:
(a) The 3-piece washroom may be replaced with a 2-piece (4.6 m2), a 3-piece
with a hand-held shower device (4.6 m2) or a traditional 3-piece (7.0 m2).
(b) In addition to the required barrier-free access to one side of the toilet, space
for staff to assist should be provided on the opposite side.
(c) The height of the windowsill should be as low as permissible by code in order
to provide the maximum view from the patient bed.
(d) Wall protection should be considered, especially at the head of the bed.
(e) It should be possible to view the patient’s head from the entrance door.
(f) Wardrobes, if moveable rather than built-in, should be fixed to the wall for
safety.
(g) Horizontal and vertical clearance should be provided at the bedroom door for
traction equipment.
(h) A fold-down surface for documentation/charting should be provided on the
staff area side of the bed.
(i) There should be sufficient space for equipment, including monitor, ventilator,
supply cart, and mobile staff charting station in the event the room is used
for step-down/high-dependency care for patients transitioning from the
critical care unit).
(j) Each bed should have a landscape view.
25. Inpatient Individual Mandatory:
washroom washroom: (a) Each bedroom shall have direct access to a washroom.
(b) Privacy shall be allowed, while also including a door that is easily accessible
Single 4.6 by staff if necessary.
barrier-free (c) There shall be sufficient space for a 1500 mm wheelchair turning radius. In
rooms for bariatric patients, there shall be an 1800 mm turning radius.
patient, 2 pce 4.6 (d) The washroom shall be barrier free and contain a toilet with appropriate
grab bars, a sink, and a shower with grab bars and fold-down seat.
patient, 2 pce 5.6 (e) The toilet shall be capable of supporting 250 kg.
(bariatric) (f) The toilet centre line to wall shall be in accordance with applicable
requirements.
patient, 3 pce 4.6
(with (g) There shall be grab bars behind and beside the toilet.
hand-held (h) Toilets with tanks shall not be used, due to the risk of condensation.
shower) (i) Accessibility shall be provided for patients and staff on both sides of the
toilet.
patient, 3 pce 5.6 (j) There shall be clear space on one side of toilet of at least 1100 mm for
(med/surg transfer use.
unit) (k) The grab bars shall be able to withstand 250 kg downward force.
(l) The grab bars shall meet accessibility standards.
(m) The shower area shall be open to the toilet area and a minimum dimension
of 1200 mm × 1500 mm.
©
Table 11.1 (Continued)
patient, 3 pce 7.0 (n) Showers shall have no floor lip, but the entire room shall be sloped to a
(traditional) drain.
(o) Seating shall be provided in the shower area.
(p) The shower shall have a handheld spray nozzle on the side wall and a
movable/portable shower seat.
(q) The washroom sink shall be able to withstand 250 kg downward force
(patients could lean on sink for support).
(r) A wheelchair-accessible counter shall be provided at the washroom sink.
(s) A dry area shall be provided for towels/clothing.
(t) Shelving shall be provided above the counter and beside the mirror.
(u) Sink handles shall be positioned for maximum accessibility.
(v) The door shall be a minimum 1050 mm.
(w) Controls and other hardware shall be easy to use by patients with varying
physical ability levels.
(x) Readily accessible nurse-call shall be provided, to be shut off only at source.
(y) The room shall include separate waste disposal equipment for patient waste.
The toilet shall not be used to dispose of waste from bedpan, etc.
(z) Provisions shall be made at the washroom sink location for placement of the
patient’s personal items.
(aa) Clean bedpan storage shall be provided either at the bedside or in the
washroom.
(bb) The washroom floor shall have non-slip finish with an integral cove base.
Advisory:
(a) Consideration should be given to the location of grab-bars requirements to
facilitate self-enablement (at the sink, for example) as well as facilitate
assistance.
(b) The distance from bed to washroom should be minimized.
(c) Hollow-core doors should be used to facilitate movement.
(d) Sensory lighting adjustable for brightness should be provided.
(e) Providing a heat lamp in the shower area should be considered.
(f) A clean storage area for patient wash basin should be provided either at the
bedside or in the washroom.
(g) A grab bar should be provided to help patients to stand at a barrier-free sink.
(h) The toilet paper dispenser should be mounted at an extended placement in
front of toilet to allow easy access by patient.
(i) Shelving should be provided above the toilet to accommodate a bedpan
and urine bottle.
26. Isolation room 1 Bedroom Mandatory:
suite, private, suite, AIR In addition to the inpatient bedroom requirements (Item 24),
AIR isolation (a) Each inpatient AIR isolation suite shall have a single vestibule, alcove, or
anteroom, to be used for access and egress for staff while caring for patients
Bed area 16.2 that require airborne precautions.
Washroom 7.5
(b) Self-closing doors shall be used for all AIR as well as for anterooms.
Anteroom 7.5 (c) Glazed panels shall be provided in the anteroom doors and side panels to
ensure visibility of the patient.
Family zone 3.0 (d) A washroom (including shower or tub) that complies with the requirements
of Clause 11 shall be accessible directly from the bed area.
(e) There shall be hand hygiene sink in the bed area and in the anteroom in full
view of staff, patients, and visitors accessing the space.
©
Table 11.1 (Continued)
Staff zone 3.0 (f) A soiled linen hamper and waste container shall be located within the
anteroom.
Supply alcove 1.4 (g) Enclosed patient waste disposal units shall be readily accessible from every
inpatient bedroom.
(h) Monitoring devices and alarms shall be outside each room to monitor
pressure differential. These shall be available so that the rooms can be
monitored on admission and daily while occupied by those requiring
airborne precautions. Measurements shall be taken at the door between the
inpatient bedroom and the anteroom.
(i) Systems in place to monitor air supply and exhaust system function. These
systems shall be connected to the building automation system with alarms
to notify the plant engineers of any problems with the systems.
(j) The AIR shall be constructed to minimize air leakage into the space. The
room shall be well sealed by ensuring walls, windows, ceilings, and
penetrations into the space (e.g., electrical, plumbing) are sealed properly.
Walls shall extend to the underside of the slab and be fully sealed.
(k) A gap of 6 mm to 12 mm shall be left under the door to allow for airflow
into the room.
(l) Air flow, circulation, filtering, pressure differentials, exhaust systems, and
alarms shall be in accordance with CAN/CSA-Z317.2.
(m) Windows shall be positioned to allow visibility of the patient from the
corridor
(n) The room design shall allow easy access and maintenance to mechanical
systems.
(o) AIRs for pediatric or adolescent patients shall also comply with the
requirements of Clause 8.5.
(p) Minimum distances around and between beds shall be in accordance with
Table 7.1.
Advisory:
Doors that provide direct access from the corridor to the room may be used
where transport of the patient through the anteroom is not practical. A preferred
solution is a wider door or a fixed leaf arrangement.
27. Imaging/ Varies, 0.6 for Mandatory:
equipment each alcove For mobile C-arm and mobile X-ray:
alcove space (a) Equipment shall not be stored in operating rooms.
(b) Space for lead (Pb) apron rack(s) on wheels shall be provided (at least
1200 mm × 900 mm).
28. Laundry for 11.0 Mandatory:
inpatient (a) The laundry shall be wheelchair accessible.
continuing (b) The laundry shall reflect similar challenges of the home as part of the
care and for transition.
rehabilitation (c) Doors shall be a minimum 1050 mm or 860 mm with a 600 mm door leaf.
care (ADL (d) Provision shall be made for a washer and dryer in an ADL apartment as well,
laundry) but only as a secondary if an ADL laundry room is provided elsewhere.
(e) Space shall be provided for folding and hang drying.
(f) Flexibility shall be provided to allow for task lighting.
(g) A family/visitor space to assist the patient shall be accommodated.
(h) Nurse-call shall be provided.
©
Table 11.1 (Continued)
Advisory:
(a) As an easily adaptable item in transition to the home, using contrasting
colours of different planes and furniture for ease of orientation should be
considered.
(b) Combining the ADL laundry and kitchen in one area should be considered.
(c) Consideration should be given to whether, based on program requirements,
a full ADL apartment is required or only a laundry and kitchen.
29. Lockers 20.0 Advisory:
(a) Lockers for staff should be within the boundaries of the department where
purse 0.15/locker the staff are working, and they should be next to staff lounge and staff
washrooms.
Half 0.40/locker (b) Half size lockers may be used.
(c) Lockers should be assigned to a single individual.
Full 0.70/locker
30. Lounge, 2.5 per Mandatory:
patient/ occupant (a) A lounge shall be in the inpatient unit.
visitor — (including (b) Visibility of activities from a staff care desk or other staff location shall be
General circulation) provided; camera observation is optional but less desirable than a direct
view.
(c) Natural light and a view of the outdoors shall be provided.
(d) Separate areas shall be provided to isolate quiet and noisy activities; separate
rooms should be provided.
(e) Adequate storage space shall be provided for activity equipment and
supplies.
(f) Acoustic treatment to reduce ambient noise and acoustic separation from
other areas shall be provided.
11.0 m2
Advisory:
Lounges should not be used for eating meals.
31. Lounge, 2.5 per Mandatory
patient/visitor occupant (a) The walls shall be of impact-resistant material and solid ceiling material.
(pediatric and (including (b) The floor shall be of resilient, water-resistant material.
adolescents) circulation) (c) Space shall be provided for the storage and use of age-appropriate toys and
games.
(d) Nurse call system shall be provided.
Advisory:
(a) The lounge should be furnished with TVs and computers.
(b) Lounges should not be used for eating meals.
32. Medication Varies Mandatory:
room according to (a) A scientific refrigerator/freezer shall be provided.
delivery (b) The necessary security for narcotics shall be provided.
model;
not less
than 9.5 (c) The room shall include a mobile medication cart or an automated
dispensing cabinet for all medications used on the unit (except those with
specific storage, security, or safety requirements).
(d) Another medication cart or automated dispensing cabinet shall be used for
IV admixtures.
©
Table 11.1 (Continued)
(e) The room shall be secure with access restricted to clinical and pharmacy
staff.
(f) Computer workstation (s) shall be provided for clinical pharmacists.
(g) A hand hygiene sink shall be mounted on the wall adjacent to the door and
away from medication preparation area due to risk of splashing and
aerosolization.
Advisory:
(a) Ease of access for staff should be considered.
(b) Technology for drug dispensing, to increase safety and security, should be
considered.
33. Nourishment Varies Mandatory:
centre according (a) Room shall be equipped with double sink, refrigerator, and microwave to
to unit/ provide patients with light snacks.
program size (b) Storage cupboards with counter space shall be required.
(c) Ice machine (may need water filter) shall be provided.
10.0
(separate
enclosed
room
3.0 (alcove
only)
34. Offices (staff) Type 1: 9.0 Advisory:
type 1 — one Type 2: 10.0 (a) The office should have an exterior view.
desk/no Type 3:11.0 (b) All offices should be acoustically insulated for confidentiality.
meeting space Type 4:14.0 (c) The entry door should have a vision panel with blinds.
(d) Office users should have a sightline to the door when seated at their
Type 2 — one workstations.
desk, two
visitor chairs
Type 3 — one
desk, small
meeting area
Type 4 — one
desk, meeting
area/four chairs
35. Outdoor space Varies Mandatory:
(a) If an outdoor space is provided, a safe enclosure shall be provided to prevent
wandering away from the outdoor space.
(b) Safe mobility shall be facilitated by the selection of ground finish, lighting,
and assistive devices (pavers shall be avoided in circulation areas).
(c) Only non-toxic plants shall be provided.
(d) The space shall be designed to accommodate both small and larger group
activities.
(e) Access shall be barrier-free and should have the potential for year-round use.
(f) A communication/response system shall be included.
