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Supply, Processing & Distribution February 2010

TABLE OF CONTENTS

Section 1 Foreword &AcknowledgmentsIntroductionAbbreviationsLegend of Symbols

Section 2 NarrativeGeneral ConsiderationsTechnical Considerations

Architectural ConsiderationsEngineering ConsiderationsConcerns Specific to Supply,Processing & Distribution

Section 3 Functional DiagramsRelationship Diagrams andGeneric Layout

Section 4 Guide Plates (typical order)Floor PlanReflected Ceiling PlanDesign StandardsEquipment Guide List

Section 5 AppendixGlossary of TermsSEPS / Cross-ReferenceGuide Plate Index

TABLE OF CONTENTS

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Section 1

Foreword & Acknowledgements

Page

Foreword..1-1

Acknowledgements1-3

Abbreviations..1-7

Introduction.............1-5

Legend of Symbols....1-9

FOREWORD & ACKNOWLEDGEMENTS CONTENTS SECTION 1

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FOREWORD & ACKNOWLEDGEMENTS CONTENTS SECTION 1

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Foreword

The material contained in the Supply, Processing & Distribution Department Design Guide is theculmination of a partnering effort within the Department of Veterans Affairs by the VeteransHealth Administration and the Office of Construction & Facilities Management, StrategicManagement Office. The goal of this Design Guide is to facilitate the design process and toensure the quality of VA facilities while controlling construction and operating costs.

This document is intended to be used as a guide and to supplement current technical manualsand other VA criteria in planning Supply, Processing & Distribution Departments. The DesignGuide is not to be used as a standard design. Use of the Design Guide does not preclude theneed for a functional and physical design program for each specific project. It is theresponsibility of the Project Architect and the Project Engineer to develop a complete andaccurate project design that best meets the users needs and applicable code requirements.

Lloyd H. Siegel, FAIADirector, Strategic Management OfficeOffice of Construction & Facilities ManagementWashington, DC

FOREWORD & ACKNOWLEDGEMENTS SECTION 1-1

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Acknowledgements

Credit is due to the following individuals whose guidance, advice, and effort made thispublication possible:

Office of Construction & Facilities Management

Donald H. Orndoff Director, Office of Construction & Facilities Management

Lloyd H. Siegel, FAIA Director, Strategic Management Office

Kurt Knight, PE Chief, Facilities Quality Service, FQS

Donald L. Myers, AIA, NCARB Senior Architect, Consulting Support Service

Satish Sehgal, PE Senior Mechanical Engineer, FQS

Mulraj Dhokai, PE Senior Mechanical Engineer, FQS

Alejandra De La Torre Architect, Facilities Quality Service

Advisory Group

Bobby Osburn SPD Executive Program Director

Tommy C. Stewart Director, Clinical Programs

Consultants

N.K. Bhandari Architecture & Engineering, P.C.

James Resig, PE, LEED AP

Jennifer Thayer, AIA

Francis Cauffman RAM-TECH Engineers, P.C.

Stephen Hegeman, AIA Ravi Raman, PE

Catherine Gow, AIA Tim Myers, PE, LEEDAP

Sharon Doyle Fred Sanczawa, PE

Gloria Cascarino

Suzanne Campano

Jessica Hawk

Gina DeMatteis

Erin Disbrow


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Introduction

The Supply, Processing, & Distribution Department Design Guide was developed as a design

tool to assist the medical center staff and the contracting officers in better understanding thechoices that designers ask them to make, and to help designers understand the functionalrequirements necessary for proper operation of Supply, Processing, & Distribution (SPD)Departments based in a VA Hospital.

The Design Guide is intended to be a graphic consolidation of existing Department of VeteransAffairs standards and criteria. It contains data from the following sources:

ADA Standards for Accessible DesignInternational Building Code, 2006

NFPA 101Barrier-Free Design Guide PG-18-13

Design and Construction Procedures PG-18-3Equipment Guide List PG-18-5Equipment Reference Manual PG-18-6Fire Protection Design ManualMaster Construction Specifications PG-18-1National CAD Standards and Details PG-18-4Physical Security Design Manual (Final Draft)Room Finishes, Door Hardware Schedules PG-18-14Seismic Design Requirements H-18-8Signage Design GuideSpace Planning Criteria for VA FacilitiesSustainable Design and Energy Reduction Manual (Final Draft)

VA Technical Criteria (PG-18-10 Design Manuals) pertaining to Architectural,Interior Design, HVAC, Plumbing, and Electrical

2006 AIA Guidelines for Design and Construction of Health Care FacilitiesHVAC Design Manual for Hospital ProjectsEmergency Power & Water Supply During Natural Disasters, Phase 2Energy Conservation (EPACT 2005 and DOE Final Rule)Energy Conservation (Executive Order No. 13423 Dated January 24, 2007:

Strengthening Federal Environmental, Energy and TransportationManagement)

Memorandum of Understanding (MOU): Federal Leadership in High Performanceand Sustainable Buildings.

Commissioning Guidelines (issuance pending)

The Design Guide refers to the above mentioned sources when data is either too detailed or toobroad to be included in this guide. These sources can be accessed at www.cfm.va.gov/til.

This Design Guide is not intended to be project-specific. It addresses the general functional andtechnical requirements for typical VA SPD Departments. While this Guide contains informationfor the vast majority of space types required in an SPD Department, it is not possible to foreseeall future requirements. The project-specific space program is the basis for an individual projectdesign. It is important to note that the guide plates in Section 4 are generic graphic

http://www.cfm.va.gov/tilhttp://www.cfm.va.gov/til

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representations intended as illustrations of VAs furniture, equipment, and personnel spaceneeds. They are not meant to limit design opportunities.

Equipment manufacturers should be consulted for actual dimensions and utility requirements.

