hospitals

Transcription

hospitals

HOSPITAL NTRA. SRA. CANDELARIA. TENERIFE
HOSPITAL
NTRA. SRA.
CANDELARIA.
TENERIFE
PROPIEDAD:
Servicio Canario de Salud
CENTRO:
Delegación Tenerife
ARQUITECTO:
D. Fernando Cruz Alonso
JEFE DE DEPARTAMENTO:
D. Juan Jesús Núñez Concepción
JEFE DE OBRA:
D. Antonio Pérez
D. Patricia Fuertes Miquel
INSTALACIONES:
D. Angel Silva Borrego
Detalle de la fachada
163
Reforma y ampliación del Hospital
Ntra. Sra. de Candelaria. Tenerife
Antecedentes
El hospital Nuestra Señora de Candelaria (HNSC) está situado en
el municipio de Santa Cruz de Tenerife y fue inaugurado en 1966.
Junto con el cercano hospital de Ofra (hospitalizaciones de larga
estancia), a unos 900 m de él, componen el denominado Hospital
Universitario Nuestra Señora de Candelaria (HUNSC), centro hospitalario público de alcance general, de tercer nivel.
Bien comunicado con las autopistas del Norte y del Sur de Tenerife,
el complejo hospitalario está orientado a la asistencia médica de la
zona Sur de la isla, y es hospital de referencia para las islas de La
Gomera y El Hierro. Si bien, a nivel de atención especializada extrahospitalaria, presta atención a la totalidad de la isla.
Además de las poblaciones de referencia a las que asiste, anualmente afluyen a Tenerife 3,5 millones de turistas extranjeros; lo
cual supone (de media) unas 100.000 personas más en la isla a
diario, y ello sin contar con los demás turistas que provienen del
resto de España.
164
Vista aérea
El Plan Director de
ampliación y reforma
El HNSC es un complejo hospitalario formado por diferentes pabellones de distintas
épocas de construcción, que se han visto
afectados por continuas transformaciones.
La necesidad de renovar su estructura hizo
que el Insalud impulsara, ya en 1986, la
elaboración de un Plan Director de Obras.
Sin embargo, el citado Plan sólo atendía a
recuperar el deterioro de los edificios, sin
promover la renovación funcional que el
hospital precisaba para hacer frente a la
asistencia sanitaria propia del siglo XXI.
Una vez asumidas las transferencias sanitarias, el Servicio Canario de la Salud decidió
que aquel Plan Director debía ser analizado en profundidad para determinar si era
capaz de desarrollar la totalidad de las misiones encomendadas a la Institución y, por
otro lado, si era viable construir un hospital
de futuro sobre las estructuras preexistentes.
A lo largo de 1995 un equipo profesional
multidisciplinar estudió las necesidades asistenciales de la población residente en las
áreas geográficas cuya cobertura de asistencia correspondía al HNSC.
A partir de la estimación de esas necesidades y de las otras funciones – docentes y
de investigación - desarrolladas por el Hospital, se elaboró un Plan Funcional que fue
aprobado en 1996. El antiguo proyecto de
Plan Director no podía dar satisfacción a las
necesidades evidenciadas por el nuevo Plan
Funcional.
El reto era encontrar el diseño que se adaptara a las exigencias de la asistencia sanitaria
y que fuese a la vez realizable sin interrumpirla ni mermar sus capacidades, reduciendo en lo posible el impacto ambiental negativo sobre usuarios y personal del hospital.
Para ello se plantearon unos objetivos básicos cuyo cumplimiento guió la redacción
del nuevo Plan Director. Dichos objetivos
fueron:
• concentrar las actividades en grandes
áreas, destinadas a la atención de pacientes con necesidades homogéneas, proporcionando una mayor intimidad a las
áreas de hospitalización y una eficiente
funcionalidad a las áreas de actividad técnico - asistencial
• reducir los desplazamientos innecesarios
de pacientes
• acortar, en la medida de lo posible, la duración del ciclo asistencial
• potenciar la eficiencia a través de la estructura física del edificio
que vino a cubrir una necesidad asistencial
aún no satisfecha por este hospital.
• favorecer el trabajo de equipos multidisciplinares para mejorar la calidad asistencial
prestada, impulsando al mismo tiempo su
desarrollo profesional
También dispone de 138 camas destinadas
al desarrollo de procedimientos de diagnóstico y terapéutica en régimen de Hospital
de Día, que hacen posible la asistencia a
gran número de pacientes sin ingreso hospitalario. En este aspecto, se desarrolla una
actuación especialmente importante en el
campo de la cirugía ambulatoria, que permite realizar casi 4.000 intervenciones quirúrgicas al año con la reintegración de los
pacientes a su domicilio el mismo día de la
intervención.
• generar un marco confortable para el encuentro entre los usuarios y los profesionales que los atienden
• adecuar las instalaciones de cara a garantizar la seguridad, ahorrar energía y respetar el medio ambiente
Se abrieron 50 locales más de consulta externa (existían 87) y de ejecución de procedimientos diagnósticos y terapéuticos
por parte de las especialidades clínicas que,
junto con medidas organizativas y los Hospitales de Día anteriormente citados, hacen
posible que cada vez más pacientes puedan
ser sometidos a estas técnicas sin separarlos
de su entorno habitual.
El nuevo Plan Director eliminaba la concepción inicial del hospital, basada en pabellones por especialidades, dando paso a una
estructura que priorizaba la concentración
de las actividades afines, en estructuras diferenciadas.
Así, el HNSC (es decir, sin contar el Hospital
de Ofra) pasó de las 739 camas anteriores
a 853 camas de hospitalización, pero gran
parte del crecimiento se centró en unidades
que buscaban solucionar deficiencias en
áreas específicas: UCI, que afectan a los pacientes más graves; habitaciones individuales para el aislamiento selectivo de pacientes infecciosos y/o con inmunosupresión; y
pacientes con patología psiquiátrica aguda,
Finalmente, los servicios centrales se incrementaron considerablemente en todas sus
áreas, con el desarrollo de unidades de nueva planta que permitieron disponer de:
• 2 áreas quirúrgicas para pacientes ingresados y 1 para cirugía ambulatoria con 23
Planta general
URGENCIAS GENERALES
ASEO MINUS
ACCESO URGENCIAS
ASEO
ASEO
RESALTO
LOSA ASCENSOR
DESPACHO
J.SERVICIO
INSTAL
ACIONE
S
ASEO
ASEO
ALMACEN
MATERIAL
ESPERA DE
FAMILIARES
DE FALLECIDOS
ESPERA
INTERNA
INFANTIL
ESPERA
EXTERNA
RECEPCION
ADMISION
VENDING
TELEFONOS
ESPERA
INTERNA
ADULTOS
ARCHIVO
URGENCIAS
SALA DE
YESOS
DESPACHO
SUPERVISION
ALMACEN
MATERIAL
ASISTENCIA
SALA DE
CURAS
LIMPIEZA
ALMACEN
EQUIPOS
ALMACEN
LIMPIO
BOX
ASISTENCIA
BOX
ASISTENCIA
ALMACEN
MATERIAL
OBSERVACION
CAMA
OBSERVACION
CAMA
OBSERVACION
CAMA
OBSERVACION
CAMA
OBSERVACION
BOX PACIENTE
AGRESIVO
BAÑO
ASISTIDO
RCP ADULTOS
BOX PACIENTE
AGRESIVO
INSTAL
ACIONE
S
INSTAL
ACIONE
ALMACEN
MATERIAL 112
S
FARMACIA
ASEO
PACIENTE
CONTROL
VESTUA
PREPARACION
LIMPIA
RIO
VE
ST
ÍB
ALMACEN
MATERIAL FUNGIBLE
Y CLINICO
ALMACEN
LIMPIO
ASEO
PACIENTE
SUCIO
O
CAMA DE
OBSERVACION
VESTÍBU
CAMA DE
OBSERVACION
TRIAJE
SUCIO
ALMACEN
LIMPIO
BOX
ASISTENCIA
BOX
ASISTENCIA
BOX
ASISTENCIA
PREPARA.
LIMPIA
TRABAJO
PROFESIONAL
CONTROL
ALMACEN
LIMPIO
BOX
ASISTENCIA
ASEO
PACIENTE
CAMA DE
OBSERVACION
CAMA DE
OBSERVACION
ASEO
PACIENTE
RIO
CONTROL
PREPARA.
LIMPIA
ASEO
PERSONAL
ASEO
PERSON.
ASEO
PERSON.
VESTUA
LO
CAMA
OBSERVACION
SUCIO
LOCAL
CELADORES
ASEO
PERSONAL
ASEO
PERSONAL
UL
TRIAJE
RCP INFANTIL
ASEO
PACIENTE
ASEO
PACIENTE
BOX PACIENTE
AGRESIVO
+7.00
BOX
OBSERVACION
AISLADO
VESTUA
RIO
CAMA DE
OBSERVACION
EVAC.
ASCEN.
CAMA DE
OBSERVACION
CAMA DE
OBSERVACION
TRABAJO
PROFESIONAL
APARCAMIENTO
SILLAS Y
CAMILLAS
BOX
POLIVALENTE
CAMA DE
OBSERVACION
BOX
POLIVALENTE
BOX
POLIVALENTE
SALA DE
BAÑERAS
BOX
POLIVALENTE
SALA DE
AEROSOLES
BOX
ASISTENCIA
BOX
ASISTENCIA
BOX
ASISTENCIA
BOX
ASISTENCIA
BOX PACIENTE
AGRESIVO
BOX PACIENTE
AGRESIVO
BOX
ASISTENCIA
BOX
ASISTENCIA
BOX
ASISTENCIA
BOX
ASISTENCIA
BOX
ASISTENCIA
CAMA
OBSERVACION
CAMA
OBSERVACION
CAMA
OBSERVACION
BOX
ASISTENCIA
CAMA
OBSERVACION
BOX PACIENTE
AGRESIVO
CAMA
OBSERVACION
VESTUA
RIO
VESTUA
RIO
FOSO
ASCENS
OR
CAMILLA
RIO
ACIONE
RIO
ÉN
CAB.
INSTAL
VESTUA
ALMAC
VESTUA
S
DE
COCINA
ASEO
ASEO
PERS.
RAYOS X
URGENCIAS
PASARELA COMUNICACION
URGENCIAS
ALMAC
ÉN
COMED
DE
VAJILLA
CONTROL
RAYOS X
URGENCIAS
OR
RAYOS X
URGENCIAS
CONTROL
TERRAZA
2 CAMAS
2 CAMAS
ESTAR PACIENTES
1 CAMA
1 CAMA
S
LA
1 CAMA
+7.00
INSTAL
ACIONE
CANCE
2 CAMAS
2 CAMAS
2 CAMAS
2 CAMAS
INSTALACIONES
2 CAMAS
INST.
INST.
PREPARACIÓN
PACIENTE
SALA TÉCNICA
VESCULAR-1
ASEO
DE
VAJILLA
UTILES
LIMPIEZA
RAC
VESTIBULO
INDEPENDENCIA
LENCERÍA
SALA TÉCNICA
TAC-1
PREPARACIÓN
PACIENTE
CABINA
INST.
CABINA
ASEO
PERS.
SALA TÉCNICA
TELEMANDO-1
ASEO
ÁREA MAYOR
CUIDADO
CAMILLA
LAVADO
ASEO
PACIENTES
ALMACÉN
CABINA
ALMACÉN
ALMACEN
INST.
CONTROL
RESERVA TEC.
SALA INFORMES
TELE-1 Y TELE-2
IZADOR
SUCIO
7 PUESTOS
SUCIO
LIMPIEZA
LAVADO
MÉDICO
CONTROL
VASCULAR-1
1 CAMA
LAVADO
CARRO
S
PREPAR
FRIOS ACIÓN
1 CAMA
1 CAMA
SUPERV.
PREPAR
VERDU ACIÓN
RAS
2 CAMAS
PREP.
ESCLUSA
2 CAMAS
2 CAMAS
2 CAMAS
2 CAMAS
2 CAMAS
SALA TÉCNICA
RESERVA TEC.
CONTROL
TAC-1
PREPAR
PESCAD ACIÓN
OS
LO
SALA INFORMES
RM Y RESERVA TEC.
EQUIPOS RADIOLOGÍA
ESTANTERÍAS
DESPACHO
JEFE SECCIÓN
DESPACHO
JEFE SECCIÓN
SUCIO
CÁMAR
VERDU
A
RAS
HO
CÁMAR
CONGE
A
LADOS
ANTECÁ
CÁMAR
CONGE
A
LADOS
MARA
ESORES
N E F R O L O G I A (6 CAMAS)
CÁMAR
CARNES A
T R A N S P L A N T E S (4 CAMAS)
ALMAC
ÉN
VÍVERES
D I G E S T I V O (22 CAMAS)
DE
CÁMAR
PESCAD
A
OS
DESPAC
COMPR
CABINA
ESCLUSA
CABINA
1 CAMA
TRANSPLANTES
ÉN
OL
DESPACHO
JEFE SECCIÓN
CONTROL
RM
CONTROL
TAC-2
S
ALMAC
ALMAC
DE
ÉN
DIARIO
CONTR
SALIDA A TERRAZA
CONTROL
VASCULAR-2
SALA INFORMES
VASCULAR-1 Y 2
ESCLUSA
VESTÍBU
MONTA LO
CARGA
CÁMAR
PRODU
PREPAR CTOA
ADO
DE
ALMACÉN
CONTROL
TELEMANDO-2
ASEO
ASEO
MINUSV.
SALA DE
CURAS
1 CAMA
TRANSPLANTES
VESTÍBU
ASEO
CÁMAR
BASURA A
S
RECEPC
MERCA IÓN
NCIAS
SALA TÉCNICA
RM
CONTROL
TELEMANDO-2
ASEO
ES
ALMACÉN
LENCERÍA
ENFERM.
1 CAMA
TRANSPLANTES
PREPAR
CARNES ACIÓN
LACION
SALA INFORMES
TAC-1 Y TAC-2
ALMACÉN
ESCLUSA
LAVADO MATERIAL
CLÍNICO REUT.
LIMPIO
1 CAMA
TRANSPLANTES
TERRAZA
CLIMAT
6 CAMAS
AISLADOS OCASIONALES
ESPERA CAMAS
INSTALACIONES
LIMPIO
N3
CÁMAR
LÁCTEO A
S
PREPARACIÓN
PACIENTE
PREPARACIÓN
PACIENTE
SALA TÉCNICA
VASCULAR-2
Y TAC-2
2 CAMAS
ASEO
CABINA
CABINA
SALA TÉCNICA
TELEMANDO-2
ASEO
PERS.
DESPACHO
INFORMACIÓN
ESTAR
PERSONAL
ASEO
PACIENTES
SALA
PROFESIONAL
ESPERA
CAMA
SALA TECNICA
ASEO
INST.
INSTALACIONES
ASEO
ASEO
ASEO
MÉDICO DE
GUARDIA
+7.00
SUCIO
P.C.
LIMPIO
ESPERA
CAMA
ESTAR DE
FAMILIARES
AIRE
ACONDICIONADO
ASEO
MINUSV.
CARROS
CABINA
VESTÍBULO
INDEPENDENCIA
P.C.
CLIMAT
IZADOR
VESTUARIO
MASCULINO
P.C.
P.C.
P.C.
RESERVA
DIÁLISIS
16 TAQUILLAS
VESTUARIO
FEMENINO
MONTACAMAS
MONTACAMAS
46 TAQUILLAS
CHIMEN
EA
+7.00
G.E.
DORM.
MEDICO
VESTUARIO
CAB.
ALMACEN 2
OFICIO
TRATAMIENTO
AGUA
USO
EXCLUSIVO
TRABAJO
PROFESIONAL
DESPACHO
INFORMACION
CABINA
VESTUARIO
ARCHIVO
MANTENIMIENTO
MAQUINAS
CONSULTA
HEMODIALISIS
VESTUARIO
F.E.A.S.
NEFRO.
F.E.A.S.
NEURO.
SUPERVISORA
ALMACÉN
SALA DE REUNIONES DIGESTIVO
CONTROL
ESPERA
CAMAS
(PROVICIONAL)
ASEO
3 PUESTOS
VESTÍBULO
INDEPENDENCIA
CABINA
P.A.
SUCIO
SUCIO
SUCIO
SECRETARIA
NEFROLOGIA
ESPERA
PACIENTES
DESPACHO
JEFE SERVICIO
NEFROLOGIA
CUARTO
OSCURO
ASEO
DIALISIS PERITONEAL
ALMACEN
CONSULTA
DIALISIS PERITONEAL
ALMACEN 1
P.A.
TRANSP.
2 CAMAS
AGUDOS 2
AGUDOS 1
2 CAMAS
P.A.
P.A.
SALA DE
CURAS
2 CAMAS
VESTUARIO
CONSULTA
DIALISIS PERITONEAL
P.A.
TRANSP.
DESPACHO
JEFE SERVICIO
NEUROLOGIA
VESTUARIO
SALA DE SESIONES
TECNICAS LIMPIAS
ASEO
P.A.
N E U R O L O G I A ( 22 CAMAS )
SECRETARIA
NEUROLOGIA
VESTUARIO
MASCULINO
LENCERIA
APOYO
SALA DE REUNIONES
NEUROLOGIA
ASEO
PERS.
ASEO
VESTUARIO
FEMENINO
BAÑO ASISTIDO
P.A.
2 CAMAS
N E F R O L O G I A ( 14 CAMAS )
CABINA
ADJUNTOS Y FEAS
2 CAMAS
1
15
2
14
ASEO ASEO
P.A.
P.A.
SALA DE LECTURA
SECCIÓN MAMA
ADMON NEFROLOGIA
ARCHIVO
SALA DE REUNIONES
SESIONES CLÍNICAS
13
23
3
4 PUESTOS
ENFERM.
PREP.
0
2 CAMAS
ASEO
ASEO
SUPERV.
12
4
2 CAMAS
INST
ASEO
CABINA
2 CAMAS
11
5
2 CAMAS
7
8
9
2 CAMAS
2 CAMAS
SUCIO
LIMPIO
10
6
2 CAMAS
INST
DESPACHO
J.SERVIVIO
ASEO
SALA DE
LECTURA
CABINA
VESTIBULO
DISPENSACION
ALMACEN
ALMACEN
RAC
VEST.
FEM.
ALMACEN
INSTRUM.
ALMACEN TEXTIL
RAC
LIMPIO
INST
VEST.
MASC.
COMUNICAC.
VESTIBULO
ESCALERA
ARCHIVO
SUCIO
COLECTOR VAPOR
2 CAMAS
DESPACHO
SUPERVISOR
OXIDOETILENO
2 CAMAS
ASEO
AMSCO MAGDATA
SALA DE
ESTAR
2 CAMAS
SECRETARIA
ASEO
SALA
TECNICA
CABINA
INST.
2 CAMAS
DESPACHO
SUPERVISOR
CABINA
2 CAMAS
DESPACHO
SUPERV.
MONTAJE
TEXTIL
2 CAMAS
CABINA
22
ASEO
VESTUARIO MÉDICO MAS.
10 TAQUILLAS
INF. Y SUP.
7.5
ALMACENAMIENTO ESTERIL
CARROS
LAVADO
CARROS
10 TAQUILLAS
INF. Y SUP.
MATERIAL
LAVADO
CABINA
VESTUARIO MÉDICO FEM.
PREPARACION Y
EMPAQUETADO
ALMACÉN
AMSCO MAGDATA
CABINA
30 TAQUILLAS
INFERIOR Y SUPERIOR
VESTUARIO FEMENINO
PROFESIONALES ENFERMERÍA
CONTROL
DESPACHO
VESTUARIO MASCULINO
PROFESIONALES ENFERMERÍA
+7.00
AMSCO MAGDATA
OBSTÁCULO
EN SUELO
30 TAQUILLAS
INFERIOR Y SUPERIOR
ESCLUSA
ESPERA
22
5
NIVEL 7
+3.50
+7.00
RAMPA EN 11.10 mts.
+8.75
+5.25
2.5
22
ESPERA
+9.75
N7-CE
CONSULTA
O C E A N O
ESPERA
ESPERA
CONSEJERIA DE SANIDAD Y CONSUMO
CONSULTA
G O B I E R N 0
CONSULTA
D E
C A N A R I A S
CONSULTA
CONSULTA
CONSULTA
ESPERA
CONSULTA
22
CONSULTA
CONSULTA
SECRETARIA
P R O Y E C T O D E E J E C U C I O N F A S E 1C
HOSPITAL NTRA SRA DE CANDELARIA
CONSULTA
0
CONSULTA
CONSULTA
ESPERA GENERAL
CONSULTA
CONSULTA
CONTROL
CONSULTA
CONSULTA
ESPERA
SANTA CRUZ DE TENERIFE
CONSULTA
CONSULTA
CONSULTA
SECRETARIA
CONSULTA
ARQUITECTURA.
PLANTA NIVEL 7.
PLANOS DE CONJUNTO COMPLEJO HOSPIT
ZONAS DE ACTUACION.
ES
M A Y O 1999
7.5
21
F E R N A N D O
C R U Z
A L O N S O
165
166
quirófanos, frente a los 16 anteriores
• 1 Servicio de Urgencias con 28 compartimentos de atención urgente
• 1 unidad de Radioterapia capaz de desarrollar técnicas de braquiterapia y radioterapia externa con 3 aceleradores lineales,
y espacio reservado para 1 más
• 1 Servicio de Diagnóstico por la Imagen
con 21 salas que incrementan notablemente su capacidad, incluyendo áreas de
radiología vascular intervencionista con
2 salas; y áreas de alta tecnología con 2
equipos de escáner y 1 resonancia magnética nuclear
Todos esos cambios llevarían al hospital
a una superficie de 120.188 m2, siendo
51.303 m2 de nueva construcción y 66.792
m2 de reforma.
Fase 0
Consistió en unas primeras intervenciones
orientadas a crear condiciones de infraestructura y de seguridad que permitieran iniciar la obra principal sin riesgos. Afectaron
a los Servicios de Lavandería, Cocina, Medicina Nuclear y Radioterapia. Se actuó sobre
una superficie de 6.800 m2, de los cuales
2.600 m2 fueron de nueva construcción y
4.200 m2 fueron de reformas.
Fase 1A
• 1 Laboratorio de hemodinámica y cateterismo con 1 sala, y con posibilidad de
incorporar una 2ª en caso de que las necesidades asistenciales así lo justifiquen
• 1 Servicio de Neurofisiología Clínica con
7 salas
Estas estructuras se completaron con áreas
de apoyo, como las destinadas a depósito y tratamiento de residuos radiactivos, y
nodos de comunicaciones.
Algunos de esos nuevos servicios supusieron hitos en la historia médica de Canarias,
ya que incluían en sus estructuras equipos
singulares absolutamente novedosos. A
título de ejemplo, en verano de 2007 se
instaló el primer PET(1) de Canarias, siendo
además un equipo con tecnología combinada de TC (tomografía computarizada), que
permite obtener imágenes mixtas morfológico - funcionales de alta calidad.
Estrategia de fases
Vista de la fachada
La realización de una transformación total
como la descrita sin interrumpir el proceso
de la asistencia sanitaria llevaba forzosamente a una estrategia de fases, que permitiera realizar los traslados necesarios para
abordar progresivamente las actuaciones
en cada sector del Hospital.
1
Tomografía por emisión de positrones
• Superficie remodelada: 15.654 m2
• Superficie de obra nueva: 12.288 m2
• Fecha de comienzo: 29-11-1994
• Fecha de finalización: 30-4-1999
En esta fase se realizaron diversas actuaciones:
15
135.00
14
131.50
13
128.00
12
124.50
11
121.00
10
117.50
9
114.00
8
110.50
URGENCIAS
7
107.00
6
103.50
5
100.00
99.00
4
96.50
ALZADO
OESTE
INSPIRATIONS NATURAL PRINTS
TRESPA METEON PZ01/ST
C
• reforma de la antigua Escuela de Enfermería, remodelando íntegramente las fachadas, muy deterioradas; y cambiando
su finalidad, que principalmente sería la
de Consultas Externas, salvo el nivel 5 que
seguiría siendo escuela de enfermería
• reforma del pabellón Materno-Infantil,
con derribo y sustitución de los 2 cuerpos laterales (Torres Norte y Sur), además
de reformar el interior para adaptarlo a 2
nuevas unidades de enfermería
• reforma del ala izquierda del Pabellón General, para Apoyos Médicos
Con la creación de las Torres Norte y Sur el
hospital pasa de tener las habitaciones repartidas por los diferentes edificios a tenerlas centralizadas en las 11 plantas de dichas
torres y del Materno-Infantil, creando un
bloque en forma de U que queda atendido
por 2 controles de enfermería.
Fase 1B
• ejecución de una nueva Central energética, un Laboratorio de investigación, una
Unidad de Hemodinámica, un Banco de
Sangre, un Bloque de 11 plantas anexo al
Pabellón general con 4 ascensores panorámicos, un pequeño vestíbulo y 2 aseos
Se llavaron a cabo las siguientes intervenciones:
• realización del ala Norte del edificio Materno-Infantil
• derribo de las antiguas lavandería y central térmica, y creación de un nuevo acceso principal al hospital
• ampliación de 5 plantas del cuerpo de enlace de Apoyos Médicos
• ejecución de 2 aparcamientos de 600 y
200 plazas, respectivamente
• ejecución de los edificios de apoyo diagnóstico, clínico y tratamiento (Bloque Quirúrgico, Bloque Obstétrico y Radiológico)
A
F
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T
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Planos de alzado
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Fase 1C
Fachada y cubierta
La fase 1C es básicamente un complemento
de la 1B. Comprende zonas de nueva construcción destinadas a Laboratorios, paritorios y áreas técnicas; pero, principalmente,
orientadas a completar la fase 1B en sus
aspectos de instalaciones especiales, elementos fijos de equipamiento y tecnología
de comunicaciones (grupos electrógenos,
mobiliario de laboratorio, maquinaria de
esterilización, brazos quirúrgicos, lámparas
quirúrgicas, cabeceros de UCI, armarios
móviles y un helipuerto).
• remodelación de la antigua Residencia
General para incluir Radioterapia, UCI
adultos, pediátricos y UCIN (neonatales)
Fase 1D
• reforma interior de 5 plantas de la Escuela
de Enfermería para adaptarlas a Consultas Externas
La última etapa de obras, denominada fase
1D y que abarcará hasta 2010, tiene por
objeto las actuaciones a realizar sobre los
edificios periféricos del conjunto:
• ampliación del edificio de Urgencias
• construcción de 3 recintos (búnkers) para
aceleradores lineales
La concentración de las unidades de hospitalización en el nuevo edificio permitió liberar los espacios necesarios en la antigua Residencia General para desarrollar los nuevos
servicios centrales, las unidades quirúrgicas
y de asistencia intensiva y las de realización
de procedimientos diagnósticos y de tratamiento, por especialidades.
Es en esta etapa en la que se producen las
más importantes incorporaciones tecnológicas a las instalaciones y a los equipamientos fijos del hospital. Por otra parte, se procede a la unificación de Consultas Externas
propiciando un fácil acceso exterior a la vez
que una interconexión por el interior con
los servicios centrales más demandados:
Radiodiagnóstico, extracción centralizada
de muestras y Archivo Central de historias
clínicas.
• Traumatología y Rehabilitación, donde
se desarrollan las estructuras de Docencia
e Investigación, Salones de actos, Cirugía
Mayor Ambulatoria, Rehabilitación y espacios administrativos del Complejo
• Urgencias
• Escuela de Enfermería, que se reforma
gradualmente para destinarlo a Consultas
Externas, a medida que se vayan generando nuevas ubicaciones para sus actuales
ocupantes
Descripción del nuevo
hospital
El hospital inicial constaba de un edificio
central y grandes bloques a su alrededor
dedicados a Hospitalización, Urgencias,
Consultas Externas y otras especialidades. El
nuevo aumenta en altura algunos de esos
bloques, y rellena espacios interiores existentes con otros bloques nuevos, además
de reformar completamente por dentro los
edificios, tanto estructural como funcionalmente.
Hospitalización (materno - infantil,
torres Norte y Sur)
Son 11 plantas de unos 1.800 m2 cada una.
• Planta sótano: aquí se ubica la Urgencia
de Maternidad con sus paritorios, quirófano de alto riesgo, salas de exploración,
salas de registro, admisión, almacenes y
demás apoyos
• Planta Baja: concentra la hospitalización
de pediatría y cirugía pediátrica, almacén
y dispensación de lavandería, central telefónica y un pequeño jardín infantil
• Plantas 1ª a 9ª: en todas ellas se sitúan,
por alas en L ó en U, las hospitalizaciones
de las diferentes especialidades. Todas las
plantas cuentan con 2 controles de enfermería, 2 salas de sucio, 2 de limpio, 2 de
preparación, 2 salitas, 2 baños asistidos y
2 salas de estar para pacientes, además
de un vestuario masculino y otro femenino, 2 aseos, 2 despachos de supervisor
y 1 sala de juntas. Las habitaciones son
dobles, con ventana al exterior, lo que las
hace muy luminosas. Todas están provistas de tomas de oxígeno y vacío y poseen
aire acondicionado. El número total de
camas es de 790, aumentando en 50 las
existentes antes de la reforma.
La Ampliación de la Torre Norte es un edificio de 9 plantas situado sobre una estructura porticada, y adosado a las unidades Norte de las plantas de hospitalización a cuyo
control se adscriben.
En cada una de sus plantas se han dispuesto 6 habitaciones (todas individuales salvo
las de la unidad de pacientes custodiados).
Su creación no sólo supone un nuevo crecimiento de la capacidad de hospitalización,
sino que permite el necesario aislamiento de
algunos pacientes y da soporte al desarrollo
de actividades específicas que requieren de
condiciones de seguridad. La superficie total de este edificio es de 3.320 m2.
Apoyos médicos
• Planta sótano: contiene la Farmacia con
sus almacenes, oficinas y una zona estéril
para la elaboración de citostáticos(2)
• Planta Baja: vestíbulo y entrada principal
• Plantas 1ª a 4ª: oficinas de apoyo médico
En la fase 1C se ampliaron en altura 3 plantas completas y 2 medias del edificio terminado y reforzado para tal fin en la fase 1A,
para albergar más despachos y oficinas, de
tal forma que quedó un edificio de 11 plantas; y una unidad en la cubierta de la planta
5, para terraza de Psiquiatría.
Bloque quirúrgico
• Planta sótano: esta planta, de 1.119 m2,
está destinada a archivos compactos de
historias clínicas, así como oficinas para
dicho servicio
• Planta semisótano: en ella se ejecutó
parte del vestíbulo de entrada, la cafetería, el almacén de basuras y la salida de
basuras del edificio
• Planta Baja: con una superficie útil de
859 m2, comprende el servicio de Pedia2
Anticancerígenos de tipo quimioterápico
Radiología
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tría y el hospital de día pediátrico. Posee
una escuela, despachos, zonas de limpio
y sucio, almacenes, sala de curas, aseos,
vestuarios y sala de proyecciones
• Planta 1ª: en ella se encuentran el servicio de Urología, de 444 m2, y el de Neurofisiología, de 342 m2.
En el primero cabe destacar los espacios
destinados a la técnica de Urodinamia y sobre todo a la de Litiasis (donde se encuentra un aparato que destruye las piedras del
riñón mediante láser). Este servicio cuenta
además con consultas, despachos, salas de
informe, sucios, limpios, almacenes, vestuarios, salas para técnicas especiales y esperas.
En el segundo está la zona dedicada al tratamiento del sueño y las salas de electroencefalografía y electromiografía, las cuales
tienen la peculiaridad de tener una jaula de
Faraday en techos, suelos e interior de tabiques realizada con malla de gallinero y con
tomas de tierra independientes, para evitar
interferencias con los aparatos. El resto de
la unidad está compuesto por potenciales
evocados(3), despachos, almacenes, esperas,
limpio, sucio, aseos y vestuarios.
Zonas interiores
3
Técnicas neurofisiológicas que registran las respuestas cerebrales provocadas por estímulos sensitivos, pudiendo éstos ser visuales, auditivos o táctiles eléctricos
• Planta 2ª: en ella se ubica el servicio de
Esterilización, conectado directamente
con la planta 3ª y 4ª de quirófanos a través de un ascensor y una escalera. Tiene
una superficie útil de 859 m2, dividida en
3 grandes zonas - lavado, empaquetado
y almacenado - separadas por 2 barreras
sanitarias.
En la zona de lavado existe una gran lavadora de carros, un túnel de lavado y una
lavadora pequeña. La peculiaridad del túnel de lavado y de la lavadora pequeña
es que se encuentran en la 1ª barrera sanitaria; es decir, una vez lavado el instrumental pasa a la 2ª zona ya estéril, donde
se empaqueta para pasar a los esterilizadores [(5 de vapor y 1 de óxido etileno
(que esteriliza a mayor temperatura para
eliminar determinadas bacterias)].
Una vez pasados estos esterilizadores de
doble puerta se pasa al área de almacenado, totalmente estéril, y ahí queda a disposición de ser transportado por medio
de un ascensor a los pasillos limpios de las
plantas 3 y 4 de quirófanos, donde será
servido a través de la ventana de guillotina colocada a tal fin, o almacenado en el
armario de doble puerta que tiene cada
quirófano.
Montaje de la
fachada
El resto del servicio tiene área de desinfección, almacenes de productos de limpieza, almacén textil, aseos, vestuarios,
zona de planchado, zona de empaquetado, sala de estar de personal, despachos y
sala de colectores de vapor.
• Plantas 3ª y 4ª: cada una de ellas, de 925
m2, posee 6 quirófanos. El modelo de la
planta quirúrgica es el de pasillo limpio,
quirófano y pasillo sucio.
• Planta 5ª: una parte se ha desarrollado
como sala de máquinas de aire acondicionado para quirófanos y sala de enfriadoras, y la otra alberga los despachos del
laboratorio de Anatomía patológica.
• Planta 6ª: tiene el laboratorio de Anatomía Patológica, y en las cubiertas anexas
aparatos de aire acondicionado de quirófanos.
• Planta 7ª: Unidad de Informática
Un quirófano está compuesto por el quirófano propiamente dicho, la zona de
preparación del paciente, la preparación
médica y una zona de sucio común a cada
2 quirófanos. El resto de la planta lo componen una retención de basura con 2 ascensores montabasuras, una zona de almacén general, almacén de sucio, apoyo,
coordinación, dictado, despacho, supervisión, aseo, pasillo de distribución, pasillo
limpio, pasillo estéril, control de acceso,
espera de camas, zona de transferencia
limpia, esclusas de personal, sala de estar
del personal, esclusa de ropa, espera de
camas externa, espera de pacientes ambulatorios, despacho de contacto y sala
de espera de familiares.
• Planta 8ª: en esta planta de 478 m2 se
encuentran ubicados los despachos de
Psiquiatría, así como vestuarios, aseos, salas de terapia, salas de espera y de visitas,
etc…
Apoyos quirúrgicos
En este edificio se intervino, hasta la fase
1C, desde la planta baja a la 4ª ; reformando finalmente en la fase 1D el sótano que
había sido ejecutado en la fase 0.
• Planta Baja: despachos para Admisión,
fotocopiadoras y Atención al paciente; el
resto es vestíbulo de acceso.
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172
• Planta 1ª: despachos y salas especiales
del servicio de Neumología.
que demoler previamente el antiguo bloque
quirúrgico.
• Planta 2ª: en esta planta se han ejecutado 841 m2 para Diálisis, ocupando una
parte del bloque quirúrgico para la sala
de diálisis. La unidad está compuesta por
el control, espera de pacientes, plasmaféresis, control de plasmaféresis DPCA(4),
aseo-vestuario, zona de sucio, DP de infecciosos, pruebas funcionales, técnicas
limpias, sala de crónicos, compartimento
de agudos, preparación y pesaje, aseosvestuarios infecciosos, reparación y almacén de equipos, y sala de tratamiento de
ósmosis.
Este nuevo bloque entró progresivamente en funcionamiento a partir de junio de
2006. Tiene 12 alturas (sótano, semisótano,
baja y 9 plantas) y 20.260 m2 de superficie, y alberga las unidades de radioterapia,
medicina nuclear, radiodiagnóstico, área de
procedimientos de gastroenterología, laboratorios, hematología y banco de sangre,
bloque obstétrico y dormitorios médicos;
así como la mayor parte de las nuevas U.C.I.
y U.C.I.N. (neonatales). En su parte superior
se sitúa el helipuerto del hospital.
2
• Plantas 3ª y 4ª: en los 225 m de cada
planta se han desarrollado 2 unidades
de reanimación post-operatoria: una de
operaciones sencillas, con pocas horas
de estancia; y otra para operaciones más
complicadas, donde el paciente puede
permanecer incluso días. También se encuentran despachos de supervisor, médico de guardia, jefe de servicio, sala de
reuniones, sala de estar y almacén.
Estructura y cimentación
Reforma de la escuela de enfermeras
Torres Norte y Sur
Esta reforma ha consistido en la demolición
interior total de las plantas, dejando la estructura y el cerramiento, y realizando la
adecuación de las mismas en semi-alas para
Consultas Externas, con un control en medio de las dos semi-alas.
Tras un exhaustivo estudio del terreno se
determinó que la cimentación para estos
edificios fuera una losa de hormigón micropilotada, de 90 cm de canto y una longitud
de micropilotes de 12 m para la Torre Norte
y de 16 m para la Torre Sur, debido en este
caso a una mayor cantidad existente de escorias.
Ampliación del edificio de urgencias
Se ejecutó la estructura de 2 edificios de 2
plantas de unos 300 m2 cada una, a ambos
lados del edificio de Urgencias ya existente;
el cerramiento de uno de ellos y el acabado
de la planta baja del otro, donde se ubicaron los 3 grupos electrógenos, una estación
transformadora para Urgencias y una sala
de cuadros eléctricos.
Bloque obstétrico y radiológico
Zonas interiores
Este helipuerto puede ser utilizado por naves de 14 m, las más empleadas en traslados sanitarios, por lo que dispone de una
plataforma de 28 m de diámetro. La superficie de aterrizaje se ha reforzado considerablemente, para que sea capaz de resistir
el impacto de la caída libre de uno de estos
aparatos.
Para poder iniciar la construcción de este
edificio, entre la antigua Residencia General y la Torre Norte de Hospitalización, hubo
4
Diálisis peritoneal continua ambulatoria
El tipo de micropilote realizado es el hoy
ellos con cruces de San Andrés; y las vigas
mediante medias HEB soldadas por la parte
inferior.