Advisory:
(a) To enhance its use, consideration should be given to locating the outdoor
space adjacent to the indoor common activity/therapy space.
(b) Inclines should be avoided wherever possible.
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Table 11.1 (Continued)
(c) Edges should be designed to facilitate wheelchair manoeuvrability while
avoiding a tripping hazard.
(d) Electrical provisions for seasonal/display lighting and music should be
considered.
(e) Year-round opportunities should be provided for sun, shade, and protection
from wind, rain, and other elements.
36. Play area 2.5 per Mandatory:
(pediatric or occupant (a) The walls shall be of impact-resistant materials.
adolescents) (b) The floor shall be of resilient, water-resistant material.
(c) The surfaces of play equipment and materials shall be washable.
Advisory:
Exterior window(s) should be provided.
37. Reception/ 4.6 per work- Mandatory
control desk station and (a) The reception/control desk shall be positioned so that there is security
additional control and staff act as an information centre and direct visitors and staff as
circulation required to the unit. The space shall include a workstation.
space
(b) The area shall be designed according to ergonomic principles. See
Clause 7.6 (occupational health and safety).
(c) A nurse call or intercom shall be provided.
(d) The station shall be designed to ensure personal security for staff.
Advisory:
(a) A counter should be provided at the back of the room for storage of paper
and other procedural material.
(b) Depending upon the physical layout of the unit, consideration should be
given to create a secondary entry for the movement of supplies, garbage,
and patients (i.e., new admission to/from procedures and tests, morgue)
away from general visitors.
(c) All entry points should be secure and require controlled access. An intercom
system between the visitor area and staff work area should be considered so
that staff can interview visitors to ensure appropriate entry into the area.
(d) The placement of the computer should be convenient to allow for easy
input but not to obstruct the visual connection between staff and the
patient.
38. Respiratory N/A Mandatory:
therapy/ (a) The area shall have a hand hygiene sink.
anaesthesia (b) A hand hygiene station shall be provided inside the door.
support area (c) The room shall be used for cleaning/storing of equipment (e.g., ventilators)
and gas cylinder storage (i.e., emergency back-up or low usage specialized
gases).
(d) The area shall include a utility sink and storage.
(e) Medical gas and medical vacuum shall be provided (for testing equipment).
Advisory:
(a) For the convenience of staff and doctors, this area should be centrally
located in the unit if required by the program.
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Table 11.1 (Continued)
(b) The room should be flexible enough to include testing (e.g., blood gases)
services.
(c) Medical air could be required as part of equipment testing.
39. Satellite Varies Mandatory:
pharmacy (a) Modular picking station(s) shall be provided.
(b) Space shall be provided for utility/supply carts.
(c) A hand washing sink and emergency eyewash shall be provided.
(d) Room shall have positive relative pressurization ventilation.
(e) Computer workstation(s) shall be provided for clinical pharmacists.
(f) Alarm monitoring and card control shall be provided.
(g) A refrigerator shall be provided.
(h) If sterile products are to be prepared, the design shall enable sterile prep
guidelines to be followed.
40. Soiled utility Small: 12.0 Mandatory:
room (a) Clean and soiled utility rooms shall be separated spaces.
Medium: (b) Soiled utility rooms shall only be used for temporary storage or supplies and
14.0 equipment that will be removed for cleaning, reprocessing or destruction.
(c) The room shall be located and arranged to provide easy access for staff to
Large: 18.0 deposit soiled supplies.
(d) Soiled utility rooms shall be designed and equipped to minimize/contain the
aerosolization of waste.
(e) A hand hygiene sink shall be provided.
(f) Space shall be provided at the point of use for rinsing of gross soil or debris
from reusable devices.
(g) Easy access shall be provided for closed human waste container cleaning
devices or disposable human waste container devices.
(h) Flooring shall be of seamless impermeable, non-slip material.
(i) Splash protection shall be provided on walls near water supply, sinks, or
human waste management systems.
(j) Counter tops shall be of non-porous material, free from seams and tolerant
of routine daily cleaning with hospital grade disinfectants.
(k) The room shall be secure with access restricted to clinical and support staff.
(l) Doors shall be kept closed and not propped open.
(m) The room shall be designed to minimize exposure of patients, staff, and
visitors to odour, noise, and the visual impact of medical waste operations.
(n) The room shall have the capacity to
(i) segregate wastes into HCF approved containers;
(ii) hold soiled linen and items for return to MDRD;
(iii) contain a human waste management system (HWMS);
(iv) contain supplies associate with waste management systems; and
(v) provide for cleaning soiled patient equipment this in not returned to
MDRD (IV poles, commode chairs, etc.).
(o) Spray wands shall not be used for rinsing of items. Equipment used for
removal of gross soiling shall minimize aerosolization of particulates.
(p) Space shall be provided for separate mobile containers for soiled linen,
general waste, medical/hazardous waste, confidential waste, and recycling,
etc.
(q) The room shall provide storage for carts that will be used to move the soiled
material from the room.
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Table 11.1 (Continued)
(r) Patient waste disposal equipment shall be provided (e.g., macerator, clinical
flushing rim sink). If hoppers are used, they shall be designed to contain any
splash and the controls shall be located so as not to expose staff to
contaminants.
(s) A washer disinfector shall be provided in accordance with the functional
program.
(t) Soiled utility rooms may have specific needs depending on the clinical unit.
Specific needs shall be identified in the functional plan and provided for
within the space.
Advisory:
(a) Access to PPE for unit based decontamination and cleaning should be
available.
(b) The use of stainless steel counters and shelves should be considered.
(c) Soiled utility rooms may be centralized or decentralized depending on the
delivery of care.
(d) Two soiled utility rooms may be provided in consideration of staff travel
distances.
(e) Access to the soiled utility room may be from two sides of the care space.
The soiled utility room shall not be used as an entrance to the care space.
(f) Wall finish materials should be smooth and impact resistant wall board
where heavy carts are exchanged in the space.
(g) Flooring finishes should be able to withstand rolling equipment and provide
minimal rolling resistance.
(h) Wall base and floor edges should be an integral cove base, tightly sealed
against the wall, and constructed without any gaps.
(i) If spray wands are already installed in an existing space undergoing
renovation, they should be removed.
41. Small multi- 11.0 Mandatory:
disciplinary (a) A separate storage area shall be provided nearby.
assessment/ (b) Acoustic and visual privacy shall be provided.
treatment (c) The room shall accommodate one therapy area for one patient (maximum)
room or one patient and family member (maximum three people per room).
(d) The room shall accommodate a workstation or single treatment table
against the wall.
(e) If incorporated, the workstation height shall be adjustable.
(f) Daylight-simulated light fixtures shall be provided.
(g) Flexibility shall be provided to allow for task lighting.
(h) Individual temperature control shall be provided in each room.
(i) A family/support person space to enable assistance shall be accommodated.
(j) Easily accessible and safe nurse-call shall be provided.
(k) The patient space shall not be directly in view of the door to the corridor.
Advisory:
(a) Allowance should be made for observation in at least some of the individual
therapy rooms.
(b) Privacy and care requirements, such as visibility by staff from the corridor
and patient privacy, should be balanced.
(c) The window, if provided, should be located to maximize the view outward
from sitting space, but also provide the ability for screening.
(d) Contrasting colours of different planes and furniture should be used for ease
of orientation.
(e) A window in the door is possible, but there should be provision for privacy.
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Table 11.1 (Continued)
42. Large multi- 46.5 Mandatory:
disciplinary (a) Audio and visual privacy shall be ensured.
assessment/ (b) The room shall accommodate one therapy area for a number of patients.
treatment (c) The treatment table shall be centrally located for ease of therapy on both
room sides.
(d) The workstation shall have adjustable height.
(e) A minimum 1100 mm shall be provided at the foot of the treatment table.
(f) A bobath-sized template shall be used for the standard treatment table area.
(g) Storage for staff-accessible patient supplies shall be provided in the room.
(h) A counter for staff access shall be provided.
(i) Wall space and backing shall be provided for mirrors.
(j) Daylight-simulated light fixtures shall be provided.
(k) Flexibility shall be provided to allow for task lighting.
(l) Multiple wall outlets shall be provided to allow flexibility in furniture/lighting
placement.
(m) Individual temperature control shall be provided in room.
(n) A family/support person space to enable assistance shall be provided.
(o) Easily accessible and safe nurse-call shall be provided.
(p) The patient space shall not be directly in view of the door to the corridor.
Advisory:
(a) Privacy and care requirements, such as visibility by staff from the corridor vs.
patient privacy, should be balanced.
(b) Contrasting colours of different planes and furniture should be used for ease
of orientation.
(c) A window in the door is possible, but there should be provision for privacy.
43. Staff coat room Varies Mandatory:
The room shall be secure with access restricted to clinical and support staff.
Advisory:
(a) The staff coat room should be located close to the entry into the
department.
(b) An upper shelf, with a continuous hanger rod below, should be provided
along one wall of the room and at the far end.
44. Staff room Varies, Mandatory:
depending The staff room shall be located within the services but away from the main
on staffing activity and patient areas.
numbers Advisory:
(a) Natural light should be considered.
(b) Kitchenette equipment may be provided.
45. Storage room Varies Mandatory:
(a) Storage space shall be provided convenient to each program/activity area.
(b) Dedicated space, subdivided or separated, shall be provided for large and
small equipment.
(c) Stored items shall be easily accessible.
(d) Easy handling of supplies and equipment shall be ensured.
(e) To provide security, storage areas shall be lockable. A safe working
environment shall be provided.
(f) Storage space shall be designed (i.e., with the appropriate type, location,
and amount) to accommodate the expected equipment inventory.
(g) Shelving systems shall be adjustable and easily maintained.
(h) Storage rooms for clean and sterile medical supplies shall comply with
CSA Z314.15.
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Table 11.1 (Continued)
(i) Equipment storage areas shall incorporate the necessary electrical or
mechanical supports and features as required by the equipment
manufacturer.
Advisory:
(a) Providing regularly spaced storage for clean and soiled equipment and for
ease of access and improved operating efficiencies should be considered (for
example, circulation patterns that will develop in the delivery of established
programs should be considered to create efficiencies wherever possible).
(b) Providing overflow space to meet unexpected storage situations should be
considered.
(c) Consideration should be given to storage requirements for all care delivery
support services (building services as well as the therapeutic equipment
services) in order to determine where storage services can be combined and
what their relationship to each other might imply.
(d) Where shelving systems are extending to/above shoulder height, a suitable
step stool should be provided as well as the space for it to be used and
stored.
46. Sub-sterile Varies; Mandatory:
supply/case assume 1.2 (a) The room shall be developed with storage for case carts and more
cart holding per cart permanent items.
area (b) A wall-mounted sink shall be provided alongside the base cabinet, located
to avoid splashing on supplies.
(c) The room shall be secure with access restricted to clinical and support staff.
Advisory:
One wall should be provided with a base cabinet with closed doors and drawers
and with wall cabinets, also with doors, above.
47. Tub/shower Mandatory:
room (central) (a) There shall be a hand hygiene sink at the entrance/exit.
(b) Each bathtub or shower shall be an individual room or enclosure that
Therapeutic 16.0 provides privacy for bathing, drying, and dressing.
tub room (c) Minimum room clearances shall
(i) conform to the requirements of CAN/CSA-B651 for the building
Stretcher 16.0 occupants most likely to use the room; and
shower room (ii) allow for health care worker assistance to the patients.
(d) Tub-mounted lifting devices shall be installed where such lifting will occur.
(e) There shall be easy access to hand hygiene sink within the room.
(f) Controls shall provide flexibility for both patient and staff access.
