SPECIALIST ENGINEERING
endoscopy services, and this number is expected to rise by 1,500 in 2019-2020. The health service has seen colonoscopy activity increase as a result of the Commonwealth Government’s National Bowel Screening Program, which has introduced biennial screening for Australians over 50.
Special design considerations Endoscopy involves a range of invasive procedures, and uses endoscopes to examine the interior of the body. Due to its invasive nature, the prevention of healthcare-associated infections in patients is a key consideration during project design. This includes the effective and safe reprocessing of reusable medical devices through AS/NZS 4187 compliance, which is supported by environmental design and plant and equipment selections.
Environmental design Physical segregation: The new department layout was configured to align with the environmental aspects of AS/NZ 4187, which included fully segregating contaminated and decontaminated areas using pass- through AERs and drying cabinets to eliminate cross-contamination. Room HVAC pressurisation gradients: The air-conditioning for the reprocessing areas was configured to achieve a positive pressure gradient from the decontaminated to the contaminated side of the pass-through AERs to maintain sterility of reprocessed reusable medical devices. Another key consideration is room pressurisation for endoscopy procedure rooms. The current Australian Facility Guidelines recommend negative pressurisation and direct exhaust to the roof for procedure rooms used for bronchoscopy. This is important in reducing the transmission of airborne viruses such as tuberculosis, which may become aerosolised during procedures. Procedure room four was constructed with a dedicated air-conditioning plant
New patient recovery bays.
with high-efficiency particulate air (HEPA) filters on the supply, return, and exhaust, to prevent the spread of airborne infections. In consultation with Infection Prevention and Control, the room was delivered as a ‘Class N’ negative pressure room, in line with International Health Facility Guidelines, with a targeted pressure of negative 15 Pa. The room has a Siemens pressure panel with a toggle switch that allows the users to switch between normal mode (net inflow pressure), and negative pressure boost mode, for use when treating patients with, or suspected of having, tuberculosis. Procedure rooms 1-3 are serviced by one shared air-conditioning unit, with HEPA- filtered supply air in each room to prevent cross-contamination, and are designed to achieve a net negative pressure inflow of air.
Structural reinforcement of existing floor: The proposed endoscopy space was located on level one, and required significant jackhammering, wet floor cutting, and a new topping slab to accommodate the fit-out. Due to the weight of the new build, additional structural support was required to reinforce the existing concrete slab. This was achieved via carbon strapping, and was an effective method to minimise disruption and space impacts below, as opposed to installing beams and column supports.
Plant and equipment Reprocessing equipment: The reprocessing equipment consisted of four Cantel Medivator Advantage Plus pass- through AERs and seven HEPA-filtered drying cabinets in order to achieve anticipated service demand. As part of the Cantel-supplied equipment, a barcode tracking system is employed on the trays to track endoscopes through the process, and endoscopy department policies and procedures have been updated to comply with current standards.
AER system commissioning and installation was completed to AS/NZS 4187:2014 and amendment 2019, including Installation, Operational and Performance Quality Requirements (IQ, OQ and PQ). AER water quality was tested against the newly developed Table 7.3 for final rinse water for endoscopes, which was included in the 2019 amendment. BEMS has also updated the scheduled maintenance plan to include ongoing water quality sample testing and monitoring in line with AS/NZS 4187 requirements. Reverse osmosis plant: The project scope included provision of two RO systems, which were custom designed to meet the final rinse water quality parameters of table 7.2 in AS/NZS 4187 and Cantel manufacturer’s requirements. These ROs were configured to automatically complete daily heat sanitisations of their ring mains, in order to maintain water
HEPA-filtered Cantel drying cabinets. 20 Health Estate Journal November 2020
Altas Copco dedicated clean air compressors for instrument air.
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