IUSS HEALTH FACILITY GUIDES Hospital Mortuary Services

IUSS HEALTH FACILITY GUIDES Hospital Mortuary Services Gazetted

30 June 2014 Task Team: B:05

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Date

Name

Template Discussion Draft 1 Discussion Draft 5 Discussion Draft 6 Development Draft 1 Development Draft 3.1 Proposal 1

January 2013 February 2013 March 2013 May 2013 August 2013 February 2014 March 2014

Tobias van Reenen Steve Fourie Steve Fourie Steve Fourie Tobias van Reenen Tobias van Reenen Ruweida Moorad Alida VonitaGrove Thompson Tobias van Reenen Peta Jeanine de Jager Vellema

Proposal 2 Editor Proposal 4 Proposal V4 Formatting Gazetted

March 2014 March 2014 May 2014 6 July 2014 30 June 2014

Jeanine Vellema Janine Smit Tobias van Reenen Sheldon Bole National Health no.61 of 2003)

INFORMATION

Act,2003(Act

NOTES

Form:

Health facility guides

Status:

Gazetted, 30 June 2014

Title:

Hospital Mortuary Services

Original Title:

Mortuary

Description: Reference:

CSIR 59C1119 B:05 - 001

Authors:

IUSS N and S task group B:05 National Department of Health, Provincial Departments of Health and Public Works

Stakeholders:

Accessing of these guides This publication is received by the National Department of Health (NDoH), IUSS Steering Committee Chairman, Dr Massoud Shaker and Acting Cluster Manager: Health Facilities and Infrastructure Management, Mr Ndinannyi Mphaphuli. Feedback is welcome. The CSIR and the NDoH retain the moral rights conferred upon them as author by section 20(1) of the Copyright Act, No. 98 of 1978, as amended. Use of text, figures or illustrations from this report in any future documentation, media reports, publications, competition entries and advertising or marketing material is solely at the discretion of the Health Infrastructure Norms Advisory Committee and should clearly reference the source. This publication may not be altered without the express permission of the Health Infrastructure Norms Advisory Committee. This document (or its updates) is available freely at www.iussonline.co.za or the forthcoming Department webportal. Application and development process These IUSS voluntary standard/ guidance documents have been prepared as national Guidelines, Norms and Standards by the National Department of Health for the benefit of all South Africans. They are for use by those involved in the procurement, design, management and commissioning of public healthcare infrastructure. It may also be useful information and reference to private sector healthcare providers. Use of the guidance in this documentation does not dissolve professional responsibilities of the implementing parties, and it remains incumbent on the relevant authorities and professionals to ensure that these are applied with due diligence, and where appropriate, deviations processes are exercised. The development process adopted by the IUSS team was to consolidate information from a range of sources including local and international literature, expert opinion, practice and expert group workshop/s into a first level discussion status document. This was then released for public comment through the project website, as well as national and provincial channels. Feedback and further development was consolidated into a second level development status document which again was released for comment and rigorous technical review. Further feedback was incorporated into proposal status documents and formally submitted to the National Department of Health. Once signed off, the documents have been gazetted, at which stage documents reach approved status. At all development stages documents may go through various drafts and will be assigned a version number and date. The National Department of Health will establish a Health Infrastructure Norms Advisory Committee, which will be responsible for the periodic review and formal update of documents and tools. Documents and tools should therefore always be retrieved from the website repository www.iussonline.co.za or Department webportal (forthcoming) to ensure that the latest version is being used. The guidelines are for public reference information and for application by Provincial Departments of Health in the planning and implementation of public sector health facilities. The approved guidelines will be applicable to the planning, design and implementation of all new public-sector building projects (including additions and alterations to existing facilities). Any deviations from the voluntary standards are to be motivated during the Infrastructure Delivery Management Systems (IDMS) gateway approval process. The guidelines should not be seen as necessitating the alteration and upgrading of any existing healthcare facilities Acknowledgements This publication has been funded by the NDoH. Acknowledgements also to Janine Smit the editor, Sheldon Bole, Claire du Trevou, Kumirai Tichaona and Mokete Mokete Content contributions were received by DoH Western Province, DoH Nothern Province and DoH Gauteng and the IUSS N&S task team B:05.

CONTENTS OVERVIEW ......................................................................................................................................... 5 COLOURS LEGEND............................................................................................................................... 6 PART A 1.

2.

POLICY AND SERVICE CONTEXT ........................................................................... 8

Legislation, policies and international guidance ............................................................................... 8 1.1.

LEGISLATIVE CONTEXT .................................................................................................................................... 8

1.2.

Further reference material and precedent ............................................................................................... 8

1.3.

INFECTION PREVENTION AND CONTROL LEGISLATION ................................................................. 9

1.4.

BUILDING LEGISLATION ................................................................................................................................... 9

1.5.

SOUTH AFRICAN BUILDING PRACTICE POLICY AND GUIDELINES ........................................... 10

1.6.

INTERNATIONAL DESIGN GUIDANCE ..................................................................................................... 10 Service Context .............................................................................................................................................11

PART B -

PLANNING AND DESIGN ......................................................................................... 12

1.

INTRODUCTION ............................................................................................................................................12

2.

LOCATION OF THE MORTUARY AND ACCESS ROUTES ...................................................................12

3.

FACILITY CAPACITY.....................................................................................................................................13

4.

SELECTING BODY-STORAGE SYSTEMS .................................................................................................14

5.

FACILITY LAYOUT ........................................................................................................................................15

6.

MORTUARY EQUIPMENT REQUIREMENTS .........................................................................................17

7.

MOVEMENT WITHIN A MORTUARY .......................................................................................................17

8.

SERVICES REQUIRED ...................................................................................................................................19

9.

BIOLOGICAL SAFETY ...................................................................................................................................19

10.

FINISHES TO FLOORS AND WALLS .........................................................................................................20

11.

AUTOPSY EQUIPMENT/FIXTURES .........................................................................................................20

12.

VENTILATION ................................................................................................................................................21

13.

AIR CONDITIONING .....................................................................................................................................22

14.

REFRIGERATION EQUIPMENT DESIGN AND INSTALLATION........................................................22

15.

SECURITY ARRANGEMENTS .....................................................................................................................22

PART C -

OPERATION................................................................................................................ 24

1.

OBJECTIVES ....................................................................................................................................................24

2.

HEALTH AND SAFETY .................................................................................................................................24

3.

MAINTENANCE ..............................................................................................................................................24

PART D - USER ROOM REQUIREMENTS .............................................................................. 26 1.

Example Room-requirement sheets .....................................................................................................26

PART E 1.

EXAMPLES AND CASE STUDIES ........................................................................... 29

Layout examples ...........................................................................................................................................29 INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT Health Facility Guides: Hospital Mortuary Services [Gazetted, 30 June 2014]

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1.1.

EXAMPLE 1: SMALL MORTUARY ATTACHED TO HOSPITAL ........................................................ 30

1.2.

EXAMPLE 2: LARGE MORTUARY WITH AUTOPSY FACILITIES .................................................... 31

1.3.