(g) Each tub/shower room shall be equipped with non-moisture absorbing
emergency staff call cord. It should be easily identifiable, accessible from the
wet area and descend far enough to be with the reach of an occupant who
has fallen or collapsed.
(h) Each room shall have storage space for supplies and PPE for tub cleaning
after each patient use.
(i) Tub/shower rooms shall not be used for any other purpose.
(j) Wall bases shall be integral with the floor, tightly sealed against the wall and
constructed without voids.
(k) Flooring material shall be slip resistant and shall not support growth of
mildew or mould.
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Table 11.1 (Continued)
(l) Wall covering shall be moisture proof/resistant.
(m) Ceiling coverings shall be non-porous and moisture resistant.
(n) Tubs with recirculating water jets shall not be used, except as provided in
Clause 8.3.3.2 for intrapartum suites.
(o) For stretcher shower rooms, the room shall have a minimum width of
3500 mm, and a minimum 1800 mm shall be provided on one side of the
shower and 1200 mm on the other side.
(p) In shower rooms, separate drains shall be provided in the entryway and
shower area.
(q) Tub rooms shall have a separate grooming area with a sink and shelf.
Shower rooms do not require a grooming area.
(r) Access to oxygen and medical vacuum shall be provided within the room.
(s) A heat lamp shall be provided.
National Building
Code
Advisory:
(a) Unless each occupant room is provided with an ensuite, at least one
standard bath for every twelve beds should be provided for general use.
(b) A separate and enclosed toilet should be considered for central tub/shower
rooms. Where provided, it shall be in close proximity to the tub or shower
and within the suite space.
(c) These rooms should be easily located for access by all staff.
(d) Natural light should be provided, if possible, with privacy screening of the
window (frosted glazing, movable window treatment, etc.).
(e) Tub/shower rooms should include a shelf and hook for patient supplies.
48. Waiting area/ Varies; Mandatory:
rooms (a) Waiting rooms for patients and accompanying persons shall be located close
to the entrance to the various departments/provider’s suite.
Seating, Assume 1.5 (b) Zones shall be created so that the more infectious persons are in a separate
general per seat area.
Seating (for at 2.0 per seat (c) Public washrooms shall be provided in close proximity.
risk areas — Advisory:
e.g., (a) Space should be provided for waiting in wheelchairs.
emergency (b) Seating should be comfortable furniture and of enough diversity for normal
dept.) and bariatric patients.
(c) Wall or ceiling-mounted televisions should be distributed throughout the
Wheelchair/ 3.0 per seat area for viewing by most of those waiting.
scooter/ (d) Signage should direct people to nearby vending machines.
bariatric (e) Telephone should be provided with local calling access.
(f) Waiting rooms should be so located that they can be observed by the
Stretcher 5.0 per seat appropriate staff in their appointed location.
49. Washroom 4.6 Mandatory:
(public) (a) The toilet and sink shall be hands free operation.
Refer to (b) Dispensers for paper towels shall be hands free (i.e., the hands only touch
Single applicable the towel).
barrier-free: Codes for (c) A mirror and coat hooks shall be provided.
grouped: standard and (d) Toilets with tanks shall not be used, due to the risk of condensation.
barrier-free
requirements
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Table 11.1 (Concluded)
50. Work area 4.6 per work- Mandatory:
(staff/student) station and (a) Workspace for nursing, allied health professionals, clinicians, clerical staff,
additional and students shall be provided in correlation with the activity of the unit/
circulation suite.
space (b) A dedicated hand hygiene sink shall be placed by the staff work area.
(c) Nurse call/intercom shall be provided.
Advisory:
(a) Pneumatic tubes should be considered for direct connections to the
laboratory and pharmacy.
(b) Area with electrical receptacles to store and charge small electrical
equipment (i.e., portable monitors) should be close to the staff work area.
(c) Tack board should be provided for display of patient received cards, photos,
and medical information relating to the specific patient.
(d) There should be a white board for the staff to diagram information to
patient and visitors.
(e) There should be a TV and multi-media player (wall or ceiling mounted).
12 Building services and environmental design
12.1 General
Clause 12 describes the specific requirements for building systems within and surrounding an HCF.
Building systems shall be designed in accordance with the OASIS principles as follows:
(a) operations (including performance, reliability, flexibility, and adaptability);
(b) accessibility;
(c) safety and security (including emergency preparedness);
(d) infection prevention and control; and
(e) sustainability (including energy efficiency, life cycle analysis, and maintainability).
12.2 Architectural systems
12.2.1 Envelope
12.2.1.1
Wall systems and materials shall be chosen to control the impact of exterior noise and vibrations (e.g.,
traffic or industrial activities adjacent to the site) on the needs and services of health care.
12.2.1.2
Strong and easy-to-maintain material should be chosen to prevent vandalism.
12.2.1.3
At least one entry door shall be a minimum of 1220 mm wide to accommodate bariatric persons.
12.2.1.4
If revolving doors are used, pedestrian doors shall be installed nearby.
12.2.1.5
A simple, easy-to-maintain design for exterior windows shall be used, with a low number of mullions used.
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12.2.1.6
The building envelope shall be designed to facilitate compliance with the HVAC requirements (e.g.,
temperature, humidity, and differential space pressurization) specified in CAN/CSA-Z317.2.
12.2.1.7
Lower humidity buffer spaces should be provided to separate spaces with high relative humidity from the
building envelope. To make such separation effective, design partitions and mechanical system air pressure
differentials should be used to minimize humid air transfer to buffer spaces.
Where high humidity space cannot be buffered from the building envelope, design shall prevent
condensation within the building envelope.
12.2.2 Ceilings and clearances
12.2.2.1
The minimum ceiling height shall be 2.4 m with the following exceptions:
(a) Ceilings in corridors, storage rooms, toilet rooms in these spaces shall be not less than 3.4 m in
height. Ceiling heights in small, normally unoccupied spaces may be reduced.
(b) Ceilings in radiographic, operating, and delivery rooms, and other rooms containing ceiling-mounted
equipment or ceiling-mounted surgical light fixtures, shall be of sufficient height to accommodate
the equipment or fixtures and their normal movement.
(c) Patient bedrooms and secure/observation rooms treatment rooms in mental health units shall have a
minimum ceiling height of 2.75 m.
(d) Minimum ceiling heights for specialized areas (e.g., ORs) are specified in Table 9.5, Items 1 to 3.
12.2.2.2
The minimum overhead clearances shall be as follows:
(a) Suspended tracks, rails, and pipes located in the traffic path for patients in beds and/or on stretchers,
including those in inpatient service areas, shall be not less than 2.2 m above the floor. Clearances in
other areas may be 2 m.
(b) Where existing structures make the ceiling clearance in Item (a) impractical, clearances shall be as
required to avoid injury to individuals, up to 1.9 m in height.
12.2.3 Doors
12.2.3.1
All doors between corridors, rooms, or spaces subject to occupancy shall be of the swing type, with the
following exceptions:
(a) elevator doors;
(b) manual or automatic sliding doors in locations where fire and other emergency exit requirements are
not compromised and where cleanliness of surfaces can be maintained; and
(c) sliding doors in rooms designed for bariatric patients.
12.2.3.2
Measurements for door width and height shall be taken as the nominal dimension of the main door leaf
(not including the side leaf), ignoring projections of frame and stops. Special consideration shall be given
to the width and height of doorways to ensure delivery and removal of equipment is not impeded or
prevented and that stretchers and bed movement is not hampered.
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12.2.3.3
The minimum door width for inpatient bedrooms shall be 1050 mm and shall include a side leaf to allow a
total width of 1525 mm.
12.2.3.4
All doors used for passage of stretchers or beds should have a usable width of at least 1100 mm.
12.2.3.5
Oversized doors should be provided to building circulation corridors for change-out and movement of
floor-mounted equipment.
12.2.3.6
Door widths for other HCF areas shall be sufficient for the movement of the equipment, office furniture,
etc., that will be used in the area.
12.2.3.7
Frame and/or door protection should be provided in areas exposed to heavy traffic and/or carts.
12.2.3.8
The minimum door height shall be 2100 mm to provide clearance for movement of beds and other
equipment (such as IV poles).
12.2.3.9
Rooms that contain bathtubs, sitz baths, showers, and/or toilets for inpatient use shall be equipped with
doors and hardware permitting emergency access from the outside. When such rooms have only one
opening or are small, the doors shall open outward or in a manner that will avoid pressing a patient who
may have collapsed within the room. Outpatient programs should also be designed with these
considerations.
12.2.3.10
Where required by the functional program, door latches on patient toilet rooms in psychiatric nursing
units shall be designed to allow staff to control access.
12.2.3.11
Safety glass, tempered glass, or impact-resistant plastic glazing materials shall be used for interior windows
in doors. Where windows are provided in doors to imaging rooms, they shall be fitted with operator
controlled screening and be radiation shielded where necessary.
12.2.3.12
Door closing devices should not be used on patient room doors. If a door closing device is required on the
inpatient bedroom door, it shall be mounted on the public side of the door rather than the private patient
side of the door, and it should be within view of a nurse or staff workstation.
12.2.3.13
Door hinges shall be
(a) designed to minimize points for hanging (i.e., by using a piano hinge type); and
(b) selected to ensure patient safety, taking into account the age, mental state, and level of care of the
patient.
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12.2.3.14
Door lever handles shall point downward when in the latched position.
12.2.3.15
Oversized doors shall be provided to building circulation corridors for change-out and movement of
floor-mounted equipment.
12.2.3.16
All door hardware shall have tamper-resistant fasteners.
12.2.4 Windows
12.2.4.1 General
12.2.4.1.1
All rooms occupied by patients or staff on a regular basis shall have glazed windows to achieve external
views and/or make use of direct or indirect natural light, where practical. All patient bedrooms shall have
external windows overlooking external areas.
12.2.4.1.2
Unless otherwise prescribed by applicable requirements, low window sill heights (no higher than 600 mm)
shall be installed to permit views to the outdoor by a patient lying in bed. A wide internal window sill may
be used for ornaments and photographs within sight and reach of patient.
12.2.4.1.3
Windows shall be glazed as follows:
(a) All glazing (both interior and exterior), borrowed lights, and glass mirrors shall be fabricated with
tempered safety glass or protected by polycarbonate, laminate, or safety screens.
(b) Doors, sidelights, borrowed lights, and windows glazed to within 457 mm of the floor shall be
constructed of safety glass, wired glass, or plastic glazing material that resists breakage and creates no
dangerous cutting edges when broken. Similar materials shall be used in wall openings of playrooms
and exercise rooms unless otherwise required for fire safety.
(c) Windows used in non-security areas shall have a breaking strain of not less than 15 kg.
(d) Glare and excessive heat gain or loss should be controlled.
12.2.4.1.4
Window opening mechanisms that prevent persons from climbing in and out of windows shall be
selected.
12.2.4.1.5
The total area of required external windows and/or external glazed doors should have a net glazed area of
not less than 10% of the floor area of the room. An opening component equal to not less than 5% of the
floor area of that same room is considered highly desirable.
12.2.4.1.6
The window design process shall include consideration of cleaning. The selection of a cleaning method
will depend on the type and location of windows used.
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12.2.4.2 Security
Entry through perimeter windows should be minimised by the use of options such as
(a) reinforcing windows to resist unauthorised entry;
(b) using heavy gauge glass bricks or laminated glass panels (in areas that require natural light but no
ventilation) that are securely mounted in the frame;
(c) permanently closing older unused windows by fixing with bolts or screws;
(d) applying film to glass to resist breakage or fit safety glass;
(e) in areas where glass could be damaged, avoiding larger pane sizes as smaller panes are inherently
stronger for a given thickness than larger panes; and
(f) use of impact-resistant Grade A safety glass complying with AS/NZS 2208 in all security areas.