Edificio de apoyos médicos
Al realizar la demolición interior y de fachadas de este edificio de 5 plantas se analizó
la estructura, y a la vista de los resultados se
decidió llevar a cabo un tratamiento contra
la carbonatación del hormigón de los pilares y las vigas de cuelgue.
Por otro lado, y dado que en la fase 1B había que recrecer 5 plantas más este edificio, se realizó un refuerzo de la estructura.
Este consistió en fortalecer previamente la
cimentación mediante una losa micropilotada, pero dejándola separada de las zapatas existentes, y por otro lado reforzar éstas
aumentando su canto e introduciendo micropilotes.
conocido como Ropress, nombre comercial
del inicial Tubfix(5). Este micropilote tiene la
peculiaridad de que se efectúa con inyección de lechada de cemento a presión a través de unos manguitos que lleva el tubo de
acero (esta operación se denomina obturación) y que se disponen cada metro.
El sistema consiste en llenar la perforación
a través de esos manguitos a una presión
y con una cantidad determinadas y prefijadas de antemano, hasta que el manguito
no abra más, lo que indicará que el terreno ha sido mejorado en esa zona obturada,
pasando a realizar la misma operación en el
siguiente manguito.
Los forjados entre plantas fueron reticulares
de hormigón armado, de 30 + 5 cm, con
luces de 7 m.
Edificio materno - infantil
Este edificio tiene una estructura metálica,
con forjados de vigueta y bovedilla de 18 +
5 cm de canto. Presentó la peculiaridad de
que al realizar la demolición y comprobar su
estado fue necesario efectuar un recálculo.
Este obligó a reforzar los pilares mediante
pletinas soldadas, arriostrando algunos de
5
Micropilotes con bulbo inyectado a presión
Estos micropilotes tenían el inconveniente
del gálibo de la planta (3 m), por lo que
tuvieron que ejecutarse con una máquina
especial de micropilotaje. En cuanto al refuerzo de pilares y vigas se realizó mediante
un encamisado de hormigón armado, ejecutando el hormigonado a través de 4 taladros realizados en el forjado, por donde
pasaban las armaduras del pilar.
Bloques quirúrgico y obstétrico radiológico
En estos edificios de nueva planta se realizó
una losa micropilotada como en los anteriores, con la única variación de que los micropilotes llevaban un sistema de relleno con
mortero en vez de con lechada.
En cuanto a la estructura, cabe destacar que
el bloque Quirúrgico se realizó con un reticular de 30 + 5 cm y el Obstétrico - Radiológico con losa de 30 cm de canto, debido
al cambio de normativa de incendios y a los
pesos de los aparatos a instalar (resonancia
magnética, escáneres, aparatos de rayos X,
gammacámaras, etc.).
Aceleradores lineales
Esta zona, en cuanto a cimentación y es-
Zonas interiores
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174
La fachada es ventilada, con acabado en
tablero fenólico tipo trespa(6). Su sección
está compuesta por una pared de bloque
de hormigón vibrado de 50 x 25 x 20 cm,
con un enfoscado hidrofugado exterior sobre el que se coloca una estructura auxiliar
de aluminio cada 90 cm, sujeta al bloque
y a los pasos de forjados con tornillería de
acero inoxidable y tacos especiales.
La elección del tipo de panel fenólico (existen muchos en el mercado) se debió principalmente a que era el único probado a
6.000 h de insolación en un clima similar al
canario, sin sufrir alteraciones.
En el bloque de ascensores panorámicos se
ejecutó un muro cortina con vidrio de seguridad siliconado verticalmente y perfilería
horizontal de aluminio, sujeto con soportes metálicos al canto de unas pantallas de
hormigón armado exentas de 11 plantas de
altura.
tructura, destaca respecto al resto debido a
los espesores de muros y losas de techo que
emplea pero, sobre todo, por la utilización
de hormigones baritados. La densidad del
árido barítico, de entre 3,8 y 4,2 t/m3, conduce a hormigones de entre 3 y 3,2 t/m3 de
densidad.
Estos hormigones tienen un gran peso y, por
consiguiente, una gran dificultad de encofrado e imposibilidad de bombeo. Por otro
lado, los camiones de hormigón no pueden
transportar más de 2,5 ó 3 m3, por lo que
los rendimientos se reducen bastante.
La elaboración de estos hormigones es bastante sencilla pero necesitan un control especial en las dosificaciones, sobre todo en
lo que respecta a la cantidad de árido barítico y de agua, por lo que es fundamental
pesar muestras de cada camión y comprobar su densidad.
Fachadas
El hospital muestra hacia el exterior un aspecto compacto y de gran volumen, con un
escalonado necesario para no crear sensación de agobio. A esto ayuda la creación de
patios interiores, que mejoran la luminosidad interior.
Instalaciones
Electricidad
La demolición del anterior edificio industrial, donde se alojaba uno de los C.T. y por
donde discurrían parte de las líneas a 6.000
V obligó a una remodelación profunda de
la red de M.T.
Se ejecutó una estación transformadora
con 2 trafos de 800 kVA y uno de 1.600
kVA para aire acondicionado a 6.000 V, con
posibilidad de pasarlo a 20.000 V cuando se
cambiara la entrada al hospital. También se
instaló un grupo electrógeno de 800 kVA.
La reforma eléctrica a realizar fue pareja
con la obra de adecuación de los nuevos
espacios hospitalarios, pues cada modificación implicaba una nueva distribución eléctrica en B.T.
Cada uno de los C.T. existentes recibía alimentación a 6.000 V, lo que simplificaba el
6
Compuesto por un núcleo de fibra de celulosa
impregnada en resinas fenólicas y una superficie
exterior (decorativa) también impregnada y
prensada a alta temperatura (150°) y a alta
presión (90 kg/cm²)
tendido eléctrico y el mantenimiento de la
instalación eléctrica del hospital, pero complicaba el funcionamiento de los grupos
electrógenos, ya que no existía posibilidad
de discriminar aquellas cargas que debían
conectarse a la red de emergencia.
La aparamenta eléctrica de protección y
maniobra es del tipo de cabinas metálicas
prefabricadas, mientras que los transformadores se alojaron en celdas de fábrica, para
así facilitar su accesibilidad.
Respecto a las plantas de los edificios, una
vez estudiadas teniendo en cuenta los servicios que albergarían, se procedió a la
sectorización en subcuadros de planta por
servicio. Cada uno de dichos subcuadros se
divide en dos armarios: uno para red-grupo
y otro para SAI(7). Del subcuadro se distribuye a las distintas dependencias a través
de los pasillos mediante bandejas de rejilla, derivando a las habitaciones con tubo
corrugado previa transición en una caja de
derivación.
La distribución en B.T. se realiza mediante
5 líneas verticales, autónomas entre sí. En
cada una de ellas existen, a su vez, 3 tipos
de líneas eléctricas:
• alimentación ininterrumpida, conectada a
una unidad SAI, de tal manera que ante
un corte del suministro no exista siquiera un microcorte; estas líneas alimentan
a equipos informáticos preferentemente
y se encuentran distribuidas por todo el
hospital
• alimentación normal red-grupo (constituyen el grueso del consumo); ante un corte
de suministro, los grupos electrógenos lo
reponen a los 20 segundos
• alimentación no esencial; ante un corte de
suministro los grupos electrógenos no lo
reponen de manera automática (se hará
después manualmente, para evitar sobrecargas y poder actuar selectivamente);
están destinadas exclusivamente al aire
acondicionado y a una nueva pareja de
ascensores monta - camas en el edificio
de Materno-Infantil
7
Sistemas de alimentación ininterrumpida
La instalación eléctrica de las habitaciones
y demás áreas discurre a través de tabiques
de pladur y de falsos techos, siendo el cable
utilizado libre de halógenos.
En la planta de quirófanos cabe destacar la
utilización de paneles de aislamiento contra
riesgos eléctricos, así como una batería por
quirófano. En el interior de estos se instaló un panel técnico que incorporaba relojcronómetro, altavoz, control de megafonía, voz y datos, negatoscopio(8), tomas de
gases y un visualizador para control de la
presión, humedad y temperatura. Las luminarias interiores son pantallas estancas para
ambiente estéril y focos halógenos regulables en intensidad desde el panel técnico.
Este sistema de paneles de aislamiento se
implantó también en el servicio de diálisis
y URPAs(9).
Fontanería
Se encuentra concentrada en patinillos registrables de agua fría y agua caliente sanitaria por cada 4 habitaciones. La tubería
utilizada en la fase 1A fue galvanizada en
verticales y de cobre para la distribución horizontal, si bien se cambió en la fase 1C a
tubería fusiotherm(10) para agua caliente y
PVC de presión para agua fría.
La recogida de pluviales y fecales se halla
diferenciada, de forma que hay 2 redes independientes. La de fecales pasa por una
rejilla antes de su envío al colector general,
8
Pantalla luminosa sobre la que se colocan las
radiografías para observarlas por transparencia
9
Unidad de recuperación post-anestésica
10
Tubo de polipropileno sin PVC que no requiere
adhesivos; idóneo para fluidos hasta una presión
de servicio de 20 bares y 95º de temperatura
175
176
y la de pluviales se envía a éste directamente, sin pasar por rejilla alguna.
Como instalación especial cabe destacar
una planta de tratamiento de agua para
diálisis (ósmosis inversa) mediante equipos
en línea, y bombonas de resina y depósitos
de sales para el agua a suministrar a las máquinas de esterilización.
Aire acondicionado
Consta de 5 plantas enfriadoras, 2 de ellas
con recuperación de calor, situadas en las
cubiertas de los edificios e interconectadas
entre ellas. Las recuperadoras de calor generan parte del agua caliente sanitaria necesaria, y el resto se genera con 2 calderas
de apoyo en paralelo.
En planta existen climatizadores bizona y
fan-coils de baja silueta, de donde salen
los conductos de impulsión y retorno hacia cada habitación. Al lugar donde se encuentran estos aparatos se le aporta aire
exterior, que se mezcla con el retorno de
las habitaciones. Por otro lado, existe una
extracción independiente para aseos que
se hace por vertical de patinillos. Todo el
sistema de aire acondicionado se gestiona
mediante ordenador.
En el bloque quirúrgico, así como en las zonas de URPAs y diálisis, se ha instalado un
sistema de aire acondicionado con enfriadoras a 2 tubos y fan-coils de pared tipo
consola, con un climatizador de aire primario en la cubierta, de donde salen los conductos hacia las diferentes plantas o servicios.
En los quirófanos se instaló un sistema de
aire con un barrido desde la zona estéril a la
zona limpia. Esto consiste en un climatizador al que se conecta en serie un regulador
automático de caudal variable, y a éste una
caja formada por una batería de frío, una
batería de calor, sección de humectación y
filtro absoluto; desde esta caja se distribuye
el aire con la humedad y temperatura solicitadas por el quirófano, por medio de conductos de acero inoxidable.
El sistema de control permite que el aire
acondicionado del quirófano no esté siempre al máximo de su eficiencia (o sea, en
modo operación), pudiendo encontrarse
también en modo mantenimiento o limpieza gracias a variadores de velocidad.
Gases medicinales
Se ejecutó una subcentral con protóxido de
nitrógeno y oxígeno, una central de vacío
con bombas y depósitos, y otra de aire comprimido con 2 compresores y aire medicinal.
En quirófanos se instalaron unas columnas
de cirugía y otras de anestesia. Estas últimas llevan incorporadas tomas de gases,
enchufes, tomas de voz y datos, soportes
para monitores y un motor que expulsa el
gas anestésico hacia el exterior por la red de
tubos preparada a tal fin.
En las unidades UCI y URPA también se
instalaron columnas de anestesia como las
descritas anteriormente, pero incluyendo
llamada a enfermera.
Transporte neumático
Se desarrolló una instalación de transporte
neumático, acoplándola a la ya existente en
el hospital, llegando a Laboratorios, Urgencias, quirófanos, URPAs y Diálisis. Se instalaron 20 estaciones de paso y 2 finales, una
en cada control de enfermería.
Detección de incendios
Inicialmente se dispusieron detectores iónicos en cada habitación o dependencia,
así como en pasillos, quedando totalmente
controlados por ordenador con un programa específico.
En las habitaciones del ala Sur de hospitalización, así como en la ampliación de Apoyos Médicos se siguió con ese sistema; sin
embargo, en el bloque Quirúrgico se pasó
de detectores iónicos a óptico-térmicos, por
lo que hubo que montar un nuevo sistema
de control que los agrupara a todos, teniendo en cuenta sus distintas características de
funcionamiento.
Pie de foto
177
HOSPITAL UNIVERSITARIO DE CANARIAS. TENERIFE
HOSPITAL
UNIVERSITARIO DE
CANARIAS.
TENERIFE
PROPIEDAD:
Consorcio Sanitario de Santa Cruz de
Tenerife
CENTRO:
Delegación Tenerife
ARQUITECTOS:
D. José Ángel Domínguez Anadón
D. Francisco Artengo
JEFE DE OBRA:
D. Enrique García Arroba
INSTALACIONES:
D. Angel Silva Borrego
Universitario de Canarias. Tenerife
Antecedentes
El Hospital universitario de Canarias (HUC) es un centro hospitalario
público de tercer nivel, de alcance general, y data de 1971. Es uno
de los dos hospitales principales de Tenerife y está ubicado en el
municipio de La Laguna, próximo a la Autopista del Norte.
De él depende el área sanitaria denominada Tenerife Norte, que
incluye 11 municipios del Norte de la isla (342.000 habitantes), y
presta apoyo a los usuarios de la isla de La Palma (86.000 habitantes) cuya atención sobrepase las posibilidades del Hospital General
de La Palma.
Aparte de su compromiso asistencial, el hospital desarrolla labores
en el campo de la investigación desde hace más de una década,
junto con la Facultad de Medicina de la Universidad de La Laguna, creando con ella una Unidad Mixta de Investigación. Entre sus
actividades prioritarias se encuentran: patología molecular de las
enfermedades raras, enfermedades neurodegenerativas, inestabilidad genómica y cáncer, epidemiología del cáncer colorrectal, respuesta inflamatoria en las enfermedades reumáticas, infecciones
nosocomiales(1) y comunitarias, y fisiopatología y prevención de las
complicaciones del trasplante renal.
1
Vista general
179
Infecciones contraídas en un hospital
180
Respecto a esto último, hay que destacar
la acreditación concedida como Centro de
Referencia Nacional para el trasplante pancreático-renal, lo que lo avala como uno de
los 3 centros del país para la formación de
especialistas en este tipo de trasplante.
Ante el envejecimiento de sus instalaciones
y la falta de espacio para implantar nuevos
servicios y tecnologías, el HUC se enfrentó
al dilema común a muchos hospitales de
trasladarse a un nuevo edificio o afrontar
un complicado proceso de renovaciones
internas. Bien posicionado al borde de la
principal autopista insular y físicamente vinculado a la Facultad de Medicina, optó por
la renovación.
El Plan Director de
Para ello, hace unos años se puso en marcha el Plan Director de Obras del HUC, un
ambicioso proceso de fases de trabajo encaminado a definir lo que habría de ser el
nuevo hospital. Las fases y su realización
actual son las siguientes:
• Fase 1 (ya realizada): edificio NEA (Quirófanos, Urgencias, UVI y Esterilización) y
2 Torres de evacuación
• Fase 2 (finalizando): edificio de actividades ambulatorias
• Fase 3 (redactado el Proyecto de ejecución): ampliación y remodelación del
HUC, actualmente en supervisión técnica
El cambio, en distintas magnitudes, supone:
Plano de alzado
• superficie construida, pasa de 71.000 m2
a más de 135.000 m2
• camas totales, de 603 a 809
• camas de Hospital de Día y de < 24 h, de
52 a 142
• superficie sanitaria por cama, de 76 a 170
m2
• locales de consultas externas y áreas de
procedimiento diagnóstico y terapéutico,
de 110 a 214
• puestos de atención de Urgencias, de 9
a 23
• quirófanos, de 14 a 21
• salas de diagnóstico por imagen, de 16
a 23
• aceleradores lineales, de 1 a 3, con previsión de otro de reserva
Fase 1. Edificio NEA y
torres de evacuación
El programa de renovación del HUC se inició con la construcción de una gran área
denominada Edificio NEA, que engloba los
Servicios de Urgencias, UVI, Quirófanos y
Esterilización; además de 2 torres de evacuación en ambos extremos del edificio de
hospitalización, y un helipuerto en la última
planta de una de ellas.
Esta 1ª fase del Plan Director se encuentra
ya realizada y en funcionamiento.
181
Se abordó, a su vez, en 2 etapas:
• 1ª etapa: Anexo nuevos servicios - Quirófanos, Urgencias y UVI
Planta Baja de hospitalización
• 2ª etapa: Torres de evacuación
Vestuarios
Esterilización
Helipuerto
Equipamiento
Aparatos elevadores
Transporte de ropa sucia y basuras
Edificio NEA
• Bloque quirúrgico
El nuevo bloque consta de 14 quirófanos,
áreas de pre- y post-anestesia, control de
la unidad, vestuarios, almacenes, áreas de
descanso de personal, etc.
• Uno para el material limpio o estéril
Los quirófanos se dividen en: 10 polivalentes, destinados a la actividad quirúrgica
programada; 1 para la actividad quirúrgica
urgente y 3 para actividades quirúrgicas específicas (cardíaca, traumatológica y oftalmológica).
Salidas:
Este Bloque tiene una clara delimitación entre las zonas limpia y sucia. A ello contribuye
decisivamente el intercambiador de pacientes, planteado como un sistema de doble
esclusa por el que acceden los pacientes en
camas y, a través de él, son trasladados a
una camilla de quirófano para acceder a la
zona limpia. El Servicio de Esterilización se
comunica con el bloque quirúrgico mediante dos montacargas.
El bloque Quirúrgico tiene los siguientes circuitos de acceso y de salida:
Accesos:
• Uno para el paciente hospitalizado, a través del intercambiador
• Uno para el personal, a través del vestuario
• Uno de recepción del Área y comunicación interna/externa
• Una para el paciente hospitalizado, desde
Quirófanos hasta la sala de Recuperación
post-anestésica
• Una desde Recuperación al exterior del
Área
• Una para el personal, hasta el vestuario
• Una para la ropa y el material sucio
El material sucio ha de salir del bloque quirúrgico sin atravesar las zonas limpias.
Con el fin de reducir al máximo la manipulación del enfermo, se le transporta en su
cama a la zona de recepción de pacientes.
A través del intercambiador accede al bloque, ubicándose en la zona de espera prequirúrgica. Una vez pasado a la camilla, su
cama es trasladada seguidamente a la sala
de Recuperación postquirúrgica, donde
quedará aguardándole.
El control de esta Unidad está centralizado,
de forma que el mismo equipo asistencial
Helipuerto
182
atienden aparte. La disposición de los compartimentos en la zona de adultos permite
diferenciar a los pacientes con patologías
médicas de los pacientes quirúrgicos.
El sistema organizativo es mixto, coexistiendo una estructura médica propia de Urgencias y otra en prestación de servicios desde
los propios Servicios del Hospital, si bien la
recepción es común para ambas. Toda la radiología convencional generada desde esta
Unidad se realiza en la propia Unidad.
Observación de
urgencias
puede acceder a todos los pacientes.
Cada quirófano tiene la siguiente dotación:
• 1 torreta de anestesia para gases [CO2,
Oxígeno, Aire comprimido, Protóxido de
nitrógeno, Vacío y Carbógeno(2) (este último sólo en el quirófano de cirugía cardíaca)]
• 1 torreta quirúrgica
• Sistema de aspiración de gases anestésicos
• Conexión informática
• Conexión telefónica
En la sala de Recuperación cada una de las
camas cuenta con 2 tomas de aire comprimido, 3 de oxígeno, 3 de vacío, 1 de monitorización y 6 de corriente eléctrica. La Recepción cuenta con cableado informático,
telefonía y megafonía.
• Urgencias
El Servicio está configurado en un área de
Urgencias de adultos y otra de Urgencias
pediátricas, con circulación diferenciada
de pacientes; las urgencias obstétricas se
2
Gas resultante de la mezcla de oxígeno con
un 5-10% de CO2; es estimulante del sistema
respiratorio y se utiliza en las anestesias generales,
colapsos anestésicos e intoxicación por drogas
depresoras (barbitúricos, opio, etc.)
En base a la demanda actual, y ante la dificultad de conseguir un sistema de comunicación con el Servicio Central de Radiodiagnóstico, se consideró necesaria otra
sala de escáner y una de ecografías en el
área de Urgencias. Ambas dan respuesta a
la demanda del Servicio de Urgencias y de
la UVI, respectivamente.
Toda la cirugía urgente generada desde
esta unidad se realiza en el quirófano de
Urgencias, ubicado en el Bloque Quirúrgico.
El Servicio dispone de una unidad de Observación para pacientes con compartimentos
individuales y monitorización, en proximidad física inmediata y bajo dependencia
funcional del Servicio. La permanencia de
los pacientes en esta zona debe ser en principio < 24 h, siempre que exista la posibilidad de drenaje.
Existe también una sala de espera de resultados, con capacidad para 6-8 personas (sillones), y otra zona de observación abierta
para pacientes atendidos en la sala de clasificación y distribución de pacientes, con 4
ó 5 camas.
Con la finalidad de evitar el bloqueo temporal de compartimentos de atención, existe
un espacio específico en el Servicio de Urgencias destinado a Exitus(3). Este espacio se
comparte con la UVI y su ubicación está en
una zona apartada del área asistencial.
Las pruebas analíticas pueden realizarse en
3
Más correctamente “exitus letalis”, es una expresión
latina que usada en el ámbito médico significa “proceso hacia la muerte”, lo que indica que la enfermedad
ha progresado hacia o desembocado en la muerte
Pie de foto
183
184
Vista general de la
UVI
el Laboratorio de Urgencias, situado en el
área central de Laboratorios, mediante comunicación por transporte neumático e informático.
• UVI
Es una estancia ovalada, con un patio central de luz natural y una zona central con
un puesto de control de Enfermería, desde
el que se vigilan los 24 cubículos individuales independientes mediante un sistema de
monitorización. Da atención a pacientes críticos con patologías médicas y quirúrgicas,
teniendo una comunicación fácil con los
servicios de Urgencias y el bloque Quirúrgico, así como un sistema mecanizado para el
transporte de muestras de sangre y resultados de Laboratorio.
Los compartimentos de la UVI son de utilización polivalente, con posibilidad de ser
cerrados y con visualización directa desde
el exterior y entre ellos. Cada uno tiene 3
tomas de oxígeno, 3 de aire comprimido y
3 de vacío.
Cada compartimento se ilumina mediante un sistema de luz de techo modulable y
otro de cabecera directa e indirecta. Posee
asimismo una conexión mínima para 6 enchufes, todos conectados a tierra, así como
un punto de agua para el lavado de manos
del personal.
Existe un sistema de alarma acústica y visual
que puede accionarse desde cada uno de
los compartimentos, siendo detectado desde cualquier zona (sala de reuniones, habitaciones de guardia, zona de relax, etc.)
dentro de la propia área. Este mecanismo se
utiliza únicamente en situaciones de emergencia, tales como parada cardiorrespiratoria de un paciente.
Disponen también dichos compartimentos
de drenaje e instalación de agua desionizada, adecuados para tratamientos de diálisis.
• Instalaciones del NEA
Para maquinaria y mantenimiento se excavó una ampliación del edificio en el jardín
situado frente al acceso a Urgencias. Esto
permite disponer a nivel del bloque Quirúrgico de salas de mantenimiento y esterilización a cargo de los servicios correspondientes, situando sobre ellas las máquinas
de climatización del Bloque, alimentadas
desde las enfriadoras que se ubican sobre la
cubierta de la Central de Esterilización.
muerto y 19 t más de estructura soporte,
todo ello en aluminio.
El sistema es de todo aire exterior, suministrado por zonas desde los diferentes climatizadores. Los caudales de extracción se
canalizan directamente al exterior por dos
conductos verticales, uno situado junto al
montacargas de envíos a Esterilización y
otro junto al de servicio a la cafetería.
Además de la rampa, para el supuesto de
un derrame de combustible seguido de incendio, la helisuperficie dispone de una vía
de escape secundaria por el extremo opuesto a la rampa. Para ello se ha construido
una escalera de dos tramos en voladizo, diseñada de modo que entre dichos tramos
quede una plataforma accesible desde el
rellano de la escalera donde se ubicará uno
de los equipos contraincendios.
La distribución de agua, gases y energía
eléctrica se efectúa con la de aire por la cámara de falso techo. Las canalizaciones van
en general por los pasillos, preferentemente por los de circulación sucia o de servicio,
evitando en todo caso cruzar sobre los quirófanos con instalaciones ajenas que pudieran requerir registro.
185
En el interior de esta Torre se ha dispuesto una rampa helicoidal, que garantiza la
posibilidad de evacuación de los enfermos
encamados aun en el supuesto de fallo o
insuficiencia de los montacamas.
Esta escalera conduce desde la helisuperficie hasta el nivel de la sala de máquinas
situada bajo ella, produciéndose la evacuación a través de esta planta hasta otra escalera situada en el extremo opuesto y que
conecta con el nivel de la cubierta general.
Torres de evacuación
Para dar cumplimiento a la normativa de
protección contraincendios, se proyectaron dos torres de evacuación del bloque de
Hospitalización.
La torre Sur es de diseño cilíndrico, de 52 m
de altura y radio exterior de 9,2 m. Se trata de una estructura de hormigón armado
forrada exteriormente de aluminio. En su
parte superior corona una losa circular de
hormigón que acoge un helipuerto de 27,6
m de diámetro, que soporta 24 t de peso
Desde este nivel hasta el espacio exterior
seguro se cuenta no solamente con la salida por la propia torre de evacuación Sur,
sino con otras dos escaleras alternativas en
el centro del Bloque hospitalario, con un recorrido al aire libre de 30 m hasta la más
próxima.
Como medios de extinción, se disponen
equipos duplicados de proyección de espuma activada mediante chorro de agua.
Cada uno de ellos va situado en el arranque
de una de las vías de evacuación, la escalera y la rampa. La presión de agua es de 7 a
8 kg/cm2 y el caudal mínimo de 250 litros/
minuto. Se dispone también un extintor de
polvo seco de 45 kg en el inicio de la rampa.
Respecto a otros medios de prevención, la
helisuperficie se descompone transversalmente en 4 faldones con pendiente del 1%
hacia un canalón perimetral continuo, en el
que se recogerá cualquier derrame líquido.
Este canalón cuenta con 4 puntos de descarga hacia un tanque separador de aceite/
agua que está situado en la entreplanta de
Compartimento de
la UVI
186
servicios de radioterapia para tratar patologías que requieren un tratamiento urgente
que no admite listas de espera, y dada la
insuficiencia existente de medios materiales
en el HUC para hacer frente a dicha demanda, se adoptó incluir el Servicio de Radioterapia en esta fase.
Del mismo modo, la necesidad de agilizar
la atención de procesos quirúrgicos y reducir sus listas de espera aconsejó igualmente adelantar a esta fase la construcción del
Área de Cirugía Mayor Ambulatoria.
Estos dos Servicios han podido incluirse en
el nuevo Edificio mediante la construcción
de una planta más, quedando con ello perfectamente integrados en las circulaciones
de pacientes ambulatorios e ingresados, y
sin tener que esperar a la 3ª fase del Plan
Director.
Por tanto, este edificio de Actividades Ambulatorias contiene:
• Consultas Externas y áreas de diagnóstico
y terapéutica de las especialidades clínicas
• Hospitales de Día
Torre de evacuación
Sur
maquinaria. La descarga de este separador
es de 125 mm y está conducida verticalmente por uno de los patinillos de la torre
hasta el atezado de piso de su planta de
contacto con el terreno, por donde se desvía hacia el drenaje.
Fase 2. Edificio
de actividades
ambulatorias
Este edificio incluye las unidades destinadas
preferentemente a atención ambulatoria,
potenciando las áreas que prestan servicios
de diagnóstico y terapéutica, y en especial
aquellas que evitan el internamiento hospitalario permitiendo que el paciente se
reintegre de inmediato a su medio social
habitual.
Ante la creciente demanda asistencial de
• Servicios centrales de alta carga ambulatoria
• Servicio de Radioterapia
• Cirugía mayor ambulatoria
El edificio consta de 13 plantas, y está formado por 2 cuerpos: uno rectangular de
altura total equivalente a la del edificio de
hospitalización existente y adosado a éste,
y otro más bajo pero más amplio de 6 plantas, desarrollado en torno a un patio y con
forma ligeramente trapezoidal. La superficie construida son 35.000 m2.
Con el bloque alto adosado al bloque de
hospitalización quedan aseguradas las conexiones al resto del hospital. Sin embargo, debido a que la altura entre plantas del
bloque de hospitalización existente era de 3
m (insuficiente para el desarrollo horizontal
de las instalaciones) y el nuevo tiene 4 m
de altura por planta, sólo conectan a nivel
entre plantas cada 4 del antiguo (12 m). El
resto de las plantas se comunican a través
de escaleras.
Cada planta está compartimentada en al
menos 2 sectores contraincendios. La superficie de estos es < 1.500 m2 si no dispone de
instalación de rociadores automáticos, y <
3.000 m2 si dispone de ellos. El recorrido de
evacuación en cada sector es < 50 m (salvo
para el archivo sito en el sótano 2, calificado
de riesgo alto, en el que dicho recorrido de
evacuación es < 25 m). Todas las plantas
disponen de al menos dos salidas a escalera especialmente protegida, teniendo todas
las escaleras 1,5 m de anchura.
Todas las puertas de salida de los elementos de evacuación son abatibles con eje de
giro vertical y llevan incorporado un ojo de
buey acristalado de 40 cm de diámetro. La
estabilidad al fuego de toda la estructura
del edificio es de 180 min.
El encuentro de los forjados con la fachada
tiene una franja de hormigón armado de 1
m de altura, y en el caso de una pared que
delimite 2 sectores contraincendio esa altura es de 1,3 m.
El paso entre plantas de los patinillos de la
instalación eléctrica está sellado con bolsas
de material intumescente para evitar puntos débiles en la compartimentación.
Fase 3. Ampliación y
remodelación del HUC
El cumplimiento de las misiones asistenciales de asistencia de área y de referencia,
sin olvidar su condición de centro docente
e investigador y su estrecha colaboración
con la Universidad, obligaba a adecuar las
dimensiones y las características funcionales
y estructurales del hospital.
En base a ello se puso en marcha la redacción del Proyecto que permitiera la construcción del nuevo HUC, Proyecto ya redactado actualmente y que se encuentra en
supervisión técnica.
Este Proyecto llevará al hospital a unas
condiciones estructurales similares a las de
cualquier otro de los grandes hospitales de
la Comunidad Autónoma de Canarias, situando al HUC entre los centros de asistencia especializada más punteros de España.
Descripción de las obras
La 1ª fase de las obras comenzó en diciembre de 1996, presentando problemas importantes que complicaban la ejecución:
• interferencia con la actividad hospitalaria
en diversas zonas, lo que dificultaba enormemente la planificación de los trabajos
• en la planta baja de hospitalización era
necesario desalojar totalmente las dependencias que estuvieran en servicio
• el nivel de acabados exigido era muy alto,
lo que obligaba a un control exhaustivo
de la ejecución
Detalle de la
ampliación
187
188
Construccion de la
torre Sur
• existencia de muchos frentes de actuación
simultáneos, lo que conllevaba a una gran
dispersión de la obra
• relaciones con proveedores e industriales
internacionales (sobre todo alemanes),
dando lugar a negociaciones bastante
complejas
En general, todas las plantas presentaban
un problema común con las instalaciones,
sobre todo en las conexiones con el hospital que estaba en funcionamiento, lo que
llevó a realizar numerosos trabajos en horarios no habituales. En la zona de Quirófanos, además, con la dificultad añadida por
la gran cantidad de ellas que discurrían por
el falso techo y el interior de los quirófanos.
En una 2ª etapa se ejecutaron las dos torres
de evacuación. Primero la cilíndrica, para la
que hubo que hacer un encofrado especial.
Esta torre fue revestida de aluminio y se colocó muro cortina en una zona lateral, además de añadirle una aleta cortaviento.
El helipuerto de la zona superior se realizó
en un material resistente pero ligero (aluminio), para no sobrecargar la estructura de
la torre.
En la fase 2 se llevó a cabo la construcción
del edificio de actividades ambulatorias
que, además de las Consultas Externas,
atiende todos los servicios ambulatorios
prestados por el HUC. Su ejecución suponía una ampliación del hospital que sólo era
posible previo ensanchamiento de la parcela existente.
Las obras debían comenzar necesariamente
por la urbanización, que había que realizar
en varias fases para mantener en todo momento los accesos al hospital. Se iniciaron
en noviembre de 2003, habilitando un nuevo acceso a Urgencias para poder eliminar
la calle que había.
A la vez se ejecutó el nuevo Centro de Seccionamiento de la línea de M.T. que sustituiría al existente, ubicado dentro de la parcela. Simultáneamente se desviaron todas
las instalaciones que atravesaban dicha parcela: M.T., B.T., telecomunicaciones, telefo-
nía, saneamiento y abastecimiento.
Existía una dificultad, proveniente de la necesidad de compatibilizar las obras con las
del edificio de aparcamientos que se estaba
construyendo, y que obligaba a respetar el
número de aparcamientos disponibles en
ese momento. Esta falta de espacio era un
contratiempo muy importante en el desarrollo de los trabajos, ya que complicaba
toda la logística para el almacenamiento de
los materiales de la Obra y la ubicación de
las grúas y las casetas de obra.
El desmonte del edificio eran unos 120.000
m3 de roca basáltica. Una vez avanzado el
mismo, se planteó por parte de la Dirección
Facultativa construir un sótano más. Esto
implicó un recálculo de la estructura y de
la cimentación. Pero además surgieron dos
problemas importantes:
• el aumento de la altura en la excavación
provocaba un riesgo real en las proximidades del solar, ya que se encontraba una
torre de 12 plantas. Para evitar el posible
deslizamiento de capas por debajo de la
cimentación de esta torre, se decidió colocar una pantalla de micropilotes con
anclajes provisionales al terreno a una
distancia aproximada de unos 14 m de
la torre, y se replantearon los sótanos del
edificio de modo que se separaron 14 m
de la torre. Posteriormente la propia estructura arriostraría la pantalla de micropilotes, perdiendo su función los anclajes
provisionales.
• la altura de los muros de contención perimetrales aumentó en 5 m (un sótano
más), alcanzando los 16 m, y tras el recálculo de la cimentación, se decidió cimentar el muro con 4 micropilotes de 14 m
de profundidad por cada metro de muro.
El sistema de cimentación elegido para el
edificio fue mediante encepados que transmitieran la carga al terreno a través de micropilotes.
La fachada se realizó con muro cortina de
paños fijos, y una pequeña cantidad de módulos practicables (16.000 m2 en total). En
las fachadas expuestas al sol la protección
viene dada por una doble fachada formada con vidrio filtrante de las radiaciones ultravioleta e infrarroja, separada y ventilada
respecto a la interior, que es acristalada con
vidrio transparente serigrafiado con una trama para impedir la visión desde el exterior.
En las no expuestas al sol la fachada es sencilla, con vidrio también serigrafiado. En todos los casos, el vidrio es doble con cámara
de aire para impedir las ganancias o pérdidas debidas a la transmisión por radiación.
Edificio de actividades
ambulatorias.
Instalaciones
Instalación eléctrica
El edificio dispone de estación transformadora propia, conectada al anillo existente
que alimenta el actual edificio del hospital.
Se instalaron 3 transformadores de potencia, 2 de 1.000 kVA y 1 de 1.600 kVA,
con relación de transformación de 20.000
/ 400-240 V, ubicados en el sótano 2 en
recinto propio.
Para casos de emergencia se dispone de 2
grupos electrógenos de 1.250 kVA cada
uno, a 400 V, ubicados también en recinto
propio en el sótano 2.
En el centro de gravedad del edificio, en el
sótano 2, se dispone en local propio el cuadro general, desde el que se distribuye a los
cuadros secundarios distribuidos por vertical y planta del edificio. Para los suministros
especiales existe un sistema de alimentación
ininterrumpida de 100 kVA, ubicado junto
al cuadro general en local independiente.
En los locales donde se practican intervenciones y en las camas de hospitalización con
pacientes anestesiados la alimentación eléctrica se realiza a través de un transformador
de aislamiento.
En los locales donde se realizan medidas de
señales muy débiles (del orden de mV o inferiores), se forra el habitáculo con material
conductivo, formando una jaula de Faraday.
El edificio dispone de una red de puesta a
tierra compuesta: una de seguridad para la
instalación de M.T., otra para protección de
las personas en la distribución en B.T. y una
tercera para protección de los equipos informáticos, aunque esta última se une en
un determinado punto con la anterior.
Instalación contraincendios
Esta instalación se compone de un sistema
de detección y alarma de incendios, y sistemas de extinción.
El primero está formado por una central
analógica de última generación, que permite direccionar cada detector e incluso
adaptar los umbrales de sensibilidad a cada
zona específica. Esto facilita la localización
del incendio en su fase inicial y evita falsas
Quirófano
189
190
Detalle de la torre Sur
alarmas en locales con cierta contaminación
ambiental.
Se complementa con un circuito cerrado de
TV que permite controlar los movimientos
de las personas en lugares estratégicos del
edificio y en sus accesos. Para la evacuación
dispone de alarmas óptico-acústicas y megafonía.
El sistema de extinción está formado por
un grupo de presión equipado con una
electrobomba de 100 m3/h a 100 m.c.a., y
una bomba de servicio para mantener en
sobrepresión la red a 70 m.c.a. El sistema se
abastece de la red general exterior del HUC,
procedente de los aljibes de abastecimiento, con capacidad para una reserva de agua
contraincendios de 1.000 m3.
Existen dos redes de extinción: una de rociadores y otra de BIEs, complementadas
con extintores portátiles de polvo polivalente y de CO2 en locales con riesgo de fuego
de origen eléctrico.
La central de detección de incendios está integrada en el sistema de seguridad general
del hospital.
Instalación de climatización
La instalación de climatización es centralizada y se compone de 3 plantas de 1.037 kW
de potencia frigorífica y unidades de tratamiento de aire que distribuyen el aire frío
en las distintas zonas del edificio, existiendo
regulación local en cada dependencia.
La producción calorífica, tanto de A.C.S.
como de calefacción y post-calentamiento,
se obtiene principalmente de la recuperación de dos de las plantas enfriadoras, con
una potencia disponible máxima de 657
kW, y una caldera de apoyo para el caso de
escasa recuperación que garantice la producción a 50 °C y el tratamiento antilegionela.