EXAMPLE 3: LARGE MORTUARY WITH AUTOPSY FACILITIES .................................................... 34

DEFINITIONS ................................................................................................................................... 35 BIBLIOGRAPHY .............................................................................................................................. 36

INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT Health Facility Guides: Hospital Mortuary Services [Gazetted, 30 June 2014]

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TABLE OF FIGURES Figure 1 Adjacency Diagram .......................................................................................................................................................... 16 Figure 2: Access and Movement in a mortuary....................................................................................................................... 18 Figure 3 Example 1: Layout ............................................................................................................................................................. 29 Figure 4 Example 1: Zoning & Access.......................................................................................................................................... 30 Figure 5 Example 2: Layout ............................................................................................................................................................. 32 Figure 6 Example 2: Zoning and Access ..................................................................................................................................... 33 Figure 7 Example 3: Layout ............................................................................................................................................................. 34


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TABLE OF TABLES Table 1: Service Requirements ...................................................................................................................................................... 11 Table 2: Example Accommodation schedule ........................................................................................................................... 26 Table 3: Room services sheet ..................................................................................................................................................... 27 Table 4: Room finishes ................................................................................................................................................................... 28


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OVERVIEW This document outlines the policy and service context and attempts to illustrate the desired planning principles and design considerations for mortuary services. • • • • •

Part A outlines the South African legislation, policies and international guidance reference documents and the service context with respect to mortuary services; Part B Planning and design; Part C operation; Part D user room requirements; and Part E provides case studies.

Parts D and E are intended to demonstrate how the principles prescribed in Part A, B, and C can be applied in worked examples. Part D, if used directly, is deemed to satisfy the principles developed in Part B, but are not the only acceptable solutions. Case studies (Part E) provide illustrative worked solutions and should not be adopted without appropriate contextual adaptation. While this document outlines design requirements and acceptance criteria which have an impact on clinical services, these requirements are prescribed within the framework of the entire IUSS set of guidance documents and cannot be viewed in isolation. The following documents should be complied with, together with this document: • • • • •

IUSS: Regulations IUSS: Project Planning and Briefing IUSS: Environment and Sustainability IUSS: Hospital Design Principles IUSS: Infection Prevention and Control


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The following table identifies additional IUSS guideline documents which are recommended for reading in conjunction with this guideline. TABLE 1 : IUSS:GNS REFERENCE DOCUMENTS

Adult Inpatient Services

x

Clinical and Specialised Diagnostic Laboratory Guidelines Mental Health

x

Adult Critical Care

Emergency Centres

Maternity Care Facilities Adult Oncology Facilities Outpatient Facilities

x

Paediatrics and Neonatal Facilities Pharmacy Primary Health Care Facilities Diagnostic Radiology Adult Physical Rehabilitation Adult Post-acute Services Facilities for Surgical Procedures TB Services

Administration and Related Services General Hospital Support Services

Catering Services for Hospitals Laundry and Linen Department Hospital Mortuary Services Nursing Education Institutions Health Facility Residential Central Sterile Service Department Training and Resource Centre Waste Disposal

Generic Room Requirements x

x

x

Cost Guidelines

x

Future Healthcare Environments

x x

x

Space Guidelines

Environment and Sustainability Materials and Finishes

Essential Integrated infrastructure planning Briefing Manual

Hospital Design Principles

Building Engineering Services

&

Procurement

Commissioning Health Facilities

x

Healthcare Technology

Maintenance

x

Inclusive Environments

Decommissioning

x

Infection Prevention and Control Information Technology and Infrastructure Regulations

Recommended

PROCUREMENT OPERATION Recommended

HEALTHCARE ENVIRONMENT/ CROSSCUTTING ISSUES Essential

Recommended

Essential

Recommended

SUPPORT SERVICES

Essential

CLINICAL SERVICES

x

x

Capacity Development

x

Colours Legend Consultants Administrators Related documents


6

Abbreviations ACH ASHRAE

Air changes per hour American Society of Heating, Refrigerating, and Air-Conditioning Engineers

BMS BSL CDC

Building Management System Biological safety level Centers for Disease Control (USA)

CSIR

Council for Scientific and Industrial Research

FD FPS HVAC HBA HCS HEPA

Floor drain Forensic Pathology Service Heating Ventilation Air Conditioning Hazardous biological agents Hazardous chemical substances High efficiency particulate air filters

IPC

Infection prevention and control

ISO

International Standards Organisation

MDR TB

Multi-drug resistant TB

NDoH NBR

National Department of Health National Building Regulations

NHS NIOSH

National Health Service (UK health service) National Institute of Occupational Safety and Health (US agency)

O&M OHS OQ PGWCDoH PPE PQ RDS

Operating and Maintenance (manual) Occupational health and safety Operational qualification Provincial Government Western Cape Department of Health Personal protective equipment Performance qualification Room data sheets

RH

Relative humidity

SABS SAO SAPS SI SOP SS

South African Bureau of Standards Senior Administrative Officer South African Police Service Le Système International d’Unités Standard Operating Procedures Stainless steel

TB

Tuberculosis

WC WHB

Toilet Wash-hand basin

WHO XDR TB

World Health Organisation Extensively drug-resistant TB


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PART A - POLICY AND SERVICE CONTEXT 1. Legislation, policies and international guidance 1.1. LEGISLATIVE CONTEXT The following documents, as amended (though not an exhaustive list) pertain and contain an additional resource of information which would supplement and provide the basis of a design brief. A finer sense of standard operating procedures and legislative context is likely to inform and enhance the design process, so the professional teams are encouraged to use these as an additional resource: • • •

• • • • • • • • • • •

•

•

Births and Deaths Registration Act 1992. (c.51). Cape Town South Africa: Government Gazette. Criminal Procedure Act 1977. (c.51). Cape Town South Africa: Government Gazette. Department of Environmental Affairs and Development Planning Western Cape Province, 2004. Western Cape health care waste management draft bill. (P.N. 255/2004). Province of Western Cape South Africa: Provincial Gazette. Department of Health (DoH), 2013. Regulations relating to the management of human remains. (Government notice No. R. 363 of the National Health Act, 2003. (c.61). South Africa: DoH. Department of Public Works, 2005. Space planning norms and standards for office accommodation used by organs of state. (Government notice 1665). Cape Town South Africa: Government Gazette. Health Professions Act 1974. (c.56). Cape Town South Africa: Government Gazette. Inquests Act 1959. (c.58). Cape Town South Africa: Government Gazette. Municipal By-laws, as applicable National Archives of South Africa Act 1996. (c.42). Cape Town South Africa: Government Gazette. National Code of Guidelines for Forensic Pathology Practice in South Africa, 20 Aug 2007 National Environmental Management: Waste Act 2008. (c.59). Cape Town South Africa: Government Gazette. National Health Act 2003. (c.61). Cape Town South Africa: Government Gazette. Standard Operating Procedures, Forensic Pathology Service, PGWC DoH, 2006 U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention and National Institutes of Health, 2007. Biosafety in microbiological and biomedical laboratories. (Fifth Edition).. Atlanta Georgia USA: U.S. Department of Health and Human Services. University of Pretoria (UP) in partnership with Southern African Legal Information Institute (SAFLII), 2012. Regulations relating to the registration of microbiological laboratories and the acquisition, importation, handling, maintenance and supply of human pathogens. (Government notice No. R. 178 of the National Health Act, 2003. (c.61). Cape Town South Africa: Government Gazette. University of Pretoria (UP) in partnership with Southern African Legal Information Institute (SAFLII), 2007. Regulations regarding the rendering of forensic pathology service. (Government notice No. R.636 of the National Health Act, 2003. (c.61). Cape Town South Africa: Government Gazette.

1.2. Further reference material and precedent •

Australasian Health Infrastructure Alliance (AHIA), 2007. Australasian health facility guidelines: Part B: Health facility briefing and planning. [online] New South Wales: AHIA. Available at: http://www.healthfacilityguidelines.com.au/Lists/Guidelines%20Parts/AllItems.aspx [Accessed 4 March 2014]. INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT Health Facility Guides: Hospital Mortuary Services [Gazetted, 30 June 2014]

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• • • • •

Department of Public Works (DPW), 1998. Fire security: A guide for architects. (Ref: F.P.O./G.61/3E). South Africa: DPW. Department of Public Works (DPW), 1998. Standard specification for air-conditioning and ventilation installations. (PW 327). South Africa: DPW. Department of Public Works (DPW), 2004. Standard electrical specifications. (PW 354). South Africa: DPW. NHS Estates, 2001. Health Building Note (HBN) 20: Facilities for mortuary and post-mortem room services. Norwich England: The Stationary Office (TSO). South African Bureau of Standards (SABS), 2013. CKS 336:2013 Mortuary trolleys. Pretoria South Africa: SABS Standards Division.

