IHFG Part B Renal Dialysis Unit
IHFG Part B Renal Dialysis Unit
IHFG Part B Renal Dialysis Unit
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Renal Dialysis Unit
Description
Renal Dialysis is a medical process that becomes necessary when the normal functions of the
kidneys become compromised by reduced kidney function and kidney failure. This may be due to
disease, injury, infection or genetic factors. Renal failure may be classified as either Acute Renal
Failure or chronic Kidney Disease. Haemodialysis and Peritoneal dialysis services involve filtering
the blood of excess fluid, and waste products normally filtered by the kidneys.
Haemodialysis is a treatment for end stage renal failure where the function of the kidneys to
remove substances from the blood is replaced by the use of a haemodialysis (dialysis) machine.
Haemodialysis requires the patient to have one of the following - arterio-venous fistula, vein graft
(artificial graft) or central line catheter inserted into their neck or upper chest for dialysis.
Haemodialysis management may require the patient to undergo dialysis for 3 to 6 hours on a daily
basis over 3 to 4 days a week.
2 Planning
Operational Models
Operational models of care for a service will influence the functional planning components for the
unit. The role delineation of a hospital will determine the type and range of the renal dialysis
services that will be provided and the associated support systems and services. The Renal
Dialysis unit may be provided as:
one of the departments in a hospital (in-centre care) and also support dialysis services as
required in an ICU, CCU or in a Renal Inpatient Unit
a dialysis unit planned as a satellite unit which may be situated on the hospital site/campus
or a stand-alone unit located within a community setting.
Models of Care
Renal dialysis can be provided in a number of settings as described in the operational models and
Planning Models.
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Renal Dialysis Unit
The development of the models of care to deliver a renal dialysis service is provided by a
multidiscipline team to support the patient/client, their family and or carer. The important role of
education should also be considered in the development of models of care.
The development of clear documented models of care by the service for the proposed renal
dialysis unit should assist with the design development and planning, ensuring the future
functionality of the unit.
Hours of Operation
Units operate from early morning until late afternoon providing multiple sessions per day. Some
units may operate for extended hours to accommodate working patients/clients.
Planning Models
Some of the factors that should be taken into consideration when planning a Renal Dialysis Unit
include:
The operational model chosen as part of the planning model
Age and mix of the patient group
Acuity of the proposed or current patient group
Comorbidity of the patient group
Rate of infectious diseases to be expected in the patient group
Functional Areas
The Dialysis Unit will consist of or have access to the following functional areas for all service
delivery methods:
Main Entry / Reception Area
Waiting
Treatment Areas
Staff Areas
Support Areas
Storage Areas:
- Clinical
- Non clinical
- Bulk items storage e.g. fluids, equipment and dialysis machine
- Service maintenance
Functional Relationships
External
Planning is to address the following key issues:
Ease of access to the unit where the majority of people will arrive by car on a daily basis
Separation of walking and stretcher/ ambulance patient arrivals
Safe access to the Unit Store rooms for the delivery of bulk items e.g. fluids on a palette
requiring mechanical lifting, moving and storage
Safe access for the delivery of food, clean linen, pharmacy, consumables, disposable items
and the related removal of bulk waste and soiled linen etc.
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Renal Dialysis Unit
Internal
The internal planning of the Renal Dialysis Unit should be planned by considering the units
functional areas/zones.
3 Design
General
The Unit shall be designed to provide:
ease of public access for patients who may arrive either walking, using mobility equipment,
families with children, on an ambulance stretcher or patient trolley
ease of access to public parking for patients who are often debilitated and who may need to
visit the unit on a regular basis
ease of delivery of large amounts of fluids (dialysate) on palettes to the Unit on a regular
basis.
Environmental Considerations
Natural Light
Natural light contributes to a sense of wellbeing of patients, staff, visitors and other users. The use
of natural light should be maximised throughout the Unit.
Natural light and a view to pleasant and interesting outdoor areas is of particular importance for
patients who spend long periods of time sitting in dialysis chairs. Every effort should be made to
provide a view to all treatment areas either by locating treatment bays adjacent to a window or
enabling unobstructed sight lines through areas to an outdoor view.
