My Name is Laila AL-Aref . I have been working as a medical laboratory technologist for more than 29 years in both public and private sectors in Amman, Jordan. My professional and practical
experience has given me a strong background in Laboratory management and supervision, Today I will be talking to you about Hospital Laboratory designs and criteria considered to make them efficient.


While clinical laboratories are among the most important spaces hospitals and related health care facilities may operate,
their functional designs are sometimes less noticed than those of higher profile areas.


To render our labs efficient and coping with new technologies the following factors should be taken into consideration: Functional Relationships, Movement, Flexibility, Energy Consumption The architects and engineers will act as liaisons between the contractors and the owners. They will answer questions, review compliance with the construction documents and
generate change orders if necessary. Understanding the responsibilities of the various members of a design team and the milestones that must be achieved during the design project allows everyone to be organized and efficient. A lack of organization, in the multifaceted laboratory project, will result in lost details and cause immediate and future problems.


This bubble diagram shown here sheds light on the different lab departments and functional relationships among them. Not only can these relationships affect the efficiency of the lab and its personnel, they can also affect the nature of future expansion. An easy way to evaluate these
relationships is through a bubble diagram. Using visual clues to organize and prioritize relationships the best location and orientation of the lab can be determined. In the same diagram, areas that can support future lab expansion, whether interior or exterior, should be included.


This illustration of specimen movement provides visual clues to aid in the more efficient organization of the lab. In the example shown here, in which a Cytology lab is being designed, the specimen movement diagram was used to help the users to relate how they need the space to be set up. As you can see, Once the specimen arrives to the lab it is kept in the refrigerator
until ML proceeds with accessioning, labeling, and then the sample is processed, worked with and slides are prepared. Once the slides are ready, they are either stored or taken to the reading room for evaluation. The specimen path shown in the diagram moves the specimen in a smooth and efficient way as well as minimizes Personnel traffic and movement inside the lab .


Some of these ideas include: Direct/indirect lighting for overall visibility, Flexible casework for workstation changes, And rolling carts for immediate flexibility


Without proper analysis of the total heat load, the equipment and personnel can be adversely affected. The amount of heat that is generated by individual pieces of equipment, when idle and in full operation, is very important in determining temperature and air requirements for the space. Fumes that may be generated, such as those from automatic stainers, are used in determining the location of vents, or addition of fume hoods. Water lines and drains are often required for lab equipment. Types of water may include deionized, tap or filtered. Drains are added for those emergency situations when something overflows, or to empty wastes generated by analyzers. Drainage from equipment may contain caustic or hazardous wastes. The system that will accept that waste must be evaluated by the engineers
to ensure that it meets environmental codes and that the plumbing materials can handle caustics. Gases, if required are to be included in mechanical information. Locating any gases remotely from the equipment requires space, but is safer for the users. (:0 , Nitrogen, Oxygen, Vacuum and other 2 specialized gases can be connected into existing risers, nearby tank closets, or tanks located adjacent to the equipment. An additional ventilation concern that greatly affects the size and arrangement of ductwork is the air demands generated by hoods and biosafety cabinets. In fact, An often overlooked addition to the mechanical information is the attachments from fume hoods and biosafety cabinets to the ventilation systems. New or additional connections, and flexible pipes may be required.


Laboratory safety is mandated through codes. Life safety codes have been issued and expanded over time by government, insurance companies and specialized regulatory agencies. Their basic premise is to protect personnel and patients. The laboratory environment can be a hazardous place to work. Laboratory workers are exposed to numerous potential
hazards including chemical, infectious, physical and radioactive hazards, fire, electrical safety, compressed gases hazards. as well as musculoskeletal stresses on a daily basis and waste disposal. However, the laboratory can be a safe place to work if possible hazards are identified and safety and infection control protocols are followed.


Occupational safety and health professionals use a framework called the “hierarchy of controls” to select ways of dealing with workplace hazards. The hierarchy of controls prioritizes intervention strategies based on the premise that the best way to control a hazard is to systematically remove it from the workplace, rather than relying on workers to reduce their exposure. The types of measures that may be used to protect laboratory workers, prioritized from the most
effective to least effective, are: - engineering controls; - administrative controls; - work practices; and - personal protective equipment (PPE). Most employers use a combination of control methods. Employers must evaluate their particular workplace to develop a plan for protecting their workers that may combine both immediate actions as well as longer term solutions. Our target here is the description of engineering controls as our talk is focusing on lab design.