12.2.4.3 Window treatments
12.2.4.3.1
Window treatments such as sun shading, blinds or curtains may be used to enhance patient comfort, light
control, privacy, to produce a home-like atmosphere and/or for energy conservation. Window treatments
shall be durable and easy to clean.
12.2.4.3.2
Fabrics/materials shall meet applicable fire safety requirements.
12.2.4.3.3
Pull-down cords shall not be used
12.2.4.3.4
Insect and security screens shall be provided where windows are able to be opened. They shall be
accessible to staff from inside the room.
12.2.4.3.5
Blinds to external windows should be installed between double glazing.
12.2.4.4 Nurseries
12.2.4.4.1
Babies should be placed so that they are at least 610 mm from external windows at all times. There should
be double-glazing to minimise radiant heat loss and some shading to prevent rooms from overheating.
12.2.4.4.2
Shading devices shall be neutral in colour or opaque to minimize colour distortion from transmitted light.
12.2.4.4.3
Windows from nurseries into corridors, if provided, should be double glazed with integral venetian blinds
controlled from within the nursery.
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12.2.4.5 Diagnostic imaging
12.2.4.5.1
Natural light shall be provided where possible in diagnostic imaging services.
12.2.4.5.2
Staff rooms and offices should have access to natural light and preferably a pleasant exterior view.
12.2.4.5.3
Where windows are provided in imaging rooms, they should be fitted with operator controlled screening
and be radiation shielded where necessary.
12.2.4.6 Operating room
Staff rooms and offices should have access to natural light and preferably a pleasant exterior view.
12.2.4.7 Laboratory
12.2.4.7.1
Windows in laboratories shall be designed to minimize glare.
12.2.4.7.2
Consideration should be given to the changing path of the sun between winter and summer and the
concern that in laboratories that operate over extended hours, staff could be operating equipment at
sunrise and sunset when direct sunlight entering the building is difficult to eliminate without external
louvres.
12.2.4.7.3
Staff rooms and offices should have access to natural light and preferably a pleasant exterior view.
12.2.4.8 Dialysis and chemotherapy
12.2.4.8.1
Dialysis and chemotherapy areas should be designed with treatment bays (sized to take a chair or a bed)
adjacent to each other in sight of a staff station.
12.2.4.8.2
An exterior view should be provided for all patients either through being adjacent to a window or by
keeping sight lines to further windows clear of obstruction.
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12.2.4.9 Pharmacy
The pharmacy area should be constructed with as few windows as possible. Where windows exist in the
pharmacy or in perimeter doors, they shall be of impact-resistant Grade A safety glass in compliance with
AS/NZS 2208.
12.2.4.10 Mirrors
Mirrors shall not be installed at hand hygiene stations in food preparation areas, nurseries, clean and sterile
supply areas, scrub sinks, or other areas where asepsis control would be lessened by hair combing.
12.2.5 Finishes
12.2.5.1 Non-combustible or flame-retardant materials
Cubicle curtains and draperies shall be non-combustible or flame-retardant and shall pass both the large-
and small-scale tests of NFPA 701 when applicable. Materials and certain plastics known to produce
noxious gases when burned shall not be used for mattresses, upholstery, and other items insofar as
practical.
12.2.5.2 Floors
12.2.5.2.1
Floor materials shall be
(a) easily cleanable and antibacterial;
(b) non-slip;
(c) of a type that does not create “drag” or “resistance” for patients using walking aids and wheelchairs;
(d) appropriately wear-resistant for the location;
(e) free of seams and creases that could harbour bacteria; and
(f) resistant to food acids (including at seams and joints).
12.2.5.2.2
Carpeting, if used, should be minimal. Carpeting should not be used in areas where there is a risk of spills,
or where there is risk of infection from dust and particulates containing environmental pathogens in the
patient population served by the area (e.g., burn units, critical care units, operating rooms, transplant
units).
Carpeting shall not be used in areas that normally house immunocompromised patients.
If carpeting is used, it shall be cleanable with hospital-grade cleaners and disinfectants. Carpet tiles, if
used, shall be of a design that is easily removed, discarded, and replaced.
12.2.5.2.3
Floors in areas used for food preparation or food assembly shall be water-resistant.
12.2.5.2.4
In all areas subject to frequent wet-cleaning methods, floor materials shall be
(a) monolithic and coved from the floor, tightly sealed with the wall, and constructed without voids;
(b) resistant to water penetration; and
(c) resistant to damage by germicidal cleaning solutions.
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12.2.5.2.5
Floors subject to traffic while wet (such as shower and bath areas, kitchens, and similar work areas) shall
have a cleanable non-slip surface.
12.2.5.2.6
The floors and wall bases of all operating rooms and any delivery rooms used for caesarean deliveries shall
be monolithic and joint free.
12.2.5.2.7
Floors in critical care areas, treatment rooms, and inpatient bedrooms shall incorporate flood-resistant
bases.
12.2.5.2.8
Floors in areas and rooms in which flammable anaesthetic agents are stored or administered shall comply
with NFPA 99.
12.2.5.2.9
Floor surfaces in patient areas shall be smooth and without irregular surfaces to prevent tripping by
patients using orthotic devices. Treatment areas shall not be carpeted.
12.2.5.2.10
Flooring shall be adequate to meet load requirements for equipment, patients, and personnel.
12.2.5.2.11
Floor and wall areas penetrated by pipes, ducts, and conduits shall be tightly sealed to minimize entry of
rodents and insects. Joints of structural elements shall be similarly sealed.
12.2.5.2.12
Floor finishes in all patient care areas and corridors for emergency should have the following
characteristics:
(a) acoustic properties that reduce sound transmission; and
(b) shock absorption sufficient to optimize staff comfort without hampering the movement of beds.
12.2.5.2.13
Rooms used for protective isolation and anterooms adjacent to rooms used for protective isolation shall
have seamless flooring with integral coved base.
12.2.5.2.14
Anti-fatigue flooring should be provided at workstations where there will be prolonged standing.
12.2.5.3 Walls
12.2.5.3.1
Wall finishes shall be washable. In the vicinity of plumbing fixtures, wall finishes shall be smooth and
water-resistant.
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12.2.5.3.2
The bottom edge of drywall shall be set at a minimum of 12 mm above the finished floor level and the gap
shall be sealed.
12.2.5.3.3
In dietary and food preparation areas, wall construction, finish, and trim, including the joints between the
walls and the floors, shall be free of spaces that could harbour insects or rodents.
12.2.5.3.4
In operating rooms, caesarean delivery rooms, isolation rooms, and sterile processing rooms, wall finishes
shall be free of fissures, open joints, or crevices that can retain or permit passage of dirt particles.
12.2.5.3.5
Moisture resistant drywall shall be used in all critical care areas
12.2.5.3.6
Wall and corner protection shall be installed in high traffic areas that are prone to damage. Service
corridors shall have protection to the lower part of the walls to minimize damage from carts and
stretchers.
12.2.5.3.7
Protective coving shall be used from the floor and up the wall in all areas where there will be frequent or
constant moisture. These include, but are not limited to,
(a) medical device decontamination areas;
(b) workrooms where soiled materials are sorted or processed; and
(c) shower facilities, change areas, and other areas that are frequently subject to wet cleaning methods.
12.2.5.3.8
Fire and smoke separations shall be clearly identified on both sides above ceilings. Labelling should be
visible from any point in the space above the ceiling. There should be at least one label every 3 m on
straight runs and additional labels as needed around corners to meet the visibility requirement.
12.2.5.4 Ceilings
12.2.5.4.1
Ceilings in clinical areas shall limit passage of particles from above the ceiling plane into the clinical
environment.
12.2.5.4.2
Solid finished ceilings shall be installed in
(a) AIRs and anterooms (if provided);
(b) burn units;
(c) inpatient bedrooms for mental health patients;
(d) 3-piece washrooms;
(e) shower rooms; and
(f) tub rooms.
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12.2.5.4.3
Ceiling finishes in semi-restricted areas shall be smooth, scrubbable, non-absorptive, non-perforated,
capable of withstanding cleaning with chemicals, and without crevices that can harbour mould and
bacterial growth.
If a removable ceiling panel system is used, it shall be monolithic, gasketed, and clipped down.
Perforated, serrated cut, or highly textured tiles shall not be used.
12.2.5.4.4
Ceilings in restricted areas such as operating rooms shall be monolithic, and shall be constructed with
drywall or removable ceiling panels complying with the requirements in Clause 12.2.5.4.3.
12.2.5.4.5
Acoustical ceilings shall be provided for
(a) corridors in patient areas;
(b) nurse stations;
(c) day rooms;
(d) recreational rooms;
(e) dining areas; and
(f) waiting areas.
12.2.5.4.6
Ceilings, exposed ceiling structure, and ceiling-mounted equipment in areas normally occupied by staff in
food preparation and food storage areas shall be cleanable with routine housekeeping equipment.
12.2.5.4.7
All conduits, piping, duct work, and open construction systems shall be covered by a finished ceiling in
locations where dust fallout would present a potential problem. All overhead piping and ductwork in the
dining and food handling areas shall be concealed behind a solid finished ceiling.
12.2.5.4.8
Solid finished ceilings are not required in mechanical and equipment spaces, shops, general storage areas,
and similar spaces, unless required for fire-resistive purposes. Replaceable acoustic tile ceilings should be
used to assist in managing ambient noise for occupants where equipment is frequently noisy and disperses
heat to the environment.
12.2.5.4.9
Replaceable acoustic tile ceilings should be used to assist in managing ambient noise for occupants where
equipment is frequently noisy and disperses heat to the environment.
12.2.5.4.10
In private patient bathrooms, any plumbing, piping, ductwork, or other potentially hazardous elements
shall be concealed above a ceiling. The ceiling and any access panels shall be of the tamper-resistive type
or of sufficient height to prevent patient access. Ventilation grilles shall be secured and have small
perforations to eliminate their use as a tie-off point or shall be of sufficient height to prevent patient
access.
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12.2.5.4.11
Where ceiling-mounted equipment is installed, support structures shall be provided above the finished
ceiling in accordance with the equipment manufacturer’s instructions.
12.2.5.4.12
In all mental health locations, including inpatient bedrooms, washrooms, and secure/observation rooms
rooms, the ceiling and air distribution devices, lighting fixtures, sprinkler heads, and other appurtenances
shall be of a tamper resistant type.
12.2.6 Elevators
12.2.6.1 Description
Elevators are the primary means used for vertical movement in HCFs and are expected to transport of both
people and materials in a safe, reliable, effective, and responsive manner. To encourage a consistent
approach to vertical transportation system design, while standardizing requirements in key areas of
concern, this Clause provides a basic platform of design considerations, performance expectations,
operational features, and equipment characteristics for elevators. While it is recognized that strict
adherence to all elements might not be universally appropriate, deviation from the stated requirements
and guidelines should be undertaken only after due consideration of the full impact of such change(s) on
the overriding design objectives of this Standard.
12.2.6.2 General
12.2.6.2.1
The elevator system shall be designed to accommodate the diverse activities of the HCF, its staff, and its
patients, in a manner that contributes the overall efficiency and effectiveness of HCF operations.
Elevator systems shall be designed to ensure there is sufficient capacity to accommodate the wide range
of user and functionality requirements, in a manner which satisfies expectations for safety, reliability,
responsiveness, accessibility, and operational efficiency. The number and grouping of elevators required
for a specific project shall be determined following traffic studies by an experienced vertical transportation
professional.
Consistent with associated architectural, structural, and related design provisions, elevators shall be
designed to accommodate potential vertical expansion or change-in-use of the HCF, with a minimum of
alterations. This may be accomplished through the inclusion of additional elevator shafts for future
development.