Todo el aire que entra en el edificio se trata
en las unidades, y en todos los casos es distribuido mediante conductos de chapa de
acero galvanizado embridados y calorifugados, con caudal de aire variable en función
de la demanda térmica. Las unidades de
tratamiento de aire disponen de entrada de
aire limpio del exterior, con salida alejada
de la toma. Para ahorro energético, todas
ellas disponen de free-cooling.
Existen locales con funcionamiento específico (informática, SAI, seguridad y control
de acceso) para los cuales se han instalado
equipos autónomos, permitiendo parar el
sistema central en horas de cierre al público.
Para la gestión simple y eficiente del edificio se ha dispuesto un sistema de control
integrado con el existente en el resto del
hospital, basado en un puesto central y una
red de controladores distribuidos, con autonomía propia. Estos controladores son los
que leen las sondas y actúan sobre el equipo de campo para mantener los parámetros
de confort.
En el sistema central se configuran los horarios de funcionamiento y los puntos de
consigna que serán instalados en cada controlador, de tal forma que aunque se pierda
la comunicación con el puesto central sigan
regulando de forma autónoma. La calidad
del aire se controla mediante sonda ubicada
en los retornos.
Instalación de fontanería
Se ha instalado un grupo de presión que
garantice la presión del agua en todo el edificio, dividiéndolo en 3 niveles de presión,
para compensar las diferencias de altura
según las plantas. Se dispone de agua sanitaria en todos los locales, y de A.C.S. sólo
en vestuarios con duchas y lavabos de médicos en zonas de atención a pacientes. El
abastecimiento se realiza mediante una red
exterior incluida en la urbanización, desde
la sala de máquinas del aljibe general.
Para las unidades de diálisis se dispone de
una red, dividida en 4 zonas, con tubería
de poliamida y con recirculación. El abastecimiento de esta red proviene de la producción central del hospital.
Instalación de gases medicinales
Se disponen redes con sectorización por
plantas para los distintos gases medicinales: oxígeno y vacío de manera general, aire
medicinal o motriz en zonas concretas y
protóxido de nitrógeno en zonas quirúrgicas.
La acometida de estos suministros se obtie-
ne del suministro general existente del hospital, excepto el vacío, que se produce por
medio de una central exclusiva instalada en
la sala de máquinas del sótano 2. En cualquier caso, en dicho sótano se ha reservado
espacio para una instalación redundante de
oxígeno y otra de protóxido de nitrógeno,
mediante rampas de botellas, así como para
la instalación de 2 grupos compresores productores de aire medicinal.
Instalación de telecomunicaciones
Debido al carácter público del edificio, donde se requiere combinar complejas instalaciones de comunicación con la movilidad
de los puestos de trabajo, se dispone una
instalación de cableado estructurado compuesta por una red vertical, que arranca del
repartidor principal de voz y datos ubicado
en un local anexo a Informática, y una red
horizontal por planta que arranca desde el
repartidor secundario de planta.
En el mismo local del repartidor principal se
instala con su equipamiento la central telefónica digital, de la que parten los pares
telefónicos interiores, y a la que llegan las
líneas exteriores de la red pública de telefonía.
Vista general
191
HOSPITAL MARQUÉS DE VALDECILLA. SANTANDER
HOSPITAL MARQUÉS
DE VALDECILLA.
SANTANDER
PROPIEDAD:
Servicio Cántabro de Salud (SCS)
Gobierno de Cantabria
193
Universitario Marqués de Valdecilla.
Santander
Descripción del complejo hospitalario
CENTRO:
Delegación Norte
El actual hospital universitario Marqués de Valdecilla (HUMV) es un
complejo hospitalario vinculado académicamente a la Universidad
de Cantabria, y está formado por un total de 25 edificios, distribuidos en 3 conjuntos principales:
ARQUITECTOS:
D. Fernando Cruz
D. Juan Casariego
D. José Manuel Baquerizo
D. Genaro Alas
D. Víctor Gorostegui
Hospital Marqués de Valdecilla
• Hospital (ó Residencia) General (1973)
• 9 Pabellones de la antigua Casa de Salud Valdecilla (1929)
D. Alejandro Solares
• Escuela Universitaria de Enfermería
• Edificio 2 de Noviembre (antiguo edificio de Traumatología)
(2003)
JEFE DE OBRA:
D. Silvino Antonio Arias
• Edificio Valdecilla Sur, que alberga las Consultas Externas (2008)
INSTALACIONES:
D. Juan Carlos Calvo
Este hospital, que proviene de la Casa Salud Valdecilla, todavía conserva pabellones de la época, además de un nuevo edificio principal
en forma de H que alberga en sus extremos al edificio 2 de Noviembre (12 plantas) y al Hospital General, comunicados a través de las
plantas 2 y 3.
El Hospital General lo forman 2 bloques en V de 10 plantas sobre
rasante más 2 bajo el nivel de calle.
El edificio 2 de Noviembre posee 12 plantas más 2 bajo rasante. En
su azotea se encuentra el helipuerto.
Vista general
194
HOSPITAL MARQUES DE VALDECILLA. SANTANDER
El bloque de comunicación entre ambos
consta de 5 plantas, 3 sobre nivel (Servicios de Urgencias y Radiodiagnóstico, quirófanos, oficinas y Hemodinámica) y 2 bajo
rasante (centros de transformación, instalaciones de calefacción, esterilización y otros
servicios generales).
La actual Escuela Universitaria de Enfermería fue construida por la Universidad de
Cantabria en base a un acuerdo de cesión
durante 99 años.
Otros edificios del conjunto albergan la lavandería, Anatomía Patológica y Mortuorio;
grupos de presión, la planta descalcificadora y la planta de agua; la central térmica, el
servicio de mantenimiento y la capilla.
La parcela en la que se asienta el conjunto
es amplia y cubre una extensión no construida de 111.000 m2, que es utilizada para
zonas verdes, circulación interna de vehículos, aparcamiento regulado para personal
del hospital (700 plazas) y para público en
general.
Hospital Cantabria
A unos 500 m del anterior y construido en
1969, está formado por un edificio principal
de hospitalización (casi 700 camas), con 12
plantas sobre rasante y una planta sótano,
y 3 edificios auxiliares. Actualmente acoge
el Hospital Materno-Infantil y diversos ServiVista general
cios, tanto médicos como quirúrgicos.
En sus dependencias se ubican, desde
1994, la Dirección Territorial del Insalud y la
Dirección de Atención Primaria de su área
sanitaria, ocupando entre ambas aproximadamente un 20% de su superficie habitable. En la planta 12 del edificio se albergan
las instalaciones del 061 (Urgencias).
Centro de Especialidades Vargas
Data de 1973 y se encuentra a 1,5 km del
hospital Valdecilla. Se trata de un edificio
único de 7 plantas más 2 de servicios, en el
que se atienden Consultas Externas del hospital; a excepción de las 2 primeras plantas,
que están cedidas para Atención primaria y
fueron remodeladas en 1995. No dispone
de parcela libre a su alrededor, configurándose como un típico inmueble urbano.
Historia
La Diputación de Santander cumplía su obligación de asistencia gratuita a las personas
sin recursos de la provincia en el Hospital
de San Rafael, un sólido edificio de finales
del siglo XVIII, cuyas 350 camas, inicialmente muchas, habían quedado insuficientes
más de un siglo después. La creación de
un hospital nuevo y mayor fue asumida por
Ramón Pelayo de la Torriente, marqués de
Valdecilla, cuya prodigalidad ya era conocida en otros ámbitos. Y a ese nuevo hospital,
inaugurado en 1929, se le llamó Casa de
Salud Valdecilla (CSV).
Ya desde sus inicios el marqués le dio una
nueva orientación: por una parte el hospital atendería a todo tipo de pacientes, sin
distinción; y por otra, destacaría por la alta
calidad técnica y científica de su asistencia,
lo que sería germen de una auténtica escuela de medicina y cirugía. Sus primeros
Jefes de Servicio fueron nombrados por un
comité de expertos en el que se encontraban Ramón y Cajal y Gregorio Marañón,
entre otros.
Su estructura componía un macro-hospital
construido en superficie por pabellones, a
fin de separar las especialidades y controlar
mejor ciertas enfermedades contagiosas.
195
Residencia Cantabria
Medio siglo mas tarde esta arquitectura se
denominaría ciudad sanitaria.
Con el tiempo la gestión del hospital pasó
a la Diputación Provincial. Y mientras tanto
la Seguridad Social inauguró su propia Residencia sanitaria, la Cantabria, en 1969. Esta
era un edificio de 12 plantas que traía como
novedad de tipo social la desaparición de
las salas de enfermos colectivas, pues disponía de habitaciones dobles con un servicio
higiénico para cada una de ellas.
Entre 1970 y 1973 se desarrollaron 3 iniciativas fundamentales: renovar funcional
y arquitectónicamente la CSV, incluida la
escuela de enfermeras; convertir el hospital
renovado en asiento de los cursos clínicos
de la Facultad de Medicina recién creada
en Santander, y establecer un acuerdo con
la Seguridad Social para unificar la actuación hospitalaria que prestaban la CSV y la
Residencia Cantabria; el resultado de esta
fusión fue el Centro Médico Nacional Marqués de Valdecilla, al que se dotó de nuevos
Departamentos y Servicios, así como de más
personal y medios materiales y económicos.
Para ello se demolieron los pabellones que
ocupaban la parte anterior del recinto hospitalario, edificando en el solar el denominado nuevo bloque médico-quirúrgico, hoy
conocido como Hospital General, que fue
inaugurado en 1973.
En ese mismo año la Seguridad Social construyó un gran edificio monobloque de 14
alturas, con helipuerto en su terraza superior, denominado Centro de Traumatología
y Ortopedia, donde se ubicaron también los
servicios generales de Cirugía y Nefrología,
con su Unidad de Diálisis.
Como consecuencia de la nueva situación
derivada del acuerdo suscrito, y de las características de las nuevas instalaciones
puestas en funcionamiento, se decide la
transformación de la Residencia Sanitaria
Cantabria en Maternidad y Hospital Infantil.
En 1981 se aprueba un Proyecto de reforma
y modernización de los primitivos pabellones de Valdecilla, incluyendo la realización
de accesos, la reconstrucción total de la galería de unión y la puesta al día de la galería
subterránea. El citado Proyecto fue reformado en 1984 y concluido en 1988.
En 1999, y a raíz de un hecho luctuoso, se
lleva a cabo la construcción del edificio 2 de
Noviembre (el antiguo Centro de Traumatología, del cual se desprendió toda una fachada), a la vez que se aceleran los trámites
para poner en marcha la ejecución de las
reformas generales del Hospital Valdecilla,
que entonces se revelan como urgentes. A
196
finales de ese mismo mes salen a concurso
público el Plan Director y la Fase I de la Ampliación y reforma del Hospital Marqués de
Valdecilla.
En 2003 se inaugura el nuevo edificio 2 de
Noviembre y la 1ª fase del Servicio de Urgencias.
En 2005 finaliza el grueso de la fase I y
comienza la fase II, terminando ambas en
2007, dando paso a la fase III.
A principios de 2009, se encuentra en ejecución la 3ª y última fase del Plan Director,
que tiene prevista su finalización en 2010.
Con todo ello, el HUMV se ha transformado
en un hospital de elevada especialización y
tecnología, incluido entre los grandes hospitales docentes e investigadores de nuestro país.
Asiste a la población del área I (300.000
hab.), y es referencia para las áreas II, III y
IV, así como para el ámbito extrarregional.
El Plan Director de
(1999)
Antecedentes
Centro de
Especialidades Vargas
En 1999 el recinto hospitalario Marqués de
Valdecilla presentaba una variedad de edificios con distintas funciones, construidos
a lo largo de su historia, y ejecutados según iban apareciendo nuevas necesidades
siguiendo las diferentes estrategias políticosanitarias. Estos edificios se comunicaban
entre sí mediante un sistema viario en superficie y otro de galerías subterráneas, trazados también como respuesta inmediata a
requerimientos concretos y no a una ordenación general premeditada.
El resultado final consistía, pues, en un conjunto espacialmente muy complejo, con
estructuras físicamente deterioradas y dificultades funcionales en muchas áreas, en
contraste con el gran desarrollo de la función médica y la importancia que poseía el
hospital dentro de la comunidad.
La parcela, con un desnivel de 14 m, estaba
incluida en la remodelación de las vías urbanas prevista en el Plan General, de modo
que, ejecutado éste, el solar quedaba accesible en todo su perímetro a través de vías
públicas, mejorando notablemente las condiciones de accesibilidad originales.
Tanto los edificios como la parcela eran suficientes en tamaño, ubicación y accesibilidad geográfica para los pacientes de Santander y del resto de Cantabria. Asimismo
el hospital estaba bien posicionado y comunicado para el acceso de pacientes provenientes de otras C.C.A.A.
El complejo hospitalario, como consecuencia de su origen (fusión de 3 instituciones:
Casa Salud Valdecilla, el Hospital General
de posterior construcción y la Residencia
Sanitaria Cantabria) mostraba una gran dispersión de instalaciones, así como la duplicidad de algunas de ellas.
Asimismo, existía una falta de coordinación
asistencial entre los Servicios que residían
en los 2 hospitales (Materno-Infantil y Ginecología en el Hospital Cantabria, y el resto
de las especialidades médicas y quirúrgicas
en el Hospital General). La fusión de ambos
requería una profunda remodelación en
el edificio sobre la parcela de este último,
manteniendo en todo caso la utilización de
la totalidad de los edificios actuales sobre
un reparto funcional de espacios radicalmente distinto.
El estudio de resistencia y estabilidad que se
efectuó en el conjunto (entre 1996 y 1997)
demostró que el edificio principal (Hospital
General) respondía y mantenía los parámetros del diseño inicial. El área de hospitalización disponía de habitaciones amplias, luminosas y con un porcentaje mínimamente
adecuado de camas en habitaciones individuales (11,2 %).
Pero el principal problema radicaba en el
estado de conservación y funcionalidad de
sus edificios, y principalmente del Hospital
General, que es el que albergaba la mayoría
de las instalaciones asistenciales. Desde su
construcción a principios de los años 70 no
se había realizado ninguna inversión significativa para su remodelación y adaptación a
las nuevas necesidades asistenciales y organizativas, ni se había dispuesto de un plan
funcional que racionalizara la disposición y
utilización de los espacios en los edificios y
en las parcelas.
En consecuencia, su configuración había
ido sufriendo una política de progresivos y
múltiples parches que buscaban de forma
posibilista la solución urgente de las necesidades de funcionamiento; lo cual, finalmente, había originado un edificio poco
confortable para los pacientes, visitantes y
trabajadores, así como funcionalmente ineficiente, y de difícil y costosa conservación
en lo que respectaba a su mantenimiento
reparador y preventivo.
La labor de reformarlo no era fácil, teniendo en cuenta que no sólo se quería mantener viva la idea inicial del marqués sino
también la organización arquitectónica del
hospital. Esto obligaba a mantener los pabellones originales, o al menos a realizar
una fiel reproducción de los mismos, con el
consiguiente esfuerzo de construcción. Se
trataba de llegar a un cambio conceptual
importante, manteniendo el mismo modelo
arquitectónico.
En la construcción de la CSV se había seguido un sistema horizontal de pabellones,
más de 20, con 3 plantas cada uno, unidos
entre sí por una galería y un túnel subterráneo, y con capacidad para 700 camas. Su
modelo organizativo y su diseño funcional,
realmente novedosos para su tiempo, habían permitido el desarrollo de una cuádruple función propia de un hospital contemporáneo: asistencia, docencia, investigación
y acción preventiva en la comunidad a la
que sirve.
Planteamiento
Más de 3/4 de siglo después de sus orígenes, el nuevo HUMV se concebía con
la misma filosofía que inspiró su creación:
ofrecer servicios asistenciales especializados
para una atención médica de alta calidad,
aunando investigación y docencia para este
cometido. Y es que el actual centro hospitalario mantenía aquellos rasgos que caracterizaron la inicial Casa de Salud Valdecilla,
determinados por una organización médica
compleja, de carácter progresista y técnicamente revolucionaria.
Trasladar este planteamiento de modelo
de pabellones a la realidad arquitectónica
y sanitaria de comienzos del siglo XXI, dominada por un nuevo concepto de hospital
abierto a la sociedad, obligaba a modificaciones internas en los distintos pabellones
y a un reciclaje de la arquitectura, con el
fin de adaptar las nuevas instalaciones a las
necesidades del momento.
Contemplando las premisas constructivas
para un hospital donde el respeto al medio
ambiente y la sostenibilidad se configura-
Antigua Casa de
Salud Valdecilla
197
198
Construcción de los
pabellones
ban como una de las bases fundamentales
de su diseño, se exigía la minimización del
impacto ambiental, el uso de tecnologías
apropiadas para reducir el consumo de
energía, y la construcción de edificios en
armonía con su entorno y de bajos costes
operacionales.
En el Plan Director se plasmaron las directrices de las intervenciones que habían de
llevarse a cabo en el recinto para conseguir
la completa reforma de las instalaciones
hospitalarias. Para alcanzar este objetivo la
Obra contaría con 3 fases, mas una inicial
de urgencia para rehabilitar el edificio destruido.
Los objetivos del Plan Director se centraron
en:
• reorganizar funcionalmente el conjunto
del hospital y sus edificios, manteniendo
el patrimonio histórico
• mejorar la coordinación y comunicación
entre los distintos departamentos
• facilitar el acceso y la circulación, separan-
do los tránsitos de pacientes, visitantes y
Servicios
• diseñar áreas más adecuadas a las nuevas
modalidades asistenciales
• aumentar el confort e intimidad de los pacientes, familiares y profesionales
• crear nuevos espacios para actividades
docentes
Esquema del Plan Director
• Fase 0 (ya realizada): rehabilitación del
edificio de Traumatología (el del siniestro
en 1999, que después se llamará 2 de
Noviembre); el incidente hizo notorio el
deterioro que venía sufriendo el hospital
con el paso de los años. Su uso sería de
hospitalización
• Fase 1 (ya realizada): demolición y reconstrucción de la zona de antiguos pabellones. Consta de aprox. 60.000 m2 con
las siguientes áreas:
-
radiología y radioterapia
cias, el abastecimiento de suministros, la
atención ambulatoria y el acceso del público a la hospitalización.
Se disponían conexiones entre los diferentes edificios, tanto en superficie como en
galería, que se estudiaron cuidadosamente para aportar seguridad y evitar interferencias entre tránsitos de distinto carácter,
viéndose favorecidas por la nueva ubicación
de los Servicios.
Fase I
-
Urgencias, UCI, bloque quirúrgico
y esterilización
servicios administrativos, de mantenimiento y de formación
• Fase 2 (ya realizada): área de Consultas
Externas; aprox. 20.000 m2
• Fase 3 (en ejecución): área de hospitalización
La Fase I, desarrollada de acuerdo y simultáneamente al Plan Director, comprendía la
totalidad de los servicios centrales del hospital. La idea principal de la propuesta consistía en la rehabilitación integral de todos
los pabellones sobre una gran superficie
de nueva planta que se crearía bajo y entre
ellos, capaz de albergar todos los Servicios
generales (Urgencias, UCIs, bloque quirúrgico, radiología, radioterapia y medicina
nuclear, etc.).
El Plan Director se completaba con la propuesta de las áreas de hospitalización y servicios hosteleros en la zona Norte, y la creación de un edificio de servicios ambulatorios
y hospitales de día al Sur. De este modo se
aprovechaba la posición centrada de los
Servicios generales, idónea para su accesibilidad desde el resto del hospital, lo que
conllevaría a una gran eficacia funcional.
Se situaban, por tanto, 2 zonas de aparcamiento al Sur y al Norte, además de otra en
la entrada de Urgencias, con las adecuadas
reservas de carga y descarga en los accesos
de pacientes y rehabilitación. Se utilizaban
las vías públicas construidas por el Plan General para segregar los tráficos de Urgen-
Esta fase se realizó entre enero de 2002 y
abril de 2007. Su ejecución es destacable
por la complejidad del proceso, consecuencia por un lado de la necesidad de intervenir
en el hospital en funcionamiento, y por otro
de la propia naturaleza de la obra.
Objetivos
Esta fase comprendía los siguientes objetivos:
• Cambio de imagen del hospital, para
paliar la confusión existente
• Mantenimiento de todos los pabellones centrales, en beneficio de la composición arquitectónica y de la historia
• Creación de una gran superficie para
albergar los Servicios generales: en
una sola planta, dando lugar a una cubierta ajardinada que recuperaría valores estéticos perdidos. Su funcionalidad,
Esquema del Plan
Director
199
200
PABELLÓN 13
PABELLÓN 12
PABELLÓN 19
PABELLÓN 17
PABELLÓN 15
PABELLÓN 20
PABELLÓN 16
+33.36 E.S.L. y canecillo
I
I
F
F
F
F
F
F
F
F
F
F
F
C 16
C 16
C 16
C 16
F
F
F
E 16
D16
D16
H16 G16
D16
H16
G16 H16
~2.70
3.80
2.95
0.05
F
F
F
3.75
.60
.87
2.20
.48
.96
.50
2.20
0.08
I
I
F
F
F
F
F
F
F
F
26.20
I
I
F
F
F
F
F
F
F
F
23.94
K 16
I
F
F
F
F
F
F
F
F
24.50
F
F
F
F
ALZADO B
F
22.19
19.60
ALZADO B
19.60 N3
19.60
19.40
19.60 N3
18.90
18.53
18.03
18.03
17.23
16.63
15.30
PABELLÓN 15
PABELLÓN 17
PABELLÓN 13
ATENCIÓN AL PÚBLICO
LIMPIEZA
ASEO
CANALÓN +31.98
28.94
0.05
HABITACIÓN
RESIDENCIA
HABITACIÓN
RESIDENCIA
0.05
0.05
0.05
28.94 N5
2.70
2.70
0.05
31.64
HABITACIÓN
RESIDENCIA
HABITACIÓN
RESIDENCIA
28.94
3.10
3.80
3.10
3.80
PABELLÓN 14
25.16 N4
25.16
DESPACHO
CANALÓN +31.98
HABITACIÓN
RESIDENCIA
HABITACIÓN
RESIDENCIA
28.94
0.05
0.08
25.16
31.64
0.05
31.64
29.35 N5
FONDO BIBLIOGRÁFICO
0.05
29.35
3.10
24.50
2.70
0.05
29.35
3.10
3.80
ASEO
SALA DE REUNIONES
ASEO
24.50
LIMPIEZA
ASEO
19.69
LIMPIEZA
ASEO
ASEO
24.50
LIMPIEZA
ASEO
19.69
LIMPIEZA
ASEO
ASEO
24.50
LIMPIEZA
ASEO
19.69
LIMPIEZA
ASEO
15.43
SALA DE YESOS
23.10
ASEO
.91
.50
15.40
2.70
15.30
SALA DE YESOS
2.70
3.66
3.07
2.00
11.29 N1
2.70
2.70
2.70
11.29 N1
15.43 N2
15.43 N2
.53
15.43 N2
0.08
.80
SALA DE YESOS
1.20
SALA DE YESOS
2.70
15.43
0.08
15.43 N2
SECCIÓN PORCHE DE URGENCIAS PEDIÁTRICAS
Ver plano Db.03
3.52
0.05
18.13
.60
.97
0.05
.60
.97
.60
.80
1.20
SALA DE YESOS
2.70
SALA DE YESOS
0.08
.90
15.43
19.69 N3
19.69 N3
ASEO
.74
19.40
0.08
2.00
3.10
3.75
3.75
3.10
0.08
19.60 N3
ASEO
24.50 N4
23.10
0.05
0.05
0.05
0.05
0.05
3.75
3.10
0.05
.97
18.13
.96
.48 .20 1.00
1.20
TRABAJO PROFESIONAL VASCULAR
.48
DECANSO MEDICOS
1.40
15.43 N2
2.70
0.08
.90
2.40
1.40
1.20
.20 1.00
.48
BOX
19.60 N3
ASEO
.50
.97
SALA DE REUNIONES
.50
.97
19.69
.96
.96
HALL
16.56
.48 .20
2.70
15.43 ASEO
0.08
15.33
.48
15.43 N2
13.99
P16-1
.97
ASEO
.50
.90
2.70
BOX
0.08
15.43 ASEO
19.69 N3
20.29
SECCIÓN DE PATIO TIPO 2
Ver plano Db.01
0.08
ASEO
0.05
0.08
4.00
0.05
0.05
3.10
19.69
0.05
0.05
.97
0.05
ALMACENAMIENTO EMBALAJE
.90
15.43
2.70
LAVADO DE CARROS
.48
LABORATORIO
1.20
15.43 N2
0.08
.50
18.13
.60
19.69 N3
ASEO
0.08
SECCIÓN DE PATIO TIPO 1
Ver plano Db.01
0.08
ASEO
.60
3.75
0.05
0.05
19.69
.97
ESPERA
1.20
SUCIO
EN PROYECCIÓN, DE ACCESO
.96
19.69
SECRETARÍA
0.08
VESTUARIO
0.08
VESTUARIO
3.10
3.75
0.05
0.05
3.10
SECRETARÍA DE SERVICIO
0.08
JEFE DE SERVICIO
.60
0.08
19.69 N3
3.10
0.05
0.05
ASEO
0.08
LIMPIEZA
0.08
3.80
3.10
0.08
0.08
0.08
3.10
3.80
0.08
24.50
ACCESO A LA
SALA DE LECTURA
2.50
0.05
2.70
0.08 2.50
HABITACIÓN
RESIDENCIA
HABITACIÓN
RESIDENCIA
0.05
0.05
28.94
0.05
2.70
0.08 2.50
HABITACIÓN
RESIDENCIA
HABITACIÓN
RESIDENCIA
0.05
0.05
0.05
28.94
PABELLÓN 18
SUCIO
PABELLÓN 12
PABELLÓN 16
0.05
0.05
0.08 2.50
2.70
ÁREA DE
IDENTIFICACIONES
JEFE DE SERVICIO
24.50
0.05
PABELLÓN 19
CANALÓN +31.98
28.94
24.50 N4
3.10
PABELLÓN 20
28.94 N5
0.05
15.40
18.03
17.53
3.80
15.30
SECCIÓN PORCHE DE URGENCIAS
Ver plano Db.02
SECCIÓN B
PABELLÓN 20
21.69
19.60 N3
SECCIÓN B
.50
0.05
2.70
0.05
2.70
2.70
0.05
2.70
11.29 N1
28.94
E 16
D16
G16 H16
F
15.43 N2
PABELLÓN 19
PABELLÓN 18
H16 G16
K 16
F
C 16
I
F
F
F
11.36
PABELLÓN 17
I
F
F
F
15.43
11.36
11.29 N1
PABELLÓN 16
F
F
F
2.65
2.70
15.43 N2
.48
15.43
13.99
0.08
I
F
F
F
19.69 N3
.69
0.05
2.70
15.43 N2
.96
ALMACEN MATERIAL
GENERAL SERVICIO
11.29 N1
2.70
2.70
I
F
F
.87
.60
.50
.48 .20 1.00
ALMACEN MATERIAL
MODULO
.96
ALMACEN APARATOS
SERVICIO
PABELLÓN 14
23.10
28.94 N5
F
19.69
18.13
.90
15.43 N2
2.70
0.08
.48 .20
TALLER
MANTENIMIENTO
ALMACEN
.96
ALMACEN
PABELLÓN 15
F
19.69 N3
18.13
.97
0.05
0.05
ALMACEN
ANGIOGRAFO
I
F
24.50
3.75
19.69
19.60 N3
SEMINARIO
0.08
PABELLÓN 13
F
.92
0.05
4.00
.97
2.40
16.56
C 16
I
CONTROL
.60
SEMINARIO
11.36
11.29 N1
0.08
PABELLÓN 12
0.05
0.05
0.08
0.05
3.75
0.08
19.69
0.05
3.66
11.36
11.29 N1
2.70
2.70
2.70
11.83 N1
2.70
2.00
.96
0.05
.96
.53
15.43
.48
15.43 N2
13.99
I
28.94
24.50 N4
0.05
2.95
.92
.69
.97
.97
.97
.60
.50
.90
2.00
15.43
.48 .20 1.00
15.43 N2
15.40
.48
15.30
.60
0.05
2.70
2.00
15.43
3.07
11.83 N1
19.69
.60
.97
.60
0.05
2.70
15.43 N2
19.69 N3
20.29
19.69 N3
18.13
VESTÍBULO RESIDENCIA
24.50
23.29
2.65
3.75
3.75
2.00
.69
3.52
15.43 N2
~2.70
0.08
3.10
3.80
0.05
0.05
0.05
3.80
0.05
19.69
19.60 N3
18.13
1 PIE L.M.
31.64
PABELLÓN 18
24.50
.50
.91
0.05
19.69
28.94
AULA (96 ALUMN.)
24.50
23.29
19.69 N3
AULA (96 ALUMN.)
1 PIE L.M.
CANALÓN +31.98
28.94
25.16 N4
25.1625.16
23.10
19.69 N3
TELEDOCUMENTACIÓN Y
PROCESAMIENTO DEL FONDO
PRÉSTAMO INFORMACIÓN
1 PIE L.M.
31.64
29.35 N5
29.3529.35
PABELLÓN 14
1 PIE L.M.
CANALÓN +31.98
~2.70
~2.70
~2.70
31.64
28.94
3.80
0.05
1 PIE L.M.
1 PIE L.M.
CANALÓN +31.98
24.50
2.70
31.64
28.94
24.50
3.80
1 PIE L.M.
1 PIE L.M.
CANALÓN +31.98
0.05
1 PIE L.M.
31.64
28.94
24.50 N4
23.10
3.95
1 PIE L.M.
CANALÓN +31.98
28.94 N5
11.83 N1
SECCIÓN A
SECCIÓN A
11.83 N1
11.29 N1
11.29 N1
10.68
10.68
PABELLÓN 16
PABELLÓN 19
PABELLÓN 20
PABELLÓN 17
PABELLÓN 15
M16
I
I
I
F
Yp
F
F
Yp
F
I
I
F
Yp
F
F
Yp
F
N16
N16
S 16
P2 16
P2 16
R 16
F16
F16
I
F
Yp
F
F
Yp
F
P116
M16
M16
M16
Q 16
Q 16
B 16
B 16
PABELLÓN 13
M16
P116
N16
N16
P216
P216
S 16
F 16
F 16
R 16
I
I
I
F
Yp
F
F
Yp
F
PABELLÓN 18
D
D
F
D
PABELLÓN 14
A16
Q 16
PABELLÓN 12
A16
26.20
I
I
F
Yp
F
F
Yp
F
19.69 N3
18.03
17.10 17.23
15.43 N2
3.15
2.60
11.19
11.29 N1
13.39
13.39
13.39
13.39
13.39
12.49
12.49
12.49
12.49
12.49
2.74
Plano de alzados y
secciones
Yp
F
F
Yp
S
14.80
18.03
17.10
15.25
F
ALZADO A
19.60
18.53
1.80
2.10 m2
1.20
16.35
15.25
13.39
12.49
2.25
S
0.70
S
2.10 m2
16.10
15.31
17.00
1.80
S
1.20
2.00
17.53
16.63
19.40
18.03
17.23
3.12
17.53
16.63
0.70
17.53
16.63
2.00
17.53
16.63
3.12
S
19.40
19.69
2.25
S
I
F
23.94
19.60 N3
19.69 N3
14.80 15.35
ALZADO A
15.35
14.90
14.80
11.29 N1
11.29 N1
realizada utilizando los sótanos de los
pabellones, resolvía satisfactoriamente la
relación de proximidad de los diferentes
Servicios generales, con una gran terraza tranquilizante en el interior de la zona
hospitalaria
referente a legislación técnica; si bien carecían de medidas suficientes frente a catástrofes: inexistencia de puertas cortafuegos,
puertas antipánico y escaleras de emergencia practicables y adecuadamente señalizadas en todos los edificios.
• Adaptación al terreno: la dificultad de
un terreno de gran pendiente se aprovechó para diversificar y jerarquizar los
accesos, escalonando la edificación y
consiguiendo suavizar su impacto en el
entorno urbano
En lo referente al mantenimiento de éstos,
se realizaba la renovación de una o dos
plantas de hospitalización por año, un quirófano y una sala de Cuidados Intensivos,
además de pequeñas reformas de adecuación y saneamiento. En las zonas reformadas y cuando eran modificaciones que lo
permitían por su extensión, se implementaban las medidas de seguridad de acuerdo
con la normativa del momento.
• Claridad de las circulaciones generales: se planteó un entramado de circulaciones en los diferentes niveles para
-
servicios internos: camas, carros
de comida, suministros y personal
-
servicios externos: visitas y pacientes ambulatorios
Estado inicial de los edificios
El complejo hospitalario estaba construido
conforme a los proyectos correspondientes,
que en su momento cumplían las normas
de obligado cumplimiento. Dado que la
normativa técnica de edificios, instalaciones
y seguridad se redacta con la precaución
de ser preceptiva a partir del momento de
la entrada en vigor de la misma y no tiene efectos retroactivos, se podía decir que
de forma general el hospital, sus edificios e
instalaciones, cumplían la normativa en lo
En cualquier caso, las labores de mantenimiento preventivo y reparador efectuadas
eran insuficientes para lograr que el hospital se adaptara, modernizara y adecuara sus
condiciones físicas a las exigencias actuales
para el confort de los usuarios y trabajadores.
Respecto a los pabellones, respondían a dos
criterios distintos: aquellos que habían sido
rehabilitados en algún momento y estaban
en una situación correcta de uso, necesitando un mantenimiento sin grandes inversiones, y aquellos que necesitaban de una
gran remodelación. En el resto del hospital,
la parte correspondiente a columnas, vigas,
arriostramientos y muros de estabilidad estaba en buenas condiciones.
En los años 1996 - 97 se había efectuado
un estudio de resistencia y estabilidad cuya
conclusión fue que los edificios cumplían
con los parámetros de diseño. El suelo respondía de manera adecuada a las solicitaciones, aunque se detectaron puntos donde había cedido, generando grietas en los
tabiques, si bien fue en zonas sometidas
a sobrecargas y estaban ya en su mayoría
corregidas y reparadas con el sistema de
parteluz.
Los paramentos verticales, tabiques, eran
preferentemente de construcción de ladrillo, aunque existían zonas amamparadas y
algunas divisiones realizadas con madera.
Estas últimas se eliminarían y sustituirían
por tabiques o mamparas con perfiles de
aluminio.
El cerramiento exterior con ventana de aluminio y cristal simple tenía dificultades de
estanquidad por deficiencias en la ventana,
por envejecimiento del soporte de madera
inferior y por desplome de las losas superiores, siendo insuficiente una labor de mantenimiento rutinaria de estos elementos.
201
Trabajos previos
Previo a la ejecución propiamente dicha de
las obras hubo que realizar una serie de
trabajos complementarios no incluidos en
el proyecto, pero necesarios para realojar
servicios existentes en la zona de obras,
adecuándolos en un nuevo emplazamiento
hasta su posterior reubicación en la zona
acabada. Estos fueron los siguientes:
• nuevos despachos para personal de mantenimiento y sindicatos
• creación de nuevas zonas de aparcamiento provisional, para compensar el número
de plazas perdidas en la zona de obras
• ejecución de edificio provisional de 120
m2 en hormigón armado para realojo provisional de la cámara hiperbárica y de la
maquinaria asociada
• reorganización de circulaciones de vehículos dentro del hospital, para que cada una
de ellas (ambulancias, pacientes externos,
vehículos particulares de médicos, etc.)
Ejecución de las obras
202
Antiguo despacho del
Marqués de Valdecilla
tuviera claramente definidas sus entradas
y salidas sin bloquear la zona de obras
Servicios afectados
• Líneas eléctricas de 12 kV que cruzaban la
parcela en varios puntos y que interferían
con las obras a ejecutar, sobre todo en la
fase inicial, pues hasta su retirada por desvío o sustitución no podían comenzar los
trabajos de excavación en su entorno
• Servicios de gas que alimentaban a las cocinas y a la central térmica
• Saneamiento, existiendo un colector municipal (ovoide de 1,6 x 0,8 m) que cruzaba la parcela de Norte a Sur y que recogía
aguas de toda la zona Norte de Valdecilla
• Tubería de agua potable de suministro al
Hospital General y a Quirófanos
Descripción de las obras
La conservación de los pabellones, incluidos
en el Catálogo Municipal de edificios protegidos, era una de las ideas básicas de la propuesta; de entrada se intentaron mantener
y renovar las estructuras originales (en principio estaba previsto demoler solamente 2
pabellones, reconstruyendo uno de ellos a
continuación).
No obstante, el profundo estudio geotécnico realizado, más el minucioso análisis
de las patologías existentes en los edificios,
revelaron la inviabilidad de esta opción: la
cimentación de los pabellones no era como
se suponía, las fachadas eran un completo
desorden de zonas macizadas, los forjados
no apoyaban debidamente en las fachadas,
etc.
Asimismo se hacía peligrosa la demolición
manual, y las fachadas eran inarriostrables.
Por lo que finalmente se decidió, para evitar
cualquier tipo de accidente laboral, derribar
completamente todos los pabellones y volver a reconstruirlos con una fachada análoga a la existente, que respetara íntegramente en sus formas y proporciones todos
los elementos constructivos y decorativos
exteriores, realizados originariamente con
materiales menos resistentes a la acción del
tiempo que los que ahora se utilizarían.
Para ello hubo que reflejar en planos y croquis los diferentes detalles de los pabellones, así como todas las piezas especiales:
molduras, barandillas, vierteaguas, columnas, canecillos de cubierta, etc. Se fabricaron moldes de los elementos compositivos
de ejecución artesanal, para lograr formas
idénticas a las primitivas. Asimismo, se mantuvo la ordenación de las carpinterías de los
huecos existentes, para lograr una exacta
reproducción de los pabellones originales.
Todas las piezas prefabricadas se fijaron
mediante dispositivos de anclaje comunes a
la fachada de fábrica, revistiendo ésta después con un mortero monocapa con dibujos formando sillares de piedra (igual que
los originales), y pintando los elementos
prefabricados. En algunos de éstos se conjugó su función estética con la estructural.
Esta solución se mostró como la más segura, y también la más aconsejable desde el
punto de vista económico y de plazos de
obra. La diferencia fundamental entre los
pabellones anteriores y los nuevos, nula a
primera vista, es la mayor durabilidad de los
segundos, no afectándoles la humedad ni
otros efectos climatológicos, a diferencia de
los primitivos.
