Seismic test building is ready to rock

Any day now an earthquake will hit Southern California — more precisely, a very tiny piece of Southern California. But no one is fretting about this temblor.

That's because the quake will be simulated using the largest outdoor shake table in the world to move a five-story concrete building that includes two floors designed and equipped to duplicate hospital clinical spaces.

Structural engineers from the University of California San Diego (UCSD) will conduct earthquake simulation tests beginning next month to measure the impact on nonstructural components and building systems. The goal is to determine if design changes are needed to minimize damage from earthquakes and related fire.

Intense ground motions generated by the steel-plated shake table, which is powered by hydraulic actuators underneath, can simulate quake levels as intense as those expected for the San Andreas fault in California.

The building and shake table are equipped with more than 500 sensors and 70 digital cameras to measure the impact of the motion on the mechanical, electrical, fire protection and other nonstructural components. Damage to nonstructural components has had a significant impact on the operation of hospitals after an earthquake.

For that reason, two of the five floors have been designed and built to closely duplicate health care facility clinical spaces, says Tara Hutchinson, P.E., professor in the department of structural engineering at the Jacobs School of Engineering, UCSD, and principal investigator on the project.

"From the interior point of view, the architectural features and the equipment features will be as realistic as we can attain," says Hutchinson.

"We should be able to observe interactions between several systems in the building for the first time," says Jose Restrepo, professor of structural engineering at the Jacobs School of Engineering and co-principal investigator on the hospital project with Hutchinson. "We will learn if current design requirements are satisfactory and recommend adjustments if necessary."

One floor is set up as a surgery suite equipped with medical devices and other equipment such as a patient lift and beds, wall-mounted equipment and mobile computers. The second hospital floor is designed as an intensive care unit equipped with nurse call stations, patient beds and medical equipment such as imaging machines, says Hutchinson.

The hospital floors will include interior fire-rated gypsum walls and a ceiling and subsystem that would be found in a typical hospital, she says. A medical gas line has been installed along with regular plumbing lines, a fire sprinkler system and HVAC ducts.

Hutchinson says plumbing systems are usually vulnerable during earthquakes, making them an important aspect of the testing. "Failure of these small piping systems, because they're attached at several locations, is common. The failure of even these small systems can render the hospital nonfunctional at the very time that its services are in high demand," she says.

Hospitals need to remain functional and operational after a major seismic event, which means they need special attention when it comes to design, installation and construction, Hutchinson says.

Since the 1970s, engineers have endeavored to determine how to improve building design codes after hospital system failures occurred in the wake of earthquakes, she says. While research has been conducted in the past, nothing to this level of detail has been done, Hutchinson adds.

The team also will conduct fire tests, says Restrepo. "These tests will allow us to observe the post-earthquake performance of the different fire barriers and see if such barriers are affected by the movement of the building during strong earthquakes," he says.

Study reports rise in violence aimed at ED nurses

Violence against emergency department (ED) nurses is on the rise, according to a study recently released by the Emergency Nurses Association (ENA), Des Plaines, Ill.

Nearly 13 percent of ED nurses reported experiencing physical violence over a seven-day period in 2010, compared with 11 percent over a similar period in the prior year, the survey reports. About 53 percent of nurses experienced verbal abuse over a seven-day period in 2010 compared with 54 percent in the prior year. More than 7,000 ED nurses were surveyed for the report.

ENA research shows that nearly 56 percent of patients who physically assaulted nurses were under the influence of alcohol, 47 percent were under the influence of illicit or prescription drugs and 45 percent were mentally ill. Nearly all perpetrators were patients, according to the report.

"EDs are not always made safe enough for these types of patients or the staff who are asked to care for them," says Gail Lenehan, R.N., FAEN, FAAN, president of ENA.

ENA research shows there are lower rates of abuse when panic buttons, locked entries, enclosed nurses' stations, call code pseudonyms, security signs and well-lit areas are used in the ED.

"But the most effective approach is a violence mitigation program that includes facilities management that listens to staff to understand what they need to keep themselves and their patients safe," notes Lenehan.

ENA has developed a toolkit to help ED managers assess their departments and problems. Visit www.ena.org/IENR/ViolenceToolKit/Documents/toolkitpg1.htm.

Johns Hopkins, Lockheed partner to redesign ICU

The Armstrong Institute for Patient Safety and Quality of Johns Hopkins Medicine, Baltimore, and aerospace and defense giant Lockheed Martin have agreed to begin research on creating a safer and more efficient intensive care unit (ICU).

Johns Hopkins is collaborating with Lockheed Martin in neighboring Bethesda, Md., to design a new ICU that streamlines complex and fragmented clinical systems and processes. The goal is to reduce medical errors and improve the quality of care for critically ill patients.

A typical ICU is loaded with 50 to 100 pieces of electronic equipment that may not communicate with each other or work together effectively, says Peter Pronovost, M.D., director of the Armstrong Institute and senior vice president for patient safety and quality for Johns Hopkins Medicine.

The piecemeal approach by which hospitals currently design ICUs is inefficient and prone to error, which adds risk to an already complicated environment, he says. A single system that could prioritize patient alarms based on individual risk of cardiac or respiratory arrest, for example, could prevent alarm fatigue.

"Lockheed Martin has the expertise to integrate complex systems to help us build a safer and more efficient ICU model not just for Johns Hopkins, but for patients around the world," says Pronovost.

PDC Summit to highlight integrated team

Demonstrating value through integrated teamwork will be the focus for the American Society for Healthcare Engineering's (ASHE) 2012 International Summit & Exhibition on Health Facility Planning, Design & Construction on March 4-7 in Phoenix.

The Summit will feature educational sessions providing strategic perspectives on health care fa­cilities as well as on industry trends, practices and issues.

Among topics scheduled for learning sessions are integrated project delivery, hospital and care systems of the future, health facility commissioning, proposed updates to the Facility Guidelines Institute's Guidelines for Design and Construction of Health Care Facilities, regulatory issues, new developments in clinical redesign and the effects of last year's tornado in Joplin, Mo. Special preconference programming includes American College of Healthcare Architects hospital tours, the ASHE infection control seminar and certification exam workshops.

Applications for learning units from the American Institute of Architects and continuing education units from the American Hospital Association and the American Academy of Healthcare Interior Designers have been submitted.

"To help you meet the challenges of creating environments in which health care providers can work effectively and efficiently and patients receive quality care, I encourage you to attend the 2012 International Summit [& Exhibition] on Health Facility Planning, Design & Construction," says Rich Umbdenstock, president and CEO, AHA.

To register and learn more about the event, go to www.ashe.org.