12.2.6.2.2
Different traffic types (i.e., public, inpatient, materials, dedicated use) should be separated as much as
possible to minimize the potential for delayed service. Depending upon the volume of traffic anticipated
for a specific project, separate systems shall be provided for general public, patient transfer, support
services, and dedicated-use applications.
12.2.6.2.3
Elevators shall provide accessible transportation for people and materials to all functional areas and shall
conform to ASME A17.1/CSA B44,Appendix E, and applicable requirements.
Provisions should be considered for persons with special mobility needs and other forms of disabilities,
such as learning difficulties or mental disorders.
12.2.6.2.4
Public elevators shall be located in close proximity to main entrances and stairways.
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All elevator systems shall be located to minimize walking distances to/from key destinations, with
maximum range of 60 m.
12.2.6.2.5
Dedicated use elevators shall be located to provide direct access between functional areas as required for
the application (e.g., MDRD to OR; Emergency to OR).
12.2.6.2.6
Elevators other than those assigned for dedicated use shall have a minimum of two elevators per group.
12.2.6.2.7
Elevators for public use should be configured with platforms that are wider than they are deep, with centre
opening doors, to facilitate the efficient loading and unloading.
12.2.6.2.8
Depending upon the requirements of a specific project and the relative requirement for the flexibility to
employ any elevator for patient movement, public elevators may be configured similar to those dedicated
to patient transfer.
12.2.6.2.9
Elevators provided for projects that are classified by applicable building codes as high-rise buildings shall
include
(a) a designated firefighters elevator; and
(b) central alarm and control facilities (CACF) monitor, control, and communication devices.
12.2.6.3 Elevators for patient transfer
12.2.6.3.1
Elevators used for patient transfer and support services shall be configured with platforms that are more
narrow than deep, with wide side opening doors, to accommodate easy movement of beds and material
carts. At least one of the elevators for patient transfer shall be able to accommodate a bed that meets the
size requirements for bariatric patients.
12.2.6.3.2
A trauma elevator should be provided for transport of trauma patients if the expected number or types of
trauma cases warrant it. Where provided, this elevator shall be large enough to accommodate a fully
equipped stretcher bed with associated accessories and a staff of six persons. Consideration should be
given to the necessity for this elevator to be equipped with special emergency devices such as medical
gases, UPS for medical devices, air conditioning, etc. Where provided, the elevator shall be sized with
minimum inside car dimensions of 1830 mm wide by 3350 mm deep and be provided with 1525 mm
wide centre parting doors.
12.2.6.4 Service elevators
12.2.6.4.1
Service elevators for movement of food services supplies and/or other heavy loads (e.g., portable X-ray)
should be provided. If service elevators are provided, at least one shall have a loading capacity to
accommodate a single piece load of at least 2270 kg and single axle loading of 1135 kg.
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12.2.6.4.2
If service elevators are provided, at least one shall serve all floors in the building, including the basement,
mechanical floors, interstitial floors, and mechanical penthouse levels. Restricted elevator operation via
card reader or key switch, to non-public areas shall be incorporated into the system design.
12.2.6.4.3
The elevator system shall include a dedicated means for transporting sterile materials and supplies from
the MDRD to surgical areas, and a separate means for the removal of soiled instruments and bio-hazardous
waste. Elevators used for each purpose shall be physically separated from each other and operate within
dedicated shafts. For Class A HCFs with large surgical facilities, elevators shall be sized to carry at least
three case carts 760 mm × 1220 mm at once.
12.2.6.5 System design
12.2.6.5.1 System capacity
Elevator system capacity shall be based on the peak traffic conditions. The design shall address the
following service criteria:
(a) traffic patterns;
(b) handling capacity;
(c) average interval; and
(d) average car loading.
The design should assume that staff will travel on both general public and patient transfer systems.
12.2.6.5.2 Equipment type
Hospital facilities having three or more levels shall employ traction type elevators for public and other high
traffic elevators.
Hydraulic elevators shall be limited to facilities with two levels and a maximum vertical rise of 5.5 m.
Where hydraulic elevators are employed, they shall be of the holeless type (i.e., not requiring excavation
to install), employing single stage, direct acting piston/cylinder configurations.
On a project specific basis, consideration should be given to use of hydraulic elevators for low traffic,
three level applications. Roped hydraulic type shall be employed where rise exceeds 5.5 m.
12.2.6.5.3 Entrances
All entrances shall have 1.5 h fire rating, unless required by project specific requirements to have a higher
rating.
12.2.6.5.4 Maintainability
Elevators shall utilize control components which are readily maintainable by a non-original equipment
manufacturer (OEM) elevator maintenance organization employing competent personnel.
Elevator equipment shall not contain proprietary software, monitoring, or other devices that limit the
HCF’s ability to engage a qualified maintenance contractor, other than the OEM/installer, for provision of
maintenance services.
Where specialized tools are required to perform these services, such tools shall be provided with the
equipment as part of the installation and become the property of the HCF.
Devices and diagnostic equipment shall be maintained so that it will not lose any function over time or
contain self-expiring software.
Fault codes, setup parameters, detailed procedural, operating, and troubleshooting instructions plus all
other materials shall be provided to an alternate contractor to undertake maintenance or service.
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12.2.6.6 Performance (traction elevators)
12.2.6.6.1
Traction elevators shall maintain their rated speed within ±3%, with smooth average starting/stopping
profiles based on minimum acceleration rates 0.9 m/s2.
12.2.6.6.2
For public traction elevators, the maximum flight time shall be 11.0 s, with the time based on a 4270 mm
single floor run and door speed based upon 1220 mm wide centre parting doors.
12.2.6.6.3
For public traction elevators, the door operating times shall be as follows:
(a) Nominal door opening time shall be 2.0 s.
(b) Nominal door closing time shall be 3.0 s.
(c) Time shall be based upon 1220 mm wide centre parting doors.
(d) Actual door times shall be adjusted as requested by the HCF to suit actual traffic conditions.
12.2.6.6.4
For public traction elevators, the door dwell times shall be as follows:
(a) Nominal car call dwell time shall be 3.5 s.
(b) Nominal hall call dwell time shall be 5.0 s.
(c) Nominal nudging initiation time shall be 20.0 s.
(d) Actual dwell times shall be adjusted as requested by the HCF to suit actual traffic conditions.
12.2.6.6.5
Traction elevators shall consistently stop at floor level ±4 mm
12.2.6.6.6
Traction elevators shall not produce horizontal peak-to-peak vibrations greater than 15 mg at any point in
hoistway, measured during express runs in either direction.
12.2.6.6.7
Machine room noise levels shall not exceed 80 dBA. Door operation noise level shall not exceed 63 dBA.
12.2.6.7 Performance (hydraulic elevators)
12.2.6.7.1
Hydraulic elevators shall provide a full load speed within range of +10% (down) and –3% (up) of the rated
speed. They shall maintain speed in either direction, under other loading conditions, within 5% of the
respective full load speed.
12.2.6.7.2
For public hydraulic elevators, the maximum flight time shall be 16.0 s, with the time based on a
4270 mm single floor run and door speed based upon 1220 mm wide centre parting doors.
12.2.6.7.3
For public hydraulic elevators, the door operating times shall be as follows:
(a) Nominal door opening time shall be 2.0 s.
(b) Nominal door closing time shall be 3.0 s.
(c) Time shall be based upon 1220 mm wide centre parting doors.
(d) Actual door times shall be adjusted as requested by the HCF to suit actual traffic conditions.
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12.2.6.7.4
For public hydraulic elevators, the door dwell times shall be as follows:
(a) Nominal car call dwell time shall be 3.5 s.
(b) Nominal hall call dwell time shall be 5.0 s.
(c) Nominal nudging initiation time shall be 20.0 s.
(d) Actual dwell times shall be adjusted as requested by the HCF to suit actual traffic conditions.
12.2.6.7.5
Hydraulic elevators shall consistently stop at floor level ±6 mm.
12.2.6.7.6
Horizontal peak-to-peak vibrations for hydraulic elevators shall be limited to a maximum of 15 mg at any
point in hoistway, measured during express runs in either direction.
12.2.6.7.7
Machine room noise levels shall not exceed 80 dBA. Door operation noise level shall not exceed 63 dBA.
12.2.7 Acoustics and vibration
12.2.7.1 General
The HCF shall be designed to ensure that the acoustic environment of the building is compatible with the
general needs and comfort of the building occupants, and the surrounding residential areas.
12.2.7.2 Architectural sound isolation
12.2.7.2.1
Floor plans shall be developed so that inpatient bedrooms and other noise-sensitive spaces are not located
next to high-noise areas (e.g., laundry room, mechanical room). The design should provide both
horizontal and vertical separation of acoustically conflicting occupancies.
Installation of mechanical equipment shall comply with the manufacturer’s specifications for installation,
e.g., isolation from vibration.
12.2.7.2.2
The main circulation routes shall be isolated from patient areas, except those routes for clinical staff who
work in the patient area. Corridors shall not be located above inpatient bedrooms or other noise sensitive
spaces.
12.2.7.2.3
Table 12.1 provides guidance for selecting the minimum sound transmission class (STC) of walls for
various room types. Special circumstances might require higher STC requirements than indicated. Large
projects with many conflicting adjacent occupancies shall have an assessment by an acoustic consultant to
define the STC and associated construction requirements.
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Table 12.1
Wall sound transmission class (STC)
requirements for various room types
Administrative offices 40
Patient interview/treatment/doctors’ offices 45
Senior administrative offices/pastoral 45
Inpatient bedrooms 45
Inpatient bedroom to noisy public space 55
Quiet counselling rooms 50
Operating rooms 50
Meeting/seminar 50
Critical care 50
Labour/delivery 55
Nurseries 55
Mechanical rooms, kitchens, laundry 55+
12.2.7.2.4
Full-height wall construction or drywall ceilings shall be used in rooms with STC 50 or greater.
12.2.7.2.5
Full height walls or drywall ceilings should be used in rooms with STC 45. Where this is not possible, the
design shall extend partitions slightly above the suspended ceiling and maximize the separation between
return air openings. Ceiling boards with a minimum ceiling attenuation class (CAC) rating of 40 and a
minimum noise reduction coefficient (NRC) of 0.55 shall be used.
12.2.7.2.6
For administrative offices where speech privacy is less critical, walls may be terminated at, or slightly
above, the suspended ceiling. In these situations, the lay-in ceiling board shall have a minimum CAC rating
of 35 and a minimum NRC of 0.55.
12.2.7.2.7
A complete, airtight sound seal shall be provided around all piping, duct, and conduit that penetrates
partitions and floors.
12.2.7.2.8
Massive wall construction (e.g., concrete block, poured concrete, brick) shall be used around areas that
produce high levels of low frequency noise.
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12.2.7.2.9
An acoustic consultant should evaluate the need for a floating concrete floor in mechanical rooms.
12.2.7.2.10
A structurally separate, double wall construction between washrooms and occupied spaces shall be built to
minimize the transfer of plumbing noises.
12.2.7.2.11
Operating rooms or laboratories with sensitive equipment should be located as far away as possible from
heavily used corridors, mechanical rooms, or other areas that could generate a high level of vibrations.
12.2.7.2.12
Laundry facilities should be located and designed to avoid structural vibration problems.
12.2.7.2.13
Other equipment (e.g., diagnostic imaging machines) can also cause and be affected by vibration and
should be located and designed to avoid structural vibration problems.
12.2.7.3 Reverberation and noise control
12.2.7.3.1
A sound absorptive ceiling finish shall be used in nurseries, nurse stations, offices, corridors, cafeterias,
large public areas and especially in areas that require voice paging. Ceiling boards or other ceiling finishes
should have a minimum NRC of 0.55.
