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Evidence-Based Design Impacts Patient Bathroom Construction: Part II of II Infection Control vs. Aesthetics

As more studies are published, evidence-based design (EBD) has become standard practice for hospital builders and designers. It‘s now accepted that hospital room design can impact a patient’s recovery. According to the Centers for Disease Control and Prevention, healthcare-associated infections (HAIs) account for an estimated 1.7 million infections and 99,000 associated deaths each year. These infections add an estimated $5 billion to the nation's annual healthcare bill.¹

There are a number of ways design can aid in the prevention of HAI’s. The hospital room bathroom, a critical area when it comes to infection control, is a perfect example. Hospital bathroom surfaces must be durable and easy to clean and maintain. Features such as doorframes, casework, and finish transitions must be carefully detailed to avoid hard to clean crevices and joints. ²

The challenge faced by hospital designers and builders is how to optimize infection control while maintaining an aesthetically pleasing environment for the patient. Patients and families want a hospital room that looks like their bedroom at home or a nice hotel. There is also evidence suggesting that patients can recover faster in this kind of “healing environment.”³

New anti-microbial products are quickly becoming standard within hospital design. One such product is tile that has anti-microbial properties. This is possible through the use of nanotechnology that allows titanium dioxide to be applied to the tile surface. The titanium dioxide works as a photo catalyst to kill bacteria and fungus – a perfect application for today’s hospital bathrooms.

Solid surface material is also a good choice for hospitals because it is easy to clean and does not promote the growth of bacteria. There are new manufacturing technologies and equipment that allow the solid surface counter tops to be made in various shapes without seams that can present cleaning challenges. Many manufacturers of tile and solid surface counters offer products that have the look and feel of stone or wood, allowing designers to create a better healing environment.

At Eggrock we can incorporate these elements into custom designed bathroom pods that exceed the high standards required of hospital bathrooms. Factory built units have the advantage of seamless construction, free of crevices where dirt and bacteria can collect. The result is a bathroom with natural finishes that offers a soothing environment while maintaining a high standard of quality and durability. Proof that form and function can coexist.

11. Ron Connovich, “Designing for Infection Prevention”, Healthcare Design, November, 1, 2009

2. Robert F. Carr, Whole Building Design Guide. 
NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM)
Revised by the WBDG

3. Steve Gressel and Kelly Hilands, “New Hospital Designs Focus On Reducing Cost, Improving Health And Flexibility”, Building Operating Management, September 2008

Evidence-Based Design Impacts Patient Bathroom Construction: Part I of II Same-Handed Design

Results emerging from more than 1,500 studies have shown the importance of hospital room design in reducing medical errors, infections and falls, as well as patient stress.1 As a result, today's leading architects and design professionals are incorporating principles of "evidence-based design" (EBD) to reduce anxiety and assist healing across a wide variety of health care applications.2

EBD covers a number of areas from room orientation to wall color. The most controversial aspect of EBD is same-handed room design where room orientation is identical throughout a hospital wing or department. The benefit to this is medical staff don't have to hesitate when entering a patient's room during an emergency because all equipment, medication, bathrooms, etc. are always in the same location ultimately reducing the risk of error.

However, this design comes with an increased cost. Instead of sharing plumbing between two toilet rooms, as in mirrored image design, same-handed bathrooms require plumbing for each toilet room. At $3,000-$5,000 per room, this cost can add up to as much as $500,000 for a 100-bed hospital.3 While an argument can be made that reducing staff errors justifies the added expense, not enough evidence exists to convince some hospital developers to incur the extra costs.

There are many factors involved when choosing between mirrored image or same-handed design for your next hospital project. Medical staff processes, current research and overall cost must all be considered. Whichever design you choose, Eggrock can help because we understand the engineering, architecture and construction issues associated with building hospital bathrooms and can value-engineer a solution that meets your needs.

We see a lot of plans for new hospitals and can often share learning from one project to the next. Designing patient rooms to be same-handed may require some extra plumbing. However, by using bathroom pods that are produced in a factory setting you may be able to leverage savings to make this a cost-neutral proposition as compared to the standard mirrored image design. In addition, the bathroom design can be value-engineered in a manner that cannot be accomplished with site built construction.

Not all same-handed bathroom designs require additional plumbing. The picture shown illustrates one way to execute a same-handed design with a shared plumbing chase. Like all choices, there are compromises and, in this case, the same-handed design results in a nested room design that has pro's and con's of its own.