Engineering controls are those that involve making changes to the work environment to reduce work-related hazards. These types of controls are preferred over all others because they make permanent changes that reduce exposure to hazards and do not rely on worker behavior. 2- By reducing a hazard in the workplace, engineering controls can be the most cost-effective solutions for employers to implement. 3 -Examples include: - Chemical Fume Hoods; - are often the primary control device for protecting laboratory workers when working with flammable and/or toxic chemicals. OSHA's Occupational Exposure to Hazardous Chemicals in Laboratories
standard, 29 CFR 1910.1-450, requires that fume hoods be maintained and function properly when used. - Biological Safety Cabinets {BSCs). Properly maintained BSCs, when used in conjunction with good microbiological techniques, provide an effective containment system for safe manipulation of moderate and high-risk infectious agents [Biosafety Level 2 (BSL 2) and 3 (BSL 3) agents]. BSCs protect laboratory workers and the immediate environment from infectious aerosols generated within the cabinet. BSCs must be certified when installed, whenever they are moved and at least annually, Other examples include Emergency eyewash and emergency shower


Eyewash fountains are at designated laboratory sinks. They are located near potentially hazardous areas. They must be inspected once weekly and documented. If possible, eyewash fountains should be plumbed with tepid water. When eye protection fails, you should go to eyewash facility: - Press handle to activate. Plastic covers will pop off. - Wash eyes / face continuously for 15 min, to prevent serious damage to the eyes. Emergency Shower Every
laboratory must be equipped with or have ready access to a safety shower. They are located near potentially hazardous areas. In case of chemical burns, go to nearest shower: - For ceiling shower, pull handle to activate. - For hand-held shower, pull out and press handle to activate. - Shower, washing affected areas, for 15 min. -Ceiling shower must be inspected twice per year and documented Hand-held showers must be inspected once weekly and documented


The word Ergonomics defines the science of refining the design of products to optimize them for human use Ergonomics designing (to help prevent work-related musculoskelatal disorders), is addressed in several ways. Well designed and adjustable chairs, keyboard trays, and monitor arms allow personnel to keep from being frozen in a fixed position every day, and subsequently developing problems. Noise and vibrations, irritants known to cause mental and physical problems for employees, must be addressed, especially in situations where large amounts of equipment are used. For example, long periods of exposure to low levels of noise, called white noise (Acoustics) , can cause fatigue, irritation and headaches. Acoustics is a problem in any area that houses large amounts of automation. In the large space required for robotics, a source of white noise, acoustics must be creatively handled. Core labs must have acoustic
panels with Different levels of sound absorption in the ceiling. Different levels of sound absorption are available from various manufacturers. It is best to specify the most absorbent. One solution was placing partial height movable panels behind the equipment. These are not only sound absorbent but can hide and control wires and plumbing lines running to the floor. Their movability allows easy access to the backs for maintenance. For large noise problems, wall panels and ceiling hung acoustic panels can be used Laboratorians must stand to do phlebotomy or work on equipment. Anti-fatigue mats can ease back strain. A common ergonomic problem in labs is slippery footing. Areas with slip hazards, such as histology, should employ gripping surfaces instead of traditional flooring. Water spills can be controlled with mats at sink areas. Such mats are also beneficial in protecting flooring from spilled stains.