Por todo ello se realizó un nuevo proyecto de estructura, consistente en 2 pórticos
de hormigón armado en las fachadas Este
y Oeste de cada pabellón, sobre los que
apoyarían losas pretensadas de hormigón
de grandes luces (12 m) para salvar la distancia entre fachadas, sin pilares intermedios. Posteriomente se realizaría la cubierta
de teja y el cierre exterior del pabellón con
termoarcilla y revestimiento final. Esta estructura, de rápida ejecución, permitiría un
mayor aprovechamiento de la superficie de
los pabellones.
Las zonas exteriores, así como los patios, se
resolvieron con muros semiestructurales de
hormigón con cara vista, ejecutada con encofrado de tabla.
203
La necesidad de realizar un proyecto de estructura trajo aparejada la ejecución de una
cimentación también nueva, que hubo que
ajustar a las difíciles condiciones del subsuelo existente, que venían siendo el origen de
ciertas patologías de los pabellones.
El proyecto inicial constaba de un estudio
geotécnico en el cual, con los sondeos y penetrómetros realizados, aparentemente no
había roca. Con ello se dibujó un perfil del
terreno y se analizaron las cotas de cimentación de los diferentes edificios. Del análisis
de dicho perfil se dedujo que podía caber la
aparición de roca en la zona de cimentación
correspondiente a Medicina Nuclear.
Ante esos datos contradictorios se decidió
realizar una campaña adicional compuesta
por penetrómetros y completada con unos
sondeos que demostraran la compacidad
de la roca, descartando la existencia de
cuevas típicas de un terreno kárstico como
el de Cantabria (concretamente, en la zona
donde está situado el hospital Valdecilla hay
constancia histórica de la existencia y explotación de minas de blenda por parte de los
romanos, por lo cual podía haber galerías
no conocidas y que habría que descartar
con los sondeos).
Con todo ello se vio que una parte importante de la obra se cimentaba sobre roca, y
muy dura, a juzgar por los resultados de los
ensayos a compresión simple de los testigos
extraídos. Y además extraordinariamente
compacta.
pabellones
204
Inicialmente, la cimentación prevista era a
base de pilotes in situ por extracción con
hélice, con un empotramiento de entre 0,6
y 1 m. Dada la extraordinaria dureza de la
roca, así como la posibilidad de existencia
de las llamadas muelas de roca caliza, características de los terrenos kársticos y reflejadas en los penetrómetros realizados, se
desaconsejaba la utilización de este tipo de
cimentación debido a dos razones:
• dificultad de encontrar maquinaria capaz
de garantizar en el terreno existente un
empotramiento como el exigido
• posibilidad de que, al encontrar una punta caliza, el pilote quedara empotrado en
una dirección pero no en la perpendicular, con la gran posibilidad de desvío que
esto provoca
Esta estructura, centro neurálgico del hospital, se percibe solo a través de su cubierta
ajardinada, que reproduce los jardines pabellonarios originales, tan atractivos; y se
dota de abundante luz natural a través de
patios, abiertos como perforaciones en este
jardín, capaces de iluminar la parte construida manteniendo la privacidad deseable
de vistas en estas áreas internas.
En los pabellones se alojan diversos usos
complementarios, centrados sobre todo
en el uso médico más interno (unidades
administrativas de los servicios, despachos
médicos, residencia de médicos, biblioteca
y aulas de docencia, etc.) consiguiéndose
un buen aprovechamiento de las antiguas
estructuras que para otras funciones eran
obsoletas.
Reducción del plazo
Por ello se decidió que el sistema idóneo era
la ejecución de toda la cimentación profunda mediante micropilotes de 180 mm, y la
cimentación en roca de tipo superficial mediante zapata aislada.
Estado inicial de los
edificios
Además de rehabilitar los pabellones antiguos, restaurándolos a su situación inicial
conceptual y de traza en el terreno, se creó
a la vez la gran plataforma ajardinada que
realzaba la estética histórica que perdura en
el tiempo del primer Valdecilla.
Una vez en marcha la fase I, el Gobierno de
Cantabria solicitó la reducción al máximo de
los plazos de la obra, con el fin de acortar
en 2 años el plazo de ejecución completa
del Plan Director; lo que suponía rebajar en
1 año el plazo de la fase I (inicialmente eran
4 años, y si bien terminó 5 años después, la
gran mayoría se ejecutó en los 3 primeros
años, con lo que se pudo adelantar el comienzo de la 2ª fase).
Esto requirió el consiguiente aumento de
equipos de trabajo en todos los oficios, llegando en determinados momentos punta
a 400 operarios trabajando a la vez en el
complejo, en muchas zonas pero muy cercanas, con las consiguientes dificultades de
gestión que ello acarreaba.
Salvando las actividades críticas del inicio,
predecesoras del resto, como fueron la retirada de los servicios afectados de líneas de
alta tensión y el derribo de 2 pabellones,
para cumplir con esa exigencia de plazo se
realizó lo siguiente:
Pie de foto
• se acabó el pabellón correspondiente a
instalaciones de calefacción, climatización, servicios y mantenimiento en abril
de 2003, pues sin él no podía ponerse en
marcha el resto de la nueva zona
205
pabellones
• se finalizó el área de Urgencias en abril
de 2003, descongestionando con ello las
dependencias de Urgencias del hospital
• se terminó la zona correspondiente a Medicina Nuclear, así como sus áreas asociadas (planta superior correspondiente a
una parte de los quirófanos) en mayo de
2004, de forma que los nuevos aparatos
de última generación (ciclotrón y P.E.T.)
pudieran instalarse en su ubicación definitiva
Se concluyó la casi totalidad de la fase I en
mayo de 2005, ganando así 1 año de plazo,
que representaba un 25 % del total previsto para la obra completa.
Fase II
Con la fase I prácticamente acabada comenzó la fase II, que acabaría en 2007. En
ella se construyó la zona de servicios ambulatorios, de nueva creación, bajo la hilera de
los pabellones tradicionales.
Comprendía un edificio (denominado Valdecilla Sur) en forma de bloque rectangular
para Consultas Externas y Hospitales de Día
Psiquiátrico, Quirúrgico (26 quirófanos) y
Médico, en régimen ambulatorio. Además,
una cafetería en el ático y el nuevo aparcamiento subterráneo (520 plazas), que se
extiende hasta el límite Sur de la finca.
Este nuevo edificio acoge el sector con mayor movilidad de pacientes y la mayor dotación tecnológica y técnica del hospital.
Entró en funcionamiento el 21 de enero de
2008, lo que permitió abrir al Sur la entrada
del hospital, a la par que permitía la interconexión entre todas las zonas del hospital.
La distribución de todas sus áreas está concebida de tal manera que, por un lado, se
facilita al máximo el acceso de los pacientes
y sus familiares y, por otro, los servicios y
asistencias interrelacionados se sitúan en
los entornos más próximos, con el fin de
conseguir una mayor eficacia y rapidez en
cada uno de los procesos y consultas que
se atiendan.
El edificio está distribuido en 3 plantas, con
amplias cristaleras.
El Hospital de Día Quirúrgico, en la 1ª planta, se encuentra conectado con el bloque
quirúrgico, UCI, Urgencias y Radiología de
los pabellones de la Fase I del Plan Direc-
206
Ejecución de las obras
tor, para facilitar el acceso ambulatorio y la
adaptación al medio de la Cirugía Mayor
Ambulatoria (CMA). Cuenta con un área de
pacientes y otra de observación.
En la 2ª planta está situado el Hospital de
Día Médico, que engloba la hospitalización
a domicilio y su área administrativa, y que
cuenta con un área de pacientes, un área
de tratamiento para quimioterapia corta,
sala de inhalaciones y sala de exploraciones,
además de diversas Consultas Externas.
El Hospital de Día Psiquiátrico, en la planta
Baja, se divide en 2 áreas de acceso único
pero separadas funcionalmente: una de
adultos y otra infanto-juvenil, dedicada a la
anorexia; ambas dotadas de salas de terapia
grupal y laborterapia, además de las Consultas de Psiquiatría.
La cafetería de público para pacientes, familiares y visitantes ocupa la planta ático
del edificio y cuenta con una amplia terraza desde donde se puede contemplar, al
Norte, los pabellones del centro; y al Sur,
la zona portuaria y la bahía de Santander.
La superficie construida de todas las áreas
de asistencia y administrativas es de 18.651
m2, mientras que el aparcamiento subterráneo ocupa 15.448 m2.
Esta fase incluye también unas obras complementarias, como la construcción de un
colector circular, la urbanización de los alrededores de la Escuela de Enfermería y la
capilla, la demolición de instalaciones ya
sustituidas, la retirada de depósitos y tierras
contaminadas, el saneamiento de uno de
los pabellones y del Servicio de Anatomía
Patológica y un nuevo centro de transformación para la implantación de la subestación eléctrica del hospital.
Fase III
Esta fase final del Plan Director tiene como
objetivo fundamental demoler el edificio
del Hospital General y su anexo de Consultas externas, así como la zona comercial
existente, sustituyéndolo por 3 edificios de
5 plantas y creando la entrada principal definitiva del hospital, que dará acceso a las
unidades de hospitalización, Bloque Obstétrico, Laboratorios (centralizados y robotizados), despachos clínicos, Anatomía Patológica, Servicio de Farmacia, subdirecciones
médicas, hostelería, etc.
Esos 3 nuevos edificios, a los que se accederá a través de una plaza pública, quedarán comunicados entre sí por medio de un
corredor central que los atraviesa en dos
niveles distintos, para facilitar la circulación
interna de pacientes y personal sanitario y
conectar con el edificio 2 de Noviembre.
Los 3 nuevos bloques albergarán 15 ud. de
hospitalización con un total de 332 habitaciones, que en uso doble serán 664 camas,
donde se prima la luz y la ventilación natural, como lo demuestra el hecho de que las
2 camas de cada habitación miren hacia la
ventana.
Para la entrada principal del nuevo Valdecilla está previsto un gran espacio acristalado
que contará con sistemas móviles para tamizar la luz y será decorado con obras de arte.
Asimismo, una calle-vestíbulo distribuirá en
el interior la circulación de personas a las
distintas zonas del hospital. En esta calle se
ubican el bloque de admisión, información,
cafetería, tiendas y locales comerciales.
Unas 120 de estas habitaciones estarán
destinadas a cuidados intermedios. En total,
8 de las 15 ud. se destinarán a la hospitalización general médico-quirúrgica, 2 serán
para Obstetricia, 2 para Oncohematología,
1 para Pediatría, otra para Neonatología y
otra para Psiquiatría. En el caso de esta última, se contará con un patio interior para
que los pacientes que tengan que estar una
temporada ingresados puedan pasear.
Bajo el suelo quedará una planta destinada a área técnica (mantenimiento y climatización), y un segundo nivel de corredores
subterráneos que enlazará los 3 bloques
nuevos con el edificio 2 de Noviembre, el
área de Urgencias y los pabellones. Por debajo de este nivel se situarán las 2 plantas
que permanecerán en reserva como zona
de expansión.
El control de enfermería está situado en
el centro, para acceder a toda el área con
facilidad. Cuando finalice la ejecución del
Plan Director, el nuevo Hospital Valdecilla
contará con alrededor de 1.000 camas de
hospitalización convencional.
En el exterior, los 3 bloques de hospitalización disponen de una fachada ventila-
Estado final de los
pabellones
207
208
Derribo del hospital
general
da con planchas de cobre envejecido, con
gran resistencia a la climatología adversa.
Se ha previsto además la incorporación de
paneles fotovoltaicos para la producción de
energía eléctrica, mediante la colocación de
células en el acristalamiento. De esta manera se permite el paso de la luz y la captación
de energía eléctrica.
Aparte de primar la atención al medio ambiente y la sostenibilidad, otro criterio tenido en cuenta es que sea un hospital flexible
y con posibilidad de crecer en el futuro.
manera controlada, reduciendo la emisión
de polvo y ruidos).
La 3ª fase se abordó durante el último trimestre de 2007, con la puesta en marcha
de nuevos quirófanos, el Hospital de Día y
el edificio de Consultas Externas (Valdecilla
Sur).
Para el derribo se utilizó una máquina con
una pinza demoledora, que no vibraba ni
producía ruidos. La apertura y cierre de sus
mandíbulas de acero permitía la demolición
de las edificaciones y la trituración de las
estructuras en una primera fase, para posibilitar la separación posterior del hormigón
y el acero.
El Hospital General quedó desalojado por
completo en febrero de 2008, trasladándose las Consultas y el resto de servicios asistenciales a los edificios Valdecilla Sur y 2 de
Noviembre.
Quirófano
Desde marzo de 2008 se llevaron a cabo
trabajos de clasificación del escombro y valoración del equipamiento existente para su
posible reutilización. Al mismo tiempo, se
procedió al corte de suministros energéticos
y al derribo del tabicado interior para facilitar la posterior demolición del edificio (de
Esta 3ª fase, que acaba en 2010, supone
el cierre de todo el proyecto y por ello resuelve aspectos de unificación y centralización, como el control eléctrico o el sistema
de alarmas. Finaliza igualmente la urbanización de todo el complejo hospitalario,
ampliando la dotación actual de plazas de
aparcamiento.
Algunas novedades del
hospital
“Hospital sin paredes”
El proyecto “Hospital sin paredes”, que supuso la informatización del servicio de hospitalización a domicilio del HUMV, comenzó a funcionar a finales de 2007. En sí, no
supone una mejora asistencial importante,
pero permite una actitud innovadora y una
mayor agilización en los procesos médicos,
tanto en aquellos que solicitan pruebas
como en los que esperan resultados, logrando una mayor eficiencia en el uso de
los recursos.
Así, los pacientes han visto cómo se acortaban los tiempos de recepción de los resultados de sus pruebas diagnósticas, cómo se
evitaban repeticiones y cómo se les recordaba las citas de sus consultas por SMS y/o co-
rreo electrónico. Respecto a estas consultas,
con un novedoso sistema de identificación
por radiofrecuencia, que permite orientar a
los pacientes hasta la sala.
El sistema de imagen digital ha permitido la
digitalización y archivo de imágenes médicas, así como su extensión a los servicios de
Radiología.
Hospedería hospitalaria
La hospedería es un nuevo recurso hospitalario que surge en 2007 para completar
aspectos de humanización relacionados con
la necesidad de alojamiento de los usuarios que, sin necesitar cuidados de ingreso
hospitalario y sin poder acudir diariamente
a sus domicilios, han de estar en contacto
con el hospital por su patología, de forma
temporal. El tiempo máximo de estancia
dependerá de la situación médica de cada
paciente.
Consta de 18 habitaciones, 8 dobles y 10
individuales, con una superficie total de 600
m2. Cada habitación dispone de mobiliario
completo y, como zonas comunes, cuenta
con 2 amplias salas de estar.
Es un sistema pionero en España para que el
paciente “sienta que accede a un hotel más
que a un recinto hospitalario”, ya que no
habrá asistencia médica alguna. La iniciativa
de Valdecilla responde al empeño por cubrir las necesidades de numerosos usuarios
desplazados desde sus respectivos lugares
de origen hasta Santander, y que acuden
por la condición de centro de referencia en
algunas especialidades.
Los requisitos para hospedarse estarán en
función de criterios de necesidad, también
por motivos de distancia, y con especial
atención a las madres lactantes con bebés
ingresados.
Radiología
209
210
I+D+i
El hospital incorpora la tecnología más
avanzada, como por ejemplo la resonancia
magnética de alto campo (Teslas); 4 angiógrafos digitales: uno biplano para Neuroradiología intervencionista, otro monoplano
para Vascular periférico y otros 2 para Hemodinámica y Electrofisiología cardíaca; un
completo sistema de monitorización para
las UCIs, que incorpora un procedimiento
de información que permite trabajar sin
soporte en papel; Quirófanos inteligentes;
y un equipo de Cromatografía líquida de
alto rendimiento (DHPLC), que permite el
análisis molecular de mutaciones genéticas,
muy importante para la detección de casos
de cáncer de mama, ovario, o poliposis en
colon que tengan un componente familiar.
Los quirófanos integrados cuentan con diversos monitores de gran calidad de imagen, una pantalla táctil que permite controlar todo el quirófano, conexión audiovisual
con otros operadores ubicados en diversas
zonas del hospital, videoconferencia y posibilidad de intercambio de información médica en tiempo real.
Medicina Nuclear
Se compone de los siguientes elementos:
• Ciclotrón: elemento que fabrica isótopos
radiactivos de corta vida (< 3 h) que, bien
mediante vía intravenosa, bien mediante
inhalaciones (gases), sirve para la detección precoz de cánceres
• P.E.T.: aparato de tomografía por emisión
de positrones; sirve para diagnosticar cánceres
• Laboratorio de síntesis: se manipulan
los isótopos extraídos del ciclotrón y se
preparan para su traslado dentro del hospital o a otros hospitales cercanos
• Búnkeres de radiología: elementos
donde se irradia al paciente con partículas de alta energía, para tratamientos de
cáncer
• Braquiterapia: tratamiento de cánceres
de tipo ginecológico, con la fuente radiológica insertada en la paciente
Los recintos donde se encuentran el ciclotrón, el laboratorio de síntesis y los búnkeres de radioterapia están formados por muros de hormigón de distintos espesores: 30
cm para el laboratorio de síntesis y la braquiterapia, y 150 - 180 cm para el ciclotrón
y los búnkeres de radiología.
Estos últimos tienen además unas zonas ejecutadas con hormigón de barita (hormigón
con densidad de 3,3 t/m3), necesario para
absorber las radiaciones de alta energía. En
las zonas donde el espesor no es suficiente (forjado) se ha dispuesto adicionalmente
un material de alta densidad, para suplir la
falta de espesor (chapas de acero de 18 cm
de espesor, puesto que el acero es unas 3
veces más denso que el hormigón).
La producción de radiofármacos no es la
misión básica de la Unidad de Medicina
Nuclear del hospital, porque es la parte
del proceso que no afecta a la asistencia,
la docencia o la investigación. La propia
tecnología de producción y distribución de
radiofármacos obliga a realizar esta actividad en horario nocturno, debido a que los
radiofármacos que produce el ciclotrón son
de vida corta y han de ser empleados de
inmediato, con lo que han de estar disponibles en el servicio de Medicina Nuclear a
diario y a primera hora. Así, la instalación
está disponible para la actividad investigadora el resto del día.
Imagen a toda
página o anuncio
Pie de foto
211
TÉCNICAS CONSTRUCTIVAS
213
Reina Sofía University Hospital, Córdoba
Rafael Méndez Hospital in Lorca, Murcia
Reina Sofía Hospital, Murcia
San Carlos Clinical Hospital, Madrid
Southeast Hospital in Arganda, Madrid
New Mataró Hospital, Barcelona
Guttmann Clinic in Badalona, Barcelona
Ciudad Real General Hospital
San Agustín Hospital, Phase 2, Avilés, Asturias
Son Llàtzer General Hospital,
Palma de Mallorca
Palmaplanas Clinic, Palma de Mallorca
Nuestra Señora de la Candelaria Hospital,
Tenerife
Canary Island University Hospital, Tenerife
Marqués de Valdecilla Hospital, Santander
HOSPITALS
1995 - 2009
214
INDEX
218
Reina Sofía University Hospital, Córdoba
221
Rafael Méndez Hospital in Lorca, Murcia
224
Reina Sofía Hospital, Murcia
227
San Carlos Clinical Hospital, Madrid
232
Southeast Hospital in Arganda, Madrid
237
New Mataró Hospital, Barcelona
238
Guttmann Institute in Badalona, Barcelona
241
Ciudad Real General Hospital
246
San Agustín Hospital, Phase 2, Avilés, Asturias
251
Son Llàtzer General Hospital, Palma de Mallorca
254
Palmaplanas Clinic, Palma de Mallorca
259
Nuestra Señora de la Candelaria Hospital, Tenerife
265
Canary Island University Hospital, Tenerife
270
Marqués de Valdecilla Hospital, Santander
215
INTRODUCTION
In this issue of Técnicas Constructivas, FCC
has included some of the numerous hospital
construction, alteration and enlargement projects
our firm completed in the 1995-2009 period.
While major hospitals are building projects, they
also have an industrial facet that makes them
especially complex to deal with; they require the
teams who design the project and the builders
who implement it to be highly specialized.
That is why we decided to publish this
monographic issue, whose slant is more
informative than technical. It looks at a selection of
our projects in various Spanish cities, endeavouring
to instil in the reader an idea of the momentum
going into investment on the part of Spain’s
autonomous communities. These regional
government institutions are heir to the former
National Health Institute (INSALUD) and have been
our necessary partners in social progress and in
the technological development of our construction
firms.
FCC has maintained a significant market share in
hospital infrastructure over these last few years.
Its specialization has enabled FCC to run in the
vanguard of this sector and garner recognition
in the form of contracts for major projects such
as the recently opened Southeast Hospital (in
Arganda, Madrid), Torrejón de Ardoz Hospital
(in Torrejón de Ardoz, Madrid) and Enniskillen
Hospital (in Enniskillen, Northern Ireland).
These three public hospitals will be financed and
managed under a concession arrangement by
FCC. Yet another show of trust from our clients,
which enables us to stay up to date, and a new
way of managing major complements of health
equipment.
217
218
Alterations to and
expansion of Reina
Sofía Hospital,
Córdoba
Background
Córdoba’s Reina Sofía University Hospital,
which had 1,511 beds in 1995, is situated
in the city of Córdoba, capital of the
province of the same name, and it serves
the population in the Central Córdoba
Hospital Area (481,942 inhabitants)
plus the populations of the South and
North areas of the province (274,992
inhabitants). Because it is highly qualified
to perform certain diagnostic and
treatment procedures (such as organ
transplants), it attracts patients from
outside the bounds set for it on the official
hospital map, drawing in people from
other areas of Andalusia.
This hospital, which is conceived as
a third-level healthcare centre (i.e., a
general hospital), can also be classified as
a university hospital, because it provides
training for the students of the University
of Córdoba Schools of Medicine and Nursing. In recent years it has also conducted
some important research work promoted
by the Reina Sofía Hospital Caja Sur Foundation.
The General Hospital caught on fire in
June 1996 and was forced to close for two
months. Consequently, priority was given
to altering certain areas of the General
Hospital, under what was termed “Phase
0” of the Steering Plan.
The project at hand is Phase 1, which
includes the following parts:
New general emergency area, larger than
the current general emergency area and
with practically twice the resources.
Construction of a building linking the
General Hospital and the Maternity
and Children’s Hospital. In the resulting
complex, hospitalization services and the
diagnosis and treatment services for the
different medical and surgical specializations (which are currently twinned, since
each building has its own facilities) are
consolidated under a single roof.
Construction of a new building for the
Outpatient Clinic, teaching and training
areas (seminar rooms, auditorium, library),
offices and rooms for clinical meetings
and a public cafeteria.
and a new one was created.
A sizeable area of special examination
rooms: For heart, lung, digestive, urological and neurological examinations, plus
examinations for outpatient treatment.
Special features of the
project
Alterations to and expansion of the Radiodiagnosis Department.
Accordingly, an overall approach had to
be taken, one that enabled an answer to
be found not only to the facility’s current
shortcomings, but also to possible future
demands, while impinging on the hospital’s normal ongoing activity as little as
possible and furnishing a short-term
response to its current problems.
General description of work done
The work consisted in the construction of
the new annex to the General Hospital
and the Maternity and Children’s Hospital
and alterations in parts of both hospitals.
The ground plan shows three zones differentiated by height and by placement with
respect to the existing construction. One
zone, which is the building for the new
Emergency Department, is adjacent to
the Maternity and Children’s Hospital;
another, for the new Radiology Department, Admissions Office, Functional
Examinations Unit and the ICU (Intensive
Care Unit), stands between the General
Hospital and the Maternity and Children’s
Hospital; and lastly, there is a new sixstorey building holding the new Outpatient Clinic and an underground tunnel.
The central zone (inner street) and the
existing building have only one storey (the
ground floor) and are roofed with a metal
skylight.
The work to be done in the General
Hospital building consisted primarily in
the creation of a new lobby, the relocation of the telephone switchboard, a new
haemodialysis area and a new staff cafeteria on floor 0. On floor +1 the new cardiology and neurology areas were built, in
areas formerly occupied by the auditorium
and the chapel. A new Haematology Unit
was also built.
The work on installed systems included
a new service tunnel built to connect the
old power plant, the new cisterns and
the medicinal gas supply room with the
Outpatient Clinic building.
The design calls for five cores of lifts and
one core of escalators, plus two auxiliary
stations for treating legionellosis. The old
transformer substation was remodelled,
In the background of the approach to
this project lay Phase 0, the “emergency”
phase, which set the pattern for the
implementation of the design of Phase 1,
with the condition of not compromising
the future of subsequent phases.
What made executing this project difficult
were the fact that the General Hospital
and the Maternity and Children’s Hospital
overlapped and the fact that a new service
tunnel had to be created to connect all the
installed systems. Connections between
buildings as well as connections between
technical premises and the power plant
had to be included. The work plan forged
to deal with this difficulty can be summarized as:
• Demolition and clean-up
• Repetition of technical studies of systems
and civil works in the light of unforeseen
contingencies
• Repetition of structural calculations
• Execution of civil works, masonry work
and new installed systems
• Connection and new hook-ups with
existing utilities
Since the building was in use, the basic
idea was to keep all services running so
that the hospital could continue normal
operations. Accordingly, the personnel
assigned to the site were gradually sensitized to the circumstances, and close
cooperation was instituted with the hospital’s technical area, especially the hospital maintenance service. Thus, the many
different processes were completed satisfactorily and without hitches.
Foremost among the procedures to be
done were the following:
Commissioning of the general
hospital’s new transformer
substation.
The new transformer substation was
mounted and installed. The new main
coupling and distribution panel was
installed in the same place as the old
one, since the power output lines were
the same. The new substation was then
commissioned, and a reliable power
supply was ensured by the existing generator sets.
No interruptions could be brooked in this
job, and any incidents had to be handled
at once. Last of all, the old transformer
substation and panel were dismantled.
New gas and vacuum room.
A single area was built to house the emergency gas manifolds for both hospitals
and the Outpatient Clinic expansion. The
changeover and manifold alternating
panels were installed, as were the remotemonitoring alarm panels. In an adjacent
area, the new vacuum station was built,
where the new pumps and five tanks were
installed.
In both cases, systems were installed
jointly to run through the new service
tunnel to the new collector substations.
Connections were run between the new
facilities and the existing facility, to facilitate manoeuvring.
Once the new cryogenic tanks had been
put in place and tested by third parties,
the shut-downs and manoeuvres required
to make the switch were scheduled with
the hospital. During this period there were
two coexisting sets of cryogenic tanks
(primary source), the tanks scheduled to
be dismantled and the new ones.
The same procedure was used with the
vacuum facilities. Service was ensured
with the existing equipment, and once the
new system was firmly in place, the four
old pumps were dismantled and coupled
to the new system, which therefore works
with ten pumps of the same specifications, with a new alternating and rotating
panel.
HVAC facilities. Connection.
The power plant was remodelled by the
Andalusian Health Service in 1998. The
water supply used to be run through the
old tunnel, where the fire had its origin, at
6 ºC for chilled water and 130 ºC for the
overheated water used in the sanitary hot
water system and the HVAC system.
First, two pump substations
completed, to provide:
were
• cold-water pumping for air treatment
units (ATUs) (7 ºC)
• cold-water pumping for the fan-coil (10
ºC)
• heat exchanging to produce HVAC hot
water from overheated water
• heat exchanging to product hot sanitary
water from overheated water
• hot-water pumping for HVAC
• sanitary hot-water accumulation and a
pasteurization circuit to combat legionellosis
All the systems for distribution to the
HVAC consumption points were equipped
with four variable-flow pipes, and all the
pumping facilities were fitted with trimmers, to adapt to demand.
Five differential pressure sensors were
installed at different points of the
water’s path to provide information on
the management program and send the
correct orders to the pumping systems.
Next, new overheated-water and chilledwater systems were installed in the newly
built tunnel (390 metres), closing the
system into a ring.
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New radiodiagnosis
department
The new Radiodiagnosis Department was
placed on floor -1, in the area between
the two hospitals, with access to both
hospitals, the Outpatient Clinic and the
new lobby and an outdoor entrance for
gurneys. The department has the following rooms:
• Five conventional X-ray rooms
• One chest imaging room
• One CAT (computerized axial tomography) room
• Three multiple diagnosis rooms
• Three vascular and haemodynamics
rooms
• One remote control room
• Six ultrasound rooms
To close the ring, connections were made
with the existing system in the old tunnel.
Shutdowns were scheduled to avoid
affecting service, and the work was done
by night. Afterwards, the new facilities
were hooked up to the collectors and/or
pipes of the power plant, and the circuits
were equipped with flow meters, shut-off
and control valves and equalizing valves.
Lastly, a 5,000-litre expansion tank using
mechanical compression was installed at
the power plant, to address the plant’s
previous lack of any such resources.
Low-voltage facilities.
The design covered not only the construction of new areas, but also the incorporation of new systems for those medical
departments that were newly set up in
already-existing areas, after each department was relocated and its old premises
were dismantled. Haemodialysis was
moved into part of the old Emergency
Unit, and the new Haematology Hospitalization Unit was moved into the old
Haemodialysis Unit’s place.
All the power supply lines in these areas
were hooked up to their assigned panels,
but the panels had already undergone
alterations (in Phase 0) and therefore were
already on hand. This meant power shutdowns had to be scheduled with Maintenance, to enable the appropriate circuit
breakers to be installed in the panels.
• One orthopantomograph
In coordination with the Physics Department partnered with the hospital, the
radiological protection and overlapping at
critical points were mapped out, and the
proper tests and room fitness certification
trials were conducted to make sure there
was no leakage.
Each room required a different type of
protection, depending on the unique
features of the equipment housed within.
Lead thickness and location varied. In the
areas where the structure was new, it
was unnecessary to line the ceiling with
lead, as the structure itself was afforded
enough protection. On the other hand,
in those areas where the ceiling belonged
to the pre-existing building, the affected
areas had to be lead lined.
The wall areas that were lined with lead
were built with lead partitions bolted with
lead-coated pins and packed between
metal frames and profiles and Pladur
panels. The lead-lined floor areas had two
millimetres of lead laid on the floor structure, sandwiched between two sheet of
geotextile. The ceiling was leaded using a
framework that featured a metal structure
suspended from the building structure
and wooden panels coated with two millimetres of lead.
The greatest difficulty was posed by the
uncertainty about which particular pieces
of equipment the Andalusian Health
Service was going to install; the wiring
and HVAC facilities would depend on
220
that knowledge. Forecasts and reservations were made, and so work was able
to continue.
Each item of equipment required its own
study of power and heat-dissipation
needs, in coordination with the suppliers and on the basis of each machine’s
specific requirements.
The vascular radiology rooms were quite
special. They demanded technical requirements close to operating-theatre standards, since vascular radiology actually
involves minor surgery.
The three rooms were outfitted with:
• Five-kVA insulation panelling
• An uninterrupted power supply
• A full complement of gases (oxygen,
compressed air, including nitrous oxide)
and vacuum equipment, four sets with
their four outlets
• Equipotential connection of all accessible metal components
• HVAC, all outdoor air (Air is not recirculated) with filtration in the patient preparation room and the vascular radiology
room itself, with the typical air extraction features of an operating theatre,
both overhead and lower
• A specific HVAC system for heat dissipation in the adjoining room, which holds
the equipment’s generator
• A scrub sink with a thermostatic mixing
valve and a long-lever tap
Haematology
hospitalization department
This department is very delicate, as its
patients are classified as immunosuppressed and thus have very low natural
defences. Haematology hospitalization
areas must be clean. Both the hospital
rooms and the nurses’ area must have
high-quality air filtration, because the
fundamental risks of infection are due
to air that has been through the HVAC
system and health personnel’s handcleaning regime.
This second point is addressed by installing wash basins outside the rooms and
taking great care with hygiene habits.
ment units provide a minimum filtration of
grade F9 (UNE_EN 779/2003), and all air is
drawn in from outdoors. The ductwork is
a medium-pressure installation.
In rooms:
• An airlock outside each room, with
plywood and glass doors, as airtight as
possible, through which patients can be
observed from the hallway
• Minimum number of air changes: 25 to
30 per hour
• The room itself is overpressurized, with
air extractors in the room, allowing only
the controlled leakage of air through
the regulating damper in the toilet room
and minimizing uncontrolled air leakage
• Leakage controlled by sealing mechanism boxes, electrical outlets, etc.–in
short, by making the premises airtight,
with a fixed ceiling and no non-airtight
light fixtures
• Ceiling air diffusion through a filter
casing and a rotating diffuser, and
extraction points set at only 30 or 40
centimetres from the floor whenever
possible
• H-13
absolute
HEPA
(high-efficiency particulate air) filters (UNE_EN
1822(1)/1999), with certificates of the
manufacturer’s in-situ air tightness tests
• Battery-powered terminal overheating
units
• Differential pressure gauges to compare
pressure levels between the room and
the hallway and to visualize the relative
overpressure of any room, and a dirty
filter alert
• Generator set to power the plenum fans
and exhaust fans of the ATU, to maintain constant overpressure
At nurses’ stations:
Technical control room
At the outset of the project, the various
systems (such as technical management,
fire alarms, gas alarms and lifts) were
being run in a scattered, localized fashion.
There was seen to be a need to create a
central control zone governing all the
system-managing units.
First of all, the buses and local networks
were readied to connect the different
equipment belonging to the different
locally managed systems. Special mention
ought to be made of the centralized technical management system: In Phase 0 the
local controllers for the remodelled areas
were installed.
Eventually the following systems (which
could not be integrated due to the fact
that the building was altered, had just
been altered again and would be altered
further while in use) were brought
together in the control room:
• Local area network in the control room
itself
• An uninterrupted power system
• The centralized technical management
system:
• 100% execution of the new areas up to
the field elements
• Integration of the processors existing in
Phase 0
• Central control station
• Two additional stations joined by fibre
optics: the power plant and the technical area of the hospital
• Central fire management station, with
incident-monitoring capabilities
• One-way soft information communication with the fire safety system and
the centralized technical management
system
• Expansion box for low-speed work
• Lift and escalator maintenance and
monitoring computer
• Battery-powered terminal overheating
unit
• Gas and vacuum alarm panels
• Since all air comes from the same
system, all air is outdoor air
• Proper study of staff clean/dirty circuits
HVAC system
• Exhaust by dirty zones, for a good sweep
A single HVAC system was set up for the
entire hospitalization area. It covers rooms
as well as nurses’ stations. The air treat-
• Avoidance of uncontrolled air circulation
from other areas of the hospital through
false ceilings
Auditorium
The hospital’s facet as a university training
ground, its scientific standing, its application of pioneering techniques and its
organ transplant program are just some
of the factors that make the auditorium
very important. The hospital auditorium
had to perform in two capacities: first,
as a classic auditorium, to host medical
conferences and sundry acts; and second,
as the venue for disseminating the many
types of work being done at the hospital,
but in real time.
For these reasons, the auditorium was
fitted with fixed audio, video, videoconferencing, simultaneous translation and
lighting facilities regulated by multimedia
systems with touch screens. A 4x4-metre
retractable projection screen was also
installed.
Audio and video systems were designed
for local use in the hospital’s operating
theatres, in the endoscopy rooms of the
Digestive System Department and in the
bronchoscopes in the Neurology Department. They are connected by fibre optics
with the auditorium systems so that the
work and operations performed in these
areas can be projected and the healthcare
staff performing them can communicate
with the people in the auditorium.
Alterations to and
expansion of Rafael
Méndez Hospital in
Lorca, Murcia
Background
On 19 January 2001, work began on
the alterations to and expansion of
Rafael Méndez Hospital in Lorca, Murcia.
Although the hospital was only opened
in the early 90’s, due to the widespread
growth of the area and particularly the
booming growth of the city of Lorca itself,
expanding the hospital became necessary,
as did a series of technological and facility
alterations to place Rafael Méndez Hospital in a competitive position to respond to
the needs of its target population.
Here is what needed to be done:
• Construction of a 12-station medical
and surgical outpatient hospital service
• Construction of an outpatient clinic
building containing 31 examination
rooms with appropriate support and
waiting areas, plus an area of doctors’
offices
• A new clinical history file big enough to
accommodate 150,000 individual files
• Expansion of the Haemodialysis Unit to
22 stations
• Expansion of the Pathological Anatomy
Unit
• Expansion of the hospitalization area
with a new 33-bed unit
• Construction of a 14-room dormitory for
healthcare staff
• Expansion of the psychiatric hospitalization facilities, equipping them with
support areas (dining hall, lounge, therapy room, etc.)
• Expansion of the administration and
management area
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• To differentiate clearly between outpatient traffic and entrances and hospitalization traffic and entrances
• To take advantage of the land’s slope
• To enable the enlargement of hospital’s
undersized car park; the new space was
to be organized clearly and with an eye
to function
• To complete the work in strictly differentiated phases designed to enable the
hospital to continue its usual activity
without disruption
• Construction of a library and a classroom
The anticipated work was to increase
the floor area by 16,618 square metres,
broken down into 5,162 square metres of
alterations and 11,456 square metres of
enlargement.
• Construction of a storehouse for waste
and chemical products
Here is a description of some of the main
jobs.
• Retrofitting of the building to comply
with basic building standard “Fire
Protection Conditions in NBE-CPI-96
Buildings” (as regards compartmentalization)
Outpatient Clinic
• Expansion of the Emergency Department
• Introduction of centralized management
for the existing building systems
• Replacement of existing lines, general
electrical service panels and HVAC
panels that were not up to code
• Installation of two generator sets capable of supplying the entire hospital with
power
• Replacement of the existing cooling
towers by three air-to-air cooling units,
thus averting problems of legionellosis
The hospital was initially laid out in two
parallel shafts that acted as traffic corridors from which all services flowed. The
layout could be described as a double
comb or a ladder.
In the solution, the old layout was maintained, and the different departments
were either slotted in between the two
shafts or “thrown out” from one of the
shafts. So, the Outpatient Clinic block was
attached to the end of the two existing
traffic corridors. With this proposal, the
following objectives were achieved:
• To integrate the expansion smoothly
into the existing building, in terms of
both form and function, while maintaining the internal traffic paths.
The Outpatient Clinic is housed in a block
separate from the hospital but most
conveniently connected with it through
the two existing traffic corridors. It has
its own direct entrances from the car
park and thus does not interfere with the
hospital’s internal traffic. This building
has direct access to the major same-day
surgery area. The 18 existing examination
rooms have now been expanded to 31.