Use of this Design Guide does not supersede the project architects and engineersresponsibilities to develop a complete and accurate design that meets the users needs and theappropriate code requirements within the budget constraints.


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Abbreviations

A Amperes

ABA American Barriers ActAC/HR Air Changes per Hour

ADA Americans with Disabilities Act

AFF Above Finished Floor

AI Acquisition and Installation

AIDS Acquired Immune DeficiencySyndrome

A & MM Acquisition and MaterialManagement

AR As Required

AT Acoustical Ceiling Tile

AT (SP) Acoustical Ceiling Tile(with Sprayed Plastic Finish)

BC Base Cabinet

C Degrees Celsius

CB Circuit Breaker

CBOC Community Based OutpatientClinic

CC Contractor FurnishedContractor Installed

CF Construction Funds For VAFurnishing of Equipment and/orInstallation

CFM Cubic Feet per Minute

CLG Ceiling

OCFM Office of Construction & FacilitiesManagement

CMU Concrete Masonry Unit

CPT Carpet Tile

CRS Corrosion Resisting Steel (SS)

CS Construction Standard

CT Ceramic Tile

CT Computerized Tomography

DG Design Guide

DS Door Switch

EMS Environmental ManagementService

ER Emergency Room

ETM Exam Treatment Module

EtO Ethylene Oxide Gas

EXH Exhaust

F Degrees Fahrenheit

FC Foot-candle

FD Floor DrainFIXT Fixture

FLUOR Fluorescent

GFI Ground Fault Circuit Interrupter

GWB Gypsum Wallboard Systems

HAC Housekeeping Aides Closet

HIV Human Immunodeficiency Virus

HP Horsepower

HR Hour

HVAC Heating, Ventilating, and AirConditioning

ICU Intensive Care Unit

K Kelvin

KW Kilowatt

LB Pound/Pounds

LLTS Lockers, Lounges, Toilets &Showers

MCS Master Construction Specifications

MOHS Mohs Chemosurgery

MTDD Mounted

NA Not Procured with Activation Funds

NSF Net Square Feet

NSM Net Square Meters

OSD Open Site Drain

P Paint (Exterior and Interior;Transparent, Semi-Transparent, andOpaque Finishes)

PACS Picture Archiving andCommunication System

PCP Portland Cement Plaster

PEC Primary Engineering ControlPG Program Guide

PH Phase

PL PlasterPPE Personal Protective Equipment

PREP Preparation

PT Porcelain Tile (Floor and Base)


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PSIG Pounds per Square Inch Gauge

QT Quarry Tile

RB Resilient Base

RES Resinous FlooringRES-W Resinous/ Epoxy Wall/ Ceiling

RSF Resilient Sheet Flooring

SC High Build Glazed Coating(Special Coating)

SD Standard Detail

SF Square Feet, Square Foot

SOPC Satellite Outpatient Clinic

SP Special Faced

SPD Supply, Processing and

DistributionSVT Solid Vinyl Floor Tile (Luxury Vinyl

Tile)

SRC Semi-Restricted Corridor

SS Stainless Steel

TELEC Telecommunications

UC Urgent Care

UFAS Uniform Federal AccessibilityStandards

UPS Uninterruptible Power Supply

V VoltsVA Department of Veterans Affairs

VACO Veterans Affairs Central Office

VAMC Veterans Affairs Medical Center

VC VA FurnishedContractor Installed

VCT Vinyl Composition Tile

VHA Veterans Health AdministrationVV VA Furnished and Installed Medical

Care Application for Equipment andInstallation

W Watts

WSF Welded Seamless Flooring (HeatWelded with Rod)

W/SF Watts per Square Foot

W/m2

Watts per Square Meter


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Legend of Symbols


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Legend of Symbols


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Legend of Symbols


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Supply, Processing & Distribution February2010

Section2

Narrative

Page

GeneralConsiderations....2-1

TechnicalConsiderations.2-3

ArchitecturalConsiderations2-5

ConcernsSpecifictoSupply,

EngineeringConsiderations.......2-11

Processing&Distribution...2-15

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General Considerations

General Planning Concepts

Flow with Sequence: Supply,Processing,andDistribution(SPD)areorganizationallyalignedundertheNurseExecutive/ChiefNurse.ThemissionofSPDistoprovideasteadyflowofpatientcaresuppliesandequipmenttopointsofneed,andtoreturncontaminateditemstoacentraldecontaminationareaforcleaning.

SPDisthefirstlineofdefenseagainstharmfulmicroorganisms.Contaminationpreventionisachievedbycloselymonitoringthefollowingelements:

Air Flow: Tominimizemicroorganismmovementfromdirtytocleanareas.Incleanareasthereisapositiveairflow.

Staff Flow: PersonnelworkeitheronthecleansideorthedirtysideoftheSPDunittoavoidcrosscontamination.

Work Flow:Referstothemovementofclean(sterile)suppliesandthereturnofcontaminateditemsfordecontaminationandsterilization.

Adjacencies: SPDmustbecloselyaffiliatedwithsurgicalproceduresuites.SPDmaybedirectlyconnectedtothesterilesupportcorefortheSurgicalSuite,ormaybelocatedwithconvenientanddirectaccessviacartliftsand/orstaffcirculation.

Processing and Distribution Methods

SPDisdividedintothreemainunits/areas.ThefirstunitisDecontamination,whereallreusablemedicalandsurgicalitemsaresentforcleaning.Itisessentialthatcontaminatedmaterialsdonotusethesamepathasthecleanmaterials.ThesecondunitisPreparation.Inthisunit,itemsareinspectedandpackagedforsterilization.Moststerilizationisaccomplishedbyusingsteam;or,inthecaseofmaterialsthatcannotwithstandintensetemperatures,ethyleneoxide(EtO)gas(oranothersuitablegas)isused.MaterialsundergoingEtOsterilizationmustbeadequatelyaeratedtoensurethatnohazardoustracesareleftondevices.ThefinalunitinSPDinvolvestheDistributionProcess,includingdistributingsurgicalcasecarts.ThisunitisfurthersubdividedintoPrimaryStockandSecondaryStock.PrimaryStockreferstothesuppliesthatarestoredwithintheconfinesoftheSPDdepartment.SecondaryStockmaterialsarethoseinuserareas

suchasclinics,nursingcareunits,andintensivecareunits.