Fire Prevention: OSHA (Occupational Safety and Health Administration) and the National Fire Protection Association (NFPA) standards may be used as references for fire prevention and preparedness questions. An accredited laboratory must have: 1) an automatic fire extinguishing system; or 2) be separated from a contiguous inpatient facility by fire-resistant construction, and class B self-closing door assemblies rated at three-quarter hours; or 3) be located in buildings classified as "business occupancy.“ The passage of fire through ductwork, and openings in walls for pipes and ducts are addressed by NFPA (National Fire Protection Association ). The use of fire dampers prevents the passage of smoke, fire or vapors between fire rated floor or walls. Ignitable liquids must be stored properly, with consideration of safety cans, and safety cabinets. In all cases, a fire bell, public address system,
or other alarm system must be audible in all sections. This includes lavatories, darkrooms, storage areas, and offices. Laboratories employing hearing-impaired persons must have other means to alert these individuals, such as a visual alarm system. Fire drills must be held often enough that all laboratory personnel, from all areas and on all shifts, participate at least once per year. Class B portable fire extinguishers must be located in all areas where flammable or combustible liquids are stored or handled. There must be documentation that all personnel have been properly trained in the use of portable fire extinguishers. This must include actual operation of extinguishers that might be used in the event of an actual fire, unless the local fire authority prohibits this. The best addition to any laboratory, to prevent fire spread and to protect personnel, is an automatic sprinkler system.


Four changes are improving efficiency and answering new challenges As lab work continues to move away from manual bench testing to increasingly more automated processes, for instance, open-plan designs are providing the flexibility necessary for labs to easily add analyzers or adapt to provide more efficient workflows. In the past, clinical laboratories were compartmentalized. Older labs are faced with the prospect of tearing down walls or built-in cabinetry to expand operations or add new equipment. Automated laboratory lines have streamlined lab processes, allowed for better staff allocation,
boosted productivity and reduced errors and cost Likewise, as attention to possible threats from new and emerging infectious diseases and bioterrorism increases, designs with the architecture and engineering features needed to isolate and safely handle biohazardous materials are more important than ever, facilitating a rise in the construction of Biosafety Level 3 (BSL-3) containment environments. And, with the emergence of molecular testing as a new tool for diagnosing and treating disease, labs are being designed to prevent the contamination of specimens used in this type of analysis.


The latest lab designs feature wide-open spaces. With the open plan or big room concept, a lab is built with no interior walls to allow the layout to be reconfigured as necessary. Using an open-plan design, a lab director and technician could reconfigure a portion of the lab themselves over a weekend to add an analyzer and be up and running for testing on Monday. There's no need to engage a contractor or the hospital's construction services department to put up temporary barriers, cut down gypsum board and stud walls, or reroute plumbing. Hospitals don't have to develop phasing plans or suspend operations to update lab workspace. Power, data and gases are mounted overhead, rather than provided through the floor or walls. Modular casework, which often is equipped with wheels for easy relocation, is used in place of fixed cabinetry. Sinks and floor drains, which cannot be moved without major construction, are placed in
areas that are unlikely to change, such as aisle walkways. Drains also can be installed in a regular grid formation throughout the lab, to be capped or uncapped as needed. This arrangement is especially useful with analyzers that require a deionized water feed and need access to a nearby drain to discharge wastewater. Many hospital clinical labs are adopting Lean operational models to prevent errors and wasted movement, wasted space, wasted energy and wasted time. Open-plan labs help to facilitate the implementation and continued operational goals of Lean design. Open-plan lab design and movable casework are also useful for new instrument validation. Before making the final decision to buy a new analyzer or change vendors, the lab can bring in an analyzer for a “test drive” or to benchmark its performance against existing equipment, without worrying about where the instrument under consideration can fit into the lab.



Lab design is also being affected by a resurgence in BSL-3 containment. Traditionally, this level of containment has been the province of large academic medical centers and military facilities. Today, with increased concern about infectious disease following outbreaks of severe acute respiratory syndrome, swine flu, bird flu, Ebola and Middle East Respiratory Syndrome, as well as increased concern about bioterrorism, even small community hospitals are becoming interested in providing this level of protection in the lab to ensure safe handling of specimens, even if only to send them out for further testing. BSL-3 labs require specialty design and construction. This includes nonporous materials, so pathogens cannot, for example, get into the plywood substrate of a countertop and multiply. Hardened epoxy-coated or
protected walls are necessary so scratches in paint can't present a similar hazard. Plumbing and vacuum lines must be fitted with multiple vacuum breakers and all penetrations into the room must be sealed so that pathogens cannot escape in the event of a loss of pressure. All plumbing leaving these areas should be either thewnally or chemically disinfected. Pass-through sterilizers/autoclaves are recommended between the testing room and the anteroom, so that everything is run through a terminal sterilizer before being thrown into the biohazardous trash. Specialized standard operating procedures and additional training are essential to the safe operation of a BSL-3 lab, but proper design is just as important. The architecture and mechanical and plumbing systems have to be designed appropriately to ensure safety.


