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Thu 18 Nov 2010 12:00 AM

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Healthy growth

Elizabeth Broomhall looks at the challenges posed by the burgeoning healthcare sector, particularly for MEP, due to the rising demand for hospital projects in the GCC.

Healthy growth
Construction work on the 260 000 m2 Cleveland Clinic hospital building in Sowwah Island, Abu Dhabi.

Leading the GCC with a US$10 billion hospital-building
initiative, Saudi Arabia is certainly preparing for a sharp rise in demand,
while Kuwait has earmarked KD37 billion (US$127 billion) for hospital projects
in the next four years, with a view to replacing inadequate facilities built
three decades ago.

Along with a growing need for healthcare facilities, there
inevitably emerges a new demand for hospital building, and as with all
developing markets, it is critical to adopt an integrated approach from the
outset. WSP Middle East’s technical director for healthcare Carl Platt says:
“Healthcare facilities are far more complex in their design than other types of
projects. The entire construction team is liable for ensuring quality standards
are met, and there are far more opportunities to get it wrong if you do not
know what you are doing.”

But before firms can even think about the general risks of
hospital building, industry specialists urge them to consider the less obvious
complexities that make hospital construction so unique. “Hospital projects are
more technologically advanced than standard construction projects as they have
more intelligent systems built into them,” says Aldar Properties’ senior
development manager Hadi Sha.

“Due to the number and complexity of these systems, there is
typically a lot of infrastructure congestion which can create co-ordination
issues and slow construction down. Medical equipment, IT and security systems,
for example, are constantly being updated during the construction period, which
can mean last-minute modifications are required.”

Quality

At the same time, contractors and designers are expected to
ensure a certain standard of quality. “Minimising the changes to the project
can help prevent a number of issues, but it is part of the industry’s DNA to
continuously seek new and innovative methods of delivering healthcare
facilities without compromising on overall quality.”

Intensifying difficulties is the fact that the UAE has no
specified healthcare standards, but tends to adopt US policies and Health
Technical Memorandums (HTMs) from the UK when required. Meanwhile, the
projects continue to be subject to government and local health authority
requirements, which vary according to the individual project and regional
demand, as well as an array of conflicting departmental specifications.

“Each hospital department has a different set of end user
requirements,” says Meinhardt’s hospital expert and head of MEP division
Stephen Clough. “In some projects you can deal with as many as 20 different
departments, so co-ordinating needs can be challenging. Often they each wish to
impart their own set of requirements which may be contrary to the agreed
general standards.” Referring to a trend of tight programmes and detailed
design specifications, Clough says that collating comments and approvals from
hospital operators can be a lengthy process. “Budget can also be an issue as
additional requirements by the end user can have a significant effect on
costs.”

One hospital feature that is particularly dependent on good
design is the need for privacy, though the requirements will vary according to
the type of hospital and location of the project. In Saudi Arabia for instance,
it is necessary to separate ladies’ and men’s sections when designing the unit,
while the number of rooms and services of any facility may be affected by the
unit’s medical specialty and average length of in-patients’ stay. The amount
and size of equipment will also need to be considered.

Space planning

As regards upholding patient dignity and care, space
planning is essential. “It can be difficult, but it is nonetheless critical to
ensure adjacencies between departments for the sake of patient dignity,” says
Platt. “For example, diagnostic and imaging suites should be positioned close
to accident and emergency departments.” Designers also need to take special
care at the design stage to avoid patients being wheeled around
highly-populated areas on trolleys or in hospital clothing.

Designing the building in such as a way so as to eliminate
the spread of noise through a facility is also important, which means MEP has
to take acoustic control into account, through strategies like fitting
attenuators in air ducts to limit sound travel. Perhaps more widely
acknowledged than the design complexities are the extremely specific MEP
requirements of hospital projects – central to efficient operation due to the
need for a closely-controlled, infection-free, safe environment, impervious to
electrical failure.

The unique challenges, which largely revolve around thermal
control, air management, power generation, waste disposal and equipment
installation, not only impact on the MEP contractor, but on all parties
involved in the project’s design and construction.

Unlike the UK
where thermal control is about keeping hospitals warm, in the UAE there is a
clear need to keep the facility cool. Contrary to standard projects where
sustainable air-con systems are installed simply and easily, hospital cooling
is more complex. Burdened with having to balance the demand for cold air with
that for natural light, hospitals are under pressure to reduce the amount of
energy used by cooling systems whilst preventing the spread of airborne
diseases – a difficult task given that most sustainable air-con systems rely on
re-circulated air.

Solar gain

Platt explains: “One of the challenges of hospital building
in the GCC is to reduce the large solar gains into the hospital. The use of
glazing to provide natural light (proven to be beneficial in the healing
process) can be problematic when you imagine what the inside of a car is like
in the summer. But, of course, we do not want to simply install bigger
chillers, due to the large amount of energy they consume.

“To maintain thermal control, engineers need to consider
alternative options such as greater insulation to keep warm air out, and
shading options which can limit the solar gains by the fabric of the building.
The difficulty with recirculated air is that you risk spreading infection. In a
normal building you would literally just recirculate the air, but in a
hospital, and especially in areas such as operating theatres and intensive care
units, this is not possible, as you would be recirculating contaminated air.” A
more efficient system is to pump filtered fresh air into a room, pull the air
out and just cool it down with the existing air.

Containing airborne diseases generally in areas of risk such
as operating theatres and intensive care units is also complicated by the need
to maintain positive air pressure in order to protect patients. “The mechanical
systems in a hospital are very advanced; the MEP works specifically have a
higher and tighter specification in a hospital than on other projects, and
there is more emphasis on air filtration,” says Clough. “Services are designed
in such a way as to compartmentalise areas to prevent the spread of airborne
diseases, and the pressurisation arrangement has to be carefully considered.”

Infection is also spread through waste. Platt says waste
disposal is a major consideration for designers and contractors, with different
systems having to be installed for different types of waste. “There are three
types of waste in hospitals, one is the general waste from sinks and toilets,
another is the chemical waste from laboratories and the last is the waste from
cleaning and sterilisation. Each type of waste must be managed separately so as
not to enter the water system and spread infection. This creates additional
challenges for construction firms and MEP specialists, who respectively have to
design and implement these systems.”

Finishing works

The finishing works, sometimes perceived to be
‘post-construction works’, are extremely important in hospital building.
According to technical experts, the need for perfection puts a substantial
amount of pressure on those not only carrying out the finishes, but on the other
contractors as well. “Upon completion, a hospital building has to be
immaculately clean,” explains Clough. “This means that nothing other than the
equipment required should be left in floor or ceiling voids, dust has to be
kept to a minimum during all stages of the build and surfaces have to be
sealed.”

Central to these requirements is hygiene and the ongoing use
of the building after construction – it being imperative to consider the
long-term operation of the facility during the design, supply and construction
phases. The paints and all the finishes must be washable and must not allow
bacterial growth. All the materials and equipment installed must be suitable
for their purpose for a long time without the need for regular repair and
maintenance. In a hospital, you cannot tolerate failures or shutdowns for
repairs.

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