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Current Trends

AcurrenttrendimpactingSPDistheincreasingcomplexityofmanysurgicalproceduressuchaslaparoscopy,endoscopy,laser,micro-vascular,andmorecomplexsurgeries.These

complicatedsurgeriesrequiremorecomplicatedinstrumentation.ThiscomplexinstrumentationhasledtothetrendforSPDtechnicianstobecertified,thusrequiringthestafftohaveacertainlevelofcompetencyandtokeepupwithperiodic/annualcontinuingeducation.

AnothercurrenttrendinSPDisinstrumenttracking.Thiscaneliminatehoursofsearchingforlostinstruments,locationofkeyassets,trackingloanerequipment,andensuringpatientsafetyandthequestforzeronevereventsthroughthevalidationofsterilizationprocesses.

Future SPD Trends

AnanticipatedfutureSPDtrend,sustainabledecontaminationandsterilizationequipmenthas

beenembracedbymanymanufacturerswhoarereviewingtheenvironmentalimpactoftheproductlines,anddevelopingmachinesthataresaferforthestaffandkindertotheenvironment.Examplesincludeequipmentfeaturesthatyieldsignificantwatersavings,theuseoffewertoxicorless-toxicchemicals,etc.

Otherfuturetrendsincludestricterprotectionofhealthcareworkers,sincepathogenicorganisms(HepatitisBorC,andHumanImmunodeficiencyVirus(HIV))havebecomeknown.

Special Considerations

EtO: Theprovisionofethyleneoxide(EtO)gas(oranothersuitablegas)mayberequiredto

sterilizeselectedinstrumentationthatisunabletosustainthehighheatofsteam-basedsterilizationprocessing.Becauseofthehightoxicityofthesterilizingagentusedinthisprocess,EtOsterilizationmustbesustainedinafullycontainedroomthatispartofthePrep,Assembly,andSterilizationspace.

Location of Bulk Storage: Bulkstorageiswheresuppliesarereceivedincaselotsfromthewarehouse,primevendorandothersources.TheBulkStorageshouldbelocatedneartheSPDClean/SterileStorageareaandconnectedtotheSPDBreakout.Nosuppliesaretobeinthisarea;lowunitofmeasure.(Note:Hospitalsterilizeditems,includinginstrumentsets,willnotenterthisarea.)

Endoscope Processing: Endoscopesmayberigidorflexible.RigidEndoscopesaretypically

sterilizedwiththesamevigorandcareasthesurgicalinstrumentation.FlexibleEndoscopestypicallyrequireminimumhigh-leveldisinfectionandoccurincloseproximitytowheretheprocedureisperformed(i.e.,GISuite).However,someSPDsuitesmayneedtoaccommodatethereprocessingofFlexibleEndoscopes.ThiswillrequirededicatedEndoscopeReprocessors.


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Technical Considerations

Natural Disasters

Hurricanes,tornados,earthquakes,andfloodsarenaturalphenomenathatoccurwithinregionalareasofdesignatedprobability.Designsolutionsshouldaddresstheseprobabilitieswheretheyoccurtomitigatebuildingdamageandlossoflifewhereverpossible.Selectionofbuildingsitesshouldavoidfloodplainsorfloodproneareas.Regionalareassusceptibletohurricanesshouldincorporatedesignfeaturesthatmitigatedamageassociatedwithhighwinds,wind-drivenrainandprojectiles.Tornadodesignmitigationissimilartohurricanes;however,muchmorelocalizedandintensiveinnature.BuildingsinareaswithprobabilityofearthquakesneedtobeseismicallyrestrainedinaccordancewithH-18-8SeismicDesignRequirements.

Becauseofitscriticalmissioninsupportingsurgicalprocedures,theSPDshouldbeplannedtoallowascontinuousanoperationaspossibleduringandimmediatelyafternaturaldisasters.

Interior Materials, Finishes and Doors

Theinteriormaterials,finishesanddoorsshallfollowguidanceinPG-18-10,ArchitecturalDesignManualandPG-18-14,RoomFinishes,DoorandHardwareSchedule.TheGuidePlateforeachspaceincludesalistingofdesigncriteriaapplicabletothatspace.

Contemporary Advancements/Evidence Based Design

Accessibility:AccessibilityisaccommodatedbytheapplicationofPG18-13,VABarrierFree

DesignGuide;ArchitecturalBarriersActAccessibilitystandards(ABAAS),AppendicesCandDto36CFR,andADAStandardsforAccessibleDesign(28CFRpart36)tospaceandfixedequipmentlayouts.


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Architectural Considerations

Location of SPD

SeveralfactorsinfluencethelocationoftheSPD.Theseinclude:

Access to the OR: Insomecircumstances,thesteriledeliverysideoftheSPDcanbedirectlylinkedwithasterilecoreoftheOR,allowingadirecttransferofmaterialsandinstrumentationandminimizingtransporttime.

Asanalternative,theSPDcanbelocatedonanotherlevel.TheSPDmaybelinkedviacleanandsoiledcartlifts.DedicatedcleanandsoiledcartliftsneedtoarriveandleaveatappropriatelocationswithintheSPD,andcannotbeusedforanyotherfunction,norcanasingleliftbeusedforbothcleanandsoiledtransport.Cleanandsoileddumbwaitersmaybeanalternative,but

arenotanidealsolutioninnewconstructionastheyrequirethetransferofitemsontothedumbwaiter,thenoffatthepointofdestination,whilethecartliftallowsforthetransportofafullyloadedcart.