Another recent medical advance that's influencing the design of clinical labs is molecular testing. Molecular diagnostics and testing quickly are replacing traditional microbiology and are the fastest-growing areas of the clinical lab. Molecular testing is an essential component of personalized medicine, which is based on a patient's individual genetic makeup. With molecular testing, lab techs can, for example, directly test the blood of a patient with a suspected systemic blood infection. It's not necessary to incubate a specimen for a lengthy period. Directly testing a blood sample for DNA markers from specific organisms can produce results in an afternoon, rather than overnight or over several days. Based on specific genetic markers in the sample, techs can determine what type of bacteria, virus or parasite is present and whether or not it's carrying, say, the genes for amoxicillin resistance. Molecular testing also can be used to identify cancer
markers in tissue samples. Instead of sending a sample of a suspected cancer to an anatomical pathology lab for overnight tissue processing and review by a pathologist, the tissue can be tested directly for specific genetic mutations that can reveal exactly what type of tumor is present. The tumor then can be treated using the best chemotherapy for that type of mutation; a database matching cancers to effective chemotherapies is under development. Pharmacogenomics is another promising area for molecular testing. Some people metabolize medicines differently than others, due to their genetic makeup. A medicine may work for one patient but not another, or may present negative side effects, based on an individual's genes. Molecular testing can help to establish, for example, whether a patient would be better served by chemotherapy or an immunotherapy treatment. This is medicine targeted at a specific patient's immune system, body chemistry or condition.


Large volumes of specimens aren't needed for molecular testing. Specimens are amplified during the process so that certain genes or portions of DNA that normally occur in small numbers are multiplied up to tens of millions of times. To avoid contaminating specimens - and then amplifying that contamination - a controlled lab environment is needed. The front-end extraction and amplification process requires a specific type of environment and specific unidirectional workflow to avoid contamination. Simply converting an old manager's office into an extraction room and a storage room halfway across the lab to be the amplification room won't work; a specimen or tech should never pass back through an area until after the specimen has been amplified and stabilized. Extraction and amplification rooms should be
built in a linear fashion, with features like pass-through cabinetry and interlock doors that allow only one door to be opened at a time, to minimize the risk of cross-contaminating or re-contaminating a specimen. Air handling and room finishes are critical to the success of molecular testing. A single speck of dust can carry bacteria that will contaminate a specimen. Seamless floors with cove bases; monolithic ceilings; and impervious, easily cleanable materials help keep extraction and amplification rooms free of potential contaminants. While the primary goal of typical BSL containment found in other lab testing areas is to protect the staff and environment from the specimens, the goal of molecular testing rooms is to protect the specimens themselves from contamination by the staff and environment.


Changing the physical plant of today's laboratories is necessitated by advancements in laboratory technologies and the adoption of more competitive business strategies. To survive in a competitive marketplace, labs must flexibly adapt to the inclusion of the new equipment and robotics, promote maximum production and efficiency, and provide the atmosphere and convenience demanded by an outpatient oriented marketplace. By following a systematic approach to planning, the design of the new lab can satisfy today's needs and be prepared for tomorrow. We talked previously about important factors in Design plans for the construction of medical laboratories in the hospital. In today's evolving healthcare environment, hospitals must
now compete for patients, and physicians. For that, Outpatient areas must be designed to be efficient and attractive to users. Patients, health care customers who are often hungry, sick, scared, or embarrassed, must be made to feel as comfortable as possible to assure their loyalty to your facility. Design inside the laboratory is important. A safe and pleasant laboratory environment will foster employee performance and satisfaction. Such an atmosphere can encourage physicians to visit the lab, resulting in increased interaction between the managers, technologists and doctors In fact, If a facility looks good and works well it reflects positively on doctors, employees, and the health insurance companies that recommend it.


Thank you for joining me today for this topic about Lab design. I hope this presentation will be useful for you in your practice.
I look forward to see you for my upcoming presentations.


For inquires or request email me at support@labtechone.com shown on the slide.