Refurbishment
When a work team enters the building, they must ensure that they have done everything they can to avoid the risk of bringing in foreign bodies
their effectiveness. It is also vital for all team members to observe the high standards of hygiene demanded by the environment, and to ensure that hands are thoroughly washed on a regular basis. Arguably most important of all is maintaining a strict regime of cleaning the site thoroughly after every work session – especially if it is a space that is currently in use by patients or staff. This need to prevent the spread of
infections also informs many aspects of the design of modern healthcare refurbishments. For example, specification of anti-microbial surfaces is now common, as is anti-moisture drywall to reduce the likelihood of moulds developing in difficult- to-clean areas. Even the layouts of hospitals and other
care facilities are now being influenced by concerns over infections, with a move towards provision of single-patient rooms for those most at risk. Many facilities have also introduced Radio Frequency Identification (RFID) systems, whereby patients and staff wear badges that allow their movement around the building to be tracked, so that operational improvements that reduce the likelihood of contaminations can be identified and implemented.
Asbestos Presence of asbestos is also a common problem with refurbishments in the
healthcare sector, as many buildings in the NHS estate date from the period when it was a ubiquitous construction material. While the protocol for its safe disposal is no different in a hospital than it would be in any other public setting, ‘getting rid’ of asbestos does intensify the challenge for a project manager, since managing and controlling its safe removal may lengthen the job, and will require site attendance by an expert team with additional specialist equipment.
Minimising disruption From large hospitals to smaller facilities, healthcare buildings typically depend on a complex network of processes and services, and the workings of these need to be understood in detail for effective project planning to be possible. The risks of getting this wrong are significant, as the operations that stand to be disrupted in a healthcare setting are more critical than in the majority of other construction settings. If power or data services running through a work site are shut down without proper understanding of the processes that depend on them, the consequences could be disastrous. At a more basic level, but just as
important, is ensuring that safe entry and exit points for patients and staff are maintained throughout the project. Of course, this is a priority for any public works, but all the more so in a busy
clinical environment. Extra-special consideration needs to be given in a healthcare setting, as busy staff or vulnerable patients could be less attentive to any potential obstructions, trip or fall hazards, so these must be avoided at all costs. If something goes wrong, and there is any question that every precaution was not taken, the potential reputational and financial damage for both contractor and client are significant.
Vehicular access Vehicular access is another consideration; the need for 24-hour emergency access for vehicles such as ambulances is a feature of many healthcare facilities, and a suitable work-around needs to be found to ensure that this is never impeded. Of course, the twin concerns of essential emergency vehicle access, and the need to minimise disruption to the staff and patients using the public access routes to the facility, can mean that transporting the necessary materials, plant, smaller equipment, and personnel, to the work site can be a significant logistical challenge, and in some cases compromises will need to be reached. Again, the key to finding the optimum
solution lies in having a thorough understanding of the processes on the ground, and using this to inform a well- thought-through plan. Where a facility is not in use 24 hours-a-
day, the best approach is to ensure that any disruptive works or transportation movements are carried out during unoccupied periods, for example overnight, or at weekends.Where works need to be carried out in a space directly occupied the following day, it is vital that
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Health Estate Journal September 2013
35
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