On the access floor (the semi-basement)
are the control area and the administrative and appointment areas. There is a
dumbwaiter for bringing up files from the
clinical history file, which is also located in
the semi-basement. On the ground floor
and the first floor are the examination
rooms, and on the second floor are the
doctors’ offices. The basement houses a
huge, new-built clinical history file, with
the capacity for 150,000 files, and the file
support area.
Outpatient Hospital Service
An outpatient medical and surgical hospital service with 12 independent stations
was built on the second floor, in vertical
alignment with the Dialysis Department.
It has two clearly differentiated entrances,
one for outpatients coming from the
Outpatient Clinic block, and the other
for patients wheeled in on beds from
the hospital proper. It also has a direct
connection with the ICU and the surgical
block. It has a broad central area enabling
all stations and the movement of the
healthcare staff and medical equipment to
be kept under constant visual surveillance.
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Pathological Anatomy Unit
Special Examination Area
The original unit was entirely too small
and was therefore enlarged. The original
space was left as a necropsy area, and
the rest of the unit was designed to go
on the second floor, next to the surgical
block, the ICU and the outpatient hospital service. The two parts of the unit are
connected vertically by a dumbwaiter.
This area was fitted in between the Outpatient Clinic pavilion and the hospitalization
area. It therefore has two entrances, one
for ambulatory patients and another for
patients in beds.
New Hospitalization Unit
This is placed where the initial hospitalization units were, in the southern wing of
the building. Their distribution is the same
as the original distribution, to facilitate the
activities of the healthcare staff. It has 33
beds in 13 double rooms and seven single
rooms.
Staff Dormitory
The healthcare staff bedrooms are centralized on the second floor, next to the surgical and obstetrics block and in vertical
alignment with the Emergency Department, so they are well connected with the
hospital’s two traffic corridors.
Haemodialysis Unit
Since the original number of stations
became too small and the original support
areas were minimal, logically the unit
could not be enlarged without disrupting its activity. It was therefore decided to
build an entirely new unit.
The new unit is situated on the first floor,
with possibilities of direct access from the
Outpatient Clinic building for ambulatory
patients and another entrance for healthcare personnel and hospitalized patients.
Furthermore, it lies next to the Laboratory
and Radiology Departments, which it uses
frequently.
Emergency Area
This was enlarged by a total of 1,100
square metres. It was equipped with a
basement changing room and a resuscitation room next to the unit’s entrance.
The observation room was doubled in size
without losing its outdoor light.
Psychiatric Unit
An entire support area was created for this
unit, which had no support area before.
An existing porch next to the Psychiatric
Unit, occupying the roof of the ground
floor, was converted to house the support
area, and the rest of the roof was put to
good use as an outdoor patient relaxation
area.
Surgery Block
The surgery block is situated between the
Intensive Care Unit and sterilization. The
five existing operating theatres were kept,
and a new one was added.
Support Storehouse
A support storehouse (for waste containment) was built, connected to the hospital
by the utility and service corridor in the
semi-basement. Advantage was taken
of the original slope of the land to build
a small ramp in the corridor to provide
passage through a tunnel beneath the
existing road.
Structural stiffening
In November 2001, the firm in charge
of project quality control issued a report
(requested by the INSALUD health institute) on the current state of the hospital’s
structure. The report stated that, with the
addition of an extra storey and on the basis
of the seismic study performed after work
began, the existing structure was inadmissible. It displayed excessive deformations
incompatible with the existing building
envelope and partitions and incompatible
with the arrangement and dimensions of
the structural expansion joints the building had at that time.
In order to reinstate building safety conditions in compliance with the standards in
force, all columns and footings required
systematic, significant reinforcement (not
required for floor structures) to reduce the
deformability of the whole and to increase
its capacity to resist deformation.
To minimize the impact of the necessary
work on the use of the hospital’s different modules, the structure reinforcement
option chosen was to install four stiffening cores that would absorb all horizontal
loads, significantly reducing the building’s
deformability and thus enabling the existing columns and footings to be retrofitted
to handle the stress.
In accordance with this plan, four external stiffening cores were built on the new
second storey (referred to as “the traumatology floor”) to brace all the floor structures underneath the traumatology floor.
In this fashion, the potential seismic loads
to which the structure may be subjected
were successfully counteracted, and the
footings in that area did not have to be
reinforced, which would have forced the
hospital to call a halt to activities and
evacuate.
For the same reasons, a similar structural
reinforcement was installed for the staff
housing area, in the area adjoining the
street leading to the support storehouse,
with the difference that this reinforcement’s foundations were laid in the hospital auditorium.
These reinforcements were constructed by
uncovering the existing footing and reinforcing it with another footing a minimum
of 6.5 metres long by 6.5 metres wide
and 1.5 metres thick, covering the original
footing. The two footings were joined by
drilling into the old concrete and anchoring it to the new concrete’s reinforcing
members with corrugated bars.
Next, a vertical box of reinforced concrete
was made, with 30-centimetre-thick
walls, up to the height of the original firstfloor structure. Except in the case of the
courtyard, they were packed with earth
up to the height of the first-floor structure, where a slab was installed to weld
the two vertical faces together. This joining procedure was applied to all the floor
structures affected by the addition of the
new storey. The last joining structure was
the structure of the former roof, which is
now the floor of the new, added storey.
In the courtyard, the opposing floor structures were braced by slabs, with a central
structure in the form of a footbridge. In
this case, the underlying ground was excavated until firm terrain was hit, and the
hole was subsequently filled in with cyclopean concrete.
Installed systems
Wiring
The foremost expansions were:
the
expansion of the transformer substation,
the replacement of the existing generator
set by two higher-capacity sets and the
new wiring for the enlargement for the
emergency area and part of the radiology
area.
As alterations, because of the expansions mentioned above, it was necessary
to modify the main low-voltage panel,
enlarge or replace power supply lines for
new cooling units and a 1,000-kVA transformer and the circuit-breaker panel for
the machines in the cooling station.
cially for them.
The added generator set is comprised of
two identical machines, coupled to run in
parallel, which together put out 2 × 775 =
1,550 kVA at a constant rate and 2 × 850
= 1,700 kVA at their emergency rate. The
set has automatic starting, switching and
shutdown capabilities, triggered by the
failure or resumption of the normal mains
power supply.
Complementary installed systems
HVAC
The increase in the area to be treated logically demanded a higher consumption of
heat and cold output. While the increase
in heating output could be handled by the
existing boilers, the same could not be
said of the necessary increase in the cooling output, so the system’s power had to
be increased.
Furthermore, because of the widespread awareness of the failings of cooling systems that use cooling towers due
to the health problems they may cause
(mainly the proliferation and spreading of the bacteria legionella), it was
decided to replace the cooling equipment
(which used cooling towers) with new air
condensation equipment, thus completely
eliminating the use of cooling towers.
So, the cooling units that had been in
service since the hospital was first opened,
which were at the end of their useful life
anyway and used a non-ecological refrigerant that would soon be taken off the
market, were eliminated.
The new air-cooling station is made up of
three air-condensed water chillers having
1,040 kW of chilling power apiece. They
are situated outdoors, at the eastern end
of the hospital complex.
Lastly, it was regarded as vital to tackle
the technical changes necessary in the
production of hot sanitary water, so that
the regulation heat treatments could
be applied to avoid the proliferation
and spreading of legionella through the
plumbing.
These changes consisted basically in the
removal of pipes, valves, heat exchangers
and electric circulation pump sets belonging to the hot sanitary water production
system in the heating station, and their
replacement by others made of materials
that met the necessary water pasteurization conditions.
The ATUs and building extractors were
situated on the roof, in sheds built espe-
A centralized technical management
system was applied to the new HVAC,
central cooling and hot sanitary water
production systems.
Their different components were structured into three levels:
Level 1:
This level is made up of the
systems’ field components (sensors and
actuators), which gather the measurements and digital inputs to be sent to
the second level; at the second level, the
systems take direct action according to
orders received from the top level.
Level 2:
This level is made up of “freely
programmable”
distributed-control
processors, which are assigned the functions of regulation, command and control
involved in building control. They can
work independently from the rest of the
controllers joined to the same communications bus and independently from
the central station, while at the same
time they receive information from and
send information to the system’s control
centre through the bus. These controllers
manage the hospital’s HVAC and wiring
systems.
Level 3:
This is made up of the building’s control centre. It has the mission
of coordinating and supervising the
facilities of its host building by acting on
the components of the lower levels. It
possesses a user interface that facilitates
controlling installed systems independently from the other levels. All system
users can connect to it, with different
access codes and categories.
This system supervises the status of all
installed systems. Synoptic diagrams
of each installation are displayed, with
changes in the colour of the symbols
representing each unit according to its
status. Any alarms that go off are received
here.
Equipment starting and stopping can be
automated. The evolution of an installed
system’s signals can be recorded graphically and numerically. Alarms events in
the different installed systems and user
command events can also be recorded
chronologically. Access to the system can
be controlled by means of a system of
code words configured by the administrator. The administrator can define each
user’s level of access to each installation.
223
All the information displayed on screen
can be printed out or saved electronically.
Alarm and event reports can be generated, and the user parameters of the automation systems that manage the remote
buildings from the general control centre
can be modified without anyone’s having
to travel to the buildings in question.
Pneumatic transport
Clothing
The hospital’s pneumatic transport system
for soiled clothing was given a general
overhaul, altered and updated. Originally,
there was a single network for soiled
clothing and rubbish. In order to avoid
contamination problems due to user error
and the frequent splitting of bags while in
transit, the specific equipment for rubbish
loading and unloading had been rendered
inoperative, and the network was being
used only for soiled clothing.
Samples
A system was installed for microprocessorcontrolled pneumatic transport of bags
of blood, samples, analyses, medicinal
products and most of the small objects
and documents that can be transported
between the various departments of a
hospital. With this system, each such shipment takes just a few seconds to reach its
destination.
The pneumatic tube system was designed
especially for hospitals and can carry
blood and samples without harming them
in any way.
The shipment carrier component is a
capsule whose useful inner diameter is
76 or 86 millimetres, depending on the
item to be transported. More than 500
shipments can be made daily. Shipment
priority is entered on the programming
keyboard built into the central computer
panel.
Transport speed inside the tube (controlled
by air-flow regulation) is three metres/
second for blood and “slow-moving”
samples and eight metres/second for
documents and miscellaneous objects.
Haemodialysis water treatment plant
The Haemodialysis Department had 14
permanent stations, two for the acutely
ill and one for peritoneal dialysis, using
water provided by the Lorca municipal
water system. The facilities were enlarged
to 22 stations.
In compliance with the strict requirements
224
binding hospital facilities that operate artificial kidneys, a water treatment plan was
needed that could run continuously, with
low operating costs and low maintenance,
to subject the water to an intense disinfecting shock treatment, remove all solids
in suspension and then demineralise the
water to the correct content. In other
words, a two-stage reverse osmosis plant
was required.
The installation work consisted of the
following phases:
First of all, taking account of the water’s
intended use and hardness, the treatment
plant includes a decalcifier. Decalcifier use
substantially lengthens the working life of
reverse osmosis membranes, and furthermore decalcifiers are the accredited solution for hospital facilities. This particular
decalcifier consists of a dual-column automatic decalcifying set with cation resins
for ion exchange in the sodium cycle. It
softens water by eliminating calcium and
magnesium (and other polyvalent cations).
The softened water then receives shock
chlorination (using liquid sodium hypochlorite) to ensure sufficient microbiological disinfection and oxidation of possible
metals, organic matter, etc. Afterwards
the water travels through a flint/anthracite
filter that eliminates the larger TSS (total
suspended solids), followed by a dechlorinating/clarifying active charcoal filter,
which eliminates the residual chlorine
and any organics that may have slipped
through.
This disinfected water free of calcium,
magnesium and all metals susceptible to
oxidation precipitation is microfiltered
with a threshold of five µ and flows to
a reverse osmosis unit, where the highpressure set forces the water through
semipermeable polyamide membranes
that reduce its dissolved load by more
than 95%. Of course, the membranes also
retain 100% of any TSS that have slipped
through the pretreatments.
The permeated water from the osmosis
process is stored in three sealed, opaque
accumulator tanks having a capacity of
5,000 litres apiece (4,000 litres of water
storage and 1,000 of air space). From
there the water is impelled into the “loop”
by a hydropneumatic set of two horizontal centrifugal pumps in parallel (one
in reserve), with the appropriate boiler.
Since this loop is closed, the impeller set
also acts in the capacity of a continuous
recirculator for the storage and distribution system’s water.
As a final health guarantee, and to avoid
recontamination, which so disastrously
effects patients, a continuous UV-ray
water sterilization unit is included inside
the loop.
The water thus treated, which meets the
specifications for artificial kidney water
(UNE 111.301/90) and the requirements
stated by the hospital’s kidney unit, is
distributed to the room through a closed
loop designed to the specific standards for
sanitary water.
Between each of the stages mentioned
above and the other stages, there are
pressure gauges to control load loss and
sampling valves for quality analysis.
Reina Sofía General
University Hospital,
Murcia
On 29 August 2000 an administrative
contract for the work on this new hospital was signed by the Murcian Health
Service and a joint venture featuring FCC
Construcción. The document certifying works commencement was signed a
month later, on 29 September.
The hospital lies on a 24,765.95-squaremetre urban lot, surrounded by streets and
constrained by two constructions in the
northern zone that had to be respected.
To the south it borders on the road that
runs parallel to the river.
The total floor area is 63,428.18 square
metres. The main building housing the
hospital proper occupies 58,834 square
metres of that, and the block containing the hospital systems and workshops
accounts for the remaining 4,594.18
square metres. There is also a basement
car park with an area of 31,072.56 square
metres; this plus the area cited above
makes a total of 94,500.74 square metres
of floor area.
Reina Sofía has 290 standard hospital
beds, of which 248 are medical/surgical, 30 are psychiatric and 12 are intensive care. Its maximum capacity (two
patients in each single room) is 340 beds.
The hospital possesses an additional 58
admissions beds (emergency/examination
and medical/surgical outpatient hospital
service), making a total of 348 beds (398
at maximum capacity).
It has 88 Outpatient Clinic examining
rooms and 10 operating theatres, with 16
resuscitation beds.
The design called for the construction of
the following buildings:
• Hospitalization building (south block)
having a ground floor and seven upper
storeys, plus another three floors underground for the car park and other
installed services. The building has a
rooftop heliport.
• Outpatient Clinic building (middle
block), with a ground floor and three
upper storeys. This building is connected
to the south block by walkways.
• Emergency building (north block), with
a ground floor and two upper storeys.
• Maintenance and service building and
DUCC (Drug User Care Centre), having
a ground floor and two upper storeys,
plus a basement (also two-storey)
attached to the main building underneath the existing street.
Description of the hospital
by blocks
Emergency building (north block)
Floor 0
Floor 0 is where the Emergency Room
proper is located. The Emergency Room
is divided into six areas: patients, family,
healthcare, support, administrative and
staff.
A large parking area sits under one corner
of the building, mostly shielded by the
upper storeys. It is large enough to accommodate nine ambulances or mobile ICUs
and 30 vehicles belonging to the companions of Emergency Room patients.
Inside the healthcare area, very close to
Patient Admissions, is the CPR (cardiopulmonary resuscitation) Emergency Room.
It is connected directly to the Emergency
Room’s classification station and antiinflammatory station. Next is a large space
designed to hold 12 examination cubicles
and a central control station.
There is an entrance to the Emergency
Room from the health area hallway. There
are also a soiled-material station with a
dumbwaiter to lower carts to the waste
area in the first basement, a clean wound
treatment room, an equipment storeroom, a staff lounge and an assisted bath.
Lastly, the healthcare area includes an
observation area, where there are 15
observation cubicles plus a cubicle for
patients who require isolation and a
cubicle for agitated patients. In the centre
of the observation room there are two
nurses’ stations, each fully equipped with
support systems.
The Emergency Department is connected
by a hallway to the middle block. A vertical connection core runs right through
the basic floors (B1, G, 1, 2, 3) of the
middle block, providing easy connections
between the Emergency Department and
the ICU (Intensive Care Unit), operating theatres, surgical outpatient hospital services and functional examination
rooms.
Floor 1
Floor 1 contains the sterilization facilities and the laboratories, plus the Pathological Anatomy Institute and the Legal
Medicine Department. Sterilization is situated beneath the surgical block and is
connected to the top-floor auxiliary sterilization station by two dumbwaiters, one
for clean carts and one for dirty carts.
Adjoining the classification and washing
zone, there are an unpacking area and
a cold sterilizer, plus the area where the
dumbwaiter arrives with dirty carts from
the operating theatres.
The laboratories are divided into several
clearly differentiated areas: sample reception, special blood work, automated work
(CORE laboratory), special biochemistry
work and microbiology work.
Floor 2
Operating theatres, an auxiliary sterilization station and resuscitation.
The accesses to the surgical block have
been meticulously designed to control
infection. To reinforce the anti-infection
criterion, the general structure is laid out
according to the need for three types of
hallways, sterile, clean and dirty.
There are two entrances: One connects
the surgical area with the general hallway leading to the core of bed lifts, and
the other connects this area of operating
theatres with the ICU. Next to the first
entrance there is a control station that
monitors the entrance to the patient area
and the staff entrance to the changing
rooms.
Across from the emergency operating
theatre, there is a special entrance for
fast, easy access to the emergency operat-
225
ing theatre.
facilities and the supply zone.
From the clean hallway there is direct
access to the patient preparation and
anaesthesia area, the surgical scrub area
(where medical staff disinfect their hands,
arms and face before donning gloves and
mask) and the dirty area.
The waste management unit works
according to a plan for the separation
of common urban-type waste (recyclable
and non-recyclable) from biological waste.
In the waste management area asepsis is
guaranteed, leachate dumping is avoided
and the proper temperature is maintained.
From the surgical scrub zone, there is
direct access to the operating theatres and
a view of the patient preparation area.
Each of the ten operating theatres has the
following features:
• Automatic, air-tight entrance and exit
doors
• An anaesthetic machine with two
intakes for oxygen, one for nitrous
oxide, vacuum, medical air, nitrogen
and an EGA (emitted gas analyzer)
• A medical gas machine with two intakes
for vacuum, one for medicinal air and
one for nitrogen
• A lamp anchor
• Power plugs and computer jacks; four
jacks for closed-circuit television
• A data box and six power plugs for each
wall
• Protection from electrical risks, Voltabloc
battery
• 1,000-lux ambient lighting and 25,000lux lighting over the operating table
At one end of the row of operating rooms
stands the auxiliary sterilization station.
It has two direct connections with the
surgical block, one through the sterile
hallway and one through what is termed
“the clean hallway”. It consists basically
of three large areas, which are the sterile
storeroom, the clean/sterilization preparation area and the dirty material pick-up
and washing area.
Once patients have been moved from
the operating table to their bed, they are
wheeled into one of the two resuscitation
rooms. In the zone closest to the entrance,
there is also an emergency cubicle used
basically in the resuscitation of patients
who have suffered cardiac arrest.
Roof
The roof holds the HVAC facilities for the
surgical block.
Basement 1
Basement 1 contains the kitchens, the
central bed station, the waste elimination
Waste arrives from every storey of the
block through the dirty dumbwaiter. It
is taken from there to an area for waste
reception and sorting. Adjoining this area
is a specially designed cart-washing area
equipped with water, a drain and an antislip floor.
The solid waste area is the largest of all.
There the urban-like waste is gathered.
Infectious waste is stored in a different
zone and managed by a company specialized in handling infectious waste.
All these premises are directly or indirectly connected to the loading courtyard
designed to accommodate the vehicles in
charge of hauling away all of the hospital
complex’s waste.
Outpatient clinic building (middle
block)
This block has two parallel hallways, one
for internal traffic (staff and patients in
beds) and the other for what is termed
“external traffic”, meaning ambulatory
patients and their companions.
Floor 0
This floor contains the outpatient hospital services and the Rehabilitation and
Image Diagnostics Departments. A porch
provides roofed access for vehicles carrying patients of this department and the
medical outpatient hospital services.
There are three rehabilitation rooms. In
front of them a zone is laid out for speech
defect therapy and electrotherapy, respiratory therapy and occupational therapy.
The kinesitherapy, hydrotherapy and
heat therapy rooms have their patient
entrances on the external hallway.
The image diagnosis service consists of the
following rooms:
• Two CAT (computerized axial tomography) examination rooms
• Two digital radiology rooms
• One mammography room
• One dental orthopantomography room
226
• One comprehensive diagnosis examination room
Floor 3
• Three ultrasound rooms
The Outpatient Clinic, which rounds out
the services on floors 1 and 2.
• One chest examination room
Basement 1
• One digital angiography room
Basement 1 holds the pharmacy, the clinical documentation area (which has the
capacity for 100,000 records), the linen
room (split into “dirty”, “clean” and
“support” sub-areas) and another parking
zone. It also houses the exhaust facilities
for the car parks on the floors below and
the equipment for the hydrotherapy pool.
• One magnetic resonance imaging room
• One extra room for future technologies
Floor 1
This floor contains the Outpatient Clinic’s services and functional examination
rooms, which include the specializations
of ENT (ear, nose and throat), urology,
respiratory medicine, digestive medicine,
cardiology and ophthalmology.
Hospitalization building (south block)
Floor 0
These departments are located on floor 0:
ENT has a hearing-test room, three examination rooms and a control desk. Urology
has an ultrasound room, a urodynamics
room and a cytoscopy room. In the cardiology zone, there are three examination
rooms, a lounge, a vascular testing room
and an informed-consent office, plus a
pharmacy storeroom.
• Blood Extraction, with a sample classification zone, a recovery or special
extraction area and an FNPA (fine needle
puncture/aspiration) room with its own
built-in laboratory
The ophthalmology module is practically
an independent ophthalmologic clinic.
It has a reception desk and six examination rooms: retina, refractive surgery,
cornea and anterior segment, strabismus
and plastic surgery, glaucoma, and retina
and vitreous humour. It also has a special
methods unit and a laser unit.
• Outpatient Clinic Administration Area
It possesses a surgical block as well, with
two operating rooms separated by a clean
zone, two staff preparation areas and
a patient preparation and recovery area
complete with support zone.
Floor 2
ICU, surgical outpatient hospital services
and the Outpatient Clinic.
The ICU is contiguous to the surgical
block. It has three accesses: an access
from the operating rooms, an access for
relatives and an access for medical staff.
In the centre of the ICU, there is a technical area that provides coverage for all
the cubicles (three isolation cubicles, two
coronary patient cubicles, six cubicles for
patients with other pathologies and one
special procedure cubicle).
The Surgical Outpatient Hospital or Major
Same-Day Surgery Hospital occupies a
position quite close to the surgical area.
It has separate areas for patients, patient
preparation, administrative work and
environmental readjustment.
• Teaching and Research, which has four
classrooms and a computer room
• Civil Safety
• Admissions, with a waiting room and
plenty of counter space for appointments, hospital admissions and reception/information
• Customer service, which includes a
patient library, a customer service office
and an information/parcel check desk
Floor 1
Floor 1 contains the library, the staff and
public cafeterias, the upper space of the
lobby (a great trapezoidal opening above
the ground floor), the hairdresser, a retail
space and the worship unit.
Floor 2
On this floor are the hospital management
offices, the Administrative Management
Unit, the social workers’ premises and the
staff meeting room, the preventive medicine area and the occupational health
area.
Floor 3
This floor houses the health staff dormitory, the neurophysiology examination
area (with electromyography and electroencephalography rooms), the sleep study
area, the eating-disorder area and the
Psychiatric Therapy and Hospitalization
Unit (which has isolation, psychotherapy
and electro-compulsive therapy rooms
and a large outdoor balcony for patients
to rest and relax on).
Floors 4, 5 and 6
Floors 4 and 5 hold the surgical hospitalization units, and floor 6 holds the medical
hospitalization units, supplemented by the
unit on floor 7.
The general layout of floor organization is
repeated throughout the hospitalization
floors. Rooms are arrayed along the outer
perimeter, while the support services and
nurses’ stations are arranged along the
edge that faces in on the hospital complex.
Floor 7
Floor 7 is very like the other floors in terms
of the number of beds it holds. It differs in
that this floor holds the Quality Unit.
Roof
The primary air HVAC equipment is
installed on the roof: two soundproofed
outdoor generator units with a total of
1,200 kVA and a 900-square-metre field
of solar panels to supply hot sanitary
water and support the low-temperature
HVAC circuit.
The heliport is on the roof and can be
reached by two stairways and a gurney
platform.
Basement 1
Here is where the auditorium (with seating for 239 and simultaneous translation
booths), the general changing rooms and
the room holding the computer servers
for the whole hospital are located. The
computer server room is autonomous
and properly insulated, without any wet
systems in the ceiling, and it has a raised
access floor.
Basements 2 and 3 (shared by the
north, middle and south blocks)
Basement 2
Basement 2 is entirely devoted to staff
parking and public parking. It has restrooms and vertical traffic cores leading
straight into the hospital and other traffic
cores leading outside. Three of the cores
have lifts suitable for handicapped use.
The power substations for the hospitalization zones and outpatient hospital services
are located in this basement, together
with the car park exhaust facilities, transformer substations and HVAC facilities.
A tunnel connects this basement to the
service building’s basement.
Basement 3
• Dialysis water treatment equipment,
made up of a preliminary decalcifier and
reverse osmosis
227
Lifts
• Passenger lifts, gurney lifts and cart
dumbwaiters, a total of 31 units
Like basement 2, basement 3 is devoted
to parking. In it lie the hydraulic substations for hospitalization, Outpatient Clinic
and emergency services.
• Treatment of osmotic deionised water
for laboratories and sterilization
Medical Gases
Wiring
• Vacuum and medicinal air supply room
Maintenance and service building
• Double mains supply under remote
control at medium voltage from the
power company
• Auxiliary stations for oxygen, nitrous
oxide and carbon dioxide
The building consists of two blocks in the
shape of a V. The larger building contains
the stations and the DUCC, while the
smaller one houses the maintenance
shops and technical offices. Between the
two stand the medical gas tanks and gasoil tanks.
Basement 2 contains the cisterns, the
pump room, a vertical traffic core made
up of a stairway and a goods lift and the
connection with the hospital building’s
service tunnel.
Basement 1 holds a service tunnel and
a tunnel running to basement 1 of the
hospital. It houses a funeral service and a
car park for staff and funeral vehicles, in
addition to a portion of the DUCC (which
extends to the second floor).
On the ground floor are the shops
(mechanic’s shop, gardening shed and
masonry shop) and the storerooms, plus
the HVAC equipment, the decalcifying
plant, a generator set and the transformer
substation.
On the first floor are the carpentry, plumbing, paint, medical electricity, electricity,
HVAC and TV shops.
On the second and last floor are the
cooling units, in a large space roofed by
a concrete slab. They are fitted with the
necessary mufflers at their air intakes and
blowers to comply with acoustics regulations.
Installed systems
Plumbing
• Preliminary treatment of mains water
in a duplex column for decalcification,
continuous chlorination and pH control
• Motorization of the main thermal
magnetic circuit breakers for priority in
case of power failure
• Medium-voltage distribution ring with
five transformer substations and a total
installed power rating of 7,880 kVA
• Cold, hot and return water system using
PVC pressure pipe for cold water and
CPVC for hot and return water
• Heated hydrotherapy pool with raisable
floor
• Hanging consoles, columns, wallmounted consoles and gas outlets even
in waiting areas
Fire Protection
• Generator sets distributed throughout
the buildings, providing a total of 3,000
kVA
• Multi-criteria carbon monoxide early
detection system with eight distributed
stations under microprocessor control
• Triple busbar in the electrical switchboards, with network, network/group
and UPS (uninterrupted power supply)
• Manual extinction by means of FHCs
and hydrant system
• Halogen-free ducts and wiring
• Automatic extinction with early-acting
sprinkler system with dry and pressurized facilities
• Lamps equipped
preheating
with
ballast
and
HVAC
• Cooling production with four aircondensed, very-low-noise screw chillers
with a total power rating of 4,340,000
frigorie/hour, and heating production
with three multi-fuel boilers with a total
power rating of 5,400,000 kcal/hour
• Two 80,000-litre underground gas-oil
tanks
• Water distribution from the heating/
cooling plant to four substations for
distribution to the different fan-coil and
HVAC circuits
• Building HVAC treatment by means of
independent circuits, according to exposure, for energy savings
• Support for low-temperature circuits
(fan-coils) from the solar power facility
(on the roof of the hospitalization building)
Pneumatic Transport
• Distribution by a pressure pump fitted
with speed selectors
• Alarm and zoning panels built into
a centralized technical management
system
• For samples and documents, with
stations at the different departments
and transfer equipment locations
• Soiled-clothing transport, with collection hopper at each floor of the different
buildings, equipped with a blower and
unloading hopper
• Automatic extinction by means of FE-13
fire suppression agent in storerooms,
library and server rooms
Communications
• Structured cable network with connections in a ring topology using fibre optics
and multi-pair cable between the different distributors
• This system is designed to provide digital image transmission and telephone
service, plus traditional voice and data
transmission service.
Rooftop Heliport
• Platform with signal beacons, fire extinguishers with foam nozzles and centralized management control
Remodelling of
San Carlos Clinical
Hospital, Madrid
Background
Since its creation in 1787, Madrid’s San
Carlos Clinical Hospital has pursued,
among other objectives, the improvement
of health care, teaching and research. The
hospital covers a population of around
650,000, it is staffed with more than
228
5,000 professionals and it is the main
training hospital for the Complutensian
University of Madrid. It has 1,193 beds
and possesses 214 outpatient examination rooms, 30 operating theatres and
latest-generation diagnostic equipment.
It is regarded as a domestic and international pacesetter due the quality of its
facilities and staff.
Rebuilt in the 60’s at its current site, the
hospital has undergone major transformations endeavouring to adapt to the arising
needs of different times. The hospital as
a whole has been the object of alteration
after alteration, generally to incorporate
advantageous new services rendered available by scientific and technical advances.
But these additions and alterations have
not always been orderly, nor have they
been based on any kind of thorough planning of the hospital as a whole. Although
it is true that they have generally solved
the problems they were meant to address,
they have created new problems in their
wake: problems of physical relationships
between departments, problems of internal traffic, communication problems and
so on.
In addition, when we entered the scene
there were still some old zones with sixbed rooms, deficient facilities and badly
aging means of communication and
transport. Altogether, as an architectural
whole, the hospital was awkward, and its
awkwardness was reducing performance
to a very low level that was hampering
daily medical work and causing a great
deal of discomfort for its users and staff.
The building was constructed as a single
175,000-square-metre block, and its
structures have been changed under
the hospital’s Works Steering Plan (full
hospital remodelling approved in 1991).
At the present time, Phase I (the phase
in which we have an interest, awarded
to FCC Construcción in March 1996) is
completed.
The Steering Plan was based on a painstaking study of the existing building, its
structure and its installed systems. The
plan put forth a consistent proposal for
updating the hospital to handle contemporary needs by thoroughly transforming
its infrastructure and the building’s own
functional structure (based on the wellconceived old building, which still provides
a valid framework for the incorporation of
new technologies and equipment) and
making the hospital more comfortable for
patients and their relatives.
Before the culmination of the Steering
Plan, while the Steering Plan was still being
implemented, what was called “Phase 0”
was started. Phase 0, approved in 1989
and completed in 1994, covered those
unpostponable tasks that were already
considered clearly necessary in order for
the hospital to remain in operation. Phase
0 also contained a series of remodelling
jobs that would free up enough space to
enable subsequent work to be done much
more quickly.
The most important part of this preliminary phase was the renovation of the
general circuits of the main building
systems, establishing a series of rings in
the basement that made it possible to
cope with the following phases of work
and creating the necessary stations for the
installed systems.
Phase I involved 40% of all work. Basically, it encompassed the remodelling of
the entire south wing and practically all
the ground and semi-basement floors of
the entire complex. It affected the Hospitalization, ICU, Haemodynamics, Endoscopy, Radiodiagnosis, Digestive Medicine,
Pharmacy, Major Same-Day Surgery,
Pathological Anatomy, Nuclear Medicine,
Haematology and Sterilization Units plus
storage and workshop zones, and it all
had to be done without hampering any
of the hospital’s healthcare, research or
teaching work.
Since the hospital is catalogued as a
level-2 protected architectural heritage
building and monument, restructuring
work is allowed, on the condition that the
original building envelope not be altered
according to urban-planning rules. And
although the floor area was increased by
approximately 1,964 square metres, the
area of the building remains practically the
same, since the increase is in services and
parking areas, which have nothing to do
with the building’s external lines.
Later, in August 2001, a complementary
design was approved to remodel the
power plant and retool it to fill new needs,
and to build a newly designed pavilion
(the San Carlos Pavilion) to hold classrooms, a gallery, a hospital staff cafeteria
and an auditorium.
This pavilion lies at one corner of the building, and its design takes advantage of the
incoming natural light. Glass is generously
used to separate spaces, so as to maintain
the luminosity.
Description of previous
condition
The structure is made of reinforced
concrete. In the previous phase (already
completed), the condition of columns,
beams and floor structures was ascertained. Corners were found that had
been laid completely bare by the effects
of impacts during the Spanish Civil War,
with seriously rusty reinforcing members
standing visible to the naked eye. These
defects had to be addressed, and in some
cases weak spots had to be reinforced.
The outer walls of the entire building were
made of double hollow face brick on the
outside, followed by an air space, insulation and thick partitioning, and the interior walls were plastered or tiled.
It had been seen that in some cases there
was no insulation inside the air spaces;
in other spots, the fibreglass blanket had
come loose; and in yet other cases the
air spaces contained an abundance of
rubble from previous work. It was therefore decided to tear down the partitioning
blocking off the air space so the rubble
and old fibreglass could be removed and
the thermal properties of the walls could
be improved by applying a parge coat to
the back of the brick façade and insulating with five-centimetre-thick panels of
expanded polystyrene before closing the
wall up again with double hollow face
brick.
In one study, it was ascertained too that
the outer walls were not resting on the
floor structures, but were standing on the
set-back ledges formed by the holes for
the heating radiators. When the radiator
system’s holes were eliminated, it became
necessary to anchor the façade walls to
the structure with angle irons and stiffeners. Weathered bricks were examined as
well.
The roofs styles on the building varied
widely, ranging from fibre cement to
flat roofs of various types (Catalan-style,
with a ventilated air space sandwiched
between the top and the bottom; covered
with roofing felt; covered with resin;
made of aluminium; covered with gravel)
and even inverted roofs. Due to the poor
condition of most roofs, which were liberally covered with patches, a full roof renovation was deemed necessary.
The dropped ceilings were largely made of
smooth plaster, and they were in very bad
shape due to water leakage, especially on
the top floors of the buildings, because of
the leaky roofs. Everything had to be renovated to make way for the new systems to
be installed.
The installed systems, which had been
maintained as they were in the original
construction, had become completely
obsolete and unequal to modern demands.
Some systems that may be regarded as
fundamental today, such as HVAC and
centralized medical gases, were nonexistent. Others, such as the high-voltage
wiring and emergency generator sets, had
some very serious defects. And different
systems, such as the fire protection and
detection system, displayed radical shortcomings.
The systems designed in this phase therefore basically had to start from scratch.
A double system of each type was maintained: The old systems were replaced in
the remodelled zones only when no other
kind of action was viable until the Steering
Plan had been fully completed.
The solution
Phase I called for the remodelling of a
major series of hospitalization units with
two basic design objectives: to enhance
the performance of the resources available to the nursing staff and services by
rationalizing and unifying the content of
work being done by the different units;
and to reach certain standards of comfort
for patients and their relatives in line with
the country’s general comfort level, by
eliminating the serious problems hampering the hospital in this field.
Concentration of the resources of general
services, including healthcare services,
hotel services and installed systems, was
set as a fundamental goal. As regards
function, the objective was to unify,
concentrate and reinforce the hospital’s
central services areas by providing them
with the equipment and installed systems
required (according to the quantity of
other resources–basically staff and space–
available). As regards installed and other
systems, the objective was to design the
most suitable systems and make them
compatible with the hospital’s existing
culture or consider changing the hospital’s
culture.
The internal traffic paths of the hospital
were untangled for a radical improvement
of the connections between the different
healthcare and general areas. The different types of hospital traffic were separated as much as possible.
Work in hospitalization areas
The hospitalization units presented
some very serious drawbacks in terms of
organization and comfort, with six-bed
rooms having no toilet and a very small
proportional amount of space for each
patient. There was thus an undesirable
level of crowding, further exacerbated by
the fact that the common toilet rooms
were under-equipped and inconveniently
located. Moreover, the nurses’ stations
were very poorly organized, hampered
by the restraints imposed by their physical structure and very small spaces that
were utterly unsuited for modern forms
of work.
Remodelling work was therefore aimed
at creating modular, multi-purpose hospitalization units with the greatest possible
number of beds. The six-bed rooms were
replaced with one- and two-bed rooms
with a full toilet room built into each, and
spacious, uncluttered nurses’ desks were
designed to enable better patient supervision and care. The nursing staff was
provided with the necessary offices, meeting rooms, storage, changing rooms and
so on.
These changes involved basically all the
hospitalization areas of the south wing
plus the Paediatrics, ICU and Resuscitation
Units, which were to share the intermediate support areas, staff areas and service
areas with the hospitalization areas.
Work in central healthcare service
areas
This work was done under the criteria
of unification and proper equipment
explained above. Basically, it covered
two major areas. The first was healthcare
services, comprising the ground floor and
first floor. A unified image was created
here, for the area including the Radiodiagnosis, Endoscopy, Nuclear Medicine
and Medical Physics Departments; and an
area was created to contain traumatology
examination rooms, a geriatric evaluation
unit, a pharmacy, pathological anatomy
services, a haematology laboratory and
a blood bank. The second area was in
what is called “the east block”, which is
the fundamental hub for surgical treatments and intensive hospitalization units.
In this zone, which already contained the
Emergency Department, it was decided
to place the 22-bed ICU and the 28-bed
surgical resuscitation unit.
229
Work in general services and
infrastructure
The most important general service and
infrastructure work included in this phase
was the conclusion of what was done in
Phase 0 in the central space. A roofed
general service entrance was built to shield
hospital loading and unloading operations
(materials for the general storerooms, the
pharmacy, the kitchens, maintenance,
systems in general and rubbish) from
outside eyes; and a set of general storerooms sized appropriately for the hospital,
a textile and support sterilization station,
the pharmacy storeroom, a roofed service
parking facility, general changing rooms,
a new nursery, an auditorium and a new
chapel were constructed.
General approach to works
execution
The idea was to disrupt the hospital’s
healthcare activity as little as possible,
under an orderly general plan that
enabled all the hospital units to keep up
their normal level of operations without
having to schedule shutdowns or sharp
reductions.
