Las interacciones sociales a propósito de las tareas

The UK NHS building stock can be broken down at three different levels. The organisational level which covers the different types of NHS Trusts, i.e. Acute – large, Acute – teaching, Primary care, ambulance etc. (HSCIC, 2013). The site level, in which the typical hospital site consists of a multiplicity of buildings each of differing age,

19

use, construction and layout (Adderley, 1989). Then the hospital building level, which includes the different spaces inside a typical hospital building.

The NHS uses a software tool called the activity database (ADB) for briefing and designing their healthcare environments. It includes information on, activities, personnel, recommended size, engineering requirements (i.e. thermal comfort), schedule of equipment, and graphical room layout (Department of Health, 2012). In a recent study the ADB was used to define the categories of spaces within hospitals (Short & Al-maiyah, 2009). The paper mentioned that a typical hospital will have between five and ten room types, but it chose to focus on six. These six were, Waiting area, Patient single bedroom, Examination room, Treatment room, Imaging room and Operating Theatre. Another source, Hospitals - Design and Development (James & Tatton-Brown, 1986) specifies five areas into which the hospital can be divided.

1. Nursing Area – patients stay and are looked after, in temperate climates the spaces are often naturally ventilated.

2. Clinical – diagnostic and treatment facilities, often artificially ventilated and associated with technical equipment required for procedures on patients.

3. Support Zone – kitchens, cafeteria, laundry boiler house, staff changing, stores, workshops and other industrial plants.

4. Offices – these are similar to general office buildings.

5. Teaching Facilities – these include lecture theatres and research facilities.

The ADB seems to focus more on the areas of the hospitals that patients come directly in contact with, i.e. the nursing and clinical areas spoken of by James & Tatton-Brown. In fact nursing areas, clinical and operational theatres are the areas which are most specific to hospital buildings, the others are found in other non-domestic buildings and there is an abundance of research on low carbon offices and schools. Wards are the centre of the hospital, canteens are there to provide food for people visiting or working on wards, most people who go into operating theatres end up in wards and the offices are essentially there to support the work which takes place on wards. Nevertheless, the weight of research conducted on hospital buildings is in the sphere of operating theatres, this fact is demonstrated, especially in the field of ventilation (Beggs et al., 2008).

It has been stated that “Wards are particularly worthy of study because they occupy a substantial fraction of the floor area of hospitals and thus there is great potential for replication of a low-energy and resilient design solution,” (Lomas & Ji, 2009). This

20

paper and Short & Al-maiyah, 2009, have paved the way for a number of other papers which have since been published on the impact building design has on hospital ward energy consumption and internal environmental conditions (Adamu et al., 2012; Lomas & Giridharan, 2012a, 2012b; Short et al., 2012). These studies will be discussed in detail further on in this review.

There are a number of different ward designs, each having their particular strengths and weakness from the occupant perspective. Three of these wards were described in a study, linking UK ward design to occupant satisfaction (Hurst, 2008). The first, Bay wards have been adopted in the past quarter century in the UK and are characterised by a central nurses station and peripheral rooms housing a small number of beds. The second, Nightingale wards, are the traditional design and the primary choice up until the 1950’s. They have large rooms where beds are placed along the edge and a centrally placed nursing station. Thirdly, Hub and Spoke designed wards have the nurses station centralised and surrounded by ward spaces. In these wards, the equipment is usually stationed in the nurses station which can lead to heat gains and hence the need for cooling. This pattern of overheating in nurse stations has been identified in various building types i.e. nucleus (Giridharan et al., 2013a) and tower (Lomas & Giridharan, 2012b).

There is a general emphasis to move from multi-bed wards to single bed rooms (Darzi, 2008). New wards are expected to include half of its beds as single rooms with the purpose of improving infection control, privacy and the overall quality of hospital stay. Most UK hospitals buildings have at least one single room for isolation however a study suggested that patients preferred multiple occupancy rooms. In 1982 it was found only 11% of people wanted to stay in single rooms due to missing the company offered in multi-bed spaces. However, it was also found that those who did stay in single occupancy rooms were more satisfied at the end of their stay than those in bay wards (Hurst, 2008).

A handful of studies have been conducted on isolation rooms with the weight of them focusing on their ventilation systems. What is particular about isolation rooms is their need to be negatively pressurised for infectious patients and positively pressurised for patients who are immune compromised (CDC, 2003). Negatively pressurised Isolation rooms are fitted with ventilation systems which extract air and provide the pressure differential between the isolated space and the surrounding rooms and corridors. This pressure differential and the air tightness of the space only allows air to leak inwards

21

preventing outward escape of airborne contamination (Tung et al., 2009). Cheong and Phua conducted an investigation into the most effective strategy for removing pollutants from isolation rooms. They used computational fluid dynamics (CFD) to model isolation rooms varying the positions of the supply and extract ducts. The results demonstrated, that the most effective method was to have clean supply air flow from the cleanest zone (near the health carer) into the contaminated zone (patient) with the extract grill located at low level near to infectious source (Cheong & Phua, 2006).

Operating theatres need to have very specific indoor environmental conditions (Balaras et al., 2007). As a consequence, many papers have been published documenting research on their particular indoor environmental needs, which have been reviewed in detail in a literature review on hospital thermal comfort (Khodakarami & Nasrollahi, 2012). In hospitals, priority is given to the internal environment of the patient over energy efficiency (Saidur et al., 2010) and there is the “viewpoint that

patients should have maximum comfort at all the necessary conditions ” (Congradac et

al., 2012).