fgi/aia interim sound & vibration guidelines for hospitals & healthcare facilities

FGI/AIA Interim Sound & Vibration Guidelines for Hospitals & Healthcare Facilities

Copyright 2007 ANSI S12 WG44

Developed by the founders & co-chairmen of ANSI S12 WG44*:

David M. Sykes, ASA, INCEGregory C.Tocci, PE, FASA, INCE Bd Certwith William Cavanaugh, FASA, INCE Bd Cert, &

Wallace Clement Sabine Medalist (2006)

*These individuals led the development of the documents discussed in this seminar: the FGI/AIA Interim Guideline and the Green Guide for Health Care Acoustic Credits

A 1-hour seminar


Thanks

The developers thank Doug Erickson, John Kouletsis, Kurt Rockstroh, Martin Cohen, Robert Loranger, Judene Bartley, Robin Guenther, Sholem Prasow, Debra Levin, Roger Leib, Roger Ulrich, Anjali Joseph, Bart Franey, Uriel Cohen, Orfeu Buxton as well as Harvard Medical School, the leaders and members of ASA, INCE & NCAC, and the members and sponsors of ANSI S12 WG44 for their commitment to & support of this work.


3 goals of this seminar

Inform you about the new AIA Interim Guideline on acoustics (noise, privacy, sound & vibration) & the Green Guide’s two new acoustic credits

Learn from users about situations where acoustical issues arise in healthcare projects

Advise you where to turn for guidance when questions arise (we are your portal to the acoustics profession)


Context

U.S. Noise Control Act (1972) de-funded in 1980 30 years of ‘benign neglect’ yielded 6% per year

growth in noise in healthcare facilities (>2X) Now urgent: we have “pandemonium” and “an

epidemic of noise” in healthcare & elsewhere Drive to fix acoustical problems began with HIPAA

& patient-centered care movement New recognition by LEED that “environmental

quality” should include noise, vibration & sound


Authority

Commissioned in 2005 by AIA & the Facility Guidelines Institute (www.fgi-guidelines.org)

Published 11.1.06 Prepared by ANSI S12 Workgroup 44 – healthcare

acoustics, speech privacy & security, A joint technical committee of the three leading organizations in acoustics: ASA, INCE and NCAC

Copies & interpretation: www.healthcareacoustics.org

Read-only: www.fgi-guidelines.org


The standard for GGHC’s new EQ acoustics credits

The LEED-based Green Guide for Healthcare V2.2 (1.31.07) now contains two credits for acoustics

The Interim Sound and Vibration Guideline is the sole reference standard for these credits

Download from: www.gghc.org See “Construction” section “Environmental Quality-Acoustics Credit 9.1-9.2”


Objectives of the documents

Brief, comprehensive handbook Healthcare specific based on existing standards & best practices Objective & measurable criteria Practical guidance for designers

- Look-up tables- Code language linked to AIA Guidelines

- Design guidance


International scope

The drafting committee included 480 authorities from 10 constituencies & several countries:

- Legislators - Planners, architects & designers- Regulatory agencies - Facility managers & engineers - Leaders of large HCOs - Acoustics researchers & - Clinical professionals practitioners - Healthcare lawyers - Acoustics professionals in large - Planners mfg. organizations


Mission

The character and magnitude of all of the sounds in a building should be compatible with the intended use of the space. This rarely means silence, but it implies “quiet” which is the absence of distracting, annoying, interfering or unpleasant sounds.

William Cavanaugh

MIT, B. Arch ’51, FASA, INCE Bd. Cert.


Medical perspective:Doctors know noise causes…

Sleep disruption (slows recovery) Stress response (compromises outcomes) Impaired communication (medical errors) Lost privacy (errors & misdiagnoses) Clinician “burnout” (accidents & staff turnover)


Abundant medical evidence

Joseph & Ulrich: Sound Control for Improved Outcomes in Healthcare Settings (2007). Center for Health Design

Quieting Weinberg 5C: A case study in Hospital Noise Control (2006), Busch-Vishniac, et al. JASA

Ulrich & Quan, et al: The Role of the Physical Environment in the Hospital of the 21st Century… (2004). Center for Health Systems & Design/Texas A&M; with Zimring, Anjali, Choudery, Georgia Institute of Technology

Busch-Vishniac & West, et al: Noise Levels in Johns Hopkins Hospital (2005) with Barnhill, Hunter, Orellana, Chivakula. JASA

Rubin, Owens & Goldern: Status Report (1998): An investigation to determine whether the built environment affects patients’ medical outcomes. Center for Health Design at Johns Hopkins


Example: sleep loss…

Risk of Injuries, Falls

Incidence of Pain

Weight Gain

Diabetes

Increased Consumption of

Healthcare Resources

Impaired Attention

and Reaction Time

Decreased Memory

and Concentration

Impaired Task Completion

Psychosocial difficulties

Insufficient or

Disordered Sleep

Worse Mood; depression

Cardiovascular Disease


Significance of sleep for US obesity?