One point that bears stressing is that, since
the whole hospital occupies a single building, construction had a much more overall
repercussion and affected the hospital’s
operation more widely. It was very necessary to adhere to a carefully plotted work
schedule and to cooperate very closely
with the hospital’s departments, especially
the Maintenance Department. A works
tracking committee was therefore created,
made up of FCC technicians and hospital
healthcare and managerial personnel. The
committee’s main job was to ensure the
quality and quantity of hospital care being
provided at all times.
All demolition work was done with the
utmost care, inside buildings as well as in
the outer walls, inner courtyard, service
tunnel entrances and pathological anatomy services. Thorough safety measures
were taken, and the proper machinery
was used to advance as quickly as possible
with the least noise and inconvenience for
the normal operation of the hospital. Any
hospital areas or components that might
be affected were always isolated from the
rest of the areas with screens and temporary partitions. Work sites were sprinkled
to keep down the dust. Signage was used
to keep unauthorized personnel out.
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atric outpatient hospital services and
the Pharmacy Department.
Centralized HVAC system
This was the system whose installation
accounted for the lion’s share of the
remodelling work, because it was totally
new to the building. The following air
treatment systems were used:
• Induction Units: The chosen system has
four-pipe induction units, with individual apparatuses for each room in the
dropped ceiling, allowing the temperature of each room to be controlled
separately. Air is drawn out through
each room’s toilet room and through
the “dirty” zones, so there is a slight
depression in the rooms with respect
to the hallways and in each toilet room
with respect to its adjoining room, thus
avoiding the risk of cross contamination.
• Expansion Tanks with Reheating Battery:
A half-speed, single-duct system was
designed, with reheating at the end,
for the hallways where there are nurses’
stations. The vents are housed in the
dropped ceiling and are individually
controlled through electronic probes
actuating a regulator and three-way
valves installed in the hot water circuits.
All the treated air is drawn entirely from
the outdoors and distributed at low
speed.
• Half Speed: In places where the
required level of ventilation is always
greater than the sensible heat needs.
To avoid high energy expenditure, cold
air needs to be mixed with untreated
outdoor air or return air, depending on
the zone (air-mixing boxes).
In some zones, there are air/water heat
recovery systems for the exhaust air. These
systems are made up of a heating/cooling
unit and heat exchangers, attached to
each other by a system of pipes, closedcircuit recirculating pumps and safety and
shut-off devices.
The cooling unit chosen for the hospital is
a centrifugal unit using HFC 134a (1) as its
refrigerant. For the condensation system,
a cooling tower was installed on the building’s roof.
A service tunnel used to run out from
the cooling unit. The vertical pipes that
rise to the floors where the HVAC system
was installed were connected to the
pipes in the old service tunnel. The ring
was completely closed up to the point of
its return to the cooling unit. The circuit
was completed with shut-off and control
• Heater Units: The zones covered by
heater units are the maintenance storerooms and workshops. Water is distributed individually on a room-by-room
basis. The units are wall mounted and
provide
independent
temperature
control in each room.
GAS
• Low Speed
• Sterile areas: In the sterilization zone
and the “isolation” zone, the HVAC
units’ heating batteries are supplemented with an electric battery, so
that in the summer these highly critical areas will not have to depend on
the central hot water system for what
heat they might need. All air blown in
is drawn from outdoors and returned
to the outdoors through exhaust fans
or heat exchangers.
• All outdoor air: For the zones of the
hospital that require a high volume
of ventilation (“dirty” sterilization,
the pharmacy storeroom, the general
storeroom and changing rooms).
• Return air: In pathological anatomy, ICU
support, “isolation” hallways, classrooms, radiodiagnosis waiting rooms,
customer service, traumatology, geri-
of all HVAC equipment plus the rest of the
automatic control functions. The entire
system can be governed equally well from
the centralized control and command
system or from local control panels.
Medical gases
This system provides the hospital with a
continuous supply of each gas, together
with the controls that enable operators to
ascertain the system’s status at all times.
The gases supplied are:
• Oxygen
• Nitrous oxide (more commonly known
as “laughing gas”)
• Vacuum
• Breathable air
• Nitrogen (as a carrier gas)
Since the hospital was already built and
running, the first thing was to redesign
and relocate the medical gas supply rooms.
This made for improved service centralization and stronger safety measures and
brought the system up to standards.
Thus the hospital now has the necessary
equipment for the main and backup gas
supplies, which may be summarized as:
MAIN SOURCE
BACKUP SOURCE
Oxygen
30,000-litre cryogenic tank Two automatic double
manifolds holding 2 x 12
bottles
Nitrous Oxide
4,000-litre cryogenic tank
One automatic double
manifold holding 2 x 8
bottles
Medical Air
Mixer
Two automatic double
manifolds holding 2 x 12
bottles
valves installed in the general distribution
systems, technical rooms and air treatment units.
The synthetic air mixer is supplied with gas
from the oxygen tank and the other preremodelling tank, which holds nitrogen.
Through communication between the fire
switchboard and the central management
computer, the HVAC system can help
the fire-extinguishing systems by keeping
non-burning zones relatively smoke free
as long as possible and trying to establish
air flow in the most advantageous direction.
Between the two sources of supply (main
and emergency), there are automatic
“source” selection panels, through which
the supply is connected to the hospital’s
general systems.
Automatic control of the facility is
entrusted to the centralized technical
management system, which is designed to
handle the starting, signalling and control
1
Hydrofluorocarbon
For suction, there were initially two
vacuum stations located in the basement.
• One of them held a compact 2 x 192
m3/hour unit with an accumulator tank,
double filtration and a waste separation
chain.
Because it was in good condition, this
station was left as is and was connected
to the surgical block’s gas supply system.
• The other held three electric pumps, two
of which were in poor condition due to
age. Moreover, the accumulator tank
was undersized and had no filtration or
waste separation.
This station was replaced by a new modular station, which was connected to the
general systems that supply the rest of
the hospital’s departments and also to the
first station, so a backup reserve would be
available.
Mention should also be made of three
small vacuum units that were kept on the
hospital floors for use by specific departments. They were all in poor condition
and were scheduled to be replaced by the
new units described above.
Centralized technical
management
The system is designed to provide centralized control and monitoring for all the
building’s installed systems. The substations for local equipment control incorporate DDC(2) technology and can be run
independently if communications with the
central station fail.
The substations feature multitask,
multi-user, real-time, microprocessorcommanded controllers with an associated
series of functional modules connected by
a process bus.
The system’s overall capacity permits operators to communicate from the central
station with any substation and to display
and/or modify any set point.
This system’s programming affords:
To supply the different zones of the hospital with gas, a ring has been installed in
the basement and connected to the existing ascending pipes, so that if any of the
pipes has to be shut off due to a problem
or alterations, the supply to the rest of the
zones is ensured.
• System access protection by means of
tiered passwords
At the gas outlets on each floor, zoning
panels are installed that include shut-off
valves for each gas. There are even ceilingmounted shut-off cocks for the services
where greater responsibility is at stake,
such as the operating theatres, so they
can be rendered independent of the rest
of the system.
• Incident summary, trend display and
follow-up protocols
The new gas supply room, which runs
completely automatically, holds five 250
m3/hour pumps, three 2,000-litre buffer
tanks, two bactericidal filters and two
waste separators. The pumps start up
cyclically, the first one entering being the
last to be connected, to avoid premature
wear in any one pump.
From the collectors, the distribution
system carries gas to the different zones.
It travels horizontally through the dropped
ceilings and vertically through specially
prepared spaces.
In the central control unit, the status of
each zone is verified and the gas consumption information transmitted by the different control panels is added up to find the
hospital’s total gas consumption figures.
The levels and pressures of the cryogenic
tanks where the gases are stored are also
supervised.
• Scheduled handling
• Interactive real-time graphics
• Alarm treatment, with immediate alert
triggering and alarm logging
• Processing of data that is collected
locally and transmitted regularly and
automatically to the central station
• Image editing
Pneumatic transport
Soiled clothing
This system has to pick up, move and
discharge soiled clothing fully automatically. It can perform at a rate of more than
2,000 kilograms of soiled clothing per
hour.
The bags containing soiled clothing
are picked up from automatic hoppers
installed along four vertical paths in the
service zones of the nursing wings. The
system allows bags to be held at the
different floors, so the hospital can organize shipments continuously or on a fixed
schedule.
Bags are transported pneumatically by
suction, through galvanized steel pipes
400 millimetres in diameter. The blower
that creates the transport vacuum inside
the pipes is situated at the very end of
2
Direct digital control
231
the pipes’ horizontal circuit, in a closed,
acoustically insulated area, in the courtyard next to the laundry.
There an automatic pneumatic discharge
collector installed. It is commanded and
controlled from the central computer. It is
equipped with highly sensitive photoelectric eyes to detect bag arrival.
With this transport system, the waiting
time between floors and laundry is shortened. Also, it is no longer necessary to run
laundry carts through the halls, and soiled
clothing is moved in hidden, airtight pipes.
Lastly, fewer personnel are required, so
there is less handling of soiled clothing
and consequently a lower risk of infection.
Rubbish
The rubbish system is entirely identical to
the soiled clothing system, except that
the rubbish bags are for a single use only
and, unlike the laundry bags, cannot be
salvaged. In addition, they are resistant to
friction.
Samples, blood and small objects
This is a microprocessor-commanded
system whose carrier is a capsule 10.5
centimetres in diameter and 24 to 35
centimetres long, with a threadless revolving lid attached to the capsule. Two lines
have been installed. They run independently but are connected to one another
by a central exchange device, which is also
microprocessor controlled and enables
capsules to be switched from one line to
another with no waiting time. The two
lines and this transfer device are modular
and can be added to to make new lines in
later remodellings.
The exchange device can hold up to a
maximum of ten capsules per line, to keep
the pipes available even at times when
shipment demand is at its heaviest.
Line 1 is primarily for samples, blood
and analyses, while line 2 is reserved
for medicinal products, documents and
communications with the nurses’ station.
Fifty-six automatic capsule reception and
sending stations have been installed. Each
is bifurcated. All stations are easy to use,
with no hatches in front or moving parts
that can be manipulated from the outside.
Some of them are intermediate stations,
and others are terminal stations.
The stations are joined by PVC pipe 11
centimetres in diameter, with curves
having a radius of 80 centimetres. Adjacent pipe sections are connected by
232
sleeves welded on the outside.
The transport speed inside the pipe
is three metres/second for blood and
samples (slow) and can be set at three or
eight metres/second for all other items.
Deceleration on arrival is provided by an
air cushion created by a control servovalve
and an air compression module.
Throughout the trajectory, capsule speed
and position are controlled by sensors,
which emit signals to the computer that
regulates the “traffic” on that particular line, which in turn “talks” to the
exchanger. They may all have shipment
priorities established in advance.
This transportation system is very accurate and silent, because the two compressor sets, which perform the double job
of blowing out and in, have silencers on
both outlets and sit on insulating beds to
prevent transmitting vibration.
Due to the speed and independence
of this means of transport (seconds, as
opposed to the minutes a conventional
system would take), the response time is
faster, patient care is better and staff do
not have to act as couriers.
Fire protection
The work included the installation, alteration and enlargement of the fire protection system for the hospital zones included
in this project. This covered fire extinction devices (manual and automatic), fire
detection devices and fire alarms.
The extinction system is made up of a
network of FHCs and automatic water
sprinklers distributed in four independent
zones, each with its own control station.
Water is supplied by a network of pipes
over five kilometres long, with diameters
ranging between one and six inches, and
a pump unit.
In the transformer substation, the pharmacy storeroom, the room containing the
generator set and the main low-voltage
panel room, five automatic extinguisher
systems using the gaseous agent FC-13
have also been installed, with pipes to
bring in the agent from outside and
sprayer nozzles for its deployment.
Manual fire extinguishers of the following types have been mounted: portable
chemical, CO2 and water extinguishers
and multi-purpose dry chemical extinguisher carts. The system is completed by
a dry riser system in the building’s stairwells, with 24 floor outlets for use by the
fire department, and four four-inch riser
hydrants with their corresponding water
system.
The fire detection and alarm system is
made up of a central station, three independent autonomous switchboards, two
linear light-beam smoke detectors and an
endless number of optical smoke detectors, rate-of-rise detectors, duct smoke
detectors, alarm buttons, alarm bells,
remote action indicators, alarm repeaters
at nurses’ stations, power packs and automatic doors with closing selectors and
electromagnetic auxiliary contacts showing ON/OFF status. The system includes all
necessary wiring (33,535 metres of structural wiring in rigid PVC or metal pipes,
depending on the wiring path).
Southeast Hospital,
Arganda, Madrid
Background
Southeast Hospital in Arganda del Rey is a
new hospital belonging to the Community
of Madrid. The public authorities chose a
company (of which FCC forms a part) to
receive an administrative concession to
build the hospital (between 2005 and
2007) and later to manage the services
supporting the hospital’s healthcare activity and businesses. This includes maintenance (preventive, corrective and spare
parts), cleaning, urban and hospital waste
collection, internal/external transport,
orderlies, administrative staff, reception,
information and switchboard operation,
surveillance and security, sterilization,
laundry, restaurant/catering service, disinfection and vermin extermination, storage and distribution management, street
and garden upkeep, parking, cafeteria
service, retail shops, vending machines
and management of telephones and TVs
in rooms.
The concession to operate this hospital
is good for 30 years. The hospital serves
a population of 140,000 inhabitants
belonging to the city of Arganda itself and
another 20 cities and towns in Arganda’s
area of influence.
The 41,700-square-metre lot lies south
of the city’s urban nucleus in an area just
now being developed. The floor area is
45,000 square metres, and there are 687
parking spaces.
The hospital has been outfitted with an
initial complement of 110 hospitaliza-
tion beds, which can be increased to 148
in 2017. The hospitalization rooms have
two beds apiece and are generally used as
single rooms but may be used for double
occupancy under certain exceptional
circumstances.
Organizational outline
The general organizational outline that
was proposed to provide a response to the
prerequisites was based on the hospital’s
variability, adaptability and expandability
conditions. None of these conditions were
to be compromised in future by the initial
solution (except by the lot’s own physical
limits). The outline was to permit functional areas and possible future expansions of functional areas to switch places
with one another at any time.
To achieve this, a solution was put
forward envisioning the building as a vast
container made up in turn by a series of
standardized containers clustered to form
basic cross-shaped modules.
The elementary basic module or cell
is a 4.65-metre-tall space whose floor
measures 14.4 by 14.4 metres. This
module is constructed with trusses having
a span of 14.4 metres, resting on columns
to form porticos parallel to the façades
and separated by 3.6/4.5/5.4 metres, so
as to leave an entirely clear space.
The truss edges are used to create service
spaces through which all the hospital’s
general installed systems run. In this location all systems can be inspected and
accessed from maintenance walkways
erected expressly for that purpose. This
arrangement completely frees the interior
space for hospital use, allowing maximum
flexibility in use and minimum interference
from the standpoint of building maintenance and subsequent operation as well
as from the standpoint of subsequent
modifications or adjustments of the building’s use.
These modules are clustered in turn
around two main traffic corridors:
• External traffic corridor
• Internal traffic corridor
The external traffic corridor is dedicated
to outside patients and visitors, while the
internal traffic corridor is dedicated to
staff, supplies and hospitalized patients
who must be moved in beds or on gurneys
to the central diagnosis or treatment
services.
The proposed outline enables the building to be expanded in three dimensions
(lengthwise, breadthwise and heightwise),
restricted only by the conditions inherent
in the lot.
comfortable environment in the hospital
than would be created if the windows
looked directly out of the building’s
façade, since the urban surroundings are
not the most restful.
For this reason, the areas that have a
greater number of conditioning factors,
are more difficult to move and have
higher costs are arranged in the central
zones, albeit without ever losing sight
of the necessary proximity requirements
of different areas. Thus, the hospital can
expand in future according to its own
needs, and the central areas in turn can
grow, taking over the space of other
nearby areas that can more easily be
moved into the zones enlarged in future.
Distribution by floors
There are mainly two reasons behind the
geometry of the containers in each of the
areas:
• Length of the paths staff have to travel
• Flexibility in the use of spaces
The paradigm of the first reason is the
hospitalization units, where nursing and
auxiliary staff must be on the job 24 hours
a day, every day of the year. It is therefore of the utmost importance to keep the
paths they have to travel as short as can
be.
One example of the second factor is
how the clinic rooms, special examination rooms and physician’s offices are
grouped. With the planned concentration
(grouped two by two) and the uninterrupted physical arrangement adopted, this
grouping affords a great deal of flexibility
when assigning locations to the different specializations and makes it easy to
convert spaces from one use to another.
This situation is also facilitated by the existence of the service space.
The required spaces have been arranged
so that they share common traffic points
and supporting zones, with the goal of
optimizing internal traffic and the circulation coefficient in the common areas (restrooms, storerooms, changing rooms).
The building has been constructed to
enable this to be achieved optimally.
Without sacrificing direct light or natural ventilation (i.e., situating the habitable premises along the façade), a more
compact solution has been attained than
with other alternatives. In addition, there
is no reduction in the quality of spaces,
due to the size of the courtyards (10.8 by
14.4 metres) and their landscaping; these
private gardens create a quieter, more
The functional programme was dealt with
by creating nine floors, from floor -2 to
floor +6. Floors -2 and -1 are devoted
exclusively to parking, and floor +6, which
is built in one zone only, is devoted to
installed systems and space reserved for a
future main sterilization station.
Floor 0 houses the lobby and the areas for
admissions, rehabilitation, the cafeteria,
blood extraction, the laboratory, the pharmacy and the clinical history files.
On floor +1 lie the Emergency Department (entered from the side at ground
level), the Image Diagnostics Department
and the dialysis unit. Due to the slope of
the terrain, the building grows higher,
housing the general supporting services
and the mortuary, all of which are entered
directly from the service drive.
On floor +2 lie the Outpatient Clinic, the
special exploration rooms, the outpatient
hospital services and some of the physician’s offices. The rear portion of the floor
houses the teaching and research areas,
the nursery and the citizen participation
area.
Floor +3 houses the psychiatric, paediatric, newborn and obstetrics hospitalization wards, in addition to the administrative areas belonging to management, the
Computer Department, the chapel and
the patient library.
On floor +4 lie three conventional hospitalization units, the rest of the physician’s
offices and the rooms of the physicians on
duty.
Floor +5 houses the Surgery Block, the
Obstetrics Block, the ICU, MAS and the
Anaesthesia Department.
Lot development and access
The lot is completely enclosed, with an
access control booth at the entrance to
the hospital grounds. For smooth internal traffic circulation, a drive has been
built all the way around the lot’s perimeter, with turns into the different groundlevel and underground parking areas, the
Emergency Department entrance and the
service drive.
From the drive around the perimeter,
233
there is direct, completely impedimentfree access to the hospital’s two public
entrances. Furthermore, from the underground car park, access to the main lobby
or directly to the outdoors can be gained
by means of the lift clusters.
Ambulances and other emergency vehicles
have a direct drive from the main entrance
to the Emergency Department entrance.
Next to the Emergency Department door
lies the emergency vehicle car park.
All service vehicles (victuals, pharmaceuticals, general stores, maintenance) turn
from the perimeter drive onto the service
drive. The service drive is a restrictedaccess entry point controlled by barriers
and CCTV so that only authorized vehicles
can gain admittance. This arrangement
heightens the premises’ security and
enables this entire area to be kept under
tighter control.
The two arms remaining on the sides of
the lot are regarded as unfit for anything
but landscaping, given their narrowness,
the water company’s easements and the
extremely steep slope. Part of the smaller
arm is used for above-ground parking.
The inner courtyards are treated as recreational space that may be used by staff or
patients.
Future enlargement
The hospital’s execution envisaged building the structure so that it can accommodate the expansion of the hospitalization
facilities in 2017 and the necessary space
can be reserved for laboratory facilities,
the Image Diagnostics Department, the
main sterilization station and the nursery.
Likewise, the rest of the spaces called for
in the functional programme have been
constructed with all their installed systems,
although the systems are not complete or
on line. These spaces basically pertain to
different hospitalization units, Outpatient
Clinic rooms, special examination rooms,
the outpatient hospital services’ complement of treatment booths, dialysis facilities and the ICU.
HVAC
Thermal demand study
The thermal demand of the zones to be
treated was calculated by selecting several
parameters, such as outdoor and indoor
conditions, thermal characteristics of the
wall materials, occupancy levels and lighting loads, ventilation and air changes, etc.
234
To calculate the building’s cooling load,
it was necessary to find the anticipated
occupancy levels of the different premises
and the thermal loads to be offset due
to electrical loads, essentially the loads
created by artificial lighting.
HVAC and ventilation units
Air conditioning reaches all sections of the
hospital. Given the characteristics of the
diverse zones, their breadth and the type
of service they render, the option taken
was to include basically all-outside-air air
treatment units. And the units were to be
centralized, so the thermal demand on
each unit could be offset.
As a special solution in the room and
office zone, additional treatment units
were installed at points located by virtue
of the variability of the loads existing in
these rooms and their users’ different
requirements.
Indoor atmosphere composition is
controlled by drawing in outside air for
ventilation and for offsetting thermal
loads when needed.
• Rooms, Examination Rooms and Offices
In each room or other area along the
façade, a four-pipe induction unit was
installed that had been selected to offset
the load that internal sources and sunlight
place on the room or area in question.
Primary-air HVAC units were installed on a
zone-by-zone basis. Through a high-speed
duct system, they provide ventilation air
and forced automatic induction.
• Operating Theatres and Delivery Rooms
One HVAC unit was set up for each operating theatre or delivery room. The treatment is all-outside air with 20 air changes
per hour and three levels of filtration:
prefiltration, high-efficacy filtration and
absolute filtration. Absolute filtration
occurs in terminal ducts fitted with rotating air diffusers that are highly appropriate for these areas. Exhaust is drawn out
at two levels: near the floor and close to
the ceiling.
Each HVAC unit is equipped with a fan
trimmer and a flow meter to ensure the
unvarying nature of air changes regardless of the filter silting level. The exhaust
fan also has a trimmer controlled by the
differential pressure between the operating room and the hallway.
• Resuscitation, ICU, MAS, the Emergency
Department and Clean and Dirty Halls
These zones were fitted with HVAC units
similar to the ones described above, e.g.,
all outside air, with trimmers in HVAC
units and exhaust fans, and three filtration levels.
In the remaining halls of the Surgery Block
and in the laboratories, only the first and
second filtration stages are implemented.
• Image Diagnostics and Dialysis
In these zones, which contain numerous
spaces with different requirements, variable-flow mixing systems were installed
with variable volume regulators in the
inlet and return/exhaust branches of the
different rooms or premises.
climate conditions will be uniform at each
and every point in the zone.
• Grilles and Diffusers
Generally, all the inlet ducts are made
of galvanized steel sheet metal sheathed
with insulation, and all the diffusers and
grilles are plenum-mounted. Their sound
level is less than 30 dBA.
In critical zones (such as operating theatres
and resuscitation), the connections to the
diffusion plenums are made of rigid ductwork.
An all-outside-air system was set up,
with terminal reheating batteries for local
adjustment of the inlet temperature in
different places.
The inlet air ducts are insulated over their
entire length and are fitted with cleaning ports every ten meters. The return
air ducts have been built without insulation except where they run outdoors or
through unheated areas, in which case
they match the same characteristics as the
inlet ducts. None of the exhaust ducts are
insulated.
• Halls, Lobbies and Auditorium
• Fire Protection
Free-cooling HVAC units were installed,
provided with air prefiltration and a
second stage of high-efficacy filtration.
Fire dampers have been installed in ducts
wherever there is a change in fire sectors.
All fire dampers are duly indicated, and
measures have been taken to make them
accessible from the outside.
• Rehabilitation
Air diffusion
• General Features
Air distribution is performed according to
the fundamental maxim to adhere to in all
air-conditioning systems for large, multizone premises: The five basic air conditions (temperature, relative humidity,
speed, purity and change) will be identical
at each of the points in the zone.
In winter and summer alike, the indoor
temperature is linked to the outdoor
temperature. The temperature must be
uniform throughout the zone, and simultaneous differences of more than 1 ºC are
not allowed.
The air blown into the building must be
filtered. It must contain no particles larger
than six microns and a quantity of less
than six milligrams of particles per cubic
metre.
The air speed will not be in excess of 0.25
metres per second at a height of less than
two metres from the floor.
The air from zones that may produce
strong odours or thin air, such as restrooms, is vented directly outdoors, and
such zones are kept under lower air pressure than contiguous zones.
The design and distribution of the treatedair diffusers and air intakes are such that
Hot sanitary water (HSW)
According to calculations, for a water inlet
temperature of 12 ºC and preparation at
60 ºC, the building needed an accumulation capacity of 15,040 litres and 650 kW
of HSW production power. Three stainless steel tanks holding 5,000 litres apiece
were therefore provided.
In the choice of the HSW heater, the
principle followed was that, even if there
were a specific furnace dedicated to HSW
production, the same furnace would also
have to serve to heat the building, and the
heating furnaces would have to contribute likewise to the production of HSW.
At low-demand times in the winter,
the energy left over from a big heating
furnace could be used to product HSW,
or else the HSW furnace might be sufficient to satisfy the building’s energy and
HSW production demand, especially when
the two demands do not occur simultaneously.
In the choice of water heaters, the HSW
heater that satisfied the furnace power
modulation conditions for the building
jointly with a suitable power output for
HSW was a 690-kW furnace.
Two redundant heat exchangers were
estimated to be needed for HSW production. Both the heat exchangers and the
HSW heater itself have been designed to
enable the temperature to be raised to
above 70 ºC.
Heat production
The furnaces have been fitted with heating-oil burners. A storage facility for that
type of fuel was therefore furnished also;
there are two underground double-walled
(steel/steel) tanks holding 50,000 litres of
heating oil apiece.
Steam production
On floor 6 a boiler room was installed
to produce steam for use in HVAC unit
humidification. Because the steam needs
were estimated to be 445 kilograms/hour
and because it must be possible to build
enlargements in future, a steam boiler
producing 603 kilograms per hour was
selected, although two identical boilers were eventually set up for enhanced
system reliability.
The steam distribution system is made of
stainless steel, from the boiler room to the
terminal units.
Distribution of pipes
The distribution network starts at the
main service facilities and runs through
dropped ceilings and utility shafts to the
terminal units.
For the HVAC units, there is a four-pipe
distribution system with a constant flow
rate. The system uses four circuits:
• One circuit for floor 5 (Surgery Block)
• One circuit for floor 1 (Emergency
Department, Image Diagnostics Department, etc.)
• Two circuits for the remaining HVAC
units, distributed according to building
exposures
The feed lines to the fan-coils and induction units also use four pipes with a
constant flow rate. They follow two
circuits distributed according to building
exposures.
exchangers, pumps, etc.) and for the pipes
themselves. In the hidden or inaccessible
portions, the insulation is rigid fibreglass
pipe insulation bonded with heat-hardening resin and jacketed with aluminium
kraft paper.
In pipes mounted outdoors, in the boiler
and chiller room, tunnels, accessible utility
shafts and in HVAC rooms, the insulation
is rockwool or fibreglass, depending on
the diameter of the pipe. The finish of the
latter is 0.6-millimetre-thick aluminium
foil. Thermal bridges and vibration transmission are avoided at all pipe supports.
Pipes are held in place by isophonic
clamps and galvanized HILTI frames or a
similar system.
Forced ventilation in the car
park
This ventilation was envisaged from the
standpoint of reducing the concentration
of the pollutant gases vehicles produce
in combustion to the levels permitted by
safety and hygiene conditions.
Although floor -1 has the same area as
floor -2, there is in floor -1 a zone where
direct natural ventilation to the outside is
available. Therefore, floor -1 was regarded
as a smaller area for purposes of forcedventilation calculations.
• Description of the Solution
The mechanical ventilation system works
by blowing air out. Air enters through the
natural ventilation holes set in the basements.
The system’s characteristics are the following:
• The system is activated by automatic
detectors
• It is outfitted with independent switches
for each floor that enable the fans to be
started up; the fans are situated in easily
accessed, duly indicated spots
• It guarantees the operation of all its
components for 90 minutes at a temperature of 400 °C
235
six air changes per hour and the system
must be activated by automatic detectors.
Nevertheless, Arganda’s municipal code is
more stringent, as it requires a minimum
capacity of seven air changes per hour.
The system is directly connected to a
carbon monoxide (CO) detection system
designed so that nowhere on the premises
can a CO concentration of more than 50
ppm be reached, and so no point on the
premises can lie at a distance of more than
12 metres from a suction grille. Each floor
is in addition served by two independent
ventilation units.
• Systems Installed
Four exhaust zones per floor were mapped
out. Each is equipped with two fans for
50% of the necessary air flow.
• CO Detection
For CO detection, a system of detectors
was installed, laid out in a proportion of
one detector per 300 square metres at the
most. If the CO concentration reaches the
critical value of 50 ppm, the switchboard
sends an optical and acoustic alarm signal.
Furthermore, should the main fire station
detect a fire, it will send a signal to the
main CO detection station, which will
then order the fans to start up.
Wiring
A main low-voltage HVAC panel was
installed to cover the electricity needs of
the different components of the HVAC
system. The panel is powered by three
transformers, each having a power output
of 1,250 kVA.
From this panel run the power lines to the
chillers, the distribution panels of each
floor and the end panels in the boiler and
pump rooms. The distribution panels on
each floor contain the circuit breakers for
the power circuits of the other panels on
their floor and the circuit breakers for the
terminal units in their area of influence.
From the HVAC panels, power is supplied
to HVAC units, pumps, furnaces and boilers, fan-coils and air curtains.
The pipes are made of weldless drawn
steel. Before they were laid, the pipes
were sandblasted where necessary, and
a double coat of anti-rust primer was
applied. After welding, the welds were
gone over again with primer.
• It is powered directly from the main
panel
• Design Flows
The outputs from the panel to the secondary panels and the connections between
panels and all the wiring to end points of
consumption are made out of halogenfree copper cable. All outputs from this
panel have a differential relay whose
sensitivity and time are adjustable.
There is insulation for all the components
installed in the pipes (valves, filters, heat
For forced ventilation, standard NBECPI/96 establishes that there must be
The power lines from the exhaust panel
to the garage exhaust fans are made of
• No point is situated more than 25 metres
from a hole or fume exhaust point
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90-minute fire-rated halogen-free copper
cable. To house these lines, covered metal
trays made of sheet metal were installed
along the wires’ path in the dropped ceilings and utility shafts.
The following criteria were taken into
account when dimensioning the lines:
• Voltage drops < 5% from the starting
point of the wiring (transformer substation)
• The power lines running to motors have
to be able to withstand an intensity of
125% of the motor’s rated current.
• Trays have to be sized so as to respect a
reserved space of more than 30%
The secondary panels have been installed
endeavouring to cover functional areas
and at the same time split the terminal
distribution network into sectors. They are
provided with pilot lights showing their
operating status in addition to manual/
stop/automatic switches for commanding
the same machines.
Centralized technical
management
Managing the systems installed in the
hospital in a centralized scheme means
keeping them all under the guidance of
one system that can provide the supervision, automation and control specific to
each installed system and enable the sharing of all kinds of information and operations among installed systems, always
taking advantage of the control system’s
own existing communications infrastructure.
System topology
The system employed at this hospital is
divided into three levels: the management level, the automation level and the
field level. Thanks to distributed artificial intelligence(3), each of these levels
functions both autonomously and in
networked coordination with the others.
• The automation system, for control,
operation and monitoring of the primary
plant
• The environmental automation system,
for control of the comfort conditions
in individual environments and for the
operation of lighting and handling of
window blinds
• A component that integrates a wide
variety of equipment at all levels of the
system
One of the main characteristics of this
system is the possibility of enlarging
gradually from the smaller systems to the
larger, more distributed systems.
The communication networks employed
are designed specifically for building
services. They enable all users (if duly
authorized) to gain access to all data and
functions of the connected devices. The
system employs the two most widely standardized communications protocols in the
world.
Management level
The ease of use of the management
level reduces the operating costs and
the necessary training time while at the
same time achieving great reliability. The
management level possesses the following applications.
• Tool bar: This provides general information about the system and enables any
of the user applications to be launched
• Floor display: This shows some complete
graphics of the installed systems that
enable the system to be quickly monitored and operated
• Schedule manager: This permits centralized programming of all the functions of
the building’s time-controlled services
The system’s main components are:
• Alarm display: This provides a detailed
view of the alarms for fast location and
failure elimination
• The management station, for highlevel operation and monitoring, graphic
displays of processes, automatic alarm
distribution and a wide range of different data analysis functions
• Alarm router: This manages the transmission of alarms to printers, fax machines,
mobile telephones and e-mail in a highly
flexible fashion
3
More appropriately referred to as “distributed
cognition”, this is the set of the bodies of knowledge
that are present in different units of the installed
systems (via sensors, data readings, etc.) and that,
when shared, become appropriated by the group
• Trend display: This makes it possible to
adjust the plant on the basis of analyses of the historical data logged in the
system
• Object display: An efficient tool that
enables browsing through a tree structure where all the points of the system
are organized by hierarchy; the values of
these points can be read and modified
depending on the users’ access rights
• Access display: This enables viewing of
the log of alarms, system error messages
and user activities; the information is
saved chronologically and can be filtered
and organized in order to perform an
evaluation at any time
• System configurator: This is used to
create the general configuration of the
management station and associated
applications
• Graphics editor: A powerful tool for
the efficient creation of graphics of the
building’s installed services
Automation level
The heating, ventilation, air-conditioning
systems and other services of the buildings
can be controlled and monitored through
the system. The system’s main characteristics are its modularity, with its different
freely programmable controllers, its wide
variety of operator terminals and its integration possibilities, since it is an open
system.
Installed systems to be controlled
• Primary Installed Systems. Cold and Heat
Production
• Heating/cooling plant: From the control
panel situated in the machine room,
an operator can adjust the cooling
machines, the primary and secondary
cooling and heating circuits, the startup and shut-down sequences for cold
and heat production, the furnaces, the
boilers, etc.
• HSW production
• Air treatment units (ATUs): Primary-air
HVAC units, operating theatre units,
units to treat all outside air with heat
exchange capabilities, with free cooling;
start-up and shut-down sequences...
• Secondary Installed Systems
These are the terminal units whose objective is to set the flow and/or temperature
conditions for the air blown and treated
by the primary systems in response to the
thermal load variations detected in the
zones they cover.
• VAV (variable air volume)
• Four-pipe induction system
• Four-pipe fan-coil system
The helicopter landing platform (heliport)
lies on the roof of the main building.
• Transformer substation
The hospital is designed so that it can be
enlarged, upward as well as lengthwise,
to meet future healthcare requirements.
• Generator set
Distribution by function
• Plumbing
Hospital block
• Fire protection
• Ground Floor - Entrances and
Customer Service
• Electrical and Electromechanical Systems
New Mataró Hospital
Background
The Catalonian Health Service held a
tender to design and build the New
Mataró Hospital and an attached underground parking building on the basis of a
basic design prepared by the Catalonian
Health Service’s own technical services.
FCC Construcción was awarded the
contract to build the hospital, build the
parking facility and operate it under a
concession and generally develop the
hospital grounds.
This new healthcare building is the official
main hospital for the El Maresme district
and more directly for the city of Mataró
and its neighbouring towns, so the New
Mataró Hospital provides service for more
than 250,000 inhabitants. It belongs
to the network of hospitals and healthcare services for public use run by the
regional government of Catalonia, and
it is managed by the El Maresme Health
Consortium.
The hospital stands on a lot ceded to the
Catalonian Health Service by the city of
Mataró, and it is strategically located next
to motorway C-32 for ease of access from
all points of the district.
The lot has an area of 50,188 square
metres, and on it 43,733 square metres of
hospital building and 8,500 square metres
of attached underground parking building have been constructed. The edifice is
conceived in longitudinal terms, as moulding to the terrain and taking advantage of
the natural slope for easier access by foot.
The building’s layout on the lot is split into
two clearly differentiated areas, one for
public use, with public entrances, underground parking, above-ground parking
and a landscaped area, and the other for
restricted use, devoted to the emergency
entrance and deliveries.
The block formed by the first tiered body
of the building has, on the ground floor,
the admissions and customer service area,
the administration area, the management area, the library, the auditorium, the
chapel, the public coffee shop, the Outpatient Clinic (45 examination rooms) and
retail space.
• Hospitalization Floors
On floors 1 and 2 lie the hospitalization
units. There are 330 adult beds and 24
newborn beds. Structural preparations are
made for a 150-bed enlargement.
• Medical Floor
The healthcare departments are in semibasement 1. They are the Emergency
Department (with 20 examination booths
and 12 observation booths), the surgical
block (with 10 operating theatres), the
obstetrics block (with two delivery rooms
and one operating theatre), the area housing image diagnostics (10 examination
rooms) and complementary examinations
(24 rooms), the intensive wound-dressing
unit (14 beds), the outpatient hospital
services (12 beds) and the rehabilitation
area.
• Medical Service Floor
237
Building procedure
The hospital was built with the idea
always in mind that the building had to be
completed as soon as possible. Therefore
both traditional procedures and prefabricated components were used.
Structure construction was begun with
reinforced concrete columns and waffle
slab floors in general, while a combined
structure of columns and metal crosspieces was being prepared in the workshop for the central core of the building.
The façades were built using prefabricated
walls between frames, but the underground car park was prefabricated in its
entirety: columns, floor structures, inner
and outer walls.
The materials were chosen to provide
comfort and ease of maintenance at the
same time, and the systems installed
incorporated the most advanced technology available at the time.
Earthmoving
For a building, the hospital required a
great deal of earthmoving; 240,000 cubic
metres of earth were moved, in work to
excavate through decomposed granite
gravel and hard rock (granite), the formation of earth platforms underneath the
semi-basement floors and backfill for
walls.
Roofs
In general, the roofs of the non-hospitalization floors are landscaped, since
they can be seen from the hospitalization
wards. Before the roofs were filled with
topsoil and landscaped with different
species of plants, they were waterproofed
with root-resistant textiles and drainage
systems to carry off rainwater.
In semi-basement 2 are the blood banks,
the pharmacy, sterilization, laboratories,
clinical healthcare information, the mortuary, dressing rooms, rooms for the physicians on duty, the staff coffee shop, storerooms and the janitorial area.
The upper roof, next to the helicopter
landing platform, is an inverted roof.
Industrial Building and General
Services
The underground car park is waterproofed as well, since it was stated in the
design that the earth fill might be planted
with not only plants and garden shrubs,
but also trees.
