Building design for healthcare facilities
Although the detail of architectural design of dialysis units is beyond the scope of this site, some design, layout and internal building concepts are useful to consider when plotting the fabric of a truly sustainable dialysis environment (14).
Low energy building design and regulation is evolving rapidly. In Europe, national strategies towards very-low-energy buildings now exist in several EU member countries. Among the EU states that officially designate for very low energy buildings are Austria, Czech Republic, Denmark, Finland, France, Germany and the UK. In 2008, several member countries announced their intent to revise their national legislative building codes within 5 years, and set targets for new low energy building codes to be in place from 2015 – 2020 (15, 16).
In Australia, and elsewhere, cash-poor administrations have historically created their dialysis infrastructure in any available space, whether for on-site in-centre facilities, or for suburban satellites. Vacant balconies, disused factories, re-cycled offices, derelict hotels, converted domestic houses – all these recycled building options have been used as ‘it’ll have to do’ dialysis sites. Rarely – if ever – are dialysis buildings purpose-planned and/or eco-sensitively designed.
Of all patient-directed healthcare areas, dialysis units (without equal) are sites where patients – the same patients – spend prolonged, recurrent time. Commonly, patients are chair-tethered for 4 or 5 hours, thrice weekly, for 156 individual episodes of care/year in these buildings. Many dialysis patients are now in their 3rd or even 4th decade of maintenance therapy. Yet, most (if not all) are airless, lightless, depressing areas, often thrown together in unplanned haste as dialysis growth and demand dictates, and with little (or no) thought to optimizing either the patient or staff environment.
We could – we should – do much better.
Eco-building design for business and commercial ventures is an advanced science. Accepted imperatives for commercial and public buildings include the use of space, natural light, in-door vegetation, innovative decoration and, where appropriate, intimate privacy.
Not so for dialysis units, built as they are by budget-conscious hospital administrations. Out-of-sight, out-of-mind seems a common thread.
External dialysis unit design also suffers badly. Attention to building position and orientation, sun-strike and shade, natural lighting vs. artificial light, insulation against heat and cold, the use of roof space… these and other features of passive eco-building design are not commonly considered part of the dialysis planning ‘landscape’. They should be.
A German study has shown that passive eco-buildings, while ~8% more expensive to build, so effectively reduce subsequent maintenance and operating costs that the greater expense of the initial construction is recouped within the first 1/3rd of the lifespan of the building.
Consider the following ‘potentials’ for sensitive dialysis building design:
- Appropriately positioned and oriented to maximally befit from summer shade and winter sun.
- Lit by natural light to minimize internal lighting.
- All fluorescent strip lighting replaced by LED lighting systems.
- Internal plumbing that maximally re-uses RO RW for toilets and cleaning.
- Internal plumbing that recycles RO RW for on-site waste processing (e.g. OzSteri™, Sterishred 250™, Meteka™ or Celitron™) to re-cycle, re-use and/or on-sell segregated and processed wastes and plastics.
- roof-top solar-array for solar-assisted power –for building uses, dialysis equipment support and waste-processing practices.
- Roof-top earth insulation that, potentially, might also support a vegetable planting – patient-tended and RO RW-watered – to (1) provide a healthy food source for patients and staff plus (2) create an occupational place of pride to enhance patient self-esteem and engagement.
- Partnership arrangements with adjacent buildings, businesses, parks, and gardens to share any RO RW unused by the dialysis service.
These and other potential design and eco-practices have simply not been considered nor established in the design structure of current dialysis services.
All are feasible. All are possible. None are in use.
A demonstration ‘green dialysis service’ is both desperately needed and utterly possible. It simply needs institutional or government will to make it happen.
Air-conditioning and heating is clearly essential for patient (and staff) comfort – especially in arid or equatorial regions or at north/south extremes. Whilst in intelligent building design, temperature regulation is commonplace, current dialysis building design rarely considers this – or rates it highly – with ‘cold and hot spots’ a frequent complaint of dialysis patients.
Most dialysis buildings seem to actively work against good design practice, largely due to the ‘ad hoc’, lowest-cost-possible nature of their creation in spare hospital space, or in old, disused factories, tenements or hotels.
Intelligent design is currently incorporated widely into northern European building design (e.g. buildings in Germany, Denmark, Sweden and Finland). The energy requirements – and occupant comfort – can be improved by ~70% (see “Passive vs. standard building design”: Reiter und Rentesch: Kostenfestellung, Ev-Luth, Kindergarten Dobeln, 2009: personal communication, Harry Mann: architect).