Access to Loading Dock: TheSPDreceivesfreshsuppliestostore,inventory,anddistributetoaugmentinstrumentationthatisthenusedtostocksupplyorcasecarts.Accesstotheloadingdockneedstobestraightforwardandsimpletoallowtherepeatedandconsistentdeliveryofmaterial.Iftheloadingdockisonadifferentlevelofthefacility,caremustbetakentoplantheentireroutefromthedocktotheSPD,confirmingcorridorwidth,elevatorsize,etc.

Environmental Requirements

EnvironmentalconsiderationsmostcriticaltoSPDare:temperature,humidity,ventilation,light,andprotectionfromcontaminants.

Facilitydesigniscrucialtotheefficiencyandeffectivenesswithwhichtheseneededenvironmentalconditionsaremet.Designfeaturesdeservingparticularattentioninclude:

Separationofsoiledareasfromcleanareas Restrictedareas ContainmentareaforEtOgas Heating,ventilation,andairconditioning(HVACSystems) Roomrelationships(regardingfunctionandstaffutilization)

Modularityofdesign/flexibility Interiorsurfacesandfinishes


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Space Planning Criteria

SpaceplanningcriteriaforSPDincludesthefollowingconsiderations:

Quantity of Space:Thequantityofspacewillbedrivenbythetotalthrough-putneedsoftheSPD,whichis,inturn,drivenbythesurgicalvolumesandsurgicalproceduremix.Keyfactorsindeterminingtotalsizewillbethetotalnumberofsterilizersneededandthetotaldailythroughputofinstrumentationcarts.TherelationshipbetweensurgicalvolumesandSPDthrough-putisdirect;iftheORsareplannedtoexpand,theSPDneedstohavecorrelativecapacity.

Location of Space: TherelationshipbetweenSPDandtheORSuitesiscritical,aspreviouslynoted.Inaddition,aclearpathfromloadingdockstotheSPDisessential.

Quality of Space: Thespaceitselfmustbeabletoprovideanappropriatelycleanenvironmentforthehandlingofsoiledinstrumentationandsterileinstrumentationandsupplies.Mechanical,

electrical,andplumbingrequirementsaredefinedunderEngineeringConsiderations.Inaddition,finishesmustrespondtotheneedtobeabletocleantheenvironmentappropriately.

Room Relationships & Adjacencies

OneoftheprimarypurposesoftheSPDistodeliverclean/sterilesuppliesandinstrumentationtotheOR.Itdoessobyreceivingandcleaningsoiledinstrumentationandbystagingandassemblingsterileinstrumentationandclean/sterilesuppliesfordeliverytosurgicalsitesandotherareasthatrequiresterileimplementationwithinthehospital.Indoingso,itmustpromoteefficientdeliveryofmaterialwhilemaintainingthecleanandsterilestatusofinstrumentationandsupplies.Thefourkeyspacesaresequentiallylinked,andinclude:

Decontamination: SoiledinstrumentationarriveshereasthefirststageintheSPDprocess.Soiledinstrumentationisreceivedviaclosedcasecartsthatmayreturnviaelevators,dedicatedcartlifts,ordumbwaitersdirectlytotheSoiledReceivingandDecontaminationRoom.

Preparation, Assembly, and Sterilization Area:ThisroomisdirectlyconnectedtoDecontamination.Equipmentpassesthroughawasherdecontaminatorthatallowsthetransferofinstrumentationthroughthewasher/disinfectororsterilizertothePreparation,Assembly,andSterilizationArea.Accessforsterilizermaintenancemustbeprovided,andtheremaybeapass-throughwindowforsmallitems.

Clean and Sterile Storage: ThisroomisdirectlyconnectedtothePrep,Assembly,and

SterilizationRoomandisusedtostoreandpicksterilizedinstrumentationandsterilesuppliesfordeliverytothepointofuse.

Staff Support:ThesespacesservetoprovideadministrativeandbreaksupportforSPDstaff.

ItiscriticaltothefunctionalefficiencyandsafetyoftheSPDthatthesespacesaresequentiallylinkedforone-wayflow-throughofinstrumentationandcarts.Thispromotesthemaintainingofthesterilestateofinstrumentationasitiscleanedforre-use.


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Functions of Areas within SPD

Clean Receiving and Breakout Area: Thisspaceservesasanareatoreceiveandbreakoutdisposablesuppliesreceivedfromthewarehouse,primevendor,ormanufacturers.Thisareais

alsowherespecialtycartssuchascrash/codecartsandisolationcartsarereturnedafteruseforthesuppliestoberemovedbeforetheemptycartistakentotheDecontaminationAreaforcleaning.Thisareaisalsousedtoreceiveloanerinstrumentsandequipmentandforthemtobepickedup.Consignmentsuppliesandimplantsaretobereceivedhere,aswell.

Anteroom: Thisspaceservestomaintainproperairpressurerelationshipswhenpersonnelmovebetweenadjacentspaces.

Decontamination Area:Thisincludesstagingspaceandcirculationspacedesignedtoallowforthegrossdecontaminationofinstrumentation,followedbytheplacementoftheinstrumentationonawasherdecontaminatorthatwilldelivercleaninstrumentationtothePrep,Assembly,andSterilizationRoom.Inaddition,thereisapass-throughwindowforselecteditemsthatareeithertoodelicateorwillnotfitwillbedirectedtotheEtOSterilizerinthePrep,Assembly,andSterilizationroom.

Automatic Cart Washer: Thisroomhousestheequipmentthatreceivessoiledcarts,washesthem,anddeliversthemtotheCleanandSterileStorageRoom.