1. "Health Outcomes Driving New Hospital Design," New York Times, 18 May, 2009, Carol Ann Campbell
2. Ulrich, Roger, Ph.D., et al. "The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity." Sept. 2004. Report to The Center for Health Design for the Designing the 21st Century Hospital Project. This project was funded by the Robert Wood Johnson Foundation.
3. "Inboard, Outboard, or Nested?" Healthcare Design, 1, March, 2009, Camie Maze, AIA, LEED, AP. See http://www.tka-architects.com/content.html

Factory Based Construction Reduces Landfill Waste

The US generated 143.5 million tons of construction waste in 2008 but only 28% was reused, recycled, or sent to waste-to-energy facilities[1]. Construction and demolition debris is estimated to be up to 30% of total U.S. landfill waste.[2] As developers and contractors recognize the value environmentally sound construction practices can add to their business, a growing number are making efforts to reduce construction waste sent to landfills. In fact, a new study published by McGraw Hill Construction found that 61% of contractors consider sustainable waste management the second most important aspect of green building, behind energy efficiency. The biggest drivers of this trend are client demand, government regulations, and competitive advantage.[3]

At Eggrock, we have been able to reduce waste by 90% using factory based construction methods. Eggrock bathrooms are built in a factory where the design and assembly processes are tightly controlled. For example, designing bathrooms using CAD tools allows us to optimize placement and usage of materials prior to production and has reduced the amount of gypsum we use by 30% and ceramic tile by 10%. I recall one Marriott hotel project where 3,000 cut tiles were saved by changing the bathroom dimension by just 1”.

In addition to designing out waste from the start, factory production optimizes the management of the entire waste stream. Virtually all of our construction waste is recycled including gypsum, cardboard, and plastic. We established a single-stream recycling program eliminating the need to sort waste materials in our plant, making it easier for factory personnel to recycle. We also use an innovative gypsum recycling company that converts our gypsum waste into a powder, which is then re-used to make new gypsum board.

Bathroom construction generates heavy waste that is expensive to recycle and can harm the environment. Gypsum, tile, mortar, glass and metal are common components of the bathroom construction waste stream. From our experience building thousands of bathrooms, we have found that site-building a typical bathroom can generate over 700 pounds of waste. For a 150 bathroom project, the site waste is 87,500 pounds or 700 cubic yards of landfill waste.[4] A developer who purchases pre-built bathroom pods can eliminate the cost of waste removal, improve their competitive advantage, and have a positive impact on the future of our environment.

Take a look at our recycling video on YouTube.

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[1] Waste Market Overview & Outlook 2009, Waste Business Journal, San Diego, CA, www.wastebusinessjournal.com.

[2] Green Development and Construction: A sustainable building program, Illinois Sustainable Technology Center,www.istc.illinois.edu/tech/green_development.cfm

[3] Sustainable Construction Waste Management: Creating Value in the Built Environment, Smart Market Report, McGraw Hill Construction, Nov 10, 2009, http://construction.ecnext.com/coms2/analytics.

[4] Waste Management at the Construction Site, Laquatra and Pierce, Cornell University, 2004

Bakery Square Development in Pittsburgh Uses Bathroom Pods to Streamline Construction

Eggrock completed shipments of 220 bathroom pods for Concord Hospitality’s new Marriott SpringHill in Pittsburgh, PA. Concord Hospitality is one of the most respected names in the hotel development business and manages over 6,000 guest rooms in 11 states and two Canadian provinces. This project will become an exciting lifestyle center environment in an affluent and densely populated location. The property blends historic architecture with new construction.

Tim Osiecki, Executive Vice President of Concord, said, “I am absolutely thrilled with your product. Your fit and finish and overall attention to detail is outstanding! This quality simply cannot be achieved in the field on a consistent basis - if ever. It’s a real pleasure working with true professionals that have a passion for what they do.”

Tough Times Call for Creative Construction Solutions

All of Eggrock’s customers are experiencing a much tougher funding environment in which to get their projects off the ground. The irony is that these times can be a good opportunity to build a hotel because construction costs are more competitive.

Today we are seeing our customers providing much higher levels of equity than ever before. We recently had a customer that was forced to provide over 60% equity on their project. Eggrock can’t help you get your project financed but we certainly can help get your equity producing revenue much faster. Using Eggrock bathrooms can reduce schedule by two months which translates into less general conditions, interest expense, and faster “heads on beds.”

Workmanship quality is even more important during these times as hotel operators compete for fewer customers. Most hotel bathrooms are, quite frankly, poorly constructed. We constantly receive photos from friends and colleagues of hotel bathrooms they experience while they travel. Most of them include a note saying, “They should have used Eggrock!”