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"Noise and Vibration Effects on Staff Performance and Patient Welfare in Healthcare Facilities Track: Indoor Environmental Topics

Monday, 1/26, 2:15 PM - 3:45 PM Seminar 36 (Basic) - Water Tower Parlor (6) Sponsor: 2.1 Physiology and Human Environment, 9.6 Healthcare Facilities, 2.6 Sound and Vibration Control Chair: Lily M. Wang, Ph.D., P.E., Member, University of Nebraska-Lincoln, Omaha, NE

Minimizing Noise in Healthcare HVAC Design


Presenter: Michael P. Sheerin P.E., LEED AP Principal, Director of Healthcare Engineering TLC Engineering for Architecture Orlando, Florida
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Noise Issues in Healthcare Settings


Patient Safety Elevated Blood Pressure Sleep Loss Healing Environment Healthcare Staff Loss of Focus / Distractions / Exhaustion Speech Recognition / Miscommunication Resultant Medical Errors Health Information Privacy Confidentiality Compliance with Federal Regulations Patient Satisfaction! Consumer-Oriented Care
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Healthcare Settings Affected by Noise


Neonatal Intensive Care Units & Well Baby Nursery Premature infants High Sensitivity to Noise & Light Clear Recognition of the Health Implications!

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Healthcare Settings Affected by Noise


Adult Intensive Care Units & Patient Rooms Sleep Disruption = More Medications Rate of Wound Healing Re-hospitalization

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Healthcare Settings Affected by Noise


Airborne Infectious Isolation Rooms Poor Low Wall Exhaust Diffuser Selection High Air Volume Dedicated duct system creates direct noise paths

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Healthcare Settings Affected by Noise


Nurse Stations Fatigue & Patient Care Triage & Registration Speech / Patient Privacy

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Healthcare Settings Affected by Noise


Nurse Stations Fatigue & Patient Care Triage & Registration Speech / Patient Privacy

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Healthcare Settings Affected by Noise


Operating Rooms Hard Surfaces = Reverberant Space Speech Discrimination Patient Safety Hard ducted or flex with solid inner liner

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Noise Criteria for Healthcare Settings


World Health Organization Patient Room Day 35 dB (A), Night 30dB (A) Studies have shown that no hospitals comply, often with peak noise levels exceeding 85 dB! Thankfully, no enforcement either. AIA Guidelines 2006 edition 2.1 General Hospitals Para 3.4.6 Newborn Intensive Care The combination of continuous background sound and transient soundshall not exceed an hourly Leq of 50 dB and an hourly L10 of 55 dB, both A-weighted slow response. The Lmax shall not exceed 70 dB

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The Reality of Noise in Healthcare Settings


Plethora of Physiological Monitor/Alarm Noises plus Associated Medical Equipment Patient Care and Staff Actions Contribute or Reduce Noise in Patient Areas HVAC NOISE IS ONLY ONE FACTOR BUT AN AVOIDABLE ONE Other Factors can include Overhead Paging & Housekeeping

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HVAC Design Strategies to Reduce Noise in Healthcare Settings


Be Aware of Architectural Design & Specifications Acoustical Ceiling Tiles / GWB Ceilings Flooring (carpeting?) Floor to Floor or Ceiling Height Partitions Partition Construction (sound batt?)

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HVAC Design Strategies to Reduce Noise in Healthcare Settings


Review Placement of HVAC Equipment near Critical Spaces, including Above / Below / Adjacent Rooms! Rooftop Units AHU / Mechanical Rooms CV / VAV Boxes Major Pipe Routing What are the Occupied Areas near or closely served by this equipment?

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HVAC Design Strategies to Reduce Noise in Healthcare Settings


Determine Actions for Protection of Critical Areas from HVAC Noise Distance / Mass / Attenuation Arrange Main and Branch Ductwork to Minimize Balancing Issues Keep Duct Air Velocity within Reasonable Limits Select Air Diffusers to Minimize Noise Issues Locate Air Diffusers to Avoid Cross-over Conditions and Provide Safe Developed Distances from Noise Sources (ie Terminal Boxes, Vol Dampers)