1.3. INFECTION PREVENTION AND CONTROL LEGISLATION The National Infection Prevention and Control Policy and Strategy document makes specific reference to certain Acts and their relevant regulations, which bear relevance to the development and implementation of these health facility guidelines. These are: • •

•

• • •

Constitution of the Republic of South Africa, 1996. s.2,24,27,36&39. Department of Health, 2003. Regulations relating to the application of the hazard analysis and critical control point system (HACCP system). (Government notice No. R. 908 of the Foodstuffs, Cosmetics and Disinfectant Act, 1972. (c.54)). Cape Town South Africa: Government Gazette. Department of Labour, 2001. Regulations for hazardous biological agents. (Government notice No. R. 1390 of the Occupational Health and Safety Act, 1993. s.43). Pretoria South Africa: Government Gazette. The Environmental Conservation Act 1989. (c.73). Cape Town South Africa: Government Gazette. The Foodstuffs, Cosmetic and Disinfectants Act 1972. (c.45). Cape Town South Africa: Government Gazette. The Occupational Health and Safety Act 1993. s.8(1). Cape Town South Africa: Government Gazette.

1.4. BUILDING LEGISLATION The following legislation and regulations impact and provide guidance on the provision and design of health care facilities as above: •

Building Regulations and Building Standards Act 1977. (c.103). Cape Town South Africa:

Government Gazette. •

Promotion of Equality and Prevention of Unfair Discrimination Act, 2000. (c. 4). Cape Town South

Africa: Government Gazette. • • • • •

•

South African Bureau of Standards (SABS), 1986. SABS 1200 A-1986 Standardized specification for civil engineering construction. Pretoria South Africa: SABS Standards Division. South African Bureau of Standards (SABS), 1992. SABS 0100-1 The structural use of concrete Part 1: Design. Pretoria South Africa: SABS Standards Division. South African Bureau of Standards (SABS), 1992. SABS 0100-2 The structural use of concrete Part 2: Materials and execution of work. Pretoria South Africa: SABS Standards Division. South African Bureau of Standards (SABS), 1993. SABS 0160 General procedures and loadings adopted in the design of buildings. Pretoria South Africa: SABS Standards Division. South African Bureau of Standards (SABS), 2010. SANS 10400-A: 2010 The application of the national building regulations Part A: General principles and requirements. Pretoria South Africa: SABS Standards Division. The National Environmental Management Act 1998. (c.107). Cape Town South Africa:

Government Gazette.


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1.5. SOUTH AFRICAN BUILDING PRACTICE POLICY AND GUIDELINES •

•

Department of Health (DoH), 1980. Regulations governing private hospitals and unattached operating theatres. (Government notice No. R.158 of the Health Act, 1971. (C.63). Cape Town South Africa: Government Gazette. The South African Pharmacy Council, 2004. Good pharmacy practice. (Board notice 129). Cape Town South Africa: Government Gazette.

1.6. INTERNATIONAL DESIGN GUIDANCE •

• • •

• • •

• •

•

American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), 1999. ANSI/ASHRAE standard 52.2-1999 Method of testing general ventilation air cleaning devices for removal efficiency by particle size. Atlanta USA: ASHRAE. American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), 1989. ASHRAE standard 62 Ventilation for acceptable indoor air quality. Atlanta USA: ASHRAE. American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), 2003. HVAC design manual for hospitals and clinics. Atlanta USA: ASHRAE. American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), 2009. ANSI/ASHRAE/ASHE standard 170-2008 ventilation of health care facilities. Atlanta USA: ASHRAE. Chartered Institution of Building Services Engineers (CIBSE), 1997. CIBSE applications manual AM10 natural ventilation in non-domestic buildings. London: CIBSE. Chartered Institution of Building Services Engineers (CIBSE), 2000. CIBSE applications manual AM13 mixed mode ventilation. London: CIBSE. Department of Health and Human Services (Center for Disease Control and Prevention), 2003. Environmental control for tuberculosis: Basic upper-room ultraviolet germicidal irradiation guidelines for healthcare setting. USA: DHHS. QASA. “Know Your Rights” [Accessibility & the Built Environment] World Health Organisation (WHO), 2009. WHO policy on TB infection control in health-care facilities, congregate settings and households.Geneva Switzerland: WHO. Guidance has also been provided by AIA (USA), NHS (UK), and Australian Health Facility Guidelines on Healthcare Building Design. Additional references can be sourced from www.tb-ipcp.co.za


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2. Service Context The following table gives an indication of the service requirements for mortuaries within different types of public hospitals. TABLE 1: SERVICE REQUIREMENTS

Service

District

Regional

Tertiary

Small (beds)

50-150

Min 300

Min 400

Medium (beds)

150-300

Large (beds)

300-600

Max 800

Where practical

Where practical

Training

Central

Specialised

Max 800

Max 1200

Max 600

Optional

Yes. Attached to medical school

Conduct research

Yes

Mortuary Short-term stay (+2˚C)

Yes

Yes

Yes

Yes

Long-term stay (-20˚C)

Yes

Yes

Yes

Yes

Autopsies (20°C -21°C)

Yes

Yes

Yes

Yes

Yes

For the determination of capacity requirements of mortuaries refer to the recommendations further on in this document. This guidance document relates to mortuaries located within and serving hospitals, with respect to persons that die due to natural causes in that hospital. This document excludes mortuaries dealing exclusively with cases that require medico-legal investigation of deaths from unnatural causes. Post mortems conducted in hospital mortuaries should be limited to conducting investigations and procedures where no medico-legal investigation is required and death from natural causes is suspected. Hospital deaths from natural causes and those suspected to be of unnatural cases should not be managed in the same facility unless the hospital mortuary is equipped to comply with the specific staffing infrastructure and operational requirements as they relate to the legislated forensic pathology services mandates, etc. The requirements for forensic-pathology service mortuaries are not exhaustively detailed in this document. It is also noted that some hospitals may opt to contract out the removal and storage of decedents to private undertakers and these hospitals may require only the minimum in terms of refrigerated body storage.


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PART B - PLANNING AND DESIGN 1. INTRODUCTION 1.

2.

All state-run mortuary facilities fall within the domain of the Department of Health, both National and Provincial; and in an effort to provide engineers and architects who are required to either design new facilities or upgrade existing facilities, this document provides the minimum standards necessary to comply with existing legislation. This document will provide designers of this type of facility with guidelines as to what is required in terms of the following: • • • • • • • • • • • • • • • • • •

3.

4.

5.

Type of service and package of care being provided Mortality rate Access and egress Discreet management of human remains Size and dimensions of the actual facility Positioning of mortuaries within hospitals Finishes of surfaces in these facilities Water-supply requirements Drainage requirements Electrical supply and lighting requirements Installation requirements for equipment and services Body-storage requirements Body-handling facilities Body-holding areas Body-viewing area Autopsy equipment (tables) Air conditioning and ventilation requirements (for infection and indoor air quality control) Security of the facility

In addition to the items listed above, it is also necessary to consider the needs of visitors to these facilities, particularly those wishing to, or who are required to, identify bodies. In line with this it is also necessary to take the handling of bodies into consideration as it pertains to issues of patient dignity. Forensic pathology mortuaries are not exhaustively described in this document, although the majority of hospital mortuaries do have basic facilities for general autopsies that are not medico-legal in nature. A forensic pathology service mortuary has laboratory facilities attached, as well as legislated operational requirements that are outside the scope of regular mortuaries found in hospitals. It should be noted that there are a number of principles that hold true for both hospital and forensic pathology mortuaries. Compliance with the requirements of the Occupational Health and Safety Act (Act 85 of 1993 as amended) are to be complied with at all times during the design of a mortuary.

