Environment, hospital, design

The first chapter in this section provides a unique account of the ecology, i.e. distribution, survival and life-style, of microorganisms in the factory environment, and should enable process designers, controllers and quality control personnel to comprehend, trace and eradicate the sources of failure due to extraneous microbial contaminants in the finished product. Much of the information given here is applicable to hospital manufacture also, and this is extended in a contribution (Chapter 19) dealing with contamination in hospital pharmaceutical products and in the home. 

The paper by Izumi is reminiscent of the era in which therapists took the new psychedelics in order to better understand their patients. In this case, the drug was taken to facilitate the design of a mental hospital that would provide a properly therapeutic environment for patients. The hospitals that have been built as a result of these experiences have been the first major innovations in mental-hospital construction in many years, and herald an era in which buildings will be people-oriented, in contrast to the present, when people are required to be building-adapted. 

There appears to be no doubt that the design concerns that have been discussed are important in the specific case of designing facilities for the care and treatment of the mentally ill. The degree to which the architectural environment supports the medical program at the Yorkton Psychiatric Centre, and at other hospitals that have been designed with perceptual considerations in mind, has not yet been measured and may be difficult to measure. However, there is a slow accumulation of information confirming the validity of the argument that the environment does have contributory effects and merits serious concern. Some of this information comes from former patients and chronic patients who, in their lucid moments, have described their environmental needs. 

In the near future, within the context of our changing health care environment and research environment, there is a need for multidisciplinary approaches. The clinical pharmacist should demonstrate, according to their expertise in the principles governing therapeutics, that they are able to participate fully in this expanding process within the research environment. Thus, a hospital pharmacist would be valuable in the design, development, review, and preparation of the protocol and, finally, in evaluating and reporting results. 

Technically almost any reaction can be classed as operating on a scale that is beyond the molecule whether it is the catalysis of polypropylene, the solidification of cement or gene transcription. What makes the concept of supramolecular chemistry attractive is that there is an implicit act of design in the use of existing molecules, or in the synthesis of new ones, to prepare molecular assemblies that have particularly desirable qualities. Such qualities may include detection of biologically important species in a hospital environment, monitoring agrochemicals in watercourses, controlled release of pharmaceuticals into a patient or even the ability for a supramolecular interaction to act as a bit of information on a chemical computer chip. 

In addition to these plans, in October 2001 the French Minister of Health announced Plan Biotox as an immediate response to the terrorist anthrax attacks then taking place in the United States (Plan Biotox, 2001). This plan focused on the provision of specific therapy and early life support to be provided in a contaminated zone with the provision of specially trained and equipped SAMU crews capable of operating in a toxic environment and also provision for the reception of contaminated patients at designated hospitals. A key feature of the new plan was the mass purchase of small portable gas-powered ventilators that can assure a high quality of essential ventilatory care at the scene of the emergency and in hospitals that may receive mass casualties (see Figure 8). 

A major challenge in the development of these two sensors was the selection of the proper electrolyte. For the Back Cell design, the polymer electrolyte required a unique set of properties. The polymer must have relatively high viscosity upon fabrication to prevent it from entering the pores of the substrate and blocking the triple points. The polymer must have sufficient ionic conductivity to eliminate pick-up of electrical noise. In addition, the polymer must have a stable water content at the high relative humidities found in respirator circuits. An obvious requirement is that the gas must dissolve in the polymer electrolyte. For the CO2 sensor, an enzyme, carbonic anhydrase, is used to improve response time. Therefore, the hydrogel must provide an hospitable environment for the enzyme to retain its activity. 

Finally, the medical logistical requirements will be increased. It has been stated that up to 40% more transport is required to move a typical field hospital in a chemical environment, and the fuel necessary to power air pumps, special filtration units, and air conditioners is an added requirement.35 Water requirements may also be increased in a chemical environment. Medical treatment facility planners should recognize the importance of environmental factors within a chemical warfare theater. For example, the MOPP gear may not be designed for the climatic conditions on the battlefield. Tests have shown that perspiration compromises the ability of the battledress overgarment to protect the wearer from chemical agents36 and may actually predispose an individual to injury.32... 

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Hospitals are extraordinarily noisy places, sometimes necessarily but often because of poor design and buildings that are ill equipped for sick people. If it was a hotel, you d complain and tell your friends to avoid the place as it s a hospital you have to put up with it. Noise, as we all know, disrupts sleep, which is particularly critical to recovery it also increases stress and raises blood pressure. On the staff side, communication is harder, distractions are greater and concentration is poorer. The combination of quiet floor coverings, private rooms, good insulation, quiet ventilation and heating systems and quiet equipment can transform the environment. An ambience of monastic calm, rather than a downtown bus station. 

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