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Proposed 2010 FGI (AIA) GUIDELINES


x.4 Acoustic Design Considerations *x.4.1 General The planning and design of new facilities or the retrofitting of existing facilities shall conform to all applicable codes, regulations, and guidelines setting limits on exterior sound in the environment and interior sound within all building spaces. x.4.2 Site Exterior Noise This section provides design guidance on how to address environmental noise at a facility site over which the facility may or may not have administrative or operational control. This section is not intended serve as a means to qualify the suitability of a site with respect to environmental noise exposure. Examples of noise sources a facility can control are power plant, HVAC equipment, and emergency generators that are part of the health care facility. (An on-site noise source over which the facility may have limited control is helipads. The location and operation of helipads are subject to federal regulation and other safety and environmental considerations.) Examples of noise sources a facility cannot control include highways, rail lines, and airports and general urban, industrial, and public service equipment and activities.
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Proposed 2010 FGI (AIA) GUIDELINES


x.4.2.1 Consideration of exterior noise sources. The planning and design of new facilities or the retrofitting of existing facilities shall include due consideration of all existing exterior noise sources that may be transmitted from outside a building to its interior through the exterior shell (exterior walls, windows, doors, roofs, and ventilation and other shell penetrations). Hospital design should also consider future noise source development, such as the construction of highways, airports, or rail lines in the vicinity of the project. x.4.2.2 Consideration of hospital facility noise source transmission. Planning and design shall also include due consideration of hospital facility noise source sound transmission to nearby residences and other sensitive receptors. Exterior facility equipment sound can be controlled to achieve acceptable sound levels inside hospital facility spaces and at neighboring receptors through compatible siting of noise sources and receptors to take advantage of distance, orientation, and shielding. Exterior facility equipment sound can also be controlled using quiet equipment selections and noise control equipment such as silencers and barriers. *x.4.2.3 Exterior noise classifications. Exterior noise classifications identify exterior noise exposure that is not produced by the facility.
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RECOMMENDED RESOURCES:
The Center for Health Design www.healthdesign.org The Robert Wood Johnson Foundation www.rwjf.org Facility Guidelines Institute www.fgiguidelines.org

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Proposed 2010 FGI (AIA) GUIDELINES


x.4.5 Sound Isolation Performance of Constructions x.4.5.1 Sound isolation shall be considered for all occupied spaces. x.4.5.2 Adequate sound isolation will result in speech privacy, acoustic comfort, and a reduction in noise-produced annoyance. x.4.5.3 Sound isolation between hospital occupants and noise sources is determined by the sound level difference between source and receiver and by the level of background sound at the receiver's location. Table 1.6-4: Recommended sound isolation performance between enclosed rooms Adjacency combinationSTCcPatient roomPatient room (horizontal)451Patient roomPatient room (vertical)50Patient roomCorridor (with entrance)352Patient roomPublic space50Patient roomService area603Exam roomCorridor (with entrance)352Exam roomPublic space50Toilet roomPublic space45Consultation roomPublic space50Consultation roomPatient rooms50Consultation roomCorridor (with entrance)352Patient roomMRI room 603Exam roomMRI room603Exam roomExam room (no electronic masking)50Exam roomExam room (with electronic masking)40Public spaceMRI room50Notes 1In cases where greater speech privacy is required when both patient doors on either side of a patient 197

Proposed 2010 FGI (AIA) GUIDELINES


x.4.6 Design Guidelines for Speech Privacy in Open-Plan Spaces x.4.6.1 People working in open plan spaces are most productive when there is a minimum of distraction from voices, equipment, etc. This involves designing the acoustical environment to minimize such distractions and improve a persons ability to concentrate. Table 1.6-5: Speech privacy for open-plan spaces Speech Privacy GoalAIPISTISIINormal (non-intrusive)=0.20=80%=0.23=0.25ConfidentialSpecial consideration required. x.4.6.2 Confidential speech privacy is not readily achievable in open plan spaces due to the lack of barriers, low ambient sound levels, and typical voice effort. x.4.6.3 Options for achieving confidential speech privacy in open plan spaces include provision of a separate room where conversations can occur in private. x.4.6.4 Methods of determining speech privacy (1) Privacy Index (PI) criteria are defined in ASTM standard E1130. (2) The Speech Intelligibility Index (SII), defined in ANSI standard S3.5-1997, replaces the Articulation Index (AI) of ANSI standard S3.5-1969. SII criteria can be used in the design of open office space; they

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RECOMMENDED RESOURCES:
The Center for Health Design www.healthdesign.org The Robert Wood Johnson Foundation www.rwjf.org Facility Guidelines Institute www.fgiguidelines.org

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