2. LOCATION OF THE MORTUARY AND ACCESS ROUTES 1.

The position of the mortuary in a hospital should be such that the mortuary is easily accessible to mortuary staff and related service providers without presenting either aesthetic, emotional or ethical problems for unrelated hospital staff, patients or visitors. Visitors to the mortuary, however, should be provided with clear and direct access to the mortuary upon arrival at the hospital, without having to travel unnecessarily through hospital departments.


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2.

3. 4. 5. 6.

7.

Where bodies are moved into or out of the mortuary, they should not be moved through general public-access areas. Appropriate routes would include technical service or goods corridors and through the hospital’s support services yard. Special considerations should be given to plans for contingency access to the mortuary in the event of case-load surges, which may result from disasters. Bodies should not be held for any period in any locations between the body-holding rooms within clinical areas and the mortuary. Where a mortuary unit is used jointly between the hospital and the local authority it is beneficial for the mortuary to be in a building separate from the main hospital building. The delivery of bodies to the mortuary and their subsequent removal from the facility is to be such that it is carried out in a manner that is not visible to the general public, preferably in a covered and enclosed area. While siting and access are important aspects when locating a mortuary, it is also important to provide the mortuary with pleasant surroundings in order to promote the dignity of those working in or visiting the mortuary.

3. FACILITY CAPACITY 1. 2.

3.

The layout and size of a mortuary is largely determined by the number of bodies stored and whether body storage needs to be in cabinets or in refrigerated rooms. In order to determine the storage capacity of a hospital mortuary it is recommended that historical data, where available, should be used. In the South African context it is suggested that a storage capacity of between 5 and 10 bodies per 100 beds should be used. This varies with the rural or urban location of the facility. This capacity should not take into account the need to store bodies from deaths which are not hospital related, typically motor-vehicle accident deaths and deaths from criminal activity. Requirements for contingency storage capacity related to disaster management should be considered. The body storage capacity required can be estimated on the basis of the number of deaths per year in the hospital, the length of time of holding and the required body store occupancy rate. The number of body trays can be calculated from Equation 1 below.

𝑩𝑻 = (𝑫 × 𝑺)/(𝟑𝟔𝟓 × 𝑹)

-Equation 1

Where: BT = Number of body trays D = Number of deaths per year requiring body trays S = Average length of stay (in days) R = Required body tray occupancy rate


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Example:

The number of body trays required in a hospital that records 800 deaths per year (not necessarily all within the hospital per se but including bodies delivered to the hospital), with the average length of time that a body remains in the mortuary being 8 days and with a body tray occupancy rate of 80%.

BT = (D x S) / (365 x R) = (800 x 8) / (365 x 0.8) = 6400 / 292 = 21.92 With body cabinets generally having a storage capacity of three bodies per cabinet the calculated required capacity should be rounded up to the nearest multiple of three and as such in the above example 8 cabinets would be required.

4.

The estimated storage capacity for bodies in a mortuary could be confounded by a number of local factors, such as: • •

5.

Mortality rate from natural causes. Mortality rate from infectious disease. (Highly contagious disease deaths require special storage facilities.)

Where the hospital is expected to place the body in cold storage until collection by forensic pathology services, the following additional factors should be considered with respect to numbers of unnatural deaths (accidental, suicidal, homicidal, unknown and procedure-related deaths) anticipated at any particular hospital, including: • • • •

Mortality rate from foul play (homicide) or suicide Mortality rate from traffic or other accidents Mortality rate from procedure-related deaths Mortality rates from sudden, unexpected or unexplained deaths

4. SELECTING BODY-STORAGE SYSTEMS 1.

2.

3.

Body-storage systems are principally divided into refrigerated rooms or body cabinets. Differences within these system types occur where specific temperatures or sizes are required based on risk, need and capacity requirements. Body cabinets should be arranged such that the lowest shelf would have capacity for the heaviest bodies. Where a system of functionally separate body cabinets is selected, this system would have an inherent redundancy against failure, as the failure of a single unit would not necessarily imply a system failure. In contrast, a refrigerated room would require less maintenance and would have a lower frequency of failure; however a single component failure could be critical if standby condensing units are not installed. For this reason, multiple-cabinet systems are recommended for areas where expected maintenance response times would negatively affect the mortuary’s operations. It is possible to have a requirement for a mixture of refrigerated rooms and body cabinets. This could be affected by local cultural requirements such as for families who object to bodies sharing storage space, the case load of the facility or the case profile.


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4.

5.

6.

7.

Where there is a requirement for the long-term storage of bodies, these are to be kept at a lower temperature than would be the case in a refrigerated room. In this instance separate body cabinets are required. Long-term storage of bodies is most often required when an indigent person dies and difficulty is experienced in locating the next of kin, as the person cannot legally be buried until this process has been completed. In general, smaller facilities rely on body cabinets for the storage as these facilities do not have the space or the need for the large-scale storage of bodies, they would not appreciate the functional flexibility offered by these systems. By rule of thumb, any facility that has the requirement to store fewer than 12 bodies at any given time should use body cabinets. This gives the option of providing both short- and long-term storage with the smallest facility and equipment footprint. Bodies suspected of having succumbed to a highly contagious and dangerous disease require special treatment. These should be stored in such a manner that they do not present a hazard to personnel working in the mortuary. Typically these bodies should be stored at the same temperature as longstay bodies, e.g. -20˚C, and should be placed in hermetically sealed plastic body-bags. Provision for the secure cold storage of body parts should be provided.

5. FACILITY LAYOUT 1.

2.

As mentioned, the layout and size of a mortuary is going to be largely determined by case load and whether storage is in cabinets or refrigerated rooms. It is acceptable to have a mixture of refrigerated rooms and body cabinets. In a mortuary facility there are a number of separate areas that need to be considered other than the body-storage areas. These include: a. Reception area for members of the public who are required to visit the mortuary on official business – typically to identify bodies or to pay their last respects to a deceased person. b. Ablution areas for staff. Where unisex ablutions are provided it is recommended that no urinal is provided. c. Visitors’ admin space close to the reception area, where any admin or official business related to the identifying of a body can be completed. d. Staff admin space close to the point where a body is delivered to the mortuary, so that pertinent documentation can be completed – both with respect to the delivery of the body, as well as when the body is released from the mortuary again. e. Office space for pathologists to write up reports in instances where this could be required. This is dependent on the size of the mortuary as small facilities would not require a separate room(s) for this function. f. Waiting and circulation areas for visitors to the mortuary. g. Viewing room, from where a body can be viewed through a curtained glass window between this space and the body-display room. h. Body-display room, where a body is placed for identification purposes. There is to be access to this area via a lockable door to the viewing room in instances where it is necessary for non-mortuary personnel to have direct access to a body in the viewing room. There is to be access to this room from the body-storage area to allow bodies to be brought in for display purposes. i. Body preparation area, where a body that is delivered to the mortuary needs to be attended to prior to it being placed in the viewing room. j. Shower facilities (staff) k. Changing room (staff) l. Storage space for equipment and clothing that is worn in the body-preparation and autopsy spaces. m. Body-storage facility (cold room or refrigerated cabinets), depending on the length of time that bodies are expected to be kept in the facility. INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT Health Facility Guides: Hospital Mortuary Services [Gazetted, 30 June 2014]

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n.

o.

