Best Practices - Oncology Hospital Construction
Best practices for building an oncology hospital include designing treatment rooms around specific and complex cancer therapy equipment, designing for radiation shielding, and controlling dust and noise. Hospitals should also design for resiliency and resolve compliance issues early to avoid additional costs. These are outlined below.
PROTON THERAPY CONSTRUCTION
- Gilbane Building Company, a global construction and facility management firm, published its best practices for building specialized cancer care centers with proton therapy facilities.
- Proton therapy creates a beam of protons to target a cancerous tumor with a high dose of radiation while minimizing damage to nearby cells.
- One best practice is to design the facility around a specific proton therapy equipment rather than the other way around.
- Gilbane recommends selecting a proton therapy manufacturer first, then determining the building structure according to shielding requirements, mechanical and electrical connections, and patient treatment considerations.
- This is to help builders avoid undefined costs in the construction bidding process as proton therapy and its equipment are complex in nature.
- Another best practice is to be familiar with the proton therapy device's requirements for tolerance, shielding, concrete embeds and dimensions early in the construction bidding process.
- This is to help plan for added capacity levels should existing site utilities fail to support the proton therapy equipment.
- Lastly, all system upgrades to the proton therapy equipment should be defined including those that will affect underground utilities.
- This is to ensure adequate protection of nearby facilities from heavy load transfers during proton equipment delivery.
RADIATION SHIELDING DESIGN
- Gilbane also identified designing for radiation shields as a best practice when constructing oncology specialty hospitals.
- Healthcare Design Magazine published the following best practices for radiation shielding design in specialized cancer facility construction, specifically carbon-ion therapy centers.
- Based on studies of existing cancer centers utilizing carbon-ion therapy, treatment rooms should be maximized by building the patient immobilization functions outside together with spaces for changing and sub-waiting.
- As carbon-ion therapy requires greater shielding than most therapies, entry to treatment rooms should be designed in a maze to minimize radiation leaks.
- The right amount of thickness for radiation protection (typically between 6 to 10 feet) should be based on calculations made by shielding consultants.
- However, pre-engineered modular blocks made of concrete can be considered for flexibility in construction and design.
- The article also stated that in basement areas, earth can also be considered as a natural and economical radiation shield.
NOISE, DUST AND VIBRATION
- Gilbane also identified controlling dust, noise and vibration as best practices for cancer treatment facility construction projects.
- The National Center for Biotechnology Information (NCBI) featured Synergy Health and St. Joseph’s Hospital's book discussing best practices for minimizing noise in hospital construction.
- The hospital had established a National Learning Lab after consultation with national leaders from healthcare administration, research, hospital quality improvement, and authorities in hospital quality accreditation and architecture.
- Among the Lab's best practices was to reduce noise by separating walls between rooms, using airspace insulation and decreasing transfer noise.
- The Lab suggests that optimum materials in mechanical, plumbing and electrical systems should be leveraged to dampen noise.
- The book also reported that vibration noise was reduced using isolation and dampening devices.
- A 2018 study in Cancer Journal for Clinicians states that hospital construction planning need to comply with requirements for indoor-air quality from an internal committee.
- The study stated that project contractors are required to have containment plans for dust within and without the construction site.
- The researchers added that construction activity releasing harmful dust should be conducted within institutional guidelines.
- In addition, certain cancer treatment rooms should have specialized ventilation systems with high efficiency filters to catch 99.99% of particulates.
- The 2018 Hospital Construction Survey from the American Society for Healthcare Engineering (ASHE) identified resilient design as a top priority and current best practice among hospital construction projects.
- The report defined resiliency as a design that resists natural and manmade disasters.
- ASHE also stated that resilient design incorporates the capability for quick recovery.
- The majority (89%) of the 274 facilities professionals interviewed across the US said resiliency is integrated into their design strategies.
- ASHE suggested using a hazard vulnerability assessment to help define resiliency design for hospital construction projects.
- A featured project was the Texas MD Anderson Cancer Center, which successfully implemented resiliency design after suffering from Tropical Storm Allison.
- The oncology hospital installed storm gates, flood walls, watertight compartments, and hurricane-force window glasses which helped it successfully withstand Hurricane Harvey.
- The key priorities for resiliency design in hospital construction projects include infrastructure and measures against fire, winter storm and power outages.
EARLY RESOLUTION OF COMPLIANCE ISSUES
- The 2019 Hospital Construction Survey from the American Society for Healthcare Engineering (ASHE) also identified early resolution of compliance issues as a current best practice in hospital construction projects.
- The survey stated that healthcare construction leaders resolve compliance issues by partnering with consultants, having regular conversation with authorities, and taking early action on potential problems.
- One example is Tushar Gupta, principal of the architecture firm EYP. Gupta said that early action and regular communication with authorities helped resolve numerous compliance issues in their health care construction projects.
- Another is John Wilson, director of construction for Parkland Health & Hospital System. Wilson said that regular conversations with authorities helped resolve compliance issues for their $1.3 billion replacement hospital project.
- According to the survey, compliance issues due to improper interpretation of code construction cost 10% of hospital construction spend on average.
- Proper compliance with construction code is crucial especially for cancer centers designing facilities around specialized therapy equipment including proton and carbon-ion therapy equipment.
We have provided best practices surrounding construction of oncology specialty hospitals using industry surveys, whitepaper, trade book, studies and trade media articles. As resources detailing best practices specifically for oncology specialty hospitals were not very prevalent, we had to use sources older than 2 years to address the request. While our major sources were the 2018 and 2019 Hospital Construction surveys as well as the list from leading global construction firm Gilbane, we used other resources to corroborate and supplement our findings. This included a 2008 book featured in National Center for Biotechnology Information (NCBI) which gave rationale and practical steps for minimizing noise and vibration disturbances, supporting the list from Gilbane. This was also the case for Gilbane's whitepaper detailing best practices for constructing specialty oncology hospitals housing a specific and complex therapy equipment. We have outlined our findings above.