The Forgotten Healthcare Obligation

Special Needs Healthcare Design

Natassja Wynhorst

Client Experience Executive, Interite Healthcare Interiors

The design and construction of healthcare facilities and environments must adhere to certain standards for the space to comply with strict Australian standards, inclusive of hygiene codes and safety regulations to name a couple. Due to this, many other important aspects in which are recommended, as opposed to specifically being outlined as obligatory are often overlooked, forgotten, or worked-around to save time, money and to create a constructional short-cut.

One of these important aspects that are often over-looked is the need for good acoustics within a healthcare environment.

Creating a comfortable acoustic environment in healthcare plays an extremely important role in supporting and maintaining safety, health, healing and well-being for all occupants. Not only this, but noise pollution can create and influence medical errors as it can act as a distraction.

In any regular working environment, good or bad acoustics can cause significant outcomes and effects on productivity, employee satisfaction and the overall workplace health; making unwanted noise a significantly important consideration in the design and construction of an office. Healthcare spaces are not exempt of this, in fact, there may be more severe ramifications for bad acoustics in a medical space.

Sound affects humans both physiologically and psychologically, especially within a space in which individuals are healing, are more sensitive and may be mentally unstable. Noise pollution, or sounds that are unwanted, can increase blood pressure, heart rates, respiration rates and blood cholesterol levels, ultimately inhibiting the healing processes within healthcare environments (1).

Conversely to this, pleasant and desired sounds can assist in facilitating a sense of well-being and relaxation. An example of this is the utilisation of certain music used to assist in the treatment of depression, to reach autistic patients, and to calm distressed individuals.

Not only do the acoustics have certain impacts on health and well-being of the centre’s main users, it also impacts the level of privacy throughout the space. For example, bad acoustics may cause speech to reverberate throughout the space, causing personal conversations and consultations to be heard by others throughout the space. This breach of privacy has the high potential to influence poor client experiences, ultimately resulting in a loss of attraction and retention of clients.

Good acoustic conditions not only improve privacy for patients and staff members, it also promotes healthy sleepy patterns, healing, comfort, morale and equipment efficiency and usability (1).

Although the World Health Organisation recommends and urges that noise in healthcare environments should not exceed 35-dB, various studies have collected data in which reflect the average background noise of a hospital to range from 45-dB and 68-dB. Similar to these results, a survey conducted by Press Ganey, discovered one of the most common complaints among hospital patients is the noise, or a direct result from the noise pollution (2).

Noise transfer vs noise reverberation
Bad acoustics result in unwanted noise travelling throughout the space of the medical building. Issues with the building structural acoustics are commonly a result of a lack of consideration during the design and planning stage of the project and can cause two separate acoustic dilemmas: Noise transfer and noise reverberation.

An example of noise transfer is the transferral of private discussions in adjoining rooms. This can occur as a result to four different circumstances, however can easily be avoided if considered during the planning of the healthcare facility.

The first way noise transferral can occur is through the ductwork of the space and can be addressed and minimised through the installation of acoustic baffles, or the correct initial design.

Secondly, noise transferral can occur through the ceiling space. Traditionally, in many medical centres in which were built prior to the healthcare functionality of the space, the ceiling space is already installed, however it can be overcome through the implementation of acoustic tiles, insulation, or slab-to-slab construction partitions.

Thirdly, noise transferral can occur via the building’s walls and doors. An excellent way to prevent this occurrence is to contract an acoustic engineer who may be able to determine the best route of addressing the issue. This may include the installation of additional layers of plasterboard and to soundcheck the plasterboard, or to install drop seals and frame seals within sliding doors.

The fourth, and least common, noise transferral occurrence is through the flooring of the building. This is the least commonly found issue within healthcare practices as the flooring is generally designed in way to utilise materials for functions such as hygiene, or comfort.

Noise reverberation is a separate dilemma resulting from the issue of bad acoustics. Rather than the noise transferring through structures, noise reverberation refers to the noise “bouncing off” surfaces; this is common in healthcare environments as solid surfaces are heavily utilised. This dilemma can be overcome by incorporating furnishings that absorb noise, such as implementing carpet in place of vinyl, acoustic panels on walls and/or ceilings, and placing and arranging soft furnishings throughout the space.