12.2.7.3.2
A highly sound absorptive ceiling shall be used for special care nurseries, and open offices where privacy is
important (e.g., home care, large admitting areas). Ceiling boards or other ceiling finishes should have a
minimum NRC of 0.75.
12.3 Structural systems
12.3.1 General
12.3.1.1
The structural design of the HCF shall comply with applicable building requirements.
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12.3.1.2
The building structure should be designed for a specified life span in accordance with the needs and
expectations of the local and provincial/territorial authorities. This includes all primary structure and the
secondary structure supporting cladding systems.
12.3.1.3
The building structure should be designed to permit flexibility and to be adaptive to future changes.
12.3.2 Structure
12.3.2.1
The structure of the building shall utilize
(a) cast-in-place concrete (beams, columns, slabs, etc.);
(b) structural steel systems with concrete topping placed on steel deck; or
(c) a structural system with equivalent or better strength and durability as Item (a) or (b).
The structure shall be designed to withstand earthquakes and other seismic events.
12.3.2.2
Structural steel joists should not be used in the design of the floor and roof systems in Class A HCF.
12.3.2.3
Cast-in-place post-tensioned precast concrete structures and precast hollow core slabs shall not be used in
Class A HCF.
12.3.2.4
Expansion joints, including those between existing and new structures, shall be designed to avoid abrupt
changes in floor elevation.
12.3.2.5
Anchor points should be included for roof access and activities such as window washing and replacing
equipment on multi storey buildings. Anchor points should also be provided in mechanical areas with
heavy equipment.
12.3.3 Design loads
12.3.3.1
Patients’ bedrooms shall have a minimum floor occupancy live load 2.4 kPa or 9 kN concentrated,
whichever produces the more critical effect.
12.3.3.2
General office areas shall have a minimum floor occupancy live load 3.6 kPa or 9 kN concentrated,
whichever produces the more critical effect.
12.3.3.3
Records storage areas shall have a design live load that is based on the type and layout of the proposed
storage system, but not less than 7.2 kPa.
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12.3.3.4
Floors of interstitial spaces shall have a minimum live load 1.5 kPa or 1.5 kN concentrated, whichever
produces the more critical effect, plus equipment loads.
12.3.3.5
The structure shall have adequate capacity for suspended piping loads and access routes for heavy
equipment. Floors in mechanical rooms shall be designed to accommodate a minimum of 100 mm thick
concrete housekeeping pads.
12.3.3.6
As part of the planning process, the HCF shall obtain information on the loads associated with heavy
medical equipment such as diagnostic imaging equipment, X-ray equipment, surgical lights, surgical
tables, etc. The HCF shall also obtain information on the loads associated with heavy equipment in the
MDRD. The structural elements of the building (walls, floors, and ceilings) shall have adequate capacity to
support this equipment in the areas where the equipment will be located, and on the access routes to
those areas.
12.3.3.7
The minimum roof design live load shall be 1.5 kPa or 1.5 kN concentrated, whichever produces the more
critical effect. For roofs over mechanical rooms, the concentrated load shall be increased to 4.5 kN for all
elements except metal deck. Roof structures shall be able to support ponded rain load associated with a
plugged roof drain.
12.3.3.8
For buildings close to property lines on urban sites, the design process to accommodate snow loads shall
include the assumption that the neighbouring property will be built higher than the HCF.
12.3.3.9
When there is a known plan to change the usage of an area in the future, design should be for the more
stringent of current and future live loads.
12.3.4 Vibration control
12.3.4.1
Floor structures shall be designed to prevent floor vibration due to walking from exceeding comfort
thresholds for all administrative areas and non-critical areas such as lounges, waiting areas, cafeterias, etc.
4–8 Hz
12.3.4.2
General operating rooms and areas with sensitive inpatient bedrooms shall be designed to limit floor
vibration to the tactile perception threshold (typically 0.05% of g (4–8 Hz)). Less sensitive inpatient
bedrooms may have slightly higher levels of floor vibration; 0.1% of g (4–8 Hz).
12.3.4.3
Floors in spaces with sensitive equipment (e.g., microsurgery or neurosurgery ORs; MRI suites) should be
designed to the specific criteria provided by the equipment manufacturer, assuming the most stringent
requirements. Where vibration sensitive equipment is supported directly from the floor structure above,
the vibration criteria shall also apply to the floor above.
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12.3.4.4
Rooftop mechanical equipment should be located on a stiff portion of a lightweight roof to avoid
resonance problems. If the dead load of the equipment causes the roof structure to deflect more than
6 mm, the roof shall be reinforced.
12.3.4.5
A minimum of 100 mm thick concrete housekeeping pad shall be provided for all mechanical equipment.
12.3.4.6
Floors for mechanical rooms shall have a minimum of 130 mm thick concrete to minimize structural
vibration problems.
12.4 Mechanical systems
12.4.1 General
These requirements are intended to ensure that the building environment is compatible with the general
needs, comfort, and safety of the patients, staff, and visitors.
12.4.2 Heating, ventilation, and air conditioning (HVAC) systems
12.4.2.1
Design and construction of heating, ventilation, and air conditioning systems shall meet the requirements
of CAN/CSA-Z317.2 and CAN/CSA-Z317.13.
12.4.2.2
Acoustic controls shall limit noise generated by HVAC systems to acceptable levels as specified in
CAN/CSA-Z317.2.
12.4.2.3
Acoustic controls for HVAC systems should avoid over-silencing for spaces such as examination rooms and
offices where speech privacy is important.
12.4.3 Plumbing systems
12.4.3.1
Design of plumbing systems shall meet the requirements of CSA Z317.1 and applicable building
requirements.
National Plumbing Code
12.4.3.2
Potable water supply and distribution systems shall be protected from backflow contamination in
accordance with CAN/CSA-B64 Series.
12.4.4 Medical gas systems
12.4.4.1
Design and construction of medical gas systems shall be in accordance with CSA Z7396.1.
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12.4.4.2
Design and construction of oxygen concentrator systems for medical gas systems, when used, shall
comply with CAN/CSA-Z10083.
12.4.4.3
Medical supply units (i.e., headwalls, articulating arms, and columns with medical gas outlets) shall
comply with CAN/CSA-Z305.8.
12.4.5 Fire protection
Fire protection systems shall be designed, commissioned, and tested in accordance with
(a) NFPA 10 (portable fire extinguishers);
(b) NFPA 13 (sprinkler systems);
(c) NFPA 14 (standpipe systems); and
(d) NFPA 96 (commercial cooking systems).
12.4.6 Commissioning
12.4.6.1
HVAC, plumbing, fire protection, and building control systems in newly constructed or renovated facilities
shall be commissioned in accordance with CSA Z320 and CSA Z318.0.
12.4.6.2
Medical gas systems shall be commissioned and tested in accordance with CSA Z7396.1.
12.4.7 Redundancy
Redundancy shall be provided to maintain HCF operation healthy and safe indoor environment in the
event of utility or equipment failure.
12.4.8 Essential electrical systems
Essential equipment and controls shall be connected to the emergency electrical power supply system in
accordance with CSA Z32 to ensure continual operation during utility power outages.
12.4.9 Equipment access
Design and installation shall allow sufficient space around equipment for easy access, ease of maintenance,
and repair and removal of equipment.
12.4.10 Sustainability
Environmentally sustainable strategies should be adopted in the design, construction, and operation of
mechanical systems to attain high performance over the building lifetime. This includes
(a) effective and efficient systems that conserve energy and water resources;
(b) comfortable and healthy indoor environment; and
(c) minimum impact on the environment by means of emitting less pollutants and greenhouse gases.
See Clause 4.6.
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12.4.11 Pneumatic tube transport systems
12.4.11.1 Description
12.4.11.1.1
Pneumatic tube system applications have evolved from being a non-critical paper handling system to a
critical material handling system providing functional and economic efficiencies for a modern HCF. Typical
transaction expectations range from 4 to 6 transactions per patient bed per day. The busiest stations are
typically laboratory, pharmacy, and emergency.
12.4.11.1.2
Pneumatic tube systems provide the capability to send a carrier with a payload of up to 7 kg from any
station to any other station via the shortest route, and without manual intervention. Carriers travel
through a network of galvanized steel tube (150 mm standard, 100 mm available) connecting the various
components that are located on multiple zones. Zones are arranged to handle the anticipated traffic
through routine and peak traffic time periods. Systems safely transport virtually anything that will fit in the
carrier including 1000 ml IV bottles or bags, laboratory specimens, whole blood, drugs, surgical
instruments, and records. Modern pneumatic tube systems operate 24 h per day at extremely high uptime
with minimal maintenance.
12.4.11.1.3
Typical station locations for pneumatic tube transport systems include
(a) nursing stations;
(b) laboratory;
(c) pharmacy;
(d) emergency;
(e) ICU;
(f) CCU;
(g) medical records;
(h) admitting;
(i) blood bank;
(j) central stores; and
(k) medical device reprocessing.
12.4.11.1.4
Features for include pneumatic tube transport systems can include
(a) transaction verification prior to acceptance and delivery;
(b) multiple carrier dispatch capability at station;
(c) sealed carrier;
(d) RFID carrier tracking and monitoring;
(e) capability to receive multiple carriers at station;
(f) card swipe station access by operator;
(g) security transaction selection (controlled carrier delivery);
(h) stat transaction selection (priority dispatch);
(i) priority assignments programmable for carrier dispatch and receive;
(j) carrier arrival indicators at station and also through remote discrete address assignable locations;
(k) empty carrier rerouting within the system on a pre-programmed priority basis; and
(l) full monitoring of system transactions, operation, diagnostics, and settings through multiple monitors
if required, remote connection or connection to the HCF network (useful in laboratory and
pharmacy).
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12.4.11.2 Safety considerations
To prevent spills from taking place during transport, the design specifications for pneumatic tube transport
systems shall specify
(a) the materials that will normally be sent through the system;
(b) prohibited materials (i.e. materials that cannot be sent in a carrier under any circumstances);
(c) packing requirements, including the method of bagging liquids and gels; and
(d) the means and equipment needed to clean out system components in the event of a spill.
12.4.12 Other robotic transportation systems
The HCF should be aware of other robotic transportation systems coming on the market, which include
automated guidance vehicles (AGV), drug management systems (DMS), autonomous mobile robots
(AMR), and track vehicle systems (TVS). These should be evaluated by the HCF in their respective
functional programs with criteria such as capital cost, operational costs, human resource utilization,
ergonomics, and safety.
12.4.13 Catastrophic events management
Mechanical systems shall be designed to allow the isolation and independent control of system elements
to respond to catastrophic events such as infectious disease outbreak, hazardous spills, smog, and fires.
12.5 Electrical systems
12.5.1 General
12.5.1.1 Electrical Standards
Electrical systems shall conform to the following Standards:
(a) the ;
(b) CSA Z32; and
(c) CSA C282.
The number, location, and installation of electrical receptacles shall be in accordance with CSA Z32. In
addition, the planning process should consider the need for receptacles and electrical power during
normal use, and in emergency situations.
12.5.1.2 Sustainability and energy
Electrical systems shall be designed to operate efficiently and effectively while meeting the energy needs of
the building. Alternative systems for the generation of electrical power should be considered (e.g., wind,
solar, or green power purchase). Equipment and lighting with better energy efficiency ratings should be
given preference.
12.5.1.3 Monitoring and metering
Electrical distribution systems whose load-carrying capacity is greater than 250 kVA shall be designed to
facilitate the installation of a means to monitor separately the energy consumption of electrical power
feeders for
(a) hard-wired lighting;
(b) heating, ventilating, or air-conditioning systems;
(c) service water heating;
(d) elevators; and
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(e) special equipment or systems of more than 20 kW, including
(i) computer rooms;
(ii) kitchens; and
(iii) printing equipment.
