Fitting out healthcare buildings while patients are still being seen

Patients don't stop arriving because the builders are in. A GP surgery, a dental practice or a clinic still has a full appointment book, and a care home still has residents living in the rooms either side of the work. The job has to fit around them.

Most of what I'd say about building around a business that cannot close applies here too. This post is about what changes when the people on the other side of the screen are patients or residents rather than customers or staff.

Dust is an infection risk, not just a mess

In an office, dust is a nuisance and a cleaning bill. In a healthcare building it can carry fungal spores and bacteria, and the people most at risk are the ones least able to fight them off. So the separation has to be built to a higher standard than almost anywhere else.

• Full-height screens sealed at the floor, the ceiling and every joint, rather than hoarding panels butted together
• Ventilation grilles in the work zone sealed, or the system serving it isolated, so dust isn't pulled into ductwork and delivered to a consulting room down the corridor
• A clean-down point and tacky mats at the exit from the works
• Waste bagged and covered before it leaves the zone, and taken out by a route patients don't use
• The boundary of the works damp-wiped at the end of every shift

Water needs the same thinking. When pipework is altered, redundant runs should be cut back rather than capped and left, because a dead leg of standing water is where legionella grows. The building's water risk assessment may need updating once the work is finished.

Most practices and care operators have someone responsible for infection prevention and control. They should see the method before work starts and be able to walk the screen line whenever they want.

The screen between the works and the waiting room is part of the building's infection control for as long as it stands. Treat it like a wall, not a curtain.

Phasing around the appointment book

On an office floor we phase by zone. In a surgery the zones are set by the clinics. The first conversation with a practice manager is about which rooms can come out of use, when, and where those clinics go in the meantime. Sometimes a meeting room becomes a temporary consulting room. Sometimes a service moves elsewhere for a while. That is the practice's call, but it has to be made with the programme in front of them.

A care home is different again. Moving a resident out of their room is a big event for them and their family, and the home decides who moves, if anyone. We plan around that decision rather than the other way round.

Each phase has to come back ready for clinical use, not nearly finished. Clinical rooms usually have their own finishes: sheet flooring coved up the wall so there's no joint for dirt to sit in, wipeable wall finishes, sealed ceilings and the right hand-wash basins and taps. What a room needs depends on what it's used for, and that should be set out in the client's brief.

There is published guidance for healthcare buildings, the Health Building Notes and Health Technical Memoranda, covering things like ventilation, water and fire. Which parts apply depends on the type of building and who commissions the work, so confirm that with the client's estates or compliance lead rather than assume.

Noise windows

Quiet means something specific in a healthcare building. A GP listening to a chest, a hearing test, a difficult conversation in a consulting room: none of those can happen next to a core drill, even if the noise level would be acceptable in an office.

So noisy work is agreed in windows: before the first appointment, over lunch, after the last clinic or at weekends. Structure carries vibration further than people expect, so the window has to cover the rooms above and below as well as next door. The practice manager should have one number to ring to stop noisy work immediately, and the person who answers should be the one running the job.

Fire strategy when people can't just walk out

In a care home, and in many clinical buildings, the fire strategy assumes some people will need help to move. Rather than everyone leaving at once, residents or patients may be moved through fire doors into the next protected part of the building. This is often called progressive horizontal evacuation, and it only works if the compartments and fire doors are intact at every stage of the works.

That means:

• Any hole made in a fire-resisting wall or floor is sealed the same day, temporarily if necessary
• Fire doors stay shut and working, never wedged open for a delivery
• Detector isolations are done under a permit and reinstated before the end of the shift
• Hot works are permitted, supervised and checked afterwards
• The manager knows every day what has been isolated and where the works boundary is

The operator remains responsible for fire safety in their building throughout. Our job is to make sure the works never undermine it. There's more on the general principles in fire safety in a fit-out.

Before you ask for prices

Send us the floor plans, a list of the rooms and how each is used, the clinic times or routines that can't move, and some photos. We'll tell you how we would phase it and what it is likely to cost, including the separation and out-of-hours work, and the person who prices it will be the person running it on site. More on how we approach this work is on our healthcare fit-out page.