Targeted design considerations
Whilst a lot of acoustic issues often require systematic and operational changes, there is much that can be done during the design stage of the space also. A simple example of this is to specifically arrange the placement of furnishings and seating to provide a greater distance between patient doors in adjoining consult or long-stay rooms. This mitigates the sound transmission, even when the doors are left open (2).

Additionally, adjoining long-stay rooms eliminate the potential of placing headwall penetrations, such as oxygen pipes, which can often create high-frequency sounds. This is good, however, due to this constraint, patient restrooms are often placed on the adjacent wall to another patient’s non-restroom wall, allowing potential transferral of plumping noises (2).

Such issues of the placement and arrangement of design elements is essential in the initial stages of developing an acoustically sound healthcare environment.

Sound-absorbing surfaces
If unable to revert or change the structural components of a healthcare building in order to mitigate noise pollution, the utilisation of sound-absorbing furnishings and surfaces can have a positive impact to facilitate a better acoustic environment.

As previously mentioned, acoustic tiles that possess a high noise reduction coefficient (NRC), are an excellent means to mitigate noise transferral via the ceiling space. Rubber flooring, sound-absorbing flooring backing, and sound-absorbing wall panels all effectively limit the noise transferral levels (2).

Whilst the implementation of carpeting is an excellent option to decrease any noise reverberation in a patient waiting area, it is not always the best consideration for surgical and patient care areas in which require durable and easily cleanable surfaces. Vinyl, or sheet linoleum flooring options are a consideration in place of carpet in such areas, as they can soften sounds and offer decent acoustics.

Curtains are an excellent option to incorporate patient privacy and to prevent noise reverberation in smaller scale healthcare environments (2). However, larger and more public-profile healthcare areas may require a greater level of finish, in which acoustically rated products such as wood-lock ceiling systems with an acoustical liner are a more accurate consideration.

Mitigating mechanical noise
In addition to material solutions, mechanical noise can be overcome and addressed in the initial design stage of the facility. There is a higher possibility of sound and noise travelling to unwanted areas when the object creating the noise is located close by. In which case, the positioning and layout of the healthcare environment is an essential stage in mitigating mechanical noise pollution.

For example, equipment in which makes a high transferral of noise such as surgical and emergency areas are not ideal to place in adjoining rooms of a patient recovery unit or long-term stay room. The noise and business that will be seen through open doors and heard through bad acoustically designed walls and ceilings will inhibit the healing process, and may also cause negative effects such as stress, anxiety and an overall bad client experience.

Back-to-back electrical or data outlets should be off-set; furthermore, noise-producing equipment such as freezers, vending machines, refrigerators and ice machines are recommended to have a physical separation from open corridors to healing areas (2).

Achieving a high-performance acoustic design in healthcare facilities, centres and practices is a challenge, considerably more if one does not know what to look for. The topic of acoustics may not be a legal obligation, however if it lacks consideration in the design and construct of the environment, it has the potential to cause severe legal ramifications as privacy can be breached, healing processes can be inhibited, and distractions can create medical errors.

A growing awareness of the issue revolving around the lack of knowledge in acoustics has become increasingly evident in recent years, as medical environments are refurbishing into contemporary design, and expanding into residential areas and other sites.

Its importance is not be taken lightly, and should be treated as an obligation, as if effects the productivity, morale and service delivery of the medical centre; ultimately influencing the centre’s long-term success and reliability.

 

Disclaimer: Views, information or opinions expressed within this article are solely those of the author. This article does not necessarily represent the official policy or position of any other agency, organisation, employer or company and includes information obtained from third parties. These views are subject to change and revision.

 

1. WSP, “Acoustics in Healthcare,” retrieved October 25..
2. Barbara Horwitz-Bennett, 2016, Healthcare Design, “A Sound Plan: How To Achieve Optimal Healthcare Acoustics,” retrieved October 25.

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