Autopsy facility, where the cause of death can be determined. This facility will differ from mortuary to mortuary, depending on whether forensic pathology service or standard medical autopsies to determine the cause of death are conducted. Figure 1 is an example of an adjacency diagram for a typical mortuary. In this instance the proximity also relates to visual and physical access. It is also understood that not all

FIGURE 1 ADJACENCY DIAGRAM

p.

q.

r. s. t.

mortuaries would require all of the spaces indicated in this diagram, and that some of the spaces shown as being immediately adjacent could be included as a single area if functionality and privacy considerations permit it. There remains abundant scope for variations in the planning of the layouts making up the mortuary. The hospital architect should consult with all stakeholders to arrive at an ideal solution. When developing the facility layout, careful consideration should be given to the routes through the facility of staff, bodies and visitors. These routes should overlap as little as possible and there should never be a common entrance for bodies and staff or visitors. The room requirement sheets are presented in USER ROOM REQUIREMENTS of this document. Storage space for body lifts must be provided. Suitable sluicing facilities are required to be able to clean equipment and fabrics after completion of any work in the mortuary facility.


16

6. MORTUARY EQUIPMENT REQUIREMENTS 1. 2.

Equipment for storage and transportation of bodies should meet environmental hygiene standards. For mortuary trolley design and supply, the SABS published standard CKS336:2013 Mortuary Trolleys is recommended. It should be noted that this is not a normative South African National Standard, and individual requirements may differ. a. Body-cabinet selection and installation requires the following considerations: b. Three-level body cabinets could be selected which have a single door to give access to all of the body trays, for instances where separation between bodies is required. Alternatively, cabinets that provide a single door for access to all the body trays are acceptable. c. It is critical that bariatric (obese) bodies are catered for in each cabinet. The lowest-level tray should be designed for this purpose. d. Special consideration is to be given to the provision of capacity for storage of juvenile and infant decedents. The handling of these bodies is an especially sensitive and emotive issue, and separate storage in dedicated cabinets is recommended. e. Body lifts must be supplied to facilitate the loading of bodies into and removal of bodies from the cabinets. Body lifts help to preserve dignity when handling bodies, while at the same time making it easier and safer for mortuary personnel to handle bodies. f. A clear space must be provided in front of the body cabinets to allow for the placing of a corpse into the cabinets. It is recommended that there be at least a 3m clearance between the front of the cabinet and any fixed structure. This is to accommodate whatever means of conveyance is used to transport a corpse to the storage area and then load it into the cabinet. g. Due to the vast array of cabinets available on the market and the lack of an appropriate national standard, it is not yet possible to prescribe sizes for refrigerated cabinets in this guide. h. The required cabinet size is fundamental when designing a mortuary. Where space is not too limited and there are no indications that there may be cultural concerns relating to the storage of bodies together in a cold room, it is recommended that cold rooms be used. Cold rooms offer space savings when compared to cabinets. i. A temperature gauge must be installed close to the door of the facility to indicate the storagespace temperature. This gauge should have an alarm system connected to it to give a warning should there be an unacceptable rise in temperature in the storage space. Typically, if the temperature should rise more than 2˚C above the set temperature, an alarm should be activated at a point that is manned at all times. j. Body cabinets and refrigerated rooms must be supplied with electrical power from the hospital’s essential services electrical supply. k. A slop hopper is to be provided to allow for the cleaning of the body preparation and autopsy areas, in particular after the completion of any work carried out in these areas. l. To allow for the rinsing of body parts and organs, during an autopsy procedure it is important that suitable basins be provided in close proximity to a downdraft autopsy table. m. Where there is transition between “clean” and “dirty” areas, provision is to be made to allow for the cleaning of footwear in a “transitional” area. This helps prevent the transport of contaminants from dirty areas.

7. MOVEMENT WITHIN A MORTUARY 1. 2.

Movement of members of the public visiting the mortuary is to be restricted such that they do not have access to the body-preparation or autopsy areas. (Figure 2) The facility must be available within the mortuary where body identification can be conducted in a private and dignified manner. This viewing area should consist of a body-display or layout room with


17

3. 4. 5. 6. 7.

an adjacent viewing room, where the body can be viewed through a curtained shatter-proof glass window. The requirement for a viewing and identification area also pertains to hospitals which outsource their mortuary services. The viewing room and visitors’ admin rooms should be designed such that counselling can be conducted in a pleasant environment for bereaved persons. The design of the viewing facility should allow adequate space for persons to view a body in a dignified manner. Direct access to the body-layout room from the viewing room is to be provided via a lockable door, to allow visitors access to the body. Ablution facilities are to be available to members of the public who are required to visit the mortuary complex

FIGURE 2: ACCESS AND MOVEMENT IN A MORTUARY

8.

Where a dedicated room, as described above, cannot be allocated for placing a body for viewing purposes, the persons who are viewing a body should be given a private space for viewing the body through a curtained shatter-proof glass window, as a minimum. 9. Adequate facilities to accommodate at least 7 visitors are to be provided. 10. Staff access to the mortuary facility is to be separate from the general public. (Figure 2) a. Mortuary staff change rooms should be provided with secure lockers for storage of street garments, lab coats, personal protective equipment and valuables.


18

b. c. d. e. f.

g.

Mortuary staff may have completely separate ablution facilities from those used by the general public requiring access to the mortuary facility. In a free-standing mortuary building the delivery to and removal of bodies from the facility may be via the same access point to the building. A mortuary that forms an integral part of a hospital will require separate routes for receiving bodies and the subsequent removal thereof. In the unusual event that a body arrives from outside the hospital, the normal route of removal should be used for receipt of the body. A clear distinction is to be made between “clean”,” “dirty” / “wet” and “transitional” areas. This is best achieved by creating a physical “RED LINE” on the floor indicating the separation of these areas, with “yellow lines” used to demarcate “transitional” areas. Receptacles for the collections of dirty clothing, etc, must be made available at the transition area from dirty to clean areas and in change rooms. A well-drained facility for washing vehicles which have been contaminated with decomposed bodies or body fluids should be provided in an enclosed area, near to the mortuary.

8. SERVICES REQUIRED 1.

2. 3. 4. 5. 6. 7.

Hygienic floor drains that are resistant to corrosion from blood and chlorine should be provided in all “wet areas” of the mortuary and should be directly connected to the sewer system. These areas include body preparation, autopsy space, etc. These areas require thorough cleaning after every procedure, using large quantities of water and decontaminating and disinfecting chemicals and soaps. Sluicing facilities are to be provided in both the body-preparation and autopsy areas if they are not a common area. Open floor channels should be avoided. Where this is not possible, these should be covered by durable, flush-fitted stainless steel grids. No sewer connections external to the mortuary services should be made to the line between the wet area drains and the main sewer system in order to prevent backflow to other areas. The provision of hot and cold water in the facility is imperative, with all basins, sinks, ablution areas and autopsy tables being provided with both. Anti-backflow devices should be fitted to the water-supply lines serving mortuary table faucets to prevent backflow should supply water pressure fail. Electricity supply to the mortuary – particularly for refrigeration purposes – is to be provided from the essential supply system for the hospital. Alternatively, a back-up generator is to be supplied to allow for the maintenance of required temperatures in the cooling/freezing facilities in the mortuary.

9. BIOLOGICAL SAFETY 1. 2. 3. 4.

5.