In addition to the hospital building proper,
there is a second construction, a twostorey industrial building that contains
the laundry, the kitchen, the maintenance
area and the room housing the building systems equipment. This building
is connected to the main building by a
service tunnel.
The industrial building is roofed with
lacquered sheet metal and sandwich insulation panels.
Façades
The outer walls were most important,
because –the need to build quickly due
to the deadline issue aside– a building’s
façade says a lot about the building and
238
gives it its architectural character. For that
reason, what was sought was not only a
suitable system of construction, but also
the simplicity and functionality the building’s use required.
It is therefore a highly focused facility that
forms part of the system of hospitals for
public use and thus operates under an
arrangement with the Catalonian Health
Service.
The result was that prefabricated
modules were used between columns
and windows. This required large components that could live up to all applicable
standards and yet not fail to provide the
required geometry, levelling and linearity
on installation.
Description of the building
To make these components, moulds were
crafted in specialized workshops, and
the components were cast using specific
binders and stainless steel reinforcement
framework.
The insulation called for in the design was
incorporated at the site, and the interior
walls were built according to the needs of
each case.
Guttmann Institute
Background
The Guttmann Institute Foundation, a notfor-profit organization chartered in 1962
in Barcelona, created in 1965 the first
Spanish hospital specializing in the treatment and rehabilitation of paraplegic and
quadriplegic patients. Since then it has
been a pioneer in bringing to Spain the
most advanced techniques, procedures
and technologies in the realm of neurorehabilitation from all over the world, to
improve the quality of life of people who
have neurological physical disabilities.
With time the need for a new building
became pressing, to replace the original building and moreover furnish larger
facilities for a greater healthcare capacity. Thus, under an agreement signed in
1995 by the Catalonian regional government, the ONCE Foundation and the
Amigos del Instituto Guttmann initiative,
such a building was erected on some land
near Germans Trías y Pujol Hospital in
Badalona, with which the new Guttmann
Institute reached a cooperation agreement concerning shared functions.
The Guttmann Institute is the main hospital in Catalonia for the medical and surgical treatment and comprehensive rehabilitation of persons with medullary lesions,
cranioencephalic trauma, non-traumatic
cerebral injuries, progressive degenerative
diseases and other physical disabilities of a
neurological origin and for the neurological rehabilitation of children.
The new location for the hospital, an
excellent site with a view of Barcelona
and its coastal environment, has room
for spacious gardens, parking, a heliport,
spaces for families to spend time together,
indoor and outdoor rehabilitation zones, a
multi-purpose athletic facility for competitions, rehabilitation pools, a multi-purpose
room, a hairdresser, a patient laundry, a
chapel, a nursery, a shopping area, kitchens, dining halls, a coffee shop and all the
facilities the hospital’s own administration
needs.
On a 35,200-square-metre lot, the total
floor area is 17,200 square metres. The
five-storey-tall building is adapted to the
slope of the land.
Floor 0 or the access floor, where the
lobby, the customer service offices, the
Outpatient Clinic and the athletic pavilion’s tiers of seating are located, along
with two hospitalization wings, with
common areas and general restrooms.
Floor +1, where the administrative and
management spaces are located, with
common areas and general restrooms plus
a classroom seating 80.
Level -1, where there are another two
hospital units, a multi-purpose athletic
pavilion and therapeutic pools with shared
changing rooms, an image diagnostics
area, a bar, a dining hall, neuropsychology, a functional rehabilitation area, a
surgical block, sterilization, radiology and
a chapel, with common areas and general
restrooms.
Level -2, with outdoor access to the loading dock, where the kitchen areas, storerooms, the staff dining hall, water tanks,
staff changing rooms, the laundry, linens,
the mortuary service, the pharmacy and
the general system and building maintenance rooms have been placed.
Level -3, comprising the spaces intended
for vehicle parking and the spaces for
rubbish and waste.
• Medullary lesions: paraplegia, highlevel quadriplegia with respirator dependence and problems involving the cauda
equina(4), whether of traumatic origin or
medical or congenital origin (as in spina
bifida (5)).
• Cerebral damage: of traumatic or nontraumatic origin (tumours, encephalopathies, cerebral vascular accidents,
hypoxia) with serious functional and
cognitive consequences, and those
cases where only the higher functions
are affected.
• Progressive illnesses: multiple sclerosis
(MS), Parkinson’s disease, amyotrophic
lateral sclerosis (ALS), Friedreich’s ataxia,
muscular dystrophy, and so on.
• Other disabling complaints: persons
having a serious physical disability as a
consequence of the sequelae of polio,
other polyneuropathies, adult cerebral
paralysis, major amputations, and so on.
• Children’s rehabilitation unit: for children up to age 16 with major physical
disabilities of neurological origin (medullary lesions, cranioencephalic trauma,
non-traumatic brain damage, progressive illnesses, etc.)
Building procedures
Earthmoving, foundations and structure
Special machinery was used to excavate
41,920 cubic metres through hard rock
to reduce the elevation of the site; and
41,862 cubic metres of earth excavated
from the site were used in filling, terracing
and compacting work.
The foundations are shallow, with strip
footings for walls and isolated footing for
columns, with two-way bracing.
The building’s structure is mainly waffle
slabs for floors and concrete columns.
Retaining walls and foundation walls
around staircase and lift cores. The pool
roof is a 30-centimetre concrete slab,
with 50-by-108-centimetre girders and a
15-metre span between columns. Metal
structures were used for the multi-purpose
athletic facility and the lobby.
4
A complex of symptoms and signs consisting in
lower back pain, unilateral or bilateral sciatica,
motor deficit in the lower limbs, sensory disorders,
sphincter disorders (urinary and/or anorectal) and
disorders in the sexual sphere
5
Birth defect of the neural tube wherein one or more
posterior vertebral arches have not fused correctly
during gestation, leaving the spinal cord unprotected
by bone
Distribution by function
At present, the Guttmann Institute
conducts its healthcare activity through
five clinical units:
Outer Walls and Roofs
The outer walls combine a white singlecoat mortar finish with exposed-frame
curtain walls containing transparent
glass with white butyral(6) or tempered,
acid-etched glass, and aluminium frames
for windows and closing walls between
storeys.
The roofs are flat, inverted and covered
with round gravel. Roofs at the multipurpose athletic pavilion are made of a
sandwich of ribbed sheet aluminium, and
roofs in the outdoor rehabilitation zone
are made of pavement with artificial stone
supported by PVC.
Interior finishes
Floors are generally paved with terrazzo
tiles, although at the surgical block the
flooring is anti-static conductive PVC;
at radiology, it is anti-static PVC; at the
swimming pool, restrooms and changing
rooms, it is anti-slip PVC; in the multipurpose athletic pavilion, it is PVC athletic
flooring with an elastic component
underneath; and the parking facility and
service room floors are trowelled, painted
concrete.
The interior dividing walls are made of
brick, on which a mortar coat and a plaster coat have been sprayed and smoothed.
The wall finish in the halls and public areas
of the entire building is decorative HPL(7)
up to door level, with stainless steel trim.
In the surgical zone, the finish is HPL all
the way up the walls. On the walls of
hospitalization wings, public restrooms,
changing rooms, swimming pools, the
Radiology Department, the pharmacy
and the administration and management
offices, it is Tarkett-type vinyl; and in the
multi-purpose room, the chapel and the
athletic pavilion, it is wood all the way up
the wall. Polyurethane paint is used in the
basements, and plastic paint is used along
the top of the walls in the public areas.
The dropped ceilings contain plasterboard tiles with a vinyl finish. The system
6
7
is removable, made of cold-rolled, whitelacquered box profiles, with self-levelling
suspension and a threaded bar as the
general base. Sound-absorbing flat ceiling
in the athletic pavilion. False ceilings made
of plaster in the surgical zone, the multipurpose room, the kitchen and the lobby.
Significant units
Pools
There are two hydrotherapy pools. One is
large, 13 by 6 metres, ranging in depth
from one to 1.8 metres. It has two side
ladders and a side wheelchair ramp, in
addition to a mechanical lift for patients
of reduced mobility.
Water is pumped in through nozzles on
the vertical walls of the pool and returned
through skimmers(8) placed around the
pool’s edge. There is also a grate skirting the entire the pool to collect water
splashed out of the basin.
There is another, smaller pool measuring
8.5 by 2.5 metres and a maximum of one
metre high. It is raised above the floor,
and it is accessed by using a crane that
swings both in and out. This swimming
pool is split into two zones. One has three
tiered levels, and the other descends to
the maximum depth. Both have support
rails for patients to grip.
Multi-purpose athletic pavilion
The athletic pavilion measures 32 by 23
metres on the ground and has a clear
height of seven metres. There is a rail-andcurtain arrangement for separating the
pavilion into two spaces for different uses.
The pavilion is set up in two levels. At
the bottom level lie the athletic court and
the attached changing rooms (also used
for the pools). This level can be reached
directly from the rehabilitation zone and
the general hallway on the ground floor.
The top level holds tiered seating and
doors providing access for people who
have come in through the front door. It
also holds the floor’s general restrooms.
PVB or polyvinyl butyral is a resin that is regularly
used in laminated safety glass. It is very good for
adhering panes of glass to each other, because it
transmits stress between panes, although the PVB
itself has no mechanical resistance. It also prevents
fragments of glass from coming loose if the pane is
broken.
The roof is sheet metal over a sawtooth
metal structure with skylights and maintenance catwalks. Sound-absorbing finishing panels are installed in the ceiling.
High-pressure laminate. Several transparent layers
are pressed together with decorative paper, forming
a single unit that can resist an extreme load. This unit
is then placed on a foundation board and pressed to
adhere to it. The result provides maximum resistance
to blows and high indices of resistance to wear due
to rubbing.
The rehabilitation area has different zones,
depending on the exercise patients must
take and their progress toward recovery.
Rehabilitation area
8
Also called a “protein skimmer.” This is a device that
sucks in surface water, collecting any floating debris.
239
First, there is an exhaustive rehabilitation area, with articulated beds that help
patients assume different positions, metal
accessories such as grab bars and auxiliary
devices (pulleys, braces, ropes, etc.).
Other spaces are devoted to physical therapy work and manual work, where there
are computers to help develop coordination of movement.
Another area has a guide rail from which
a patient can be suspended, to hold up
his or her body while the patient “learns”
to walk.
Yet another area is devoted to the activities of daily life. It has a kitchen and a
toilet, for practicing common household
tasks.
The outdoor area is used to practice negotiating stairs and ramps and manoeuvring
an automobile.
Surgical area
There are two operating theatres fitted
out identically, although one is larger than
the other. Each has an anaesthesia cart, a
surgical cart, a two-armed lamp, an operating table, electrically actuated automatic
doors and a recessed control panel in the
wall.
All the medical items in the operating
theatre are connected to the room’s equipotential grounding network. Likewise,
the floor has an equipotential underlayer
made of copper mesh.
Hospitalization area
There are 64 double rooms in the hospitalization area. Each has three differentiated spaces, a bed area, a toilet area and
an entrance with a clothes cupboard and
medical sink. One of the beds has a bed
crane. The toilet room is fully adapted for
patients with disabilities.
Installed systems
Plumbing
The plumbing system includes the mains
pipes, which run in from outside to water
storage tanks, the water treatment system
and the internal system carrying water to
points of use.
There is a single water main from which
the hospital draws four separate water
systems, to wit: cold sanitary water, hot
sanitary water (55 ºC), mixed water (35
ºC) and decalcified water.
Hot sanitary water is produced by heat
240
exchangers.
Water is stored in three concrete tanks
having a useful capacity of 100 cubic
metres apiece. Two of the tanks cover the
hospital’s water needs, and the third is
used for irrigation, with a backup safety
level for fire protection.
The sanitary water storage facilities have a
magnetic anti-lime treatment and include
a pump for recirculation to the tank.
Cold water is drawn off by a set of four
pressure pumps, one of which has a speed
regulator. Its flow rate is 108 cubic metres
per hour at a pressure of 30 mWC.
General plumbing uses hot-dip galvanized
pipes running through the dropped ceilings of the hallways to the distribution
cabinets, which are one to every two
rooms. The secondary plumbing uses
polypropylene pipes from these cabinets
to the points of consumption.
The 35 ºC mixed sanitary water is needed
for consumption in hospital zones, toilet
rooms and changing rooms, since some
patients have low sensitivity to temperature changes. Mixing is handled by thermostatic valves situated close to the
consumption areas. Temperature is guaranteed through a water-recirculating
pump with temperature, pressure and
flow control.
The pool water is treated using sand filters
900 millimetres in diameter for the small
therapeutic pool and two units 2,000 millimetres in diameter for the large pool. Pool
water is heated by sheet heat exchangers.
HVAC
Different zones of the hospital are defined
for significant treatment:
• Kitchens: The general smoke extraction
area, the food preparation area and the
food-serving areas have separate units
(heat pumps).
• Pools: Pool air is drawn into a pipe for
dehumidifying and returned through
grilles with double regulators.
• General storerooms: HVAC facilities consist basically in a pre-treated air
supply vented directly outdoors.
• Changing rooms, offices: Treated air
is blown in by ceiling fan-coils. Outside
air is mixed straight into the return air to
guarantee quantity and freshness.
• Rooms: The same as above, but blown
in by a rotating diffuser in the centre
of the room and returned through an
exhaust grille in the dropped ceiling
above the door to the room.
• Dining hall and rehabilitation zone:
Because of their orientation and the
existing staff load, these areas have an
independent air treatment unit. Air is
distributed through metal ductwork to
rotating diffusers built into the dropped
ceilings and returned through ceiling
grilles.
• Operating theatres: Air treatment on a
par with white room standards(9). Absolute filters with temperature, humidity
and air pressure control; one humidifier per operating room, using water
vapour; 100% outside air, blown in by
rotating diffusers and drawn out at floor
level by return grilles set in the corners
of the room.
• Multi-purpose athletic pavilion:
There is a separate air treatment unit for
the pavilion, which blows air through
metal ductwork built into the top of the
wall along one side of the pavilion. Air
return is underneath the tiers of seats,
three metres above the surface of the
playing court, through return grilles. A
good air sweep is guaranteed by the fact
that air is blown out from the wall and
returns to a spot lower in the same wall,
underneath the seating.
The cooling plant sits on the roof. It has
two 421.4-kW water-chilling units.
The heating plant is located in basement
-2. The room has an entire wall made
of metal grille for direct outdoor ventilation. There are three natural gas-burning furnaces rated for a 407-kW output
apiece.
The heating/cooling distribution system
has four pipes running through the
dropped ceiling of the general hallways
and air wells running vertically through
the different storeys of the hospital. The
system allows different areas of the hospital to be heated or cooled separately at
the same time, to adjust to zone parameters and exposure conditions.
In basement -2 and in the general hallway, this distribution system is used as a
general cold water propulsion and return
manifold. It is equipped with a dilation
9
A “white room” or “clean room” is a room especially
designed for low levels of contamination; it therefore
must meet very strict contamination, temperature,
humidity and pressure control conditions
system for hot water and cold water alike.
It has a manual and automatic air purge
system to ensure smooth operation and
facilitate starting up the system. It is fitted
with a pipe-emptying device at a low
point in the system.
A manual surrounding system has been
fitted at the hot sanitary water accumulator tanks, to raise the internal tank
temperature to 70 ºC to avoid the existence of legionella.
Medical gases
The different medical gases in the system
are oxygen, nitrous oxide, vacuum,
compressed medical air at a pressure of
four bar and air at a pressure of seven bar
for supporting medical equipment.
These are independent systems running
through the dropped ceilings of the
general hallways and rising through
vertical shafts provided for that purpose,
from the production centres located in
basement -2 to the different points of
consumption.
The oxygen, compressed medical air
and vacuum systems run through all
the hospital wings and the hospital in
general (operating theatres, rehabilitation,
doctors’ offices, pools and the Radiology
Department).
The nitrous oxide and seven-bar air
systems are only available in the operating
theatres, dental examination rooms and
sterilization rooms.
They use copper pipes welded solidly
together. Silver rod is used as the fill material.
The oxygen supply room holds two manifolds with eight 50-litre bottles apiece,
with an automatic changeover system to
guarantee supply.
The compressed-air production room
holds a double compressor unit, with oil
lubrication and subsequent filtration and
air cooling. The output air pressure can be
regulated to four or seven bar.
The nitrous oxide production room holds
two manifolds with two 50-litre bottles
apiece and a pressure-reducing station
with the capacity to process 70 cubic
metres per hour.
In addition to benefiting from the filters
and purge valves their respective production supply rooms have, the air system
and the vacuum system have been built
with the appropriate slope to facilitate
the removal of any water condensate that
forms inside the air system and any secretions/deposits that form in the vacuum
system. There is a system of easily reached
purge valves and collection reservoirs
installed at strategic spots.
The hospital is divided into eight zones,
and each of these zones has a medicinal
gas alarm station containing general shutoff valves, a pressure gauge for each type
of gas, a vacuum meter and visual and
acoustic alarm signals.
At the head of each bed in the rooms are
an oxygen outlet, a four-bar air outlet and
a vacuum outlet.
The operating theatres have all the medical gases: oxygen, nitrous oxide, vacuum
and air at four and seven bars of pressure.
Wiring
The wiring is medium voltage (25,000 V).
The transformer substation contains two
silicon three-phase power transformers
with a power output of 1,000 kVA apiece.
The low-voltage wiring runs through two
main panels located in basement -2. One
of them is near the transformer substation, and the other sits at the geometric
centre of the hospital. One powers the
machine rooms and the kitchen, and the
other, the hospital wings and the rest of
the different sections.
The wiring goes through cable trays that
run along the dropped ceilings of the
general hallways and rise through air
shafts intended for that purpose. From the
subpanels on each floor, the cables travel
through flexible, two-layer corrugated
pipes to the points of consumption or the
circuit breaker panels of each room.
The light fixtures in the general storerooms
and the garage are surface-mounted and
watertight. In the suspended ceilings in
offices and storerooms, they are recessed
fluorescent screens with V-shaped diffusers. The fixtures for the general hallways
are strip lighting recessed in the dropped
ceiling, with louvers. In the rooms, the
lights are built into the head of each bed.
In addition, there is a recessed nightlight
in the wall, and there are energy-saving
downlights recessed in the ceiling at the
entrance to each room.
In the operating theatres, the wiring was
prepared for the installation of shadowfree ceiling lamps to be provided by the
hospital. Ambient light is provided by
recessed lamps with prismatic diffusers,
equipped with an anti-dust seal for sterile
environments meeting white room standards. The operating theatres are also
equipped with a 7.5-kVA isolating transformer.
Outdoor lighting is provided by mercury
vapour lamps using metal halides. The
lampposts are four metres tall.
The hospital has an uninterrupted power
supply (UPS) furnished by two five-kVA
units having 15 minutes’ autonomy and
another two one-kVA units having 60
minutes’ autonomy.
It also has a 360-kVAr battery of capacitors
to correct the reactive voltage produced
by the fluorescent lamps.
Other installed systems
• Fire safety system: With a pressure
pump for the fixed fire-fighting equipment (FHCs) and portable fire-fighting
equipment (CO2 and multi-purpose dry
chemical extinguishers); smoke detection systems
• Security: Outdoor CCTV(10) monitoring
equipment and centralized, encoded
security locks
• TV/FM signal reception and internal
distribution
• Internal distribution of cable TV signal
• Internal telephone wiring (voice/data
network)
• Internal PA system and mood music
• Patient/nurse call system between each
room and the nursing centre, with call
forwarding between nursing centres
Ciudad Real General
Hospital
Background
Ciudad Real General Hospital (CRGH)
went into construction on 28 May 1998
on a 162,263-square-metre lot in southern Ciudad Real owned and ceded by
the city. It replaces the two hospitals the
city used to have, Alarcos Hospital and El
Carmen Hospital.
When work began, the owner was the
Spanish health institute, INSALUD, but,
after the transfer of health-related authority from national to regional governments,
the owner is now SESCAM, the Castilla-La
Mancha Health Service.
10
Closed-circuit television
241
The lot’s potential floor area is much
greater than the actual floor area built,
so there is room for future alterations or
expansions as required.
Geometric description of
the building
The structure is in fact made up of 42
independent buildings connected by
their expansion joints. The buildings are
grouped into four big blocks dubbed C, E,
W and S (Central, East, West and South).
C Block is located in the centre of the
complex, and in it are the hospitalization units. There are five floors devoted
to hospitalization, plus a ventilated crawl
space (on floor -1). The HVAC equipment
for these buildings is on the roof.
Floors 2, 3 and 4 are the same. On floor 2
there are hallways separating the patient
and family traffic from the hospital staff
traffic. These floors contain 386 hospitalization rooms, each prepared to house
two patients.
There is also a penitentiary module, with
six special rooms for housing convicts.
In the last building in C Block, which is
only four storeys high, are the offices of
the medical personnel, the computer zone
and the Data-Processing Centre (DPC).
The two-storey W Block also has a ventilated crawl space and systems machinery
sheds on the roof. In addition, it contains
the hospital’s support services and clinical treatment services: the pharmacy, the
Sterilization Department, the laboratories,
the Nuclear Medicine Department, the
files, the Radiotherapy Department, the
Outpatient Clinic, the operating theatres,
the Emergency Room, etc.
Block E encompasses the admissions,
administration and teaching areas. These
are one-storey buildings with no ventilated crawl space or rooftop machinery
sheds. They hold the chapel, the auditorium, the library, classrooms, the admissions desk, the hospital management and
the hospital administration.
Connected to the hospital by two underground tunnels is the service building (S1),
the centralized location for the storerooms, heating and cooling units and
generator sets.
Floor -1 is for the internal traffic related
with kitchen services and storerooms and
other occasional traffic. It also holds the
mortuary service, the waste service and
242
rooms for installed systems. The rest of
the floor consists of service tunnels. The
water, gas and power systems run from
their supply rooms or control stations
through the service tunnels, and the rainwater and sewage plumbing runs through
them as well.
There are also areas for the treatment of
special RIA (radioimmune analysis) waste
and hospitalized cancer patient waste,
and the general water storage cistern and
its pumping and treatment station.
The hospital is fitted with a total of eight
bed lifts (two in each lift/stairway core),
23 passenger lifts, two escalators for the
Outpatient Clinic, two cargo lifts in the
service building, three instrument dumbwaiters in the Sterilization Department
and metabolic treatment rooms and a
casket lift in the Pathological Anatomy
Department.
The complex has spacious landscaped
areas and a total of 1,180 above-ground
parking spaces.
Drives run only around the outside of the
complex, to and from the different parking areas, although there are direct routes
to the main entrance, the emergency
area, the service and delivery areas and
the mortuary service.
by functions
CRGH has latest-generation technology and a modern structure that separates the healthcare areas from the areas
frequented by outsiders. It features open
spaces full of light, specific premises
designed for teaching and training future
healthcare professionals and an involvement among the different departments
that makes healthcare procedures run
more smoothly.
The hospital is structured into different
analysis areas. These include the medical services, surgical services, common
or central services, patient management
support services and non-healthcare
support services. The types of services
have been greatly increased with the
incorporation of new units and technology; these enable the hospital to offer a
higher quality of healthcare for its target
population as well as to avoid having to
move patients to other hospitals inside or
outside the region.
The departments created only recently are
Geriatrics, Maxillofacial Surgery, Neuro-
surgery, Radiotherapy, Haemodynamics,
Childcare, Radiological Protection and the
Pain Clinic.
On the organizational side, as many
processes as possible have been reconfigured on a “same-day” basis; more outpatient hospital services have been made
available; the supplementary testing area
has been streamlined for speed; the areas
used for diagnoses have been clustered
together; and the availability of emerging
therapies such as radiotherapy and pain
therapy has been increased.
Lastly, the resulting hospital is safer
throughout its entire concept. It is a
closed, monitored area equipped with
smart systems managed from a single
point of control, and it has plenty of parking space.
The psychiatric hospitalization ward is set
up as a separate block from the rest of the
hospital services. That block also holds the
Outpatient Clinic, the hospitalization area,
the Detox Unit and the outpatient hospital
services.
There is a centralized Sterilization Department for the entire hospital. All material
from the other hospital services is deposited there. To handle the load, the service
is equipped with two instrument dumbwaiters that connect the unit with the
surgical block immediately above it.
There are three sectors for material reception and distribution: dirty, non-sterile and
sterile. Each has its own supply and staff
areas.
There is an area of special testing rooms,
obeying the philosophy embodied in
the building’s architectural design. That
philosophy calls for common and multipurpose areas centralized by product,
and thus a fragmentation of the “department” as traditionally conceived. The area
includes 11 rooms for special heart, digestive medicine, urological and lung examinations.
The Image Diagnostics or Radiodiagnosis
Department is outstanding, not only for
its latest-generation technological equipment, but also for its introduction of digital radiography. The goal is to digitalize
medical imaging services and do away
with the use of X-ray film very soon.
The clinical laboratories are designed
according to a comprehensive, all-encompassing concept that includes different areas of knowledge: blood extraction, sample reception, result reporting,
biochemistry, immunology, microbiology,
allergy, isotopes, emergency work, molecular biology, genetics, haematology, a
blood bank, the Regional Transfusion
Centre and pathological anatomy.
One of the most interesting features of
these laboratories is the fact that their preanalysis, analysis and reporting phases are
automated.
The Nuclear Medicine Department is organized into an unprotected zone envisioned
for the medical areas and patients who
have not been infiltrated and a protected
zone holding the infiltrated patients
and the medical techniques that require
special access.
Radiotherapy is a new department.
It adds two innovative techniques to
conventional radiotherapy via electronemitting linear accelerator: radiosurgery
and brachytherapy(11) for the treatment of
cancer.
This unit includes a radiosurgery operating
room or brachytherapy operating room. It
also has a CT simulator for running simulations of the treatments scheduled to be
administered. The virtual simulation and
three-dimensional planning techniques
have hugely favoured the precision of
radiation treatments.
Then there is the issue of waste disposal.
The different types of waste the hospital
creates are sorted into four clearly differentiated blocks:
• general solid waste, from the pick-up
carts
• iodine-treated liquid waste, from hospitalized patients’ rooms
• radioactive waste, from the Nuclear
Medicine Department
• infectious waste
The latter is bagged, and each bag is identified as containing infectious waste and
stored in the general waste area, to be
burned or disposed of later.
Pick-up is daily, to avoid the decomposition of organic matter.
Next to the Emergency Room entrance a
raised heliport has been built, connected
to the Emergency Room by a walkway.
No hospital in Ciudad Real has ever had a
11
Radiotherapy treatment consisting in the placement
of encapsulated radioactive sources within or near a
tumour (“short” distance between the volume to be
treated and the radioactive source)
heliport before, but, taking into account
all the medical specializations Ciudad
Real General Hospital covers, at any
time there may arise the urgent need to
bring patients to the hospital from faraway points of the province or even from
anywhere in the region.
Furthermore, the province is a very large
one. Its population density is low, and its
inhabitants are very widely scattered. This
limits their access to the health system in
general and makes it difficult to handle
emergency episodes, particularly medical
emergencies. Ciudad Real General Hospital is moreover a transplant organ extraction centre, and urgent transport is in
many cases required for that reason.
The heliport structure consists in a
concrete platform raised six metres above
the ground, far enough to clear the
surrounding obstacles and prevent their
becoming potential hazards.
Foundations and structure
Because of the irregularity of the terrain,
different foundation solutions were used.
There are single footings, strip footings, floating foundations and reinforced
concrete slabs. A total of 21,000 cubic
metres of concrete were used at the site.
Earth containment in the basement area
was achieved by combining 30-centimetre-thick reinforced concrete wall with
precast wall made of hollow-core slabs
measuring 1.2 by 3.5 metres, which
required a special footing to rest on, plus
mortising of the ribs along the edge of the
ground-floor floor structure.
Different systems were combined in the
structure as well:
• One-way joists and hollow-core slabs for
floorings, on low supporting walls made
of reinforced concrete of a thickness
ranging between 20 and 30 centimetres in the areas of the ground floor that
have no basement (E block)
• Thirty-centimetre-thick inclined slabs
of reinforced concrete on the roofs of
the hospital service buildings, whose
geometry made it necessary to assemble
approximately 75,000 square metres of
formwork
• Metal roof in the service building, made
up of ten 38.1-metre-long frames, each
made of vertical HEB profiles on concrete
columns, with 6.3-metre spans, and
inclined IPE profiles; side timbers were
also IPE profiles; total steel use: 123
tonnes
• Metal roof in the Emergency Room and
ICU courtyard, made of eight 52-metrelong frames with IPE steel profiles and
side timbers; the two central frames rest
on six box girders with a span of 10.3
metres, trapezoidal geometry, measuring 2.2 metres along the edge, built
using 20-millimetre-thick sheet metal
(200 tonnes of steel)
The vertical structure was built using
reinforced concrete columns of different geometries and sizes and 20- and
30-centimetre-thick retaining walls.
The 42 independent buildings that make
up the hospital are separated from each
other by three-centimetre expansion
joints. The solution used in most locations
was a double column, with stainless steel
Titan pins supporting the expansion joint
where necessary.
Outer and inner walls
C Block has two types of outer walls. The
main façade (where the hospitalization
rooms are located) is made of enamelled
red brick laid in a stretcher bond, with
insulation sprayed onto the wall’s internal face, backed by double hollow brick.
The two walls are held together by stainless steel anchors (five per square metre),
and the brickwork is also anchored to the
façade columns. Murfor-type reinforcement was used in the panels that are
subjected to greater stress.
• Waffle slabs of reinforced concrete in
temporary 80-by-80-centimetre pan
forms and a 12-centimetre-thick rib in
the rest of the ground floor
The rear wall of C block is made of a
prefabricated galvanized steel panel with
insulation on the internal face, anchored
to the concrete structure by an auxiliary
structure of galvanized steel; the backing
wall on this is solid brick laid in a stretcher
bond, with a water-repellent rendering
coat on the outside.
• Thirty-centimetre-thick
reinforced
concrete slabs in the rest of the floors of
the building structure
Block W, whose buildings lie to the rear
of C Block, has red or white clinker brick
façades.
243
The Outpatient Clinic façade (which faces
north) is ventilated and made of Roman
travertine marble.
The building’s internal partition walls
are made of drywall. Ground-floor walls
are two 19-millimetre drywall boards in
a 90-millimetre structure, and the rest
of the floors have a 70-millimetre structure, because the ground floor is taller.
The sound and heat insulation required
between sections is provided by rock wool
installed between the drywall layers. In
the more humid zones, humidity-resistant
drywall was used.
The partition walls between sectors are
built with solid brick laid in a stretcher
bond.
Interior finishes
The building’s floors are prefabricated
40-by-40-centimetre terrazzo tiles in the
hospitalization areas; terrazzo cast in situ
in the Outpatient Clinic, the main hallway,
the nurses’ desks and lift lobbies; conductive PVC in operating theatres; anti-slip
flooring in room bathrooms; wood flooring in classrooms, the library and the auditorium; and granite at the main entrance.
The suspended ceilings have aluminium
louver panels in hallways and installed
system zones and plasterboard tiles in the
rest. The ceilings of the auditorium, the
classrooms and the library are wooden.
Indoor window and door frames and
trim are wood in rooms and the Outpatient Clinic (the baseboards in the Clinic
are stainless steel) and all stainless steel in
hospitalization support zones. There are
screens made of stainless steel, of glass
and of glass brick.
The exterior window and door frames and
trim are aluminium.
Roofs
The roofs of C Block are flat with coloured
gravel. They are comprised of 300-gram
geotextile sheeting where slopes form,
1.2-millimetre fibreglass-reinforced PVC
sheeting, 300-gram geotextile sheeting,
four-centimetre extruded polystyrene
insulation, 150-gram geotextile and a
12-centimetre layer of coloured gravel.
The roofs on the W, E and S blocks are
sloping, and they have mostly been made
of zinc, although in some sectors of E
block they are copper. Inside these roofs
lie three centimetres of polystyrene insulation, 19-millimetre water-repellent boards,
244
a Delta-Drain-type vapour shield(12) and
0.6-millimetre pre-weathered zinc sheets
with a raised seam (Belgian-type anchoring using treated pine laths).
Installed systems
Wiring
The building’s great length (450 metres
from end to end) is the reason why
medium-voltage wiring (15 kV) was
installed. There are four transformer
substations (8,000 kVA) arranged in the
basement, next to each vertical general
panel. There is another transformer
substation (3,000 kVA) for the HVAC
equipment.
The 15-kV system is laid out in two loops
or closed rings, with the aim of ensuring
service in case of line failure and therefore
power failure. In case there is a failure in
the mains power, there are two generator
sets held in reserve, capable of producing
1,500 kVA apiece, synchronized to operate in parallel and powered at 400/230 V.
The lighting system uses fluorescent,
incandescent and discharge lamps and
is distributed with a mind to which type
of lamp is used, such that in rooms or
sections where the general public may be
present, a loss of power can never affect
more than one third.
HVAC
The object of this system is to create the
ventilation and air heat/humidity conditions demanded for the different sections
comprising the hospital. It is also in charge
of keeping air pressure low in restroom
and storeroom areas, to prevent odours
from leaking into adjacent spaces.
As this is a hospital, it has certain HVAC
needs. There are zones that require more
ventilation than the standard HVAC code
demands. But there are also other zones
where there must be no air recirculation,
to improve ventilation and avoid the risks
of cross contamination.
For nursing zones and hospitalization
rooms, two-pipe fan-coils are used, with
individual units in each room/area. They
are usually located in the dropped ceiling,
and they provide temperature control on
an independent, room-by-room basis.
The operating theatres each have independent single-zone HVAC units. Their
12
Draining geocomposite with double nodules and
built-in geotextile, designed for wall drainage and
transpiration
exhaust system is independent as well.
For those spots that require little zone division by temperature but good ventilation,
a low-speed system is used.
For the Outpatient Clinic and the outpatient hospital services, a high- or mediumspeed system with a single duct is used.
For the kitchens, there are units to draw
in pre-treated outside air and an exhaust
system to vent exhaust air through sheet
metal ducts with attached grilles.
The machine room where water is chilled
and heated is located in the service building. The rooms holding the HVAC units
and other equipment are scattered over
various spots on the roof of floor +1 and
in rooms on floor +6.
The hospital has different energy recovery
systems for different zones; there are air/
water, enthalpic and free-cooling systems.
All the water circuits have differential
pressure controls for flow regulation,
with the resulting energy savings, since
the controls can adjust the pump output
to the building’s heat needs at all times,
in addition to keeping the main fluids at
their design temperatures (6 and 85 ºC).
Fire protection system
The fire protection system is mainly to
defend the building’s occupants from the
risks of all sorts posed by fire and secondarily to safeguard the hospital’s physical
assets, including the building itself.
The hospital is a new edifice, with fireproof concrete floor structures and lateral
enclosures built of masonry. Since it
occupies an independent lot, all hospital
accesses can be used as evacuation routes
and/or fire vehicle posts.
Given the building’s characteristics, early
evacuation is vital. For that, any possible
fire must be detected from the very beginning. Moreover, due to the variety of
materials in the hospital, the types of fire
that can break out are many. For these
reasons, the option chosen was a pointto-point analogue detection system using
OTI (optical, temperature and ion) multisensors. This way the undesired alarm rate
is practically zero and the reliability of fire
detection is enhanced.
Fire shutter triggering is controlled from
the control station. If a detector gives a
fire alarm and that alarm is confirmed by
another detector in the alarm state in the
same fire sector, the control station gives
the order for the shutters for that zone to
close.
If an alarm button is pressed by hand,
the shutters in that sector are actuated directly, blocking off the sector and
sounding the sirens.
Voice and data system
This system, embodied in a structured
system of wiring, provides support for the
hospital’s telecommunications systems. It
is designed so that each connection can
be used for voice service or data service;
the necessary function is assigned in
the distribution cabinet. This makes it
an adaptable, flexible system where no
a-priori distinction is made between
stations dedicated to voice service and
stations dedicated to data service.
The system is distributed via single-mode
optic fibre, and it has voice and data jacks
in almost every room of the hospital.
It is directed from the main administration
subsystem, or DPC. The vertical subsystem
takes care of connecting the DPC in a star
array with each of the floor-wide distribution cabinets. These provide coverage for
the work stations currently required and
any future enlargements, such that none
of the computer system jacks lie outside
the 100-metre distance set in the pertinent codes.
The horizontal subsystem includes the
cables between the distribution cabinet
for each floor and the work stations on
that floor. A cable is installed for each
network connection, running free of
breaks or splices anywhere in its layout.
Comprehensive
management
installed systems
of
This system comprehensively governs
the following general types of installed
systems, using the building’s communications services and networks to do so:
• Central heating, ventilation and airconditioning subsystems
• Individual air-conditioning subsystems
• Electrical power subsystems
• Electrical lighting subsystems
• Plumbing subsystems
It can also accommodate third-party
systems. For this, it has standard connections making it possible for the end user to
plug in subsystems and equipment made
by different manufacturers.
The system’s communications network
has been designed on three platforms:
• The first is based on standard communications protocols for local networks, and
it facilitates communications among the
central supervision stations
• The second encompasses the primary
floor-wide processors and the zonewide managers (which serve as the link
to the environment processors), and it is
a point-to-point or P2P communications
system
• The third encompasses the environment
processors
Comprehensively managing the various
systems installed in the building means
keeping them all under the directorship of
a single system that permits specific supervision, automation and control over each
system, while making it possible for them
to exchange all kinds of information and
actions, always taking advantage of the
management system’s own communications infrastructure.
The distributed processors are connected
to a data bus where the point-to-point
communications
protocol
(especially
designed for real-time processes) ensures
that data transmission is highly reliable
and that all the processors connected to
the data bus have the same right to and
opportunity of data transmission.
All the data from all the distributed
processors are routed to a common database, where they are processed and their
output is prepared for the outside world.
This database is manipulated from a work
station at the service of the system’s operators.
At the work station reside a number of
operator/system liaison programs, which
are in charge of making it transparent,
comfortable and simple to request and
analyze the kinds of data and reports the
system can facilitate (from all the integrated subsystems).
The system monitors and automatically
controls the different equipment in the
various systems installed in the building,
as well as the electromechanical processes
that must be run, be they central (the
cooling/heating plants, HVAC units, transformer substations, power-distributing
boards) or individual (fan-coils, lighting).
The duly grouped information from the
hundreds of terminal units serves to establish strategies for readjusting the cool-
ing power, heating power and electrical
power to be produced or used at all times.
Each of the environments where terminal
units are installed is the object of monitoring, automation (adaptation to schedules) and control, from the system operator’s consoles. The system operator also
manages power consumption and utilizes
the resources of the various distributed
processors and subsystems, reacting to
the extent and in the combinations necessary each time.