SOURCESObesity: CDC (NHES, NHANES)Sleep: Roffwarg Science 1966, NHIS (unpublisheddata), National Sleep Foundation polls, Hale J PublicHealth 2005

1960 1970 1980 1990 200040

50

60

70

Overweight and obesein the U.S. (%)

1960 1970 1980 1990 20006.5

7.0

7.5

8.0

8.5

9.0

year

mean sleep duration (hrs)


Simple solutions

Solutions already exist Most architects have taken courses on acoustics 8,500 acoustics professionals are available What has held up implementation?- Assumptions about cost- Quality issues like noise & privacy are often

lost in value-engineering- Concerns about infection control

AIA & GGHC acceptance change this


Core concept in architectural acoustics

Source > Path > Receiver


Overview of the Guideline

1. Site exterior noise (5 pages)2. Acoustical finishes and details3. Room noise levels4. Sound isolation performance of constructions

including speech privacy5. Paging & call systems, clinical alarms, masking

systems & sound reinforcement6. Building vibration7. Glossary


1. Site exterior noise


Sec.1: Directive

Shall consider impact of exterior noise on hospital Shall consider impact of hospital noise on community Exterior noises which facility does not control:

- Highways, aircraft, trains, etc. - Helipads, ambulances Exterior noises which facility completely controls: - Cooling towers & other building MEP equipment - Delivery vehicles, refrigeration trucks, etc.


Sec.1: Four new categories

…of exterior site environmental sound

A. Minimal—rural, quiet suburban

B. Moderate—busy suburbs, multifamily residential

C. Significant—commercial urban, busy streets

D. Extreme—near highway or airport flight path


Exterior Site Noise Exposure Category A B C D

General description Minimal Moderate Significant Extreme

Day-night average sound level (Ldn) (dB) < 65 65-70 70-75 > 75

Ave. hourly nominal max. (L01) (dBA) < 75 75-80 80-85 > 85

Distance from nearest highway (ft) 1000 250-1000 60-250 < 60

Distance from aircraft flight track1 (ft) > 7000 3500-7000 1800-3500< 1800

Distance from nearest rail line (ft) 1500 500-1500 100-500 < 100

Exterior shell composite STC rating2 (STCc)

35 40 45 50

Exterior patient sitting areas OK OK NO NO

Design goal for hospital MEP noise on community

45 50 55 60

Sec. 1: Category levels


Sec. 1: “Composite STC”


Sec. 1: “Ceiling Attenuation Class”(CAC)


Sec. 1: Action steps

Determine site type (A,B,C,D) Identify & characterize noise issues Consider solutions


Sec. 2: Acoustical finishes

1. Site exterior noise2. Acoustical finishes and details (3 pages)3. Room noise levels4. Sound isolation performance of constructions




Sec. 2: Indoor reverberation


Sec. 2: Identify sound paths


Sec. 2: Compare materials

Material NRC

Brick, unglazed 0.05

1/2" GWB on metal studs 0.05

Carpet on concrete 0.30

Wood floor 0.10

Glass, ¼” plate 0.05

3/4" fissured mineral tile 0.70

Carpet on pad 0.55

Vinyl tile floor 0.05

NRC – noise reduction coefficient (ave. abs. coef. () 250 to 2000 Hz


2. Calculate absorption

Space design

Subjective description

Private room 0.15 “Average”

Corridor 0.15 “Average”

Waiting 0.25 “Medium-dry”

Atrium 0.10 “Medium-live”

Office 0.15 “Average”

Treatment 0.15 “Average”

New design tool: Average absorption coefficient ( )


Sec. 2: Choose materials

Hospitals have a growing problems with nosocomial infections

“Devices that touch patients are the source” Important to use sound absorbing materials that

are cleanable Many products are well-suited:

Baffles, ceiling tiles, insulation, wall coverings, fabrics, furniture, flooring & carpet

No special requirements from EPA, CMS, CDC, JCAHO, FGI, ASTM or ASHRAE

Manufacturers cite ASTM C1338, & ASTM G21



Analyze “source>path>receiver” issues Consider design choices Calculate absorption required Choose acoustical finishes