Detergent/Water Treatment Room: Supportsthewasherdisinfectors,sterilizers,andcartwashers.

Decontamination HAC:Inordertomaintainclarityofcleanliness,theDecontaminationAreahasadedicatedHousekeepingAidesCloset,accessedonlyfromtheDecontaminationArea

andusedonlyforcleaninginthatspace

Staff Lockers/Showers: One-wayflow-throughstafflockersareprovidedtoensurethatDecontaminationstaffarrive,dressandworkwithintheDecontaminationareawithoutcross-contaminatingotherspacesorpubliccorridors.SeparatelockersaretobeprovidedforstaffworkinginthePrep,Assembly,andClean/SterileStorageRooms.

Manual Equipment Washer Room:Spaceformanualcleaningofreusableequipment.

Soiled Cart Lift: Ifaliftisusedforthemovementofsoiledcarts,thesoiledcartliftmustdeliverthesoiledcartdirectlytotheDecontaminationarea.Soiledcartsmustberestrictedtothesoiled

cartlift.

Clean Cart Lift: Ifaliftisusedforthemovementofcleancarts,thecleancartliftmustdeliverthecleancartdirectlytotheSurgerysuitesterilestoragespace.Cleancartsmustberestrictedtothecleancartlift.

Prep, Assembly, and Sterilization:Thisroompreps,assembles,andsterilizesequipmentandinstrumentation.Instrumentationarrivesthrough-wallwasher/sterilizersorsterilizers;other


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selecteditemsmayarriveviaawindowpass-through.TheroomdecantspreppedandpackedsterilizedinstrumentsintotheClean/SterileStorageRoom.Aspartofitsfunction,thePrep,Assembly,andSterilizationRoomhasanEtOSterilizer,usedfordevicesthatcannotwithstandsteamsterilizationduetotemperatureormoisture.

Clean/Sterile Storage: Thisroomcontainsanumberoffunctionsthatsupportthestagingandstorageofcleanandsterilesuppliesfordistributiontopointofservice.Thosefunctionalzonesinclude:

Case Cart Holding:ThisareaispositionedimmediatelyadjacenttothedeliverydoorfromPrep,Assembly,andSterilizationtofacilitatetheassemblyofcasecartswithspecificsterilepacksforcasecarts.

Equipment Storage and Testing: Thisarea,positionedtoreceivecleanedcartsandcleanedmedicalequipment,accommodatesthetestingandstorageofequipmentandthetemporaryqueuingofcarts.

Case Cart Area:ThisareastoresandstockscleansupplydedicatedforORuse.Thesesupplieshavebeenbrokenouttoaccommodatefinalstockingoncasecartsorotherdedicatedcartdeliverysystems.

Dispatch/Control:Theseworkstationsaccommodatestaffthatdirecttheflowofcasecartsandcleaned/testedequipmenttopointofuse.

Inaddition,thereareseveralroomsthathaveadirectrelationshiptoClean/SterileHoldingwithallofitsworkzones.Theseinclude:

Receiving and Breakout Room:Thisroomallowsforthearrivalofcleansuppliesandthebreakingoutofthosesuppliesfromshippingcartonsandboxes.PackingdebrisshouldberemovedwithoutenteringtheClean/SterileHoldingRoom.Spaceforinventorymanagementisprovidedinthisspace.

Bulk Storage:ThisroomallowsforthequeuingofthestorageReceivingandBreakoutRoompriortounpackingandstockingshelvingintheClean/SterileStorageRoom.

Staff Lockers: DedicatedlockersandatoiletareprovidedforstaffworkingwithinthePrep,Assembly,andSterilizationRoomandtheClean/SterileSupplyStorageArea.Thisdedicatedone-wayflowthroughlockerroomisdesignedtopromotethemaintenanceofthecleanenvironmentinbothmajorrooms.

Support Spaces: ThereareseveralfunctionsthatsupportthecoremissionoftheSPD.Theseinclude:

Staff Break Room/Conference Room: TheStaffBreakRoom/ConferenceRoomisdesignedtoservestaffworkingwiththeSPD.StaffusingthisBreakRoom/ConferenceRoommustreturntotheirrespectiveworksiteswithattentiontocleaningandgowningprotocolssuitableforeachkeyspace.


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Administrative Space:ThreeofficesareprovidedforSPDstaff.Theseofficesareaccessedfromthepubliccorridor.Asadministrativestaffmoveintospecificrooms,theymustdosothroughtherespectiveone-wayflow-throughlockers.


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Engineering Considerations

Mechanical (Heating, Ventilating, and Air Conditioning)

Anadequateheatingandventilatingandairconditioning(HVAC)systemisacriticalelementinplanningforSPDandrequirescarefulevaluation.Maintenanceofspaceairflowsandrelativeairpressurizationstocontaincontaminationandtomaintaincleanenvironmentsisacriticalaspectofthesystem.TheMechanicalEngineershouldcoordinatewiththeArchitectandequipmentspecialistsinordertoaccommodatesterilizingequipmentspecifiedfortheproject.AnyrequestfordeviationfromHVACdesigncriteriamustbeapprovedbytheVAandoccurnolaterthanthedesigndevelopmentstage.ThefollowingrepresentsthehighlightsofthemechanicalsystemdesignforSPD.RefertotheVAHVACDesignManualforadditionaldesignrequirements.

HVAC System: ThecleanportionsoftheSPDareamustbepositivelypressurizedwithrespecttoadjoiningareasandthedirtyportionsoftheSPDareamustbeundernegativepressurewithrespecttoadjoiningareas.WithintheSPD,thefollowingrelativeairpressurizationsforeachofthespaceslistedmustbemaintained.