A Biosafety Laboratory Level 3 (BSL3) designation (R178-2012) is applicable for any decomposing bodies post-mortem area. This area is identified as a level-3 containment facility. BSL3 areas shall have restricted access and shall be separated from regular traffic flow routes. All doors opening into the BSL3 areas shall be appropriately labelled with biological safety hazard signage. Access to the BSL3 areas shall be through dedicated ventilated airlocks. A pressure differential of minimum +15Pa shall be maintained for the airlock relative to the BSL3 area. This pressure differential is relevant for when the doors are closed only. Room pressure differential gauges are to be fitted at the entrance to the BSL3 area. Airlock doors shall be interlocked such that only one door can be opened at a time, thereby preventing direct passage between the corridor and the BSL3 area.


19

6.

7.

It is recommended that a transfer hatch be created for the transfer of goods between areas with differing biosafety-level classifications. This device shall be designed to preserve the integrity of the containment system and the mechanical ventilation design. Air exhausted from biosafety areas should be safely discharged to the outside with no chance for reentrainment or contamination of other indoor spaces. Exhausts from biosafety areas should be vented at 3m above the roof level. Where such measures are not possible, exhaust air shall be EN1822 H13 HEPA filtered. Exhausts from biosafety areas should include anti-backflow devices.

10. FINISHES TO FLOORS AND WALLS 1. 2. 3. 4. 5.

6.

7. 8. 9.

Walls and floor coverings within a mortuary should be easily cleanable and impervious to liquids and staining. Floors are to be of such a nature that they are not easily damaged by wheeled items that are moved over them. Vinyl floor coverings are not considered to be resilient enough for this purpose. Epoxy floor coverings are preferable, as these are easily maintained and do not have joints in them where liquids can accumulate to become a health risk. Corners between walls and floors shall be coved to facilitate the cleaning of these areas. These coving details should be solid and continuous without hidden formwork and cavities. Walls are to be coated with hard-wearing and washable materials/paint with provision made for trolley bump-rails along walls exposed to high traffic. Wall coatings shall be impervious to damage from trolleys and mobile equipment. Materials such as vinyl sheeting should not be used to cover walls in wet areas. The risk of growth between the sheeting and the wall presents a health hazard to personnel working in the mortuary wet areas. Due to the potential presence of water on flooring it is essential that flooring be non-slip. Refer to the room requirement sheets herein and the IUSS:GNS Materials and finishes guidance documents for further information. Surface-mounted services should be avoided to ensure smooth and washable surfaces. Where surface mounting of piping is unavoidable, this piping should be mounted on batons, such that the space behind the piping is readily accessible for cleaning.

11. AUTOPSY EQUIPMENT/FIXTURES 1. 2.

3.

4. 5.

6.

Equipment for the storage and transportation of bodies should meet environmental hygiene standards. In the majority of instances a downdraft autopsy table is required within a hospital mortuary facility. This table should be one that is designed in such a way that there is a hot and cold water supply that is integral to table installation, as well as a drainage system that can automatically drain water/waste from the table to the sewer system of the facility. The autopsy table should have an integrated ventilation extraction or “downdraft” system in order to entrain noxious odours and infectious material that may emanate from a body. This can function to minimise the spread of any airborne pathogens from the body. Adequate stainless steel washing basins (at least one per autopsy table) must be provided in close proximity to the autopsy table for the use of personnel working in the facility. Electrical power must be provided from a 5 amp IPX5 waterproof single-socket outlet near the autopsy table to allow for the safe use of any electrical equipment that may be required during an autopsy. Lighting quality over the autopsy table must be exceptionally good. Refer to the lighting requirements specified in the room-requirement sheets herein and the IUSS:GNS Building engineering services guidance document for specifications.


20

7. 8. 9. 10. 11. 12. 13. 14.

Adequately sized worktops must be provided along the walls of the autopsy area for equipment and specimens prior to storage. It is recommended that working surfaces of at least 500x2500mm be provided per autopsy table. A balance table for a bench-top scale is required. The scale can be either permanently mounted on the work surface or stored in the autopsy equipment store. A platform scale for measuring the weight of an entire body prior to any possible dissection/autopsy work being conducted is to be accommodated. Lockable cabinets are required for the storage of autopsy equipment, as well as for any personal protective equipment morticians or medical examiners may require. Trolleys for the conveyance of bodies must be provided in the mortuary and adequate provision for the storage of these units must be available. The use of wood, such as for wooden doorframes, is not allowed in wet areas. Stainless steel bump-rails or plates should be fitted in areas prone to damage from trolleys. These devices shall be fitted such that that they do not affect the integrity and cleanability of the walls and floors. These devices shall not create crevices or gaps which could harbour pathogens or create a hygiene problem. Welded stainless steel sections shall be stainless steel Grade 316L

12. VENTILATION 1.

Mortuary areas require good ventilation. The exhaust air is to be discharged to atmosphere such that it cannot be drawn back into the mortuary, any other ventilation inlet, or any indoor portion of the hospital. 2. All external ventilation openings should be fly- and vermin-proof. 3. Exhausted air may not pose a hazard to any person who is outside the mortuary. (See roomrequirement sheets) Air exhausted from clinical areas should be safely discharged to outside with no chance for re-entrainment or contamination of other indoor spaces. Where these precautions are by no means possible, exhaust air shall be EN1822 H13 HEPA filtered. 4. Sufficient ventilation is required for controlling noxious odours present in mortuaries and should also provide a means of protection to personnel working in the facility from possible airborne infections originating from corpses. 5. Airborne-infection control is of particular concern and must be designed for in terms of the ventilation system. Tuberculosis, Hepatitis and HIV are among the most regularly encountered diseases in mortuaries in South Africa and, as such, the spread of these pathogens beyond the mortuary, via a ventilation system, must be avoided by implementing the airborne-contamination control principles for high-risk areas in the ventilation system design. Refer to the IUSS:GNS Building engineering services guidance document for further guidance on airborne-contamination control principles. 6. The ventilation system must be designed such that airborne pathogens that may be present in the body-holding area and autopsy room do not contaminate the remainder of the mortuary facility. 7. No recirculation of air extracted from the clinical areas is permitted. 8. Air from public areas, with the exception of viewing rooms, may be recirculated where this is in accordance with the National Building Regulations. 9. Exhaust ventilation is to be designed in such a manner that this extracts from the areas with the highest risk of infection, while “clean” air is to be supplied into the lower-risk areas. This is to create a pressure cascade with cleaner areas being at a relatively higher air pressure than dirty areas. 10. Air-supply registers should be at a high level and the extraction registers should be at a low level. The low-level extraction grilles shall not be more than 500mm above the finished floor level of the room from which the extraction is taken. Low-level air-register positions shall consider locations of water points and potential splashing during washing.


21

13. AIR CONDITIONING 1. 2. 3.

The mortuary and autopsy area must have a temperature maintained between 20˚C and 21˚C. Public areas must be kept at a constant temperature between 23˚C and 25˚C. Air extracted from the mortuary may not be used for energy recovery or recirculation.

14. REFRIGERATION EQUIPMENT DESIGN AND INSTALLATION 1.

2.

3. 4.

5. 6.

7. 8.

