Healthcare infrastructure norms and standards developer Infrastructure Unit Support Systems (IUSS) is in the process of developing and publishing a set of healthcare infrastructure standards and norms to act as a built environment best practice guideline.

IUSS is a structural collaboration between the Department of Health (DoH), the Council for Scientific and Industrial Research (CSIR), the Development Bank of Southern Africa and other healthcare stakeholders, including healthcare building design and engineering voluntary association the South African Federation of Hospital Engineering (SAFHE).

SAFHE president and CSIR architectural engineering research leader Peta de Jager notes that there are four categories of IUSS norms and standards, namely clinical services, support services, cross-cutting systems, and procurement and operation.

She explains that clinical services address core hospital functions, such as the correct methods in designing and constructing hospital theatre rooms.

Support services address industry best practice for the design and engineering of hospital building services, such as kitchens and laundry services, while the cross-cutting category provides industry best practice for issues, such as effective infection prevention and control, meeting environmental and sustainability targets and the use of healthcare technology.

Finally, the procurement and operation category provides a number of tools, including a set of interactive costing tools, which are used to determine the life-cycle costing of a healthcare infrastructure project.

IUSS has developed an order of magnitude costing tool as part of the procurement and operation standards, which can be used to determine the cost of developing a clinic, project operational costs and provide a guideline as to what a project’s profile of expenditure is likely to be, based on where it is in the project phasing.

In South Africa, buildings are required to comply with the South African Bureau of Standards’ South African National Standards (Sans), which are currently aimed at improving energy efficiency by reducing the amount of energy used for building services, such as heating, ventilation and air-conditioning (HVAC) systems.

However, De Jager notes that Sans guidelines do not necessarily lend themselves well to certain aspects of hospital engineering, such as infection prevention and control, or indoor air quality.

“Subsequently, the CSIR has worked with Sans committees to enable a refined approach to building design, by recognising that passive and hybrid design techniques should be used as far as possible for that particular climate zone.

“Passive design refers to design techniques, such as the envelope design, orientation of the building, use of natural ventilation and lighting systems. Hybrid design combines the use of high-tech, energy intensive solutions, such as HVAC systems with passive design elements,” she explains.

Meanwhile, De Jager points out that it has been challenging to create awareness around IUSS standards, although they have been invoked in two DoH gazettes, published in February and June last year.

The first gazette refers to health and infrastructure norms and standards, as they relate to building engineering services, infrastructure design for waste management in healthcare facilities and emergency centres. The second gazette is concerned with health infrastructure norms and standards in relation to adult physical rehabilitation, paediatrics and neonatal facilities, maternity care facilities, among others.

However, despite the successes of IUSS, the majority of built environment professionals are unaware of the specific requirements associated with the design and engineering of healthcare facilities.

De Jager notes that the correct design, engineering and maintenance of healthcare infrastructure is of particular concern. For example, poorly performing medical gas installations can not only lead to medical equipment being damaged, but can also present a risk to patients using medical gas, such as oxygen.

She states that, while the various stakeholders involved in the development of the IUSS norms and standards have done a lot of work, more needs to be done to ensure that South Africa’s healthcare infrastructure meets South Africa’s future needs.

“As custodians of the built environment, architects, engineers and maintenance staff of healthcare settings are part of the continuum of care. However, there is no formal training specialisation for these professionals. I believe government and organisations such as SAFHE need to partner with organisations that are mandated to provide training, such as tertiary institutions, to develop programmes to get all relevant people aligned with the goal of improved healthcare infrastructure,” De Jager concludes.