The built environment and health care facility design

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Presenter: Malefetsane Tsolo

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Date:25 August 2026

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Objectives

1. Describe the following with regards to the build environment

• The environment and layout.
• Patient clinical areas (wards, waiting areas, consulting rooms)
• Support areas.

2. Describe the requirements of water in the healthcare facility.

3. Describe the requirements for sanitation in the healthcare facility.

4. Describe the requirements for operating theatre.

5. Describe the role of the IPC during building design.

6. Describe the commissioning of theatre.

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IPC and the build environment

During construction or renovation of the healthcare facility.

• It is imperative that the IPC team is involved.
• To provide the opportunity to give inputs to the end product.
• Location of wash basins.
• Air-conditionings and requirements.
• The location of isolation rooms
• Important role in how effective IPC measures can take place in the healthcare facility.

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The build environment

1.The build environment has a direct effect on the implementation of IPC practices and workflow.

2.In most moderate climates, natural ventilation is preferred .

3.Mechanical controlled ventilation is preferred in the specialized area.

• Operating theatres.
• Neonatal units.
• Burn units,
• Sterile preparation.
• Decontamination areas.

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Legislation requirements

1.Buildings must comply with the provisions of:

• The National Building Regulations.
• Building Standard Act, 103 of 1977.
• Regulations governing private hospitals and unattached operating theatre unit - R158.
• Infrastructure unit support system health facility guide.
• National Norms and Standards for premises.
• Acceptable Monitoring Standards for Environmental Health Practitioners.
• Applicable provincial legislation for governing the building requirements for private hospitals.

2.There should be a close working relationship between the IPC teams and Engineers when dealing with the build environment.

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The Environment and Layout

The air temperature, humidity and airflow in the healthcare setting .

• Should provide a comfortable environment for patients, staff and carers.

Adequate airflow:

• Minimize the risk of transmission of airborne pathogens.

Airflow:

• Natural or mechanical airflow.
• Natural ventilation is more effective (achieving more than 17-40 air changes per hour).
• Mechanical ventilation (12 air changes per hour is recommended).

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The Environment and Layout

Sufficient lighting:

• Natural lighting is preferred during the day (allow safe movement)
• Artificial lighting during the night (allow safe movement)

Floors should be:

• Continuous and smooth.
• Covering should be curved or shaped to form part of the wall (2.5cm to facilitate cleaning).
• Carpets and tiles are not recommended in patient area.
• The wall should be smooth and washable.

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The Layout

• The layout of ll patient clinical areas should minimize transmission of infectious pathogens.
• Sufficient space to allow wheelchairs movement.
• Surfaces must be made of material that is easy to clean and water resistant.
• There should be a staff work station.
• The allocation of bed should not be more than six to eight per unit.
• Space between bed should be 1.2m (to avoid obstruction and easy movement.)
• High Care unit distance between the bed should be 2.4 metres.
• Hospital should have two isolation room with in-suit ablution facilities per 24 beds.

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Handwash basins

• Handwash basins should be paced outside patient zone (avoid splash and spread of pathogens).
• Handwash basins should be located to the nearest entrance door.
• Ratio of basin to beds is 1:10.
• Isolation room should have one basin outside near entrance door.
• Functional handwash basins should be fitted with non-touch or elbow taps.
• Soap dispenser and paper towels.
• ABHR should be at the point of care.

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Handwash basins

• Adequate clean surfaces around patients bed.
• Furniture must be covered in material that can be easily cleaned.
• Chairs covered impervious material for patients and visitors.
• Visitors should not sit on patients beds.
• Bedside table and over bed table.
• Mattress and pillows should be covered with intact impervious chemical resistant covers for easy cleaning.
• Bed curtains for privacy and should be changed when patient is discharged.

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Healthcare waste

• Healthcare waste should be stored separately and not in the sluice room.

Regulation 158:

• A dirty utility room/area with minimum floor area of 5 cubic metres or 7cubic metres.
• A wash hand basin, sluice sink and wall mounted bed pan and urinal racks are minimum requirements.
• A bed pan washer/disposable unit and a domestic sink may be substitute for sluice sink.

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Utility room / CSSD

• Medical devices should not be cleaned in the ward or patient area.
• All reusable medical devices should be sent to CSSD for cleaning and decontamination.
• If there is no alternative (cleaning should be done in a separate designated:
• Closed
• Well ventilated
• Deep sink with running water.
• Detergent used according to manufactures recommendations
• Cleaning brush
• Drying area after wash
• PPE should be worn at all times.

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Sanitation

• Adequate functioning toilet facilities catering for patients and staff separately.
• Patients toilets for both genders( Male and Females).
• Provision for menstrual hygiene in female toilets.
• WHO recommends one toilet per 20 users for inpatient setting and at least four toilets per outpatient setting.
• One toilet dedicated for staff
• One gender neutral toilet for patients that has menstrual hygiene facilities which is accessible for people with limited mobility.
• One bath or shower for every 12 to 15 patients.
• Drainage system must be in place and approved measure are utilized for removal of waste water.
• Adequate supply of toilet paper, liquid soap, paper towel, at basin.

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Microbiological commissioning and monitoring of operating theatres

Commissioning:

• Before an operating theatre is first used.
• After any substantial modifications that affect airflow pattern in pre-existing theatre.
• IPC team is involved at all stages from pre-design through to opening.
• Adequate time for commissioning is build into the schedule, including allowance of time for microbiological assessments (particle count).

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Microbiological commissioning and monitoring of operating theatres

Contractual conditions before handover:

• The theatre interior should be checked for for obvious defects.
• Air distribution within the theatre.
• between the rooms in the theatres suite should be check by smoke tracing.
• The air handling unit supplying, the theatre should be properly constructed, finished and functioning.
• The air change rate in theatre and preparation room should be satisfactory (>20 ACH).
• Airborne microbial contamination in an empty theatre should be satisfactory.
• Particle counts using a bio sampler should be done after filters have be changed.

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Reference

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Department of Health, 2021, Practical Manual for Implementation of National Infection Prevention and Control Strategic Framework, Republic of South Africa.

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Thank you

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