Hospital design, construction, and renovation.
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Is the deregulatory thrust of this administration having an effect on hospital design and construction? does it threaten to create an expansion and construction free-for-all in the industry? A number of architects and construction industry professionals comment on what effect, if any, they expect deregulation to have on health care construction, as well as the expected effect of financing and management in an increasingly competitive environment.
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The Guidelines for Design and Construction of Hospitals and Health Care Facilities is the most widely referred to design document in the USA and is influential throughout the world. The Facility Guidelines Institute (FGI) was founded to provide continuity in the guidelines revision process. FGI functions as a contractual, fundraising, and coordinating entity to develop and enhance the content and format of guidelines publications and of ancillary services that encourage and improve their application and use. The Guidelines and the methodology for revising them have been, and still are, in an evolutionary process. It is the desire of the AIA/AAH and FGI to see that the process continues to change and improve with each passing cycle.
OBJECTIVE: This study aimed to report an outbreak of Aspergillus endophthalmitis after cataract extraction during hospital construction. DESIGN: The study design is a case series of an outbreak of Aspergillus endophthalmitis. PARTICIPANTS: Five patients in whom Aspergillus endophthalmitis developed during a period of hospital construction in Jeddah, Saudi Arabia, participated. Severe postoperative uveitis occurred in all five patients and failed to subside with topical steroid therapy. The patients were referred to the King Khaled Eye Specialist Hospital for treatment. The causative organism was identified as Aspergillus fumigatus in each case. INTERVENTION: All five patients were subjected to aqueous or vitreous tap. Three patients had vitrectomy. Patients were given systemic, periocular, and intravitreous antifungal agents. MAIN OUTCOME: The final outcome in each patient was evisceration or enucleation, despite an intensive course of antifungal therapy. RESULTS: There were five patients, three females and two males, ranging in age from 51 to 65 years. Postoperative signs of infection developed in the patients 4 to 15 days after surgery. In all five cases, cultures of aqueous or vitreous grew A. fumigatus. CONCLUSION: Aspergillus endophthalmitis is a serious and devastating complication of ocular surgery. The outbreak, herewith, may have been related to hospital construction. The infection can be prevented, notably, by proper maintenance of old, "sick" buildings and by following certain procedures during hospital construction.
This paper presents the design approach and solutions for two major teaching hospital projects in South East Asia. It outlines the projects and highlights special aspects. Emphasis is made on the need to design in the context of environment in Asia.
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