All heat-rejection equipment associated with refrigeration in the body-storage facilities must be located on the outside of the mortuary, in a well-ventilated space at the rear of the fridge(s). Compressors installed on top of body cabinets on the inside of the mortuary are not acceptable. Heat build-up within the mortuary, as a result of this type of arrangement, potentially leads to equipment failure. Regularly serviced refrigeration equipment components should not be situated within the confines of the mortuary. Refrigeration technicians should not be required to climb onto or over a body cabinet to carry out any maintenance work. It is preferable to have refrigeration equipment situated in a separate ventilated area to the rear of the body cabinets. The designer is to refer to the selected heatrejection equipment’s installation manual to determine free space and ventilation openings required around this equipment, since these details can vary between system types. Gauges indicating the temperature within the body cabinet must be clearly visible above the door of the unit in order that this can be readily monitored. The acceptable average temperature within a normal body cabinet or refrigerated room is between 2.0˚C and 6˚C. In instances where a body has to be kept for an extended period of time a cabinet temperature of at least -20˚C is required. In facilities where large quantities of bodies are kept, cold rooms for the storage of multiple bodies on trays are recommended. The materials used for the construction of the units are to be of stainless steel to facilitate cleaning and long-term maintenance of the equipment. Grade 316 stainless steel (18/10) is preferable over Grade 304 (18/8), as it offers better corrosion resistance. For welded stainless steel construction, Grade 316L or similar is required. If a facility is required to collect and retain forensic evidence (e.g. clothing of decedents), refrigeration equipment should be provided for the preservation of these samples. Preferably this equipment should be placed in an area where it can readily be secured from unauthorised access and tampering.

15. SECURITY ARRANGEMENTS 1. 2.

3.

4.

5.

Due to the medical and legal nature of the contents of a mortuary, it is essential that a mortuary has good access control and security systems. Theft from mortuaries should be forestalled by, inter alia, constantly monitoring all entrances and preventing free access to mortuary areas. This is especially important for the body-storage areas. Access card or tag systems are open to misuse and are not an appropriate access-control measure. Combinations of tag and biometric access-control systems are recommended. Door closers with a “hold-open” mechanism should be installed on the mortuary room doors. This enables doors to close automatically with normal traffic, but can also be held open when moving equipment or trolleys through. “Crash”-type doors should be avoided as these are not easily cleanable and are subject to damage and abuse. It is recommended that a timed alarm be fitted to doors to ensure that they are closed shortly after any entrance or exit. This is to militate against the tendency of keeping doors open with some form of door stopper. Body cabinets are to be fitted with locks to prevent the unauthorised opening of these units to forestall the theft of any personal items of the deceased. INFRASTRUCTURE UNIT SUPPORT SYSTEMS (IUSS) PROJECT Health Facility Guides: Hospital Mortuary Services [Gazetted, 30 June 2014]

22

6.

In instances where historical problems relating to unauthorized entry into mortuaries is evident, it is recommended that closed-circuit TV systems be installed to help in monitoring and securing the facility.


23

PART C - OPERATION 1. OBJECTIVES The project planning, design, construction and commissioning should aim to provide: a.

a safe, secure and functional environment for visitors and staff;

b.

low capital and ongoing operating costs (service, staffing and maintenance);

c.

an environmentally appropriate design solution; and

d.

a fully accessible, inclusive environment.

2. HEALTH AND SAFETY In light of the above it is essential that every effort be made to ensure that personnel working in the mortuary are provided with all required personal protective equipment (PPE), as this is essentially an area where pathogens could be present and present a health risk to staff. The following items should be available to staff as a minimum: a. Rubber aprons (or similar impervious material) b.

Latex gloves (or similar impervious material)

c.

Mesh gloves in facilities where post mortems are performed

d.

Disposable gowns

e.

Safety glasses or full-face visors.

f.

Waterproof footwear

g.

Face masks

h.

Respirators with the appropriate filters must be available for use in high-risk situations.

i.

Storage space for PPE

No one should be permitted to enter the body storage and preparation areas without donning appropriate gowns and footwear.

3. MAINTENANCE When designing the facility, every effort must be made to limit the amount of maintenance that would be necessary to keep it in good condition. Seamless surfaces for walls and floors are critical, as this will reduce ongoing maintenance costs. The following minimum requirements should be complied with: a. Seamless floor coverings required b.

Continuous coving with radius >50mm required between floors and walls.

c.

No sharp corners on any work surfaces that could injure people working in the area.


24

d.

Ceilings to be readily cleanable.

e.

Work surfaces are to be impervious to liquids and resistant to staining and corrosion.

f.

Refer to the room-requirement sheets herein and the IUSS:GNS Materials and finishes guidance documents for further information on the general requirements for materials and finishes.

g.

All equipment requiring calibration, such as fridges and scales, are to be attended to on an annual basis or when it is suspected that they are defective in respect of their expected/intended performance


25

PART D - USER ROOM REQUIREMENTS 1. Example Room-requirement sheets TABLE 2: EXAMPLE ACCOMMODATION SCHEDULE

Room Name

Service Description

Area (m²)

Min. Ceiling Height

Occupancy (Persons)

(m) Ablution areas

Ablution areas – male and female

Shower facilities

Shower facilities – male and

Nominal Utilisation per day (hours)

3 (per cubicle)

2.8

1

4

2.8

1

2

female

3 (per cubicle)

Changing room

Staff changing room - lockers to be

8

2.8

2

2

Storage space

Equipment and PPE storage space

8

2.8

1

1

Offices

Office space – interview, body

9

2.8

2

8

9

2.8

1

8

9

2.8

4

1

27

2.8

3

3

One WHB per WC or urinal

provided

receiving, pathologist Body/bier room

Area where a body can be laid out

Viewing room

Viewing room – external to body-

for viewing and identification

layout area Autopsy room

Autopsy facility – Autopsy table with water supply and discharge and extraction ventilation. WHBs and stainless steel working surfaces


26

Table 3: Room services sheet Room Name

Pressure Wet Task Data Colour SSO SSO Relative to Services Illuminance Points Rendering 400V 230V Ambient (lux) (Ra)

Temp

Ventilation

Ventilation

(°C)

(AC/h)

Type

Reception area

22-25°C

2

Forced supply

=

Visitors ablution areas

22-25°C

15

Forced extraction

-

Public waiting area

22-25°C

2

Forced supply

Offices

22-25°C

2

Circulation Spaces

22-25°C

Viewing room

0

0

100 at floor level

0

80

0

0

150 at floor level

0

80

+

0

0

100 at floor level

0

80

Forced supply/ recirc.

=

0

2

300 at desk level

1

80

10

Forced supply/ recirc.

=

0

0

200 at floor level

0

80

22-25°C

2

Forced supply

+

0

0

100 at floor level

0

80

Layout room

20-21°C

2

Forced extraction

-

0

0

300 at table level

1

80

Storage space

22-25°C

4

Forced supply

=

0

1

200 at floor level

0

80

Mortuary

20-21°C

12

Forced extraction

-

0

1

200 at floor level

0

80

Mortuary plant area

n/a

n/a

Natural ventilation

=

1

1

150 at floor level

0

80

Autopsy table

20-21°C

20

Forced extraction

-

CW Faucet

0

1

5200 at table level

0

90

Autopsy room

20-21°C

20

Forced extraction

-

WHBs, FD

0

2

500 at floor level

1

90

Changing room

22-25°C

15

Forced extraction

-

WHB

0

1

150 at floor level

0

80

Staff ablution areas

22-25°C

15

Forced extraction

-

WHB, WC

0

0

150 at floor level

0

80

Shower facilities

22-25°C

15

Forced extraction

-

CW + HW Faucet

0

0

150 at floor level

0

80

WC, WHB

WHB

WHB, FD


27

Table 4: Room finishes Room Name

Floor

Wall / Floor Interface

Walls

Ceiling

Glazing

Finish

Finish

Type

Skirting coved and finished as per floor

Ceramic wall tiles with epoxy grout

Acoustic Ceiling tiles

Obscure 1 per WC laminate or urinal safety glass

Jointless vinyl sheet

Coved vinyl skirting

Washable acrylic paint

Acoustic Ceiling tiles

Clear laminate safety glass

0

Lockable glazed entrance door

Changing Jointless room vinyl sheet




Obscure laminate safety glass

0

Solid wood with galvanised steel or stainless steel sheet trolley plates

Material Ablution Jointless areas (all) vinyl sheet

Public waiting area

WHB

Doors Type Solid wood with galvanised steel or stainless steel sheet trolley plates