Privacy
Confidentiality for persons receiving treatment is a highly important consideration to be addressed.
The Unit should be designed to:
ensure confidentiality of personal discussions and medical records
provide an adequate number of rooms for discreet discussions and treatments to occur
whenever required
enable sufficient space within each treatment space to permit curtains to be easily drawn
whenever required
appropriately locate windows and doors to enhance visual and acoustic privacy
Acoustics
Many of the functions undertaken in the Unit require consideration of acoustic privacy including:
family/ case conference/ interviews rooms
isolation of noisy areas such as waiting rooms from clinical areas e.g. clean and dirty utilities
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Renal Dialysis Unit
Access to public areas shall be considered with care so that the safety and security of staff areas
within the Unit are not compromised.
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Renal Dialysis Unit
Finishes
Floor and ceiling finishes shall be selected to suit the function of the space and promote a
pleasant environment for patients, visitors and staff.
Nurse Call and Emergency Call facilities shall be provided in all patient areas (e.g. Bed/chair
spaces, Toilets and Bathrooms) and clinical areas in order for patients and staff to request for
urgent assistance. The individual call buttons shall alert to distributed identified ceiling mounted
annunciators and also to a central module situated at or adjacent to the Staff Station (s) or to a
paging system. The alert to staff members should be done in a discreet manner.
Provision of a duress alarm system is required for the safety of staff members who may at times
face threats imposed by clients / visitors. Call buttons will be required at all Reception/ Staff
Station areas and Consultation/ Treatment areas where a staff may have to spend time with a
client in isolation or alone. The combination of fixed and mobile duress units should be considered
as part of the safety review during planning for the unit.
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Renal Dialysis Unit
systems may undertake the water treatment activities in slightly different ways but in general the
main phases of water treatment occur in the following sequence:
Planning considerations for the design and installation of the water pre-treatment include:
water feed quality
pressure of the feed water
maximum water flow – consideration of the growth of service activity
average water flow per day – consideration of the growth of the service
spatial requirement to safely install and operate the water pre-treatment plant
drainage requirements
weight of the water pre-treatment plant and the ability of the floor to safely support that
weight
water quality monitoring systems
power supply requirements
facilities and access to safely service and maintain the water pre-treatment plant
water distribution loop
Reverse Osmosis (RO) is a process of forcing water from one side of a semi-permeable
membrane to the other, producing purified water by leaving behind the dissolved solids and
organic particles. The equipment that performs this process is usually referred to as the RO
system. The aim of all the above processes is to improve the purity of the water to be used by
removal of particulates, salts and bacteria before it comes into contact with the person receiving
haemodialysis.
Booster pumps may also be required to ensure a certain speed of water (at least 10
metres/second) and a certain pressure of water (varies dependent on the concentration of the salt
solution on the reject side of the membrane) to enable these processes and to limit the ability of
tubing contamination by bacteria and moulds. These contamination processes are also reduced
by the application of heat (85 – 90 degrees Celsius), eliminating any right angle bends, ensuring
the internal surfaces of tubing have a high level of smoothness and by keeping tubing runs as
short as possible.
The Plant Room for water treatment is ideally located as part of the Renal Dialysis Unit to keep
tubing runs short and to make it easy for staff to monitor and service the water treatment systems.
The Design Team should gain expert input from the agency that will provide these services early
in the design process to ensure that all requirements are identified as early as possible during
planning.
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Renal Dialysis Unit
Drainage Systems
Services that facilitate the drainage of fluids from the haemodialysis machines must be ventilated
to prevent condensation and the subsequent growth of mould. This should be considered when
designing covers or screens for the drainage systems. Commercial models which comply with the
relevant Standards are available.
Infection Control
Infectious patients and immune-suppressed patients may be sharing the same treatment space at
the different times of the same day. The design of all aspects for the Unit should take into
consideration the need to ensure a high level of infection control in all aspects of clinical and non-
clinical practice.
Hand washing facilities for staff within the Unit should be readily available. Where a hand wash
basin is provided, there shall also be liquid soap, disposable paper towels and waste bin provided
and PPE equipment.
For further details relating to the Infection Control refer to Part D of these Guidelines.