Sec. 3: Room noise

1. Site exterior noise2. Acoustical finishes and details3. Room noise levels (2 pages)4. Sound isolation performance of constructions

including speech privacy5. Paging & call systems, clinical alarms,

masking systems & sound reinforcement6. Building vibration7. Glossary


Sec. 3: Methods & criteria

Methods to quantify room noise: - dBA & NC are most common methods

Criteria for acceptable sound levels set by space use & special acoustical needs:

a. Anatomical sounds (heartbeats, etc.)?b. Hearing and voice testing?c. Distraction & annoyance?

d. Communication issues?e. Sleep interference?


NC curves:


NCcurve:


Room Type NC dBA

Patient rooms 30-40 35-45

Multiple occupant patient care areas 35-45 40-50

NICU 25-35 30-40

Operating rooms 35-45 40-50

Corridors and public spaces 35-45 40-50

Testing/research lab, min. speech

45-55 50-60

Research lab, extensive speech 40-50 45-55

Group teaching lab 35-45 40-50

Doctor’s offices, exam rooms 30-40 35-45

Conference Rooms 25-35 30-40

Teleconferencing Rooms 25 (max) 30 (max)

Auditoria, large lecture rooms 25-30 30-35

Sec. 3: Level by room type



Consider room types & uses Select appropriate noise level criteria (NC or

dBA) from table Review design options with ME to achieve

these criteria


Sec. 4: Isolation & privacy

1. Site exterior noise2. Acoustical finishes and details3. Room noise levels4. Sound isolation performance of constructions

including speech privacy (4 pages)5. Paging & call systems, clinical alarms, masking



Sec. 4: Methods & criteria

Sound isolation requirement depends on use of adjacent spaces

Sound Transmission Class rating (STC) for enclosed rooms (ASTM E90 & E413)

Articulation Index (AI) for open plan (ASTM E1130) Speech Privacy criteria:

- What level? (“normal,” “confidential,” “secure”)- Vocal effort? (normal, raised, loud)- Room absorption & isolation? (partitions, screens)- Background sound level? (ambient noise, masking)


Sec. 4: Closed-plan privacy


Sec. 4: Open plan privacy


Adjacency combination STCc

Patient Room Patient Room (horizontal) 45

Patient Room Patient Room (vertical) 50

Patient Room Corridor (w/ entrance) 35

Patient Room Public Space 50

Patient Room Service Area 60

Exam Room Corridor (w/ entrance) 35

Exam Room Public Space 50

Toilet Room Public Space 45

Consultation Room Public Space 50

Consultation Room Patient Rooms 50

Consultation Room Corridor (w/ entrance) 35

Sec. 4: Consider adjacencies

STCc – Composite sound transmission class rating


Sec. 4: Identify privacy goal

Privacy GoalAI

Articulation Index

PIPrivacy Index

STISound

Transmission Index

SIISpeech

Intelligibility Index

Closed Plan

NormalConfidential

Secure

<0.15<0.05

>85%>95%

<0.19<0.12

<0.20<0.10

Open Plan

Normal

Confidential

<0.20 >80% <0.23 <0.25

Special consideration required

Special consideration required



Consider isolation/privacy requirement depending on adjacencies of “sources” & “receivers”

Select appropriate isolation/privacy criteria from tables (STC, AI etc.)

Evaluate adjacent spaces as possible “sources” or “receivers”

Evaluate performance of various constructions (doors, partitions, partial-height barriers, ceilings, etc.) including composite effects of multiple elements within partitions)

Detail & specify isolating elements to assure optimum field performance


Sec. 5: Sound systems

1. Site exterior noise2. Acoustical finishes and details3. Room noise levels4. Sound isolation performance of constructions

including speech privacy5. Paging & call systems, clinical alarms,

masking & sound reinforcement (2 pages)6. Building vibration7. Glossary


Sec. 5: Paging, call, alarm, masking & sound systems

Criteria: audibility, intelligibility, minimal annoyance You can limit annoyance, distraction, sleep loss by

reducing levels in limited areas or considering non-audible & wireless signals

HCO’s should consider “positive distractions” & Active-Noise-Cancelling systems for individual patients

Operational consideration: Should paging be routinely used in hospitals or used only for life/safety emergencies?