12.5.1.4 Continuing operations
Back-up emergency systems, UPS, and transformer redundancy shall be provided to maintain HCF
operations in accordance with CSA Z32.
12.5.1.5 Reliability
Dual power supplies, dual generators with adequate fuel supplies, and dual incoming communication lines
shall be provided in accordance with CSA Z32 and CSA C282.
12.5.1.6 Equipment location
Equipment shall be located as follows:
(a) Panel boards and system cabinets shall be located in electrical rooms or equipment closets rather
than on public/patient corridor walls.
(b) Equipment rooms shall be located away from acoustically-sensitive or electromagnetically-sensitive
areas.
(c) Clear access shall be provided to equipment rooms at floor level or by means of full stair with hoisting
provisions.
(d) Local UPS shall be provided to serve individual load or groups of loads in a common area (e.g.,
laboratories), where required.
(e) Electrical rooms and closets shall be stacked vertically in multi-story facilities to facilitate distribution.
(f) The design should consider locating communication rooms away from electrical rooms.
12.5.2 Lighting
12.5.2.1 General
Lighting systems shall be designed to meet the visual, ergonomic, safety, and aesthetic needs of the
building occupants in both general and specific applications, in accordance with CSA Z317.5.
The design and location of light fixtures should be such that they can be easily maintained without
endangering patients, clinical staff, or HCF engineering staff.
Lighting levels shall be in accordance with CSA Z317.5.
12.5.2.2 Lighting controls
12.5.2.2.1
The nature of lighting and lighting control should be reviewed to establish level requirements, the number
and type of sources, and the method and location of controls for convenient and easy operation. Patients
shall be provided with control of the lighting environment in their rooms where applicable.
12.5.2.2.2
Patient corridors shall be provided with controls.
12.5.2.2.3
Adjustable lighting controls shall be provided at nurses’ stations with distinct levels to accommodate day,
evening, and late night activities, time of day, and activities. Low ambient lighting levels shall be designed
with task lighting for night shift.
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12.5.2.2.4
Light ballasts for all occupied areas shall be specified with the lowest noise rating available.
12.5.2.2.5
Natural light, if available, should be provided with effective shading controls. If telehealth services are
incorporated, black-out shades shall be provided.
12.5.2.2.6
The use of architectural features (i.e., courtyards) to bring natural light into a program area should not
impede the efficient delivery of services.
12.5.2.2.7
Proper illumination techniques shall be employed to ensure accurate skin colour. Artificial light sources
shall have a minimum CRI (colour rendition index) of 85.
12.5.3 Fire alarm
The fire alarm system shall be
(a) installed in compliance with to CAN/ULC-S524;and
(b) verified to CAN/ULC-S537.
12.5.4 Nurse call systems
12.5.4.1
The nurse call system shall be designed to fit the functional requirements of the HCF. The simplest system
that can satisfy the requirements of the HCF shall be provided. Considerations should be given to pocket
page and cordless phone sets.
12.5.4.2
Wiring in conduit or in adequately sized accessible trays shall be provided to facilitate system upgrades or
modifications.
12.5.4.3
Power supplies to nurse call system from emergency source shall be supplied with battery backup for
programmed memory retention.
12.5.5 Transformer noise and vibration
Transformers shall not be located within ceiling spaces.
Indoor transformers 75 kVA and less shall be epoxy encapsulated, and the dry type should be used.
Vibration isolators shall be provided for transformers located near occupied spaces. Flexible conduit shall
be used to make the connection to the transformer.
12.5.6 Device back boxes
Electrical or communication outlets shall not be located in back-to-back in walls. Outlets should be
separated by at least one stud space.
12.5.7 Conduit
12.5.7.1
All branch circuit wiring in clinical areas shall be installed in metallic conduit in accordance with Section 24
of the .
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12.5.7.2
Conduit shall not be installed in or below structural slabs, or slabs on grade serving clinical areas in the
HCF.
12.5.7.3
No junction boxes, terminal boxes or cabinets shall be installed in ceiling spaces in inpatient bedrooms,
procedure, or examination rooms. Where junction boxes are required in such spaces, they should contain
only wiring or systems related to the specific room.
12.5.7.4
Where cable tray systems are used for the distribution of low tension or IT system cabling, these cable trays
shall be confined to corridors or dedicated service spaces only. Wiring to patient, procedure, or similar
clinical spaces shall be installed in conduit from the cable tray.
12.6 Information technology
12.6.1 General
12.6.1.1
Information technology systems shall be provided to assist staff, patients, and the public with the
dissemination of all forms of information. Information technology systems shall be designed to manage
information in a timely, accurate fashion.
12.6.1.2
The HCF shall determine its communications and information transfer and storage needs during the
design stage. All media types shall be accommodated in an HCF, including data, video, voice, and text.
12.6.1.3
The information technology planning process shall specify the number and type of wireless systems that
will be used, and shall ensure that these systems have the necessary compatibility (i.e., will allow
communication between systems as required by the functional program) and will not interfere with each
other.
12.6.1.4
Information technology systems shall be designed to preserve confidentiality, privacy, and security of
information to maintain the trust between the public and the health care provider.
Freedom of Information and Protection of Privacy Act
12.6.1.5
The latest IEEE, EIA/TIA, and CSA standards shall be used when designing information technology systems.
The systems design should include a high level of physical and logical redundancy that promotes
continuity of service even if individual components fail.
12.6.1.6
Information and communications systems shall be compatible and shall be integrated where possible.
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12.6.1.7
The IT systems and infrastructure shall be designed to accommodate electronic health records systems.
12.6.1.8
The information technology infrastructure shall be designed to accommodate the specific needs of the
HCF. Planning for the information technology infrastructure shall include the following elements as
appropriate to the functional program of the HCF:
(a) general communications systems, including
(i) telephone (voice over internet protocol or VoIP);
(ii) cellular networks;
(iii) television;
(iv) audio conferencing;
(v) wireless networks for voice/data/video; and
(vi) education systems for staff, and for patients and their families or caregivers;
(b) clinical systems, including those for
(i) patient monitoring;
(ii) imaging (picture archiving C system or PACS);
(iii) clinical equipment and networks;
(iv) pharmacy dispensing;
(v) nurse call;
(vi) video conferencing and associated telehealth, telepathology, and e-medicine systems;
(vii) patient bedside portal; and
(viii) robotic surgery;
(c) administrative system, including
(i) patient registration; and
(ii) financial and administration networks;
(d) security systems, including
(i) entry control and area monitoring;
(ii) patient wandering monitors;
(iii) staff emergency assistance alarm; and
(iv) radio frequency identification systems; and
(e) building systems, including
(i) building automation systems;
(ii) computerized maintenance management systems; and
(iii) energy monitoring systems.
12.6.1.9
If internet phone service (VoIP) is used, land lines shall be maintained in critical areas where
communication has to be maintained in the event of network or Internet failures.
12.6.2 Structured cabling (voice/data cabling)
12.6.2.1
Structured cabling systems, including the location of telecommunication rooms, pathways, and raceways,
shall be designed in accordance with TIA/EIA-568-B.1, TIA/EIA-568-B.2, TIA/EIA-568-B.3, TIA/EIA-569-B,
and TIA-606-A for communications systems administration.
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12.6.2.2
Cabling systems shall be designed, selected, and installed in accordance with the functional program
requirements for the HCF’s information technology and communications systems. Where possible, it
should also accommodate technological advances, future expansion, and changing requirements by the
HCF.
Shielded cabling should be used for locations with electromagnetic interference (e.g., MRI facility).
12.6.2.3
UPS power backed up by emergency power shall be available in all telecommunication rooms.
12.6.2.4
For major HCFs (those over 20 000 m2) two utility service entrances should be provided to the building (or
group of buildings if a campus arrangement is used). Redundant pathways and redundant service
providers should be considered.
12.6.2.5
For HCFs that contain data centres that serve more than just the HCF, redundant utility services and
redundant physical pathways shall be provided.
12.6.2.6
For HCFs, in a campus arrangement (i.e., a group of buildings) redundant physical and logical services
shall be run between all major buildings so that the loss of one service does not affect the operation of the
building. The service routing for the two services shall be designed to facilitate this.
12.6.2.7
Physical protection of the service entry conduit (concrete encasement) should be considered.
12.6.2.8
Service entrance rooms shall be located to allow easy access by the service providers.
12.6.2.9
All telecommunications rooms shall have environmental controls for temperature and humidity.
12.6.2.10
The initial pathways and raceways shall be designed to be expandable for future growth.
12.6.2.11
When designing the cabling system, the capacity of the backbone systems shall include traditional
voice/data but also include non-traditional systems to form an integrated network.
12.6.2.12
A cable management software system and electronic drawing system shall be used to manage the
structured cabling plant. An intelligent patching system should be used to manage all aspects of the
cabling plant.
12.6.3 Data centre
If the HCF contains a data centre, the data centre and associated physical infrastructure shall be designed
in accordance with the TIA-942, ANSI/TIA-942-1, and TIA-942-2.
The data centre for a HCF should be classified as tier II and for a large data centre serving multiple
buildings classified as tier III.
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12.6.4 Wireless
12.6.4.1
If a wireless LAN system is provided, the system shall use the latest proven technology. Wireless data
security encryption shall be used on any wireless communication system to protect privacy.
12.6.4.2
The selection of all wireless systems should take into account the following considerations:
(a) scalability;
(b) compatibility;
(c) bandwidth;
(d) standardization;
(e) security;
(f) potential interference; and
(g) flexibility.
12.6.4.3
Wireless staff-to-staff communication systems using wireless PDAs or wireless phones shall be provided.
12.6.4.4
Wireless systems shall run on the structured cabling plant wherever possible.
12.6.4.5
The wireless staff communication system should be integrated with the nurse call system and the security
system. The wireless staff communication system should be integrated with the electronic health record
system, provided confidentiality can be maintained.
12.6.4.6
The wireless system design shall take into account other biomedical wireless system and interference with
these systems shall be avoided.
12.6.4.7
Quality of service (QOS) shall be incorporated for voice systems.
12.6.4.8
A wireless survey should be performed to accurately record coverage levels.
12.6.5 Network equipment
12.6.5.1
Network equipment shall be provided to service communications, storage, and retrieval of information
within the HCF.
12.6.5.2
The network equipment shall be open architecture, consistent with the established equipment standards
of the day and allow all industry protocols, software, and media types to reside on it.
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12.6.5.3
The convergence of the three media types (voice/data/video) shall be supported by the network
equipment. All HCF information systems shall be able to connect to the network.
12.6.5.4
The network equipment shall comply with the IEEE 802.1 series of Standards and IEEE 802.3.
12.6.5.5
The network shall be designed by a person with experience and qualifications in network design.
12.6.5.6
The network shall be configured to be fault-tolerant, having two core switches. For large systems, there
shall be two pathways to the edge distribution switches.
12.6.5.7
The network equipment shall be powered by uninterruptible power supplies fed from the emergency
power distribution system.
12.6.5.8
The network equipment shall be located in the data centre and telecommunication rooms.
12.6.5.9
Data security measures, such as firewalls, encryption, and authentication services, shall be deployed on the
network to protect unauthorized access to the data.
12.7 Security systems
12.7.1 General
12.7.1.1
The HCF design shall include the physical elements necessary to support the HCF’s overall security
program.
12.7.1.2
As part of its security program planning, the HCF shall prepare a crime prevention through environmental
Design (CPTED) report identifying environmental conditions that promote security.