The Renal Dialysis Unit will contain Standard Components to comply with details described in
these Guidelines. Refer also to Standard Components Room Data Sheets and Room Layout
Sheets.
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Renal Dialysis Unit
Treatment Area
Treatment Bay - Renal Dialysis TRMT-RD-I 5 x 9 11 x 9 22 x 9 28 x 9 See Note 3
Isolation Room - Type S TRMT-RD-S-I 1 x 14 1 x 14 2 x 14 2 x 14 According to service plan & risk assessment
Ensuite - Standard ENS-ST-I 1 x 5 1 x 5 2 x 5 2 x 5 For Isolation Rooms
Shower - Accessible SHD-I 1 x 4 1 x 4 2 x 4 2 x 4
Toilet - Accessible WCAC-I 1 x 6 1 x 6 2 x 6 2 x 6
Toilet - Patient WCPT-I 1 x 4 1 x 4 1 x 4 2 x 4
Bay - Beverage BBEV-ENC-I 1 x 5 1 x 5 1 x 5 1 x 5 To receive and issue refreshments to patients
Bay - Handwashing, PPE BHWS-PPE-I 2 x 1.5 3 x 1.5 6 x 1.5 8 x 1.5 Refer to part D
Bay - Linen BLIN-I 1 x 2 1 x 2 2 x 2 2 x 2
Bay - Resuscitation Trolley BRES-I 1 x 1.5 1 x 1.5 1 x 1.5 1 x 1.5 Adjacent to Staff Station
Clean Utility CLUR-12-I CLUR-14-I 1 x 12 1 x 12 1 x 14 1 x 14 Including medications and dressing set-ups
Dialysate Preparation Area BUT-2-I 1 x 2 1 x 2 2 x 2 2 x 2 Adjacent to Dialysate Fluid Bay
Dirty Utility DTUR-10-I 1 x 10 1 x 10 1 x 10 1 x 10
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ROOM/ SPACE Standard Component RDL 2/3 RDL4 RDL5 RDL6 Remarks
Room Codes Qty x m2 Qty x m2 Qty x m2 Qty x m2
Staff Station SSTN-10-I SSTN-12-I 1 x 10 1 x 12 2 x 10 2 x 12 Subdivided in larger Units
Sub Total 123.5 181.0 327.5 392.5
Circulation % 35 35 35 35
Area Total 166.7 244.4 442.1 529.9
Note 1: Meeting Room; to support patient education, community training and other functions; should have teleconferencing capability; add 4m2 to room if including
a beverage bay
Note 2: Training/Treatment room; where there is a developed program of training for home based dialysis as approved in the Service Plan a dedicated space
should be provided; this space could also be used for related procedures such as the insertion of catheters etc.
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Renal Dialysis Unit
Note 3: Treatment Bays; Bay size needs to be 9 square meters with a clear width of 3 meters along the back of the bay to ensure appropriate service placement,
machine accommodation and curtain track placement; spaces of 12m2 will need to be considered where more than 50% of patients are receiving dialysis in patient
beds rather than chairs (particularly in RDL 5/6 renal services located in tertiary referral hospitals); bays will accommodate beds or chairs
Note 4: Dialysate Fluid Bay; to hold dialysis fluid in a convenient location close to treatment bays; temperature is important for some dialysate fluids and this area
may require air-conditioning
Note 5: Main Store Room; for general stores, fluids and equipment, to be located on the perimeter of the Unit and accessible by a palette lifter. Shelving must have
100 kg weight capacity and shelves need to be at least 400 mm apart and adjustable.