Sec. 5: Problem may be code minimumsPage, call & sound reinforcement minimums:

a. 70 dBA minimum sound level; orb. 10 dBA above background noise levels

(whichever is higher); and c. Coverage within +/- 4 dB at 2000 Hz throughout areas served

These levels can represent serious intrusion! Consider limiting their use in patient- sensitive areas


Sec. 5: Criteria

Alarms:NFPA 72 (ISO 7731)

Masking systems:a. Not higher than 48 dBAb. Uniform coverage +/-2dBAc. Suitable spectrum shape (innocuous)d. May be too high for many space uses



Consider impact of criteria-determined minimum sound levels in relation to patient/staff needs

Evaluate communication system options for critical areas & set appropriate criteria, e.g.

- Wired traditional sound system?- Light/code systems?- Wireless pagers?


Sec. 6: Vibration

1. Site exterior noise 2. Acoustical finishes and details3. Room noise levels4. Sound isolation performance of constructions


systems & sound reinforcement6. Building vibration (2 pages)7. Glossary


Sec. 6: Means “minimal vibration” of building structure

Sources of vibration: footfall, MEP equipmentControls:

a. building stiffness, massb. vibration isolation of all MEP equipmentc. minimize proximity of vibration and impact sources from sensitive receivers & activities


Sec. 6: Typical sources


Sec. 6: Criteria

Space TypeFootfall Vibration

Peak Velocity (in/s)

Patient rooms & other patient areas 4000

Operating & other treatment rooms 4000

Administrative areas 8000

Public circulation 8000

Table 6.3.2-1: Recommended limits on footfall vibration in hospitals.



Consider location of MEP equipment rooms, MRI, and foot traffic with respect to patient & research areas

Select appropriate criteria for building structure, mass, stiffness, etc.

Plan circulation pathways to minimize intrusions Evaluate mobile equipment (e.g. cart wheels) Detail & specify appropriate materials & finishes


Bottom line for designers

You can’t see noise but it has profound effects on patients & staff

A row of trees will not protect a hospital from highway noise There are no paints that can absorb sound Curtains will not protect privacy in patient areas In quality surveys, doctors, nurses, administrators, patients

& families identify “noise & lack of privacy” as the top, most onerous issues

HCOs are learning how to deal with this—you can lead the dialogue as designers of the healthcare environment

90% of acoustical problems in HCFs can be solved in design at modest cost

“Fixing the problem later” is always more expensive


Concluding comments

Basis for compliance A note about solutions Example of a “new product” Getting to code Discussion, Q&A Contact information Acknowledgements


Basis for compliance

Documents are based on existing standards from recognized standards authorities & widely accepted professional best practices

Certification—standard analyses & tests can be performed in design & tested in-situ to show general conformance to the Guideline

For AHJ’s & HCO’s, this may be useful & desirable for inspections (e.g., JCAHO, etc.)


Solutions: the revolution in building sciences

Many already available products are well suited for improving acoustics without compromising infection control

Fabrics (stain-proof, wrinkle-proof, color-fast) Insulation for ceilings, walls & floors Flooring & carpeting materials Filtration methods (e.g., for HVAC systems) Wireless communications

Sources: Cleantech, Greentech, MEMs & Nano-tech


Example: aerogels are a “new & green” material

Thermo-acoustic insulation material that is: Hydrophobic Translucent Lightweight (97% air) & thin Available in multiple forms (insulation ‘blankets’

& rigid exterior glazing panels with R20) Widely available in volume


Light 20% Light

Transmission

Noise 50% Sound

Reduction

Thermal Performance R-20 The insulating value

of a 6” stud wall

TestingPermanence ofperformance Non-combustible/

no smoke Mold/mildew resistance Condensation resistance UV Stable


Questions?


Frequently asked questions

When’s the best time to consider acoustics? How do we apply this to project work? Who pays for expertise when needed & how much? How do I find an acoustical consultant? What questions do healthcare people raise?*

*ex: “can absorptive materials compromise infection control?”


Contact information

David Sykes: [email protected]

Gregory Tocci: [email protected]

Bill Cavanaugh: [email protected]


Committee sponsors

Armstrong

Cabot Corporation

CertainTeed

Dupont

Logison

Owens Corning

Quiet Solution

Sonare Technologies

Speech Privacy Systems

USG

fgi/aia interim sound & vibration guidelines for hospitals & healthcare facilities

Documents

ansi s12 wg44contextu

ansi s12 workgroup

ansi s12 wg44objectives

healthcare acoustics

ansi s12 wg44the standard

sponsors of ansi s12

acoustics noise

ansi s12 wg443 goals