1. SoiledReceivingandDecontaminationRoom NegativeAirPressure

2. Preparation,Assembly&SterilizationArea PositiveAirPressure3. EtOGasEnclosure NegativeAirPressure4. SteamSterilizerandEquipmentServiceAreas NegativeAirPressure5. PreparationandInspectionofSurgicalLinensandPacks PositiveAirPressure6. Clean/SterileStorage PositiveAirPressure

Separatededicatedexhaustsystemsshouldbeprovidedforthefollowingspaces;constant

volumeexhaustsystemsarerequired:

1. EtOSterilizers(separatededicatedexhaustsystemsfortheroomandthesterilizer).2. Automaticand/orManualEquipmentwasharea.3. GeneralExhaustofentireSPDSuite,includingsteamsterilizersequipmentareas.

Adedicated100%outsideairhandlingunitmustbeprovidedfortheentireSPDSuite.Theunitmustbeconstantvolume.Theunitshouldincludethenecessaryprimaryairheating,cooling,humidification,dehumidification,andfiltrationprovisions.

Sinceairisaverygoodcarrierofcontaminatingagents,airintheSoiledReceivingandDecontaminationunitshouldnevermixwithairinthePreparationandInspectionunit.Itis

imperativethatthesoiledareashaveanegativeairpressureandthecleanareashaveapositiveairpressure.

IndividualsupplyairterminalsshouldbeprovidedforindividualSPDareas.Supplyairterminalsshouldbeconstantvolumetypewithairflowvolumecontrolcapabilityandincludeareheatcoil.Individualareaexhaustairterminalswithairflowvolumecontrolcapabilityarenotmandatory,butshouldbeconsideredonanasneededpressurizationcontrolbasis.


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Reconditioningofthemedicalandsurgicalinstrumentsandutensilsisdependentuponthetemperatureandhumidity. TheSoiledReceivingandDecontaminationArea,andthePreparation,Assembly&SterilizationAreashouldhaveindividualroomtemperatureandhumiditycontrols.

Controls and Monitoring:

AllSuiteairsystemsaretooperatecontinuouslyinordertomaintainroompressurizationrelationships.

Provideroompressurizationmonitors,withalarms,atPreparationRoom(relativetotheDecontaminationRoom)andatClean/SterileStorageRoom(relativetothesurroundingcorridor)andatDecontaminationRoom(relativetothesurroundingcorridor).

EtOgasreleasemonitorsshouldbeplacedwithintheEtOSterilizerRoomandoutsideoftheEtOSterilizerRoominthePreparation/PackRoom,asawarningsystemforpotential

EtOleaks. Inaddition,eachoftheEtOexhaustsystemsshouldbemonitoredandalarmed.

Utilities

Equipment:Coordinateallutilitieswithspecifiedequipmentutilityrequirements.

SteamSterilizers EtOSterilizers HydrogenPeroxideSterilizers Washer/Decontaminator

CartWasher SonicCleaner ManualCleaningandWashStations

Floor Drains:

Decontamination Room:Locateinvicinityofwashstationsandequipmentloading/unloadingareas.Locatefloordrainsandslopefloortodraintopreventwaterfrompoolingonfloor.

Equipment Service Areas: Locateasrequiredforequipmentdrainageandprovidefunnelforindirectdrainageconnection.

Manual Equipment Wash Area: Afloordrainfortheareashouldhaveaminimum100mm(4inch)diameteroutlet,andbecoveredbyagridorstrainer.Locationofthedrainshouldbeatthecenteroftheroomwiththefloorslopingtowardthedrainatarateofnolessthan3mmper25mm(1/8inchperfoot),andnomorethan6mmper25mm(1/4inchperfoot).ThefloorsoutsidebothdoorsoftheManualEquipmentWashAreashouldslopebacktowardthedrain.


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Non-Patient Medical Air: TheuseofamedicalairsystemmeantforpatientcareinSPDisnotpermittedunderNFPA99.AnNFPA99CLevel3medicalairsystem,separatefromanypatientcaremedicalairsystem,shouldbeprovidedforSPD.

Electrical

FollowcriteriaasprescribedinPG-18-10,theElectricalandTelecommunicationsDesignManualforNewHospitals,ReplacementHospitals,AmbulatoryCare,ClinicalAdditions,EnergyCenters,andOutpatientClinics.

Lighting:Illuminationistypicallyprovidedutilizingrecessedfluorescentluminarieswithacrylicprismaticlensesinworkflowareas.Recessedfluorescentdirect/indirectluminairesmaybeusedintheadministrativeareastocontrolglareonmonitorscreens.Surfacemountedfluorescentfixturesmaybeprovidedforundercabinettasklightingandabovemirrorsinrestrooms.Attentionshouldbegiventoselectingfixtures,lamps,andcontrolsthatbestmeettheneedsoftheSPDstaff.ThefixturestypicallyuseF32T8lampsincompliancewiththe

EnergyPolicyAct(EPACT2005).Lampsshallhaveaminimumcolorrenderingindex(CRI)of70andacolortemperatureof3500degreesKelvin(K).Lightingistypicallycontrolledbywallmountedswitcheslocatedattheentrancetotheroom.Largerspacesmayutilizemultipleswitchingbyseparateswitchesforilluminatingaselectedareaormultilevellampingcontrol.Theuseofoccupancysensorsisrecommendedforadministrativeareas,restrooms,showerrooms,andlockerroomstohelpreduceenergyconsumption

UselightfixturesratedforwetlocationsinareasspecifiedontheGuidePlates.

Lightingloaddensitiesshouldbeverifiedfortheactualdesign,astheymayvarydependingontheroomconfiguration,fixturetypes,lampsandballastsused.

Serveselectedlightfixturesfromtheemergencyelectricalpowersystemtoallowforcontinuedoperationduringapoweroutage.Forfacilitiesthatdonotrequireemergencygenerators,provideselectedlightfixtureswithbatteryballast.

Power: GeneralpurposeduplexreceptaclesaretypicallyprovidedoneachwallinadministrativeareasandwherepowerisrequiredforgivenareasofSPD.Multipleoutletassemblies(plugmold)shallbeprovidedinEquipmentTestingandStorageandareasthatperformequipmenttestingandbatterycharging.Dedicatedduplexorspecialreceptaclesareprovidedforselectedpiecesofequipment.Workstationswithpersonalcomputers(PC's)aretypicallyprovidedwithquadruplexreceptaclesforthePC,monitorandprinter.Junctionboxesareprovidedforequipmentrequiringahardwiredconnection.

Emergency Power:SinceventilationandadequatetemperatureareintegralinthefunctionofSPD,thefollowingmechanicalsystemsmustbeconnectedtoemergencypowersystemandmustremainoperationalduringpoweroutages:SupplyAirSystem,GeneralExhaustSystem,WashAreaExhaustSystem,EtOSterilizerExhaustSystem,EtOGasReleaseMonitors,SteamSterilizers,andallDDCcontrolsforthesesystems.Additionally,thechilledwatersystemservingtheSPDSupplyAirSystemmustbeconnectedtotheemergencypowersystem.Allsterilizationequipmentisrecommendedtobeconnectedtotheemergencyelectricalpowersystemifpossible.Steamsterilizersmustbeconnectedtotheemergencypowersystem.The


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emergencyelectricalpowersystemshouldbereviewedtodetermineifsufficientcapacityisavailableforconnectionofallothersterilizersandotherSPDequipment.

Communications/Special Systems

FollowcriteriaasprescribedinPG-18-10,ElectricalandTelecommunicationsDesignManualforcommunicationsandspecialsystems.

Telephone: OutletsaretypicallyprovidedinadministrativeareasandinproximitytoworkstationsatselectedlocationswithintheSPDworkareas

Automatic Data Processing (ADP): Computeroutletsaretypicallyprovidedateachworkstationwithapersonalcomputer(PC)and/oraprinter.

Intercom:AninterdepartmentalintercomsystemshouldbeprovidedtoallowcommunicationbetweenthevariousdepartmentswithintheSPDarea.Intercomstationsshouldbeplacedin

theSoiledReceivingandDecontaminationArea;Preparation,Assembly,andSterilizationArea;andDispatchArea.ExactlocationsandquantitiesofintercomstationsshouldbecoordinatedwiththeChiefofSPD.

Public Address: Thedepartmentshouldbeincludedaspartofthehospital-widePAsystem.Thepublicaddresssystemistypicallypartofthetelephonesystemandinstallationshallbecoordinatedaccordingly.SpeakersshallbelocatedinselectedareasasdeterminednecessarybytheSPDstaff.

Life Safety and Fire Protection

AsstatedintheVAFireProtectionDesignManual,thePublicBuildingsAmendmentAct(PL

100-678)requiresallFederalagenciestofollowthelatesteditionsofnationallyrecognizedfireandlifesafetycodes.VAhasadoptedtheNationalFireCodes(NFC),exceptNFPA5000,publishedbytheNationalFireProtectionAssociation(NFPA).LifesafetyrequirementsarespecificallyaddressedintheLifeSafetyCode,NFPA101.FireprotectionfeaturesnotaddressedbytheNFCshouldbedesignedtocomplywithrequirementsofthelatesteditionoftheInternationalBuildingCode(IBC).ForguidanceoncompliancewithotherCodesandStandards,refertoPG-18-3DesignandConstructionProcedures,Topic1.


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Concerns Specific to Supply, Processing &Distribution

Equipment: EquipmentmaybepurchasedbyeithertheVA(Owner)orthecontractorandinstalledbythecontractor(CC),orpurchasedbytheVA(Owner)andinstalledbytheVAortheVendor(VV). Ifpurchasedbythecontractor,specificationsmustbeclearlywritten.

TheChiefofSPDoperationsateachVAmedicalcenterisknowledgeableaboutequipmentstylesandtypesthatbestmeettheneedsofthefacility,andshouldguidetheselectionofequipment. IfpurchasingequipmentnotlistedinGSAcatalogs,specificationsmustbesufficientlydetailedtoassurequalityacquisition.

Theselectionofequipmentshouldbefullycoordinatedwiththefacilitysdesigninorderthatutilityandspacerequirementsareconsideredduringdesigndevelopment.Itisimperativethat

allpowerandwaterresourcesbefullyaccommodated,andthatthemechanicalandventilationsystemsaredesignedtoberesponsivetoheatloadscreatedbyspecificequipment.Thus,thespecificchoiceofequipmentmustbeestablishedearlyontopromoteaconsistentandcoordinatedplan.Carefulattentionmustbegiventothelocationandcapacityofelectricoutlets,waterandsteamsupply,drains,vacuum,exhaustductsandotherutilities,toinsurecapacityandcompatibilitywiththeequipmenttobeinstalled.UtilitiesandtheirlocationsareshownontheGuidePlatesandarenotprojectspecific.Itistheresponsibilityofthepersonselectingtheequipmentandtheprojectdesignerstodeterminetheadequacyofutilitiesineachspace.

Sanitation Equipment:Frequentandthoroughcleaningofshelvesandroomsurfacesisessentialtopreventbuildupofdustandunwantedparticleswhichmaycontaminatemedicalandsurgicalsupplies.

Roomwallsaremanuallyscrubbedwitheitheradetergentand/ordisinfectant.Thus,tofacilitatecleaning,wallsaretypicallyspecifiedwithawashablesurface.FloorsintheSoiledReceivingandDecontaminationroommaybedampmoppedorcleanedwithanelectricfloorscrubber.IntheSterile/Non-SterileStorageRoom;however,cleaningwithadampmopwillsuffice.Generally,storageshelvesintheSterile/Non-SterileStorageRoomarekept200to250mm(8to10inches)abovethefloortofacilitatecleaning.