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Treatment Area
Treatment Bay - Renal Dialysis TRMT-RD-I 11 x 9 15 x 9 20 x 9 25 x 9 See Note 3
Isolation Room - Type S TRMT-RD-S-I 1 x 14 3 x 14 4 x 14 5 x 14 1 per 6 spaces
Ensuite - Standard ENS-ST-I 1 x 5 3 x 5 4 x 5 5 x 5 For Isolation Room
Shower - Accessible SHD-I 1 x 4 2 x 4 2 x 4 2 x 4 Patient use
Toilet - Patient WCPT-I 1 x 4 1 x 4 1 x 4 2 x 4
Toilet - Accessible WCAC-I 1 x 6 2 x 6 2 x 6 2 x 6 Patient use
Bay - Beverage BBEV-ENC-I 1 x 5 1 x 5 1 x 5 1 x 5 To receive and issue refreshments to patients
Bay - Handwashing, PPE BHWS-PPE-I 3 x 1.5 4 x 1.5 6 x 1.5 8 x 1.5 Refer to part D
Bay - Linen BLIN-I 1 x 2 1 x 2 1 x 2 1 x 2
Bay - Resuscitation Trolley BRES-I 1 x 1.5 1 x 1.5 1 x 1.5 1 x 1.5 Adjacent to Staff Station
Clean Utility CLUR-12-I CLUR-14-I 1 x 12 1 x 12 1 x 14 1 x 14 Including medications and dressing set-ups
Dialysate Preparation Area BUT-2-I 1 x 2 2 x 2 2 x 2 2 x 2 Adjacent to Dialysate Fluid Bay
Dirty Utility DTUR-10-I 1 x 10 1 x 10 1 x 10 1 x 10
Staff Station SSTN-10-I SSTN-12-I 1 x 12 2 x 10 2 x 10 2 x 12 Subdivided in larger Units
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ROOM/ SPACE Standard Component RDL ALL RDL ALL RDL ALL RDL ALL Remarks
Room Codes Qty x m2 Qty x m2 Qty x m2 Qty x m2
Sub Total 181.0 276.5 345.5 420.5
Circulation % 35 35 35 35
Area Total 244.4 373.3 466.4 567.7
Storage Areas
Bay - Wheelchair Park BWC-I BWC-8-I 1 x 4 1 x 4 1 x 8 1 x 8 May be subdivided
Dialysate Fluid Bay BS-1-I BS-2-I 1 x 1 2 x 1 2 x 2 2 x 2 See Note 4
Store - General STGN-8-I STGN-10-I STGN-12-I 1 x 8 1 x 8 1 x 10 1 x 12 Size will be dependent on quantity of stock to be held
Store - Main STGN-8-I STGN-16-I STGN-30-I 1 x 8 1 x 16 1 x 30 1 x 30 See Note 5
Optional; not required for electronic records; size will be dependent on
Store - Medical Records STFS-20-I (sim) 1 x 10 1 x 10 1 x 20 1 x 25
quantity of records to be held
Sub Total 21.0 40.0 72.0 79.0
Circulation % 25 25 25 25
Area Total 26.3 50.0 90.0 98.8
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Note 1: Meeting Room; to support patient education, community training and other functions; should have teleconferencing capability; add 4m2 to room if including
a beverage bay
Note 2: Training/Treatment room; where there is a developed program of training for home based dialysis as approved in the Service Plan a dedicated space
should be provided; this space could also be used for related procedures such as the insertion of catheters etc.
Note 3: Treatment Bays; Bay size needs to be 9 square meters with a clear width of 3 meters along the back of the bay to ensure appropriate service placement,
machine accommodation and curtain track placement; spaces of 12m2 will need to be considered where more than 50% of patients are receiving dialysis in patient
beds rather than chairs (particularly in RDL 5/6 renal services located in tertiary referral hospitals); bays will accommodate beds or chairs
Note 4: Dialysate Fluid Bay; to hold dialysis fluid in a convenient location close to treatment bays; temperature is important for some dialysate fluids and this area
may require air-conditioning
Note 5: Main Store Room; for general stores, fluids and equipment, to be located on the perimeter of the Unit and accessible by a palette lifter. Shelving must have
100 kg weight capacity and shelves need to be at least 400 mm apart and adjustable.
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Australasian Health Facility Guidelines. (AusHFG Version 4.0), Part B Health Facility Briefing
and Planning, Rev 4, 2012; refer to website www.healthfacilitydesign.com.au
Guidelines for Design and Construction of Health Care Facilities; The Facility Guidelines
Institute, 2010 Edition; refer to website www.fgiguidelines.org .
NSW Health – NSW Haemodialysis ‘Models of Care’ Program, NSW Renal Services
Network; 2008
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The International Health Facility Guidelines recommends the
use of HFBS “Health Facility Briefing System” to edit all
room data sheet information for your project.