12.7.1.3
The security systems that should be considered in an HCF are
(a) access control;
(b) closed circuit video surveillance;
(c) intrusion detection;
(d) staff emergency assistance asset protection;
(e) guard tour;
(f) incident reporting; and
(g) lighting.
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12.7.1.4
For larger facilities (over 20 000 m2) integration of the security system into one common security
management system should be considered. This system should be run over the HCFs network.
12.7.2 Access control system
12.7.2.1
HCFs shall have an access control system that allows authorized personnel access into controlled
department and prevents access to unauthorized personnel.
12.7.2.2
The access control system shall be integrated with other security systems to provide alarm annunciation
and control.
12.7.2.3
The access control system shall use a photo identifications system for badging needs.
12.7.2.4
Where required, the access control system shall connect to the fire alarm system to release locked doors.
12.7.3 Closed circuit video surveillance
12.7.3.1
The HCF shall have a closed circuit video surveillance system (CCVS).
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12.7.3.2
The system shall produce a video image of high enough quality to be used as evidence in court.
12.7.3.3
The system shall be connected through the building network.
12.7.3.4
Due consideration for privacy concerns shall be followed when locating cameras.
12.7.3.5
The CCVS system shall not be used for clinical observations. A separate system shall be used for clinical
purposes.
12.7.3.6
The CCVS system shall integrate with the other security systems for automatic camera call up and
recording to ensure the security incident is captured.
12.7.4 Intrusion detection
12.7.4.1
Intrusion detection systems shall be installed in areas where protection of physical or digital assets is
critical.
12.7.4.2
Intrusion detection systems should be installed in areas of the HCF that close after hours.
12.7.4.3
Intrusion detection system should be the latest proven technology at time of installation.
12.7.4.4
The intrusion detection system shall meet recognized standards for security systems.
12.7.4.5
The intrusion detection system shall integrate with other security systems for alarm recording and incident
reporting purposes.
12.7.5 Staff emergency assistance alarm systems
12.7.5.1
A wired or wireless staff emergency assistance alarm system shall be provided in all areas where there is a
danger to staff from the patients or the public. The location of the emergency assistance alarm system will
be identified in the threat, risk, and vulnerability assessment, but consideration shall be given to the
following locations:
(a) parking;
(b) emergency department;
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(c) areas where cash is handled;
(d) pharmacy;
(e) maternity;
(f) psychiatry;
(g) palliative care; and
(h) reception areas of departments.
12.7.5.2
The system shall be able to identify where the incident is occurring to allow authorized personnel to
respond.
12.7.5.3
The system shall be the latest proven technology at time of installation.
12.7.5.4
The alarm system shall integrate with other security systems for alarm recording and incident reporting
purposes.
12.7.6 Patient wandering
12.7.6.1
Patient wandering systems shall be provided in all departments where patients could be at risk of injury if
they leave the department unescorted. Dementia wards, palliative care, assisted living, and psychiatry are
all examples of where this might be needed.
12.7.6.2
The system shall alarm both locally and on the integrated system.
12.7.7 Infant protection
Maternity wards should have infant protection systems that alarm when a newborn leaves the department
without the appropriate escort.
12.7.8 Other systems
Other systems, such as electronic incident reporting, RFID asset tracking, order inventory control, guard
tour, and parking control systems, should be addressed in the threat, risk, and vulnerability assessment
report and installed if recommended.
©
(AODA), 2001
prepared by the Government of Ontario
, prepared by the Ontario Hospital Association
, prepared by the CNIB
, prepared by Universal Design Institute, 2000
CSA Z768-01 (R2006)
CAN/CSA-Z769-00 (R2008)
CSA Z773-03 (R2008)
ISO 14015:2001
ISO 14040:2006
ISO 14044:2006
ISO 19011:2002
ISO/TR 14047:2003
ISO/TS 14048:2002
ISO/TR 14049:2000
(available in both French and
English)
www.construction3chu.msss.gouv.qc.ca
©
BNQ NQ5710-500/2000
ANSI/ASHRAE 55-2010
ANSI/ASHRAE 62-2001
ANSI/ASHRAE 129-1997 (R2002)
©
The HCF class is used to specify the levels of protection, redundancy, and functionality of spaces within any
building. In many cases, the entire building may be classed as a single type of HCF. As an example, a
community hospital with typical hospital services (emergency department, minor surgery and support,
inpatient units, etc.) may be deemed to be a Class A-2 HCF. However, it is possible that a single building
may house multiple HCF classes. As an example, a surgical suite installed on a portion of a floor of a
multi-storey medical office building would house multiple HCF Classes (i.e., the area housing the surgical
suite serving an acute care function would be classed as an HCF Class A-2 where the remainder of the
building would be classed as an HCF Class C).
HCF classes should not be confused with the concept of occupancies as used in building codes.
Occupancies as determined under a building code can influence various life safety, exit, and egress
requirements independently of HCF class determination. However, the impact of higher-risk functions
within any building should be considered when determining the requirements to be applied under a
building code.
Class A-1 Large acute care hospitals (more than 350 beds)
Trauma centres
Emergency care facilities
Some rural hospitals
Class A-2 Acute care hospitals (less than 350 beds)
Rural area access hospitals
Medical clinics with overnight stay or observation
Laser eye clinics
Outpatient surgical services
Plastic surgery centre/offices
Cosmetic surgical centre/offices
Dental surgical facilities
Other office surgical facilities
General physicians’ offices with treatment spaces
Standalone laboratory facilities
Diagnostic imaging centres
Class B Nursing homes
Long term care facilities
Complex care facilities
Assisted living facilities
Psychiatric facilities
Forensic facilities
Rehabilitation facilities
Additional services facilities
Chronic care
Hospice care
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Class C Group homes
Outpatient clinics
Primary care outpatient facilities
Stand alone dialysis clinics
General dental offices
General physicians’ offices (without treatment spaces)
Laser eye clinics
Plastic surgery centre/offices cosmetic surgical centre/offices
Medical clinics with no overnight stay
Ambulatory clinics
“Walk-in” health clinics
Physiotherapy clinics
Pediatric clinics
Public health clinics
Adult day-care centres
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The following is a checklist of the factors that can be involved in evaluating a site. Although lengthy, this
list is not all-inclusive; new factors are added from time to time. Information is usually collected only for
those items that are pertinent to the project.
This checklist is adapted from the RAIC (Vol. 2,
Chapter 2.3.4).
Climate
A. Prevailing winds
1. Direction
2. Maximum, minimum, and average velocities
3. Special forces (e.g., tornadoes, hurricanes)
B. Solar orientation
1. Sun angles
2. Days of sunlight
3. Cloud cover
4. Shading of (or from) adjacent structures, natural features, and vegetation
C. Temperature
1. Ranges of variation
2. Maximums and minimums
D. Humidity
1. Ranges of variation
2. Maximums and minimums
E. Precipitation
1. Peak period totals
2. Annual and seasonal totals
Topography
A. Legal property description, including limits of property, easement, rights of way, and north indication
B. Topography maps and aerial photos
1. Contours and spot elevations
2. Slopes: percentage, aspect, orientation
3. Escarpment
4. Erosion channels
5. Extent, location, and general configuration of rocks, ledges, outcrops, ridges, drainage lines, and other
unique features
6. Visual characteristics
7. Potential problem areas during construction: siltation, erosion, etc.
C. Analysis of physical features. including major focal and vantage points and their relationships within, into, and
out from the site
D. Existing access and circulation
1. Vehicular
2. Pedestrian
E. Vegetation
F. Existing water bodies
1. Location, size, depth, direction of flow
2. Water quality: clean, polluted, anaerobic conditions, etc.
3. Use: seasonal, year-round
4. Wetlands: ecological features
5. Variations: expected water levels, tides, wave action
6. Coastal features
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G. Drainage canals: rivers, streams, marshes, lakes, ponds, etc.
1. Natural and built
2. Alignments and gradients
3. Pattern and direction
H. Existing waterway easements
1. Surface
2. Sub-surface
I. Surface drainage
1. Patterns on and off the site (location of streams and washes)
2. Proximity to floodplains
(a) Maximum flood level
(b) Frequently flooded areas
3. Local watershed areas, amount of runoff collected, and location of outfalls
4. Swampy and concave areas of land without positive drainage and other obstacles that can interrupt or
obstruct natural surface drainage
5. Potential areas for impoundments, detention/retention ponds
J. Unique site features
Geotechnical/soils
A. Basic surface soil type: sand, clay, silt, rock, shale, gravel loam, limestone, etc.
B. Rock and soil type: character/formation and origin
1. Geologic formation process and parent material
2. Inclination
3. Bearing capacity
C. Bedrock
1. Depth to bedrock
2. Bedrock classification
D. Seismic conditions
E. Environmental hazards
Utilities
A. Potable water
B. Electricity
C. Gas
D. Telephone
E. Cable television
F. Sanitary sewer service
G. Storm drainage (surface, sub-surface)
H. Fire protection
Immediate surroundings
A. Neighbourhood structures: buildings, satellite dishes, etc.
B. Shading and solar access
C. Noise from streets, emergency services, aircraft, etc.
D. Odours
E. Views and vistas
General services
A. Fire and police protection
B. Trash/refuse removal services
C. Snow removal, including on-site storage
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Site History
A. Former site uses
1. Hazardous dumping
2. Landfill
3. Old foundations
4. Archaeological grounds
B. History of existing structures
1. Historic worth
2. Affiliations
3. Outline
4. Location
5. Floor elevations
6. Type
7. Condition
8. Use or service
Land use, ownership, and control
A. Present zoning of site and adjacent property
B. Adjacent (surrounding) land uses
1. Present
2. Projected
3. Probable effects on the development of this site
C. Type of land ownership
D. Function and pattern of land use: public domain, farm type, grazing, urbanized
1. Present
2. Former
E. Location, type, and size of pertinent community services
1. Schools and churches
2. Shopping centres
3. Parks
4. Municipal services
5. Recreational facilities
6. Bank
7. Food services
8. Health services
9. Access to highways, public transportation
Economic value
A. Political jurisdictions and land costs
B. Accepted “territories”
C. Future potential
D. Size of surrounding lots and approximate price ranges
Zoning codes
A. Permitted Uses
1. By variance
2. By special use permits
3. Accessory structures
B. Minimum site area requirements
C. Building height limits
D. Yard (setback) requirements
©
E. Lot coverage
1. Floor area ratio (FAR)
2. Percentage of coverage
3. Open space requirements
F. Off-street parking requirements
G. Landscaping requirements
H. Sign requirements
Sub-division, site plan review, and other local requirements
A. Lot requirement
1. Size
2. Configuration
3. Setbacks and coverage
B. Street requirements
1. Widths
2. Geometry: grades, curves
3. Curbs and curb cuts
4. Road construction standards
5. Placement of utilities
6. Dead-end streets
7. Intersection geometry
8. Sidewalks
9. Names
C. Drainage requirements
1. Removal of spring and surface water
2. Stream courses
3. Land subject to flooding
4. Detention/retention ponds
D. Parks
1. Open space requirements
2. Park and playground requirements
3. Screening from adjacent uses
Environmental regulations
A. Water, sewer, recycling, solid waste disposal
B. Clean air requirements
C. Soil conservation
D. Protected areas, wetlands, floodplains, coastal zones, wild and scenic areas
E. Fish and wildlife protection
F. Protection of archaeological resources
Other codes and requirements
A. Historic preservation and landmarks
B. Architectural (design) controls
C. Special districts
D. Miscellaneous, e.g., mobile homes, billboards, noise
E. Site-related items in building codes
1. Building separation
2. Parking and access for persons with disabilities
3. Service and emergency vehicle access and parking
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