Ultrasonic Cleaners: Ultrasoniccleanersareoftenusedasaninitialstepintheprocessofcleaningsurgicalinstruments.Ultrasoniccleanersareamechanicalsystemthatusessoundwavesalongwithwateranddetergenttoremovesoilfrominstruments.Bothtabletopandfloorunitsareavailable.Full-sizeultrasoniccleanerisneededandrequiredTabletopunitscanalsobepurchasedspecificallyforcleaningdelicateinstrumentswithlonglumens.Floorunitsare

designedtoaccommodatelargequantitiesofinstrumentsatonetimeandcanhaveeithersingleordoublechambers.

Washer/Disinfectors: Followingtheultrasoniccleaningprocess,instrumentsareplacedintowasher/disinfectors.InstrumentsandtraysareloadedintotheunitontheDecontaminationsideofSPD,andremoveduponcompletionofthecycleonthePrep/PacksideofSPD.Washer/Disinfectorsareheatedbyeitherelectricorsteam.Automationsystemsforloadingandunloadingwasher/disinfectorsarehighlyrecommendedfordepartmentsthatprocesslarge


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volumesofinstruments.Washer/disinfectorsaretypicallyrecessedbetweentheDecontaminationareaandthePrep/PackareaofSPD.

Scope Washers: Thesefreestandingmechanicalwashersareusedtoeffectivelyprocess

flexiblescopeswithlumenssuchasendoscopesorcolonoscopes.Somewashersareequippedwithacyclethatprovidesafinalhigh-leveldisinfectionflush.ThesewillalsobeintheDecontaminationArea.

Drying Cabinets: Thesefreestandingcabinetsareusedtodryequipmenteitheronracksorhooks.Dryingcabinetsaredesignedtohaveaconstantairflowandvariabletemperaturesettings.Therearesingledoorandpass-thrudoorunitsavailable.

Steam Gun: Steamgunsarepoweredbysteamandaretypicallyusedtocleancartsandothermovableequipmentthatcanwithstandwaterandsteamtemperaturesupto270degreesFahrenheit.Asteamgunshouldalwaysbeusedinadedicatedequipmentwashroomwithnon-slipflooringandafloordrain.

Automatic Endoscope Reprocessors (AER): Mechanicalunitstowashanddisinfectimmersibleendoscopes,theseunitswillhavewaterhookupsanddrains.TheseunitsuseanFDA-approvedhigh-leveldisinfectionsolutiontodisinfectthesemi-criticalscopesaftercleaningthatdonotrequiresterilizationforuse.TheseunitswillalsobeintheDecontaminationArea.

Sterilizers

Steam:Steamsterilizersareusedtosterilizesurgicalinstrumentsandequipmentthatcanwithstandatemperatureof270degreesFahrenheit.Sterilizersareavailableinbothcart-loadingandfloor-loadingmodels.Singledoororpass-thruunitscanbeuseddependingonthedepartmentworkflow. Steamsterilizerscanbeeitherfreestandingorrecessed.

Ethylene Oxide:EthyleneOxide(EtO)sterilizersareusedtosterilizeitemsthatcannotwithstandhightemperaturesterilization.Theyaredesignedwithbothasterilizationcycleof130degreesFahrenheit,andanaerationcycle.ItemsshouldneverberemovedfromanEtOsterilizeruntilanaerationcycleiscomplete.EtOSterilizersaregenerallysmallandcanbeloadedbycartorbyhand.AseparateroomshouldbededicatedforEthyleneOxidesterilizersandnootheractivityshouldoccurintheroomexcepttoloadandunloadtheunits.EthyleneOxideisacarcinogenicgasthatcancausedifficultybreathing,dizziness,andconvulsions.ContactwithliquidEtOcancausesevereskinburns.EtOsterilizerscanbeeitherfreestandingorrecessed.AdedicatedexhaustsystemisrequiredforEthyleneOxide.ConsulttheVAHVACDesignManualforEtOexhaustsystemdesignrequirements.

Gas Plasma:Gasplasmasterilizationuseshydrogenperoxidetosterilizeinstrumentsandequipmentthatcannotwithstandhightemperaturesterilization.Thesesterilizersarepoweredbyelectricandareeitherfloororcountermounted.Therearenoplumbingorsteamrequirements,sothesterilizerscanbeeasilyrelocated.

Scope Sterilizer:Scopesterilizersusealiquidchemicaltosterilizeimmersiblescopesthatcannotwithstandhightemperaturesterilization.Thesesterilizersrequireelectricandplumbing.Unitscanbeeithermobileorcountermounted.


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Section 3

Functional Diagrams

Page

Net and Departmental GrossArea..3-1

Functional Relationship Diagram.3-2

Work Flow RelationshipDiagram.....................3-3

Material Flow RelationshipDiagram.....................3-4

Personnel CirculationRelationship Diagram3-5

Air Flow Relationship Diagram........3-6

FUNCTIONAL DIAGRAMS CONTENTS SECTION 3

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FUNCTIONAL DIAGRAMS CONTENTS SECTION 3

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Net and Departmental Gross Area

Net Area (Net Square Feet, NSF; or Net Square Meters, NSM) is the actual floor area in a roomor functional area (finish to finish) that can be used by people, furnishings, or equipment.Department Gross Square Feet (DGSF) includes, in addition to the Net Area, partitions andcirculation internal to the functional area of the department. The net to department gross factor(NTDG factor) adopted by VA for SPD is 1.30. The 1.30 factor anticipates that the internalcirculation must be added to connect functional areas and individual rooms.

FUNCTIONAL DIAGRAMS SECTION 3-1

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Functional Relationship Diagram


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Relationship Diagram

Work Flow


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Material Flow


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Personnel Circulation


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Air Flow

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