Storage space






0

Solid wood with galvanised steel or stainless steel sheet cladding

Offices






0

Solid wood

Body Room

Selflevelling epoxy





0

Solid wood

Viewing Room

Selflevelling epoxy





0

Solid wood

Autopsy Room

Selflevelling epoxy




Obscure Min 1 per laminate autopsy safety table glass





Circulation Jointless Spaces vinyl sheet

Solid wood with galvanised steel or stainless steel sheet cladding

0


28

PART E - EXAMPLES AND CASE STUDIES 1. Layout examples

FIGURE 3 EXAMPLE 1: LAYOUT


29

1.1. EXAMPLE 1: SMALL MORTUARY ATTACHED TO HOSPITAL Figure 4 demonstrates the relationships between the zones within the mortuary. In this example it is evident how visitors are managed and kept out of the working portions of the mortuary through segregation in the internal layout. The process flow of the bodies into, through and out of the mortuary has been well considered in that the flow is linear with bodies entering the mortuary at one end of the facility and exiting at the other. Unfortunately, the restrictions presented by the location of the mortuary, as can be studied in Figure 3, has forced the design into a number of compromises relating to the external flow and access to the mortuary. Staff access is quite severely compromised in being through the mortuary lobby. This mortuary lobby, in the absence of a dedicated preparation room, has the potential of being used as one. This arrangement may impact negatively on the dignity of some staff, the dignity of the deceased, and mortuary security.

FIGURE 4 EXAMPLE 1: ZONING & ACCESS

Visitors’ access to the mortuary and their adjacent toilets is near the hearse bay and turning areas. There is no natural screening of this entrance from the activities in the hearse bay and it is not inconceivable that visitors may inadvertently wander into the wrong area and be exposed to operational activities not appropriate for the bereaved.


30

The door sizes of the body storage rooms seem too small for the easy passage of a body trolley when compared to the double doors made available for the passage of the body from there through the remainder of the facility. Door size selection should not be limited by the fact that these are cold room doors. Where doors are too small for free passage of trolleys and porters, the doors’ service life would be severely shortened and any savings made on the door selection would be lost to maintenance or retrofitting an improved solution. The access to the technical area for maintenance of the refrigeration equipment in this example meets the recommendations. Here technicians do not need to enter the mortuary to perform the majority of their work and these areas are quite well separated from the admin and visitors’ areas.

1.2. EXAMPLE 2: LARGE MORTUARY WITH AUTOPSY FACILITIES Figure 5 shows the layout of a standardised mortuary design. This is a large facility with autopsy capacity. Figure 6 has been presented in order to promote an understanding of the interrelationship between the various functional parts of the mortuary. Considering the entrances shown in Figure 5, it is clear that the designer has made an effort to screen the visitors’ entrance from the hearses’ entrance. The staff entrance is also well positioned. The staff ablution facilities and showers are located between the clinical areas and the admin areas. This arrangement encourages good segregation and gowning practice when moving between the mortuary activities and external movement. The staff and visitors’ access positions are located well away from the working clinical areas of the mortuary and are also relatively remote from each other. This aids in improving security as it discourages the staff and visitors from using the wrong entrances and thereby assists in identifying persons who are present in areas where they do not belong. This design doesn’t have a dedicated body prep area and it is assumed that the weighing and measuring area is therefore used for this purpose. The large sliding doors of the cold room in this example can be compared to the cold-room doors in Figure 3 as an indication of what the door size should be like to enable easy passage. The layout in this example does not provide for a dedicated exit yard and bodies and hearses entering and leaving the facility do so through the same entrance. This arrangement increases the potential for mistakes in body handling. The common use of the bier room as access to the ID room seems to be a compromise resulting from the limited space provided for these rooms.


31



32

FIGURE 6 EXAMPLE 2: ZONING AND ACCESS


33

1.3. EXAMPLE 3: LARGE MORTUARY WITH AUTOPSY FACILITIES The example shown in Figure 7 is a standard facility layout, very similar to that of Figure 5, with the most notable changes being the inclusion of a dedicated vehicle-exit yard and the omission of the technical service area. The addition of the exit detail resolves the criticism of the arrangement in Example 2, while the omission of the technical service area for the refrigeration equipment could present an access problem for maintenance


technicians, as discussed earlier in this document. The example in Figure 7 has also resolved the compromises in the arrangement of the bier rooms and ID/viewing rooms’ available space, discussed in the previous example.


34

DEFINITIONS In the context of this document the following definitions pertain: Autopsy room: Synonymous with post–mortem examination area or suite. Containment facility: The part within the demarcated zone in which the most malodorous activities occur. This facility includes the decomposing bodies’ post-mortem examination room, airlock anteroom, and a decontamination unit each for men and women. The containment facility is sealed off from the rest of the demarcated area. Demarcated area: The demarcated area, including the post-mortem examination rooms and all supporting functional spaces is the area where most sensitive, costly and specialised processes occur. Dignity of deceased: The principle that bodies are treated with the respect and dignity befitting any person prior to death. Dissection room or suite: Synonymous with post-mortem examination area or suite. Mortuary: A mortuary is a facility for temporary storage of the deceased pending identification, medico-legal investigation and despatch. Natural death: A death from natural causes which are determined to have been the cause of illness or an internal malfunction of the body not caused by external forces. Post-mortem examination area or suite: A room and its attached service rooms designed for the performing of post-mortem examinations. Post-mortem examination: Examination after death, which may include performance of an autopsy. Unnatural death: A death falls within the accidental, suicidal homicidal, unknown (sudden unexpected or unexplained) and procedure-related categories, as further defined in the Regulations regarding the Rendering of Forensic Pathology Service and the Health Professions Amendment Act. Workbench (or bench): Unless otherwise specified, this is a surface ergonomically dimensioned for use from the standing position. This is normally 900mm high. Work-station: Unless otherwise specified, this is a surface ergonomically dimensioned for use from the seated position. This is normally 750mm high.


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BIBLIOGRAPHY Australasian Health Infrastructure Alliance (AHIA), 2010. Australasian health facility guidelines. (Revision v.4.0). New South Wales: AHIA . Australian Government Department of Health, 2009. Guidelines for the facilities and operation of hospital and forensic mortuaries. (Second edition). Canberra Australia: Department of Health. Council of the Association of Clinical Pathologists committee on mortuary design and hazards, 1961. Mortuary design and hazards. Journal of Clinical Pathology, 14(2), pp. 103-108. Health Authority Abu Dhabi (HAAD), 2011. HAAD standard for weqaya screening for cardiovascular risk factors. (Part B- Version 3.1). Abu Dhabi: HAAD. IUSS Building Engineering Services guidance document. National Code of Guidelines for Forensic Pathology Practice in South Africa. Edited by NFPSC Academic Sub-committee 20 August 2007. Singh, S., Sinha, U.S., Kapoor, A.K., Verma, S.K., Singh, D. and Sharma, S., 2006. Planning and designing of modern mortuary complex in tertiary care. IIJFMT, 4(1). Sirohiwal, B.L., Paliwal, P.K., Sharma, L. and Chawla, H., 2011. Design and layout of mortuary complex for a medical college and peripheral hospitals. Journal of Forensic Research, 2(6). Walls, C. and Brownless, J., 2000. Managing health and safety risks in New Zealand mortuaries: Guidelines to promote safe working conditions. Wellington New Zealand: Occupational Safety and Health Service of the Department of Labour. Western Cape Department of Health, 2009. Project development brief for the new academic M6 pathology forensic laboratory. Western Cape: Western Cape Department of Health.


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IUSS HEALTH FACILITY GUIDES Hospital Mortuary Services

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