The system facilitates knowledge-based
fuzzy logic control(13) to apply in certain
control loops, creating stable control
with self-learning in critical applications,
obtaining additional energy savings.
Information may refer to the current time,
but it may also be historical information,
referring to a selected time period, if what
is desired is to see what happened in a
given time interval.
Point alarms can be classified at the user’s
request as critical or non-critical, and the
alarms pending acknowledgement can be
displayed as well. When a device or piece
of equipment has passed the limit placed
on its working hours, the appropriate type
of maintenance action is indicated as well.
All these actions take place in coordination, that is, ensuring that the authorized
acknowledgement of an alarm at an operator’s station is sent over the network to
the rest of the operators’ stations.
The only exception to this latter rule is
the points from the fire panels, which are
acknowledged at a certain station termed
“the main fire station”.
Any alarm that arrives is treated by fuzzy
logic applications, which are explained
above. In this view, the alarm function
must not only show on/off status, but
also report on the alarm’s course, that
is, whether the alarm is getting worse or
better. An alarm given some time earlier,
which in turn triggers a device to address
the situation, may already be in the
process of being handled when the operator notices it. In that case no further action
on the operator’s part will be needed.
Medical gases
This installed system is for the centralized
supply of gases for medical use (oxygen,
nitrous oxide), compressed medical air
at two air pressures (five and eight bar)
13
The idea of fuzzy logic is to permit a certain variation
in the observed parameters before applying an
actuator to modify them, thus avoiding infinite
loops due to infinitesimal differences
245
and vacuum for suction. This supply is
continuous and of high quality, and it is
adequately controlled. Special attention
has been paid to safety aspects, since
these are vital supplies.
The working pressure is five kilograms
per square centimetre for oxygen, nitrous
oxide and compressed medical air. For the
compressed industrial air (used in pneumatic tools in the operating theatres), the
working pressure is eight kilograms per
square centimetre. The vacuum system
works at -0.6 bar.
The pressurized gas supply rooms have
the appropriate filtration equipment to
ensure a supply of gas free of impurities.
The rooms where the gas equipment is
housed and the zones adjoining them
have direct ventilation top and bottom to
the outdoors, enabling air to circulate and
preventing any leaked gases from entering the building’s air-conditioning system
or the compressor units’ air intakes.
They are also equipped with a drain trap
connected to the waste plumbing system
and a flameproof, airtight lighting system.
In the particular case of the compressedair and vacuum production room, the
room’s temperature is never allowed to
rise to over 40 ºC.
All areas of the hospital are equipped with
specific medical gas outlets for mounting in the wall, in panels at the head of a
patient’s bed, etc.
There are also special installed systems,
such as the anaesthetic gas exhaust
system installed in operating theatres,
which carries anaesthetic gas outside the
building through the HVAC return air
ducts.
Pneumatic transport
There is a pneumatic transport system
for blood samples and documents that
connects all points in the building to
each other. For this system, there are 72
sending stations in a basically horizontal
layout. The services that use the system
the most heavily are the Emergency Room
laboratory and the hospital pharmacy. The
operating theatres are not great users of
the system, but they are very special users,
because they need speed in both sending and reception. The Outpatient Clinic
moves mostly documents (clinical histories).
All the standard pneumatic transport
systems on the market allow a single
246
capsule to run per shipment in each facility (or zone), so supposedly a system’s
traffic capacity is given by the duration
of the shipments it handles. And duration is a function of speed and distance,
and since the speed has to be restricted
for blood shipments (two to three metres
per second), the system may be busy for a
long time for each shipment. A long busy
time limits the system’s capacity greatly.
If the speed is limited and the distances
are what the hospital’s layout requires,
the only physical way of increasing the
traffic capacity is to allow different shipments to run simultaneously. This can be
done by distributing the system as a whole
into several autonomous zones, with
the possibility of transferring shipments
between zones.
To avoid interference with the general
pneumatic network, but above all to
afford immediate full availability, the
following services have been equipped
with direct, exclusive connections:
• The Emergency Room with the Emergency Room laboratory
transport system was therefore installed,
with self-driven carts on ceiling rails.
The approximate distance is 140 metres,
so, considering a shipment every five
minutes, three carts are needed in order
to have one cart always available in the
extraction zone.
Nuclear medicine
This zone includes the following rooms:
• Radiopharmacy
• Radioisotope storeroom or gamma
source library
• Dose preparation
• Lock
• Waste storeroom
• Lounges and restrooms for injected
patients
• Examination rooms
• Gamma chambers
• Functional studies
• Laboratory
• The blood bank with the operating
theatres
• Staff changing rooms (including decontamination room)
Mechanical transport
Because of the special hazardous conditions of this area, the Nuclear Medicine
Department’s walls, floors, ceilings, doors,
windows, etc., need structural protection from radiation (usually three- to fivecentimetre-thick lead sheeting embedded
in structural elements, and five-centimetre
leaded glass where glass is required).
In hospitals, pneumatic transport systems
solve a high percentage of the interdepartmental transport needs, but they do have
the drawback of being able to handle only
a very small volume in each shipment.
To make up for this drawback, electromechanical systems have been developed that boast a large transport capacity (eight to ten kilograms per shipment).
Such systems are very good for addressing
highly specific problems, such as the distribution of clinical histories from the files to
the different examining rooms. They do
have the drawback, however, of occupying a great deal of space, so it is hard to
find room to install them.
Such equipment is usually quite noiseless.
It runs at an average speed of 0.5 metres
per second. All kinds of horizontal and
vertical paths can be installed, as long as
floor change radii and horizontal inflections are respected.
Because the extraction zone has regular (though not continuous), heavy loads
of samples to deal with, it was deemed
unfeasible to apply pneumatic transport
to move the samples to the sample reception zone. A point-to-point mechanical
Heavy or high-density concrete (using
barite aggregate) was also used to build
the premises.
The rooms for storing radioactive sources
(radioisotopes and waste) are heavily
shielded against radiation and in addition possess the appropriate storage and
handling devices.
The hospitalization rooms for these
patients are shielded too. They have
closed-circuit TV for monitoring patients
without the need to expose medical
personnel. For this same reason, there is
an automatic urine collection mechanism;
patients’ urine is not handled by staff save
when there is a breakdown.
The toilets in these rooms are special.
Made of polyester and stainless steel,
they have a system for separating solid
excretions (faeces) from liquid excretions
(urine). The solids are pushed along into
the general sewer, while the liquids are
dumped directly into the storage and
treatment tanks located in the general
radioactive waste room.
There are radiation detectors with alarms
and contamination detectors all throughout the zone. The evacuation system is
different from the evacuation systems of
the rest of the building, too.
In all the sections referred to above, the
air (which specific air-conditioning equipment renders independent from the rest
of the hospital) must not be recycled,
so before it is vented outdoors it is run
through active charcoal filters.
In brachytherapy treatment, no radioactive waste is generated (although there is
a risk of irradiation); but in the metabolic
treatments with radioactive iodine, the
radioactive source is not encapsulated,
and it is practically all eliminated in the
urine, so it generates a highly active liquid
radioactive waste that creates a contamination and irradiation risk for the hospital
staff and the public.
Solid radioactive waste may also be generated if patients contaminate their clothing, bed linens or dishes. Clearly, none of
this waste can be directly disposed of as is.
The centralized waste storeroom lies in
the basement. The liquid waste from the
metabolic treatment rooms (on floor 1)
therefore is pulled straight down by gravity.
The waste storeroom actually has two
separate sections, one for solid waste,
with 11 shielded, airtight tanks inside
concrete vessels, and one for liquid waste,
with four 2,500-litre tanks.
The tanks for liquids are made of stainless
steel shielded with lead, and they are lined
on the inside with a plastic material that
urine cannot corrode (polyurethane elastomer), without any seals or overlapping
seams.
Alterations to and
enlargement of San
Agustín Hospital,
Phase 2, Avilés
Background
San Agustín Hospital in Avilés dates back
to 1976, when it was called “the San
Agustín Health Home”. With the passage
of time, it has gradually become modernized and acquired new equipment, while
at the same time its target population has
increased to its current size of 150,000
citizens.
Apart from its healthcare function, like all
modern hospitals, San Agustín Hospital
must engage in teaching and research and
include outpatient clinic services (which
used to be located elsewhere).
The hospital required an enlargement and
some alterations. These were done in two
phases. Phase 1 was concluded in 2004.
Phase 2 covered the comprehensive alteration of the hospitalization wings, the
construction of a new Outpatient Clinic
building and an underground car park
and miscellaneous outdoor development
work.
Phase 2 was awarded in a public tender to
FCC Construcción on 27 June 2000. Work
began on 20 November of that same year.
During the course of the work, it became
necessary to make various functional
changes, install new facilities requested by
the hospital management and bring the
HVAC and plumbing systems up to the
new legionellosis prevention standards.
After that, work had to be done to apply
structural reinforcement to the floor structures and columns in the hospitalization
wings that were scheduled to be altered
in the original design.
The total area involved in Phase 2 of the
project was 48,269 square metres, which
can be broken down into 32,074 square
metres of enlargement and 16,195 square
metres of alterations (façades, installed
systems, lifts, patios, accesses, etc.).
A total of 242 beds was involved. That
plus the 166 beds already affected by
previous alterations made for an increase
of 48 beds over the initial count.
To improve hospital staff working conditions, a seventh floor was built on the east
wing of the building, to be used by the
physicians on duty.
Furthermore, a new Medical Outpatient
Hospital was created, equipped with 24
stations for onco-haematological and
AIDS treatment, and the ten-bed Surgical Outpatient Hospital was thoroughly
altered.
The Radiodiagnosis Department underwent alterations; its facilities were redis-
247
tributed within the same original area to
ensure proper separation of same-day
and hospitalized patients. In the high-tech
zone, the space devoted to the helical
CT unit, the three ultrasound machines,
the two remote control rooms, the
three conventional X-ray rooms and the
mammography room was enlarged.
the number of hospital beds, albeit on the
basis of single rooms for better patient
isolation. When seasonal increases in
demand are great enough, the single
rooms can be converted into double
rooms, and the previous solution to winter
upswings (putting three beds in double
rooms) can now be avoided.
In addition, the original parking capacity was increased to a minimum of 900
spaces (with an underground car park
that includes storerooms and shops); the
lot was fenced in, and a heliport was built.
In the Outpatient Clinic, the hospital was
equipped with a blood extraction unit in
an area with its own outdoor entrance, to
keep patients out of the hospital’s internal
areas.
The existing medium-voltage mains power
line to the hospital was run underground.
To support the different departments,
the hospital was given new administrative spaces, offices for supervisors, rooms
for physicians on duty, X-ray-viewing and
reporting rooms, storerooms on each
floor, waiting rooms, lounges, support
spaces for patient education (on issues of
interest for the recovery of hospitalized or
same-day patients), restrooms, etc.
All the jobs belonging to Phase 2 had
to be done while the hospital remained
in operation, in an attempt to interfere
with the hospital’s daily activity as little as
possible. A large share of the alterations
and even the civil engineering work were
for that reason done in evening, night,
weekend and holiday shifts.
Geometric description of
the building
The lot has an irregular shape, a jumble
of geometrical forms rather like a huge
trapezoid with one side leaning against
the road from Avilés to Heros, where the
hospital driveway is located, and other
trapezoid- and triangle-like shapes added
to the west. The lot’s perimeter measures
approximately 1,220 metres, and the lot’s
area is 54,701 square metres.
The lie of the land is irregular too, with
a steep upward southwestern slope. The
difference in elevation between the drives
turning off the Avilés road and the ground
floor of the hospital is about 13 metres.
Because the anticipated enlargements
were so very big, quite a lot of land development work was involved. The most
significant work was to change vehicular paths inside the lot, motivated by the
interference of existing paths with the
new construction and the need to furnish
the underground car park and the storage
and maintenance areas with the appropriate access drives.
Plans also called for modifying the grade
of the road leading to the main entrance
to bring it level with the elevation of the
ground floor and thus eliminate the architectural barriers to access.
Alteration work
Healthcare needs made it vital to increase
In terms of structural needs and installed
system needs, the following had to be
done, either because these particular tasks
were not taken on in Phase 1 or because
they remained incomplete after Phase 1:
• Alterations to the façade to blend in
with the façade of the enlargement built
in Phase 1
• Complete HVAC system installation
throughout the area scheduled for alterations
• Installation of wiring (voice, data and
sometimes picture) in all units scheduled for alterations, thus completing the
hospital-wide network
• Construction of an evacuation ramp
for patients confined to their beds, this
ramp to be vertically aligned for use by
the surgical area and the ICU also
• Improvement of access to the Outpatient Clinic and internal connection in
that area between floors 1 and 2
• Installation of a lift block with two cabs
for the linen service and the kitchen,
located across from the entirely insufficient lift previously used for that purpose
• Replacement of all original lifts (four
two-cab blocks)
• Improvement of old verandas
• Construction of a direct connection
between the main building and the
annex, where the teaching zone (library,
classrooms, auditorium) was to go
248
• Properly developed enlargement of the
parking area to handle a demand of
1,000 spaces at peak hours
tors. The first three escalators run directly
to the hospital services situated on each
floor.
• Enlargement and improvement of the
public cafeteria
The floor structures are separated from
the façade and leave spaces that penetrate inward, to provide vertical continuity
for the use of the space and for the outer
enclosure, rather like a skin braced by the
structure.
• Improvement of the main entrance,
reception/information, newspaper stall,
etc.
• Relocation of the central communications room from right next to the main
entrance to deeper inside the building
• Construction of a heliport
• Improvement of handicapped access
inside and outside the building and thorough adaptation to legislation on handicapped access
• Improvement of drives outside the
hospital for straighter access to the
Emergency Room area, eliminating the
original 90° curves
• Replacement of facilities in the highvoltage room and relocation outside the
main building
• Increase in the reserve water tank’s
capacity
• Unification of fire detection stations
• Improvement of funeral facilities
• Improvement of all staircases (main and
evacuation)
• Improvement of the entire general
sewer system
• Installation of fencing around the lot
holding the hospital and all its sections
• Adaptation of all sections of the hospital
to the applicable safety and prevention
standards
• Creation of a space to hold the hospital’s passive administrative file
• Creation of a space where patients
admitted to the Mental Health Ward
can stroll
Justification of form
To house the space the Outpatient Clinic
was going to need, the idea was to erect a
new building wall-to-wall with the existing
hospital, actually an expansion that would
extend the hospital’s original volume.
This building was designed to have a front
body with four storeys (ground, 1, 2 and
3) featuring accesses, lobbies on each
floor and space for rooms. The floors are
connected by passenger lifts and escala-
From this main rectangular body there
spring three more rectangular bodies,
perpendicularly, like the teeth of a comb,
to house the clinic’s examination rooms.
They are separated by two courtyards,
which are in turn closed off by an interior itinerary holding two staircases, one
in each courtyard. This pathway is for staff
traffic and potentially for evacuating the
building.
In front of this there is an outdoor car park
(on top of the underground car park),
inside the curve of the drive to the Outpatient Clinic building. The main staircases
leading to the underground car park lead
down from the outdoor car park.
The underground car park lies crosswise to
the Outpatient Clinic building, occupying
three basements of the Outpatient Clinic
building and running perpendicular to it.
The drive around the perimeter of the
complex leads to the main entrance, the
entrance to the underground car park
and, through the outdoor car park, to the
entrance to the Outpatient Clinic building,
all at an elevation of 0 with respect to the
building. The drive then descends parallel to the car park to an elevation of -3.4,
where the storerooms and necropsy facilities are, and then to -6.8, which is the car
park exit. The drive subsequently connects
to the already-existing street, which runs
to the Avilés road.
The main access has been addressed by
creating a single space at an elevation of
0 to unify the previously separate accesses
(one to the hospital, one to the auditorium, one to the rest of the building).
Vehicular traffic travels through a roundabout beneath a triangular canopy.
The outdoor treatments have been
matched to the treatments in Phase 1
of the project, to achieve aesthetic and
conceptual uniformity throughout the
building. In the indoor finishes the same
criterion has been followed, standardizing what has been done in the hospital
so that there are no disparities of criteria
between the way different areas have
been handled.
Demolition
The very nature of the alterations entailed
the performance of demolition work
affecting the entire area at issue in the
alterations.
Apart from the complete alteration of the
original nursing wings, spot demolition
was also performed in the new wing, to
enlarge and modify the nurses’ desks.
Another kind of demolition work was
effected at specific points of the different floors, for purposes such as adapting
stairs to current legislation and equipping
certain departments with cart lifts.
In the areas scheduled for a full interior
alteration, all the finishes, linings (including panelling and tiling), floors and indoor
trim and frames had to be demolished,
and all the installed systems, which were
scheduled for new equipment, had to be
stripped.
The ashlar work on the façade was kept in
general, but partial demolition did prove
necessary on the ashlar dressings around
window frames, to adapt to the dimensions of the new windows, which were
planned to coincide with the architectural modulation of the windows already
installed in Phase 1.
Foundations
This section refers to the enlargement
work done because of the new building,
which has three basement storeys. The
building’s foundations were laid by driving foundation walls around the perimeter, proceeding subsequently to empty the
space floor by floor, bracing the wall with
provisional anchors to the earth.
Structure
Starting with the structural setup of the
pre-existing building, the limitations on
height between storeys and the standard modulation of the original building’s
frames, the enlargement building was
designed to maintain the height of 3.4
metres between storeys and the modulation of one of its clusters of columns.
Two different types of structures were
implemented, depending on whether the
building in question lay outside the original hospital or constituted an enlargement
to the existing building proper.
In the first case, structures were cast of
reinforced concrete and were made up
of columns and continuous solid slabs of
various thicknesses.
In the second, structures were built of
columns, beams and metal side timbers,
with a floor structure that combined
corrugated sheet metal left as permanent
formwork and a concrete slab poured in
situ, in which the necessary flexural reinforcement had been housed.
Installed systems
HVAC systems applied
• Bedrooms for Physicians on Duty
(Seventh Floor) and Attached Offices
On the basis of four-pipe fan-coil units,
one for each room, to be ceiling mounted
with filter, cooling and heating batteries and a blower fan, with a three-speed
switch and an environmental thermostat.
The supply air is drawn in by an outside
air treatment unit with a manually operated damper, a filter, cooling and heating
batteries and a blower fan.
The air is driven to the fan-coil units
through metal ductwork. At each outlet
a butterfly-type flow regulator is installed.
Toilet room air is extracted by a ventilation
unit with a centrifugal fan.
• Hospitalization on the Third to Sixth
Floors
One hundred percent outside air supply,
with two-zone HVAC units for proper
treatment of the two façades, which have
clearly differentiated exposure conditions
(northern and southern).
The air is distributed through insulated
metal ducts, venting outdoors through
adjustable double deflection grille vents
with flow regulators selected for their low
venting speed and low noise level.
Air is extracted by means of adjustable
circular intakes in restrooms and flowregulated extraction grilles in rooms and
hallways, leading through ducts to the
extractor fan.
Temperature control is performed on a
façade-by-façade basis, with a temperature sensor and controllers that command
the actuation of the three-way valves
installed in the HVAC units’ batteries.
• Central Zone Examination Offices,
Third to Sixth Floors
The system enables the temperature to be
controlled in each of the individual offices
to be treated, by means of a combined
system of constant air flow on the façades
and variable air flow elsewhere, with individual regulators and temperature sensor
249
control in the environments to be treated.
• Radiology Zone
The constant flow system blows air in
the façade zone to combat the heat load
transmitted inward from the outdoor
ambient temperature. The temperature of
the blown air varies with the variations in
the outdoor ambient temperature.
Given the special characteristics of the
premises to be treated and the equipment
located on those premises, what was
installed was air treatment units customized for each set of premises, four-pipe
fan-coils of the correct power rating for
each room, with ventilation air supplied by
a unit with a centrifugal fan and distributed through galvanized metal ducts
provided with manually operated butterfly
flow regulators for each set of equipment.
The variable flow system blows air at a
constant temperature. The variable flow
regulator allows the necessary volume of
air to pass into each room or area according to the thermal load conditions of
consumption, to achieve the set temperature established at each environmental
sensor.
The air is blown in the constant flow
system by linear diffusers with a galvanized sheet metal plenum with a mouth
for flexible connection, while in the variable flow system rotating diffusers are
used to achieve a high level of blown/
ambient air induction.
For the restrooms, there is a shared air
extraction facility from the third floor to
the sixth floor. The extraction unit is situated on the roof level on the seventh floor.
Air is extracted through adjustable circular
exhaust intakes, and through galvanized
metal ducts it is blown outside thanks to
a ventilation unit with a centrifugal fan
that is treated to be mounted facing the
outdoors.
• Examination Modules - Enlargement, Ground to Third Floors
In this zone, a facility similar to those
described above has been installed for
each vertical module, with a variable flow
system provided with a regulator for each
examination room and a constant flow
perimeter system that incorporates an
independent constant flow HVAC unit for
each vertical module.
The lobby zone has been divided under the
same criteria as the previous modules, and
it is climate-conditioned by three constant
flow HVAC units with a return fan and
free-cooling capability to take advantage
of the energy from the outside air.
Outside air is blown into this zone by
means of galvanized metal ducts, through
high-induction rotating diffusers, as in the
cases described previously.
Air return is handled through the dropped
ceiling. The return air enters through a slot
of the appropriate dimensions situated on
the perimeter of the glassed-in zone along
the length of each storey.
The fan-coil units are equipped with an air
filter, heating and cooling batteries and a
low-noise fan, with air blown in by means
of rotating diffusers and returned through
flow-regulating grilles.
• Operating Theatres
Customized air treatment units are
installed, which blow the air through
galvanized metal ducts and vent the air
outside through rotating diffusers with
built-in high-efficiency (99.99%) filters.
For customized temperature control, heating batteries are installed with a threeway valve controlled by an environmental
sensor and a regulator.
In the air intake and return circuits,
high-precision air flow control valves are
installed for accurately controlling overpressurization and air flow from the clean
zones to the dirty zones, hallways, etc.
• Car Parks in Basements -1 to -3
For the parking zone, forced ventilation
systems are installed with centrifugal fans
capable of withstanding 400 °C for two
hours.
Air is extracted through galvanized metal
ducts with flow-regulating extraction
grilles.
The fans can be started up by the CO
detection station, which receives the
signals from the CO detectors placed
regularly at the proportion of at least one
detector for every 300 square metres.
• Water Circuits
Cold and hot water to supply the air treatment units is drawn from the existing
heating and chilling plants.
The results of the attempt to balance the
chilling and heating power of the existing
facilities and the new facilities showed
that it was necessary to install two new
condensation chiller sets with the corresponding cooling towers and the corre-
250
sponding pumps for cold and condensation water, which are connected to the
existing cold water system.
It was also necessary to incorporate a new
gas-burning furnace into the existing hot
water system, to supplement the furnace
already in operation.
The new cold and hot water distribution
system runs through the service tunnel
to the secondary pump rooms situated in
basements -1 and -2.
The secondary pumps impel the necessary
hot and cold water up the hot and cold
risers to the air treatment units located in
the installed systems rooms.
• Compliance with Regulations and
Standards
In the systems where it is necessary to use
nothing but outside air, heat exchangers have been installed. And in the units
where return air is possible, free-cooling
systems have been installed to take advantage of the energy of the outside air.
The cold water production units have at
least ten fractionation stages.
The hot water furnace is equipped with a
continuously adjusted modulating natural
gas burner that is regulated to stay in step
with the system’s demand.
In the ductwork, fire shutters have been
fitted or fireproof coating has been applied
wherever a duct crosses fire sectors.
• Control
A direct digital control system is installed.
Digital control is centralized at a station
in the Control Room, and from there the
different temperatures and the operation
and status of all the main components of
the installed HVAC systems are controlled.
Pneumatic transport. Samples and
documents
Twenty-four receiving and sending points
have been prepared, at each of which an
automatic station has been installed with
pushbutton command and control devices
and digital readouts. The pneumatic transport system begins in basement -2, where
the motor, the command station and
the two-line transfer station are located.
The entire command, manoeuvring and
control system operates at 24 V DC.
Each line operates independently,
although they are connected to one
another through the transfer station,
which sends the capsule along as soon as
the line to its final destination is free.
Stations are joined by PVC pipe 11 centimetres in diameter, which runs through
the dropped ceilings. Curves have a
minimum radius of 80 centimetres. Pipe
sections are joined by glued sleeves.
Changes between branches of the transport network are made automatically by
means of one-input/three-output bifurcations controlled by the central computer.
These bifurcations are also installed in the
dropped ceilings, with removable inspection panels.
The device carried by the system is a
capsule with a threadless revolving lid, a
diameter of 85 millimetres and a useful
length of 237 millimetres. It is fitted with
a bag with compartments for sending
analysis tubes, urine tubes, etc.
Transport speed inside the pipeline is eight
metres/second for blood and samples,
with the option of changing to three
metres/second (slow run) by operating the
flow control valve.
Initial acceleration is gradual, by the action
of a three-way valve near the pressure
pump.
Deceleration at capsule arrival is effected
thanks to an air cushion created by the
aforesaid three-way valve and an aircompressing module that works by opening and closing check valves.
Capsule passage is monitored throughout
the entire trajectory by photoelectric eyes
that transmit signals to the computer, for
correct receipt at the capsule’s destination.
The receiving and sending stations are
automatic. When a user wishes to send
a capsule from one station to any other
station, the user calls up the destination
service on the front-mounted keyboard.
The destination service appears on the
screen, and the transport capsule is placed
in the loading store inside the station,
where it is protected from manipulation
by a safety lock.
If the circuit is available, the capsule enters
the main pipeline and immediately begins
to travel.
Arrival at the destination station is at a
controlled speed, as is the final deceleration, and the capsule falls into a pick-up
basket. The sending source is reflected on
screen.
Even when there is a capsule in circula-
tion, shipment requests may be put in
from any station. The requested capsule
remains in the waiting chamber until the
computer program shows that the circuit
is available.
Samples are sent in bags with special
flaps, which fit inside the capsule and
have holes for holding plugged test tubes
and small vials, keeping them safe from
any vibration or internal movement during
transport.
When the destination number is called,
the screen and the acoustic indicator
show in an instant if that destination
can be reached or, if not, why: station
in operation, station out of order, station
down, etc.
The number that is called is included on a
list of telephone numbers, which enables
the user to ensure that the correct department number has been called. The screen
moreover indicates the source of the last
shipment. This proves highly practical in
cases where a wrong number is dialled,
since it allows the shipment to be returned
to its station of origin.
The system permits users to program
reception and sending priorities, the
“follow me” function and fixed programming for sending and/or receiving at slow
speed.
Automatic fire detection
The fire detection facility is made up
of rate-of-rise (temperature gradient),
ionization and optical analogue sensors
connected to two stations.
The optical detectors are placed in the
vast majority of areas, leaving the ionization detectors for the spots where people
are not usually present (such as machine
rooms) and the rate-of-rise detectors
for the kitchens. Optical indicators are
installed outside rooms to enable any
kindling fires to be located quickly.
In general, when the first alarm sounds, a
local warning (light and sound) is given.
The guard or person in charge has a certain
time available in which to verify the origin
of the alarm. After that time, if the station
has not been reset, a general alarm is set
off, in which instructions are given orally
or automatically over a PA system.
Son Llàtzer General
Hospital, Palma de
Mallorca
Background
This hospital, inaugurated in December 2001, is situated on the road that
connects Palma de Mallorca with Manacor. Its design is conceptually functional,
advocating a model of innovative healthcare.
In a management framework that is
increasing looking toward the foundation as an operating formula, this hospital, which is meant to provide healthcare
for 225,000 inhabitants of the eastern
zone of Palma de Mallorca, signifies an
improvement in both the quality and the
quantity of specialized healthcare in the
Balearic Islands.
As other Spanish hospitals have already
done, this new health facility takes a
step further into what has been termed
“the management autonomy” of public
centres. The Son Llàtzer Hospital Foundation was created, and on its board of
trustees are the Directorate-General of
the National Health Institute, the Autonomous Community of the Balearic Islands
and the Palma de Mallorca City Council,
which will take charge of managing the
hospital.
With this formula, the public nature of the
facility is fully maintained, thus preserving
the principles of universality, fairness and
solidarity that the national health system is
bound to uphold and using new management tools to face the demands for efficiency and societal profitability in public
resources.
The hospital bases its management model
on a threefold commitment: autonomy
of management within the framework
of the Balearic Island Health Service,
with the involvement of head clinicians
in management functions; orientation
toward quickly handled activities that
involve no hospitalization; and comprehensive computerization of all clinical and
management processes.
Description of the building
The building is moulded to the configuration of the terrain where it stands. It is
structured into three large blocks housing three differentiated health areas
connected to one another through two
hallways between them. Its facilities and
the lists of services it offers have been
designed to the particular specifications
of a general hospital for the acutely ill.
The first of the blocks, the Healthcare
Block, situated on the western side, fundamentally holds the Emergency Department and the Outpatient Clinic. Parallel to
that block, to the east, stretches a semipublic outdoor corridor or hallway that
connects the Healthcare Block to a central
complex of buildings set around courtyards and devoted to the diagnostic and
medical/surgical treatment areas. Adjacent to this infrastructure lies the indoor
hallway, a restricted-access corridor that
provides the connection to the last hospital infrastructure complex, which consists
of two differentiated blocks devoted to
the hospitalization wards.
According the structure just described, the
building’s design allows enlargement if its
future growth should so demand.
Under this functional conception, the
hospital (which is Palma de Mallorca’s
second general hospital) has two access
points: two separate entrances located
opposite one another. The objective of this
layout is to prevent the people who go to
the hospital for healthcare from mingling
with the people who go to visit hospitalized patients. This makes for greater efficiency and speed in the services the hospital renders.
Moreover, there is an internal service
drive in the middle, designed to facilitate
delivery of all those materials the hospital requires to operate. The main power
generation and distribution rooms are
located at that point as well.
Equipment
One of the objectives taken into account
right from the design stage was to furnish
the hospital with all the latest technology
to enable comprehensive management of
the hospital’s internal systems.
Accordingly, the health centre is equipped
with a room from which all the information from the different systems’ sensors
and equipment is centrally controlled,
so that all systems, from temperature to
fire protection systems, lifts, lights, etc.,
in each sector of the building can be
controlled from that one station.
To ensure the electricity supply to the
complex, two autonomous generator
sets (1,100 and 1,300 kVA) are installed.
Moreover the hospital has two transformer substations furnished with seven
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1,250-kVA transformers.
The HVAC requirements are dealt with
by three 1,869-kW oil-burning furnaces
to produce hot water and four 1,020kW chillers to produce cold water, which
is distributed by 100 air treatment units
distributed by floors.
For water treatment, a 324-cubic-metre
initial cistern has been provided to hold
untreated water, and two 486-cubicmetre cisterns have been provided for
treated water. Water is collected by
means of separate systems and delivered
to the city water system. The drinkingwater system provides specific treatments
against legionella, aspergillus and pipe
corrosion.
As regards elevation and transport
resources, the hospital boasts 24 passenger lifts, two service lifts for samples and
two escalators. A pneumatic transport
system has also been installed to pick up
samples, rubbish and dirty clothes.
An overall voice and data system has been
set up to enable data sharing and access
to the hospital’s computer system; this
enables patient data and records to be
checked from anywhere in the building.
In terms of complements and hospital
capacity, Son Llàtzer General Hospital
has a total of 564 beds and 13 operating
theatres, plus radiology, magnetic resonance imaging, ultrasound and angiography units, among other medical and surgical facilities.
Within the hospital accommodations,
the ICU has space for 16 patients in
open compartments and four patients
in isolation. A dialysis treatment unit has
also been installed, with the capacity to
accommodate 28 patients simultaneously.
The hospital has approximately 1,000
parking spaces above ground and 300 in
the basement.
As a supplementary measure, trees have
been planted between the spaces for
cars in the above-ground car parks, with
a precast concrete circle to protect each
specimen. An artificial barrier of landscaped earth has been included in the
treatment of the lot.
Aspects of construction
Structure
On a 160,510-square-metre lot, the
hospital has an above-ground floor area
of 75,018 square metres, in addition to a
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15,804-square-metre basement devoted
to parking and supplementary storage.
Most of the building has four storeys
above the ground storey, although it rises
to five storeys in the hospitalization wards
and in the parking zone mentioned previously.
The foundation was built using an
80-centimetre-thick,
14,957-squaremetre solid slab of reinforced concrete,
with another slab, 70 centimetres thick
and occupying 7,637 square metres,
placed in conjunction with the first to form
a terrace. Seven thousand, six hundred
cubic metres of concrete were poured to
form retaining walls.
The columns and floor structures were
made of reinforced concrete, and 94,760
square metres of two-way concrete joists
with an edge of 30+5 centimetres were
cast using removable waffle pans. There
are 22,817 square metres of flat inverted
roof not suitable for deck use and 2,068
square metres of roof garden.
Interiors
For interior flooring, terrazzo tiles are
mainly used, although there are certain
zones laid with conductive flexible floorings, white Carrara marble (6,500 square
metres in public entranceways) or woodsupported oak floorboards (in the auditorium).
For the interior partitions, drywall on a
metal structure is used almost exclusively,
and the same material is also used to make
the continuous false ceilings. The dropped
ceilings contain removable plaster tiles,
and other dropped ceilings have been
installed with metal slats. In the teaching
area a dropped ceiling is used also, with
acoustically absorbent wood veneer tiles.
Exteriors
Lacquered aluminium is installed around
exterior windows and doors, with double
glazing using a sheet of green coolite
glass on the outer side. The windows of
the hospitalization units, a total of 1,812
square metres, are structural glazing(14).
The façades are practically entirely covered
with ventilated cladding made of a calcareous stone from the Levante area known
as fossil yellow. A cladding thickness of
three centimetres is generally used, but
four-centimetre cladding was applied in
14
This consists in eliminating the infill-holding element
(usually an aluminium profile) from the outside of
the façade to avoid creating lines, thus creating an
all-glass surface
the higher areas of the building and on
the corners, to strengthen wind resistance.
The modulation standard for the stone is
40 x 80 centimetres, although the standard has been adjusted façade by façade
to yield an equal number of stones in the
different panels by adjusting the measurements slightly. The vertical seam is interlaced. Between the stone and the wall a
four-centimetre-thick air pocket is formed
that substantially improves the heat insulation and moisture resistance conditions,
considerably improving the comfort level
of the rooms near the façade.
The stones are held to the façade by
140-millimetre-long, 30-millimetre wide,
two-millimetre-thick stainless steel strips.
These strips have an opening at one end
for better adherence when embedded in
the wall, and at the other end they have a
drill hole to accommodate a rod made of
the same material, which is the element
that really holds the centre of the stone
in place. Each stone is grasped by two
anchors along the bottom and another
two along the top, shared by the adjacent stones. There are more than 19,000
square metres of cladding-covered area.
To clean and maintain the façades, there
are five rooftop-mounted platforms with
travelling rails and direction-changing
capability.
Technological aspects
“Paper-free” hospital
Son Llàtzer is a pioneer in the generation
and use of hospital information systems
based on the most advanced technologies, thanks to intensive automation right
from the hospital’s origin in 2001. Automation is extended to all the hospital’s
processes, from the most basic system for
managing patients, clinical histories and
departmental applications to administrative applications, economic management
and human resources.
The hospital’s Information Technology
Unit has the primary mission of providing
and maintaining the necessary technological tools for the rest of the hospital’s
clinical and administrative units, so that
they can carry out their own tasks more
quickly, efficiently and tidily. The unit is
oriented toward internal users belonging
to the hospital and their stated needs, yet
it always keeps the big picture uppermost,
where the real end user is the patient.
For this purpose, a data centre was intro-
duced as a tool for handling the clinical
and management information, with a view
to optimizing all the hospital processes at
Son Llàtzer.
In technological terms, the hospital is
committed to seeking these fundamental
objectives:
• To improve flows and healthcare
processes in which technology furnishes
added value
• Fully to implement access to a patient’s
clinical information at any time from
anywhere in the hospital
• To guarantee fast, automated communication between departments
• To establish a single appointment desk
with the philosophy of the “one-stop
window” for the patient
All the objectives are aimed at better intrahospital communication, which implies
better patient service. The computerization project is focussed not on acquiring
technology for technology’s sake, but on
evaluating the advantages that computerizing processes can offer and, if worthwhile, seizing those advantages. So, the
objectives of the Information Technology
Unit are always aligned with the hospital’s
strategic objectives.
The hospital information system is the
foundation on which all the information generated in the hospital rests. The
method that has been introduced allows
all written documents, requests for medical tests, result reception and images (digital X-rays, endoscopy images, digital electrocardiograms) to be managed through
the computer system and released into an
electronic clinical history (ECH). This project has made Son Llàtzer Hospital one of
Europe’s most innovative health centres.
Thanks to this tool, all the documentation and information generated about a
patient is fully digitalized: nursing data
(temperatures, the patient’s vital signs,
comments on the patient’s development
while hospitalized, nutrition), information
about tests, diagnoses, request systems,
laboratory results, appointments, prescriptions, etc.
One of the most outstanding parts of the
ECH is digital imaging. Instead of using
traditional X-ray film, Son Llàtzer has an
X-ray image-filing system that instantaneously attaches images to the clinical history of the patient at issue in the
report. So, the X-rays can be displayed on
any computer in the system. Use of this
computer tool is a complete revolution
with respect to work in a traditional hospital, where health staff use basically paper
and the classic established pathways.
At Son Llàtzer, there are no plastic X-rays
to clasp under an arm, no laboratory
print-outs, no printed endoscopy images,
none of the traditional EKG strips. At
present 95% of the hospital’s processes
are conducted through computer tools
without the need to use a single scrap of
paper.
Wireless (wi-fi) network and mobile
devices
In March 2002 the centre’s own medical
personnel suggested to the chiefs of the
technological area at Son Llàtzer that all
the information from the ECH be moved
to mobile devices. That would make
mobility even greater: Staff could consult
the ECH anywhere at any time. It was
the medical staff’s own demand. They
regarded such a step as basic for improving their work and not losing touch with
their natural working environment, which
is in the midst of patients and the rest of
the health personnel.
With the requested mobile terminals, any
medical data entered inside the hospital, such as a change in a prescription,
would be available to any professional in
real time. This would bring the information closer to the medical staff and would
also bring the medical staff closer to their
patients.
To cope with this request, the technological chiefs designed a mobility project
that consisted in issuing the physicians
with PDAs(15) and issuing the nursing staff
with tablet PCs(16). Moreover, a wireless
network was to be deployed with Wi-Fi
(wireless network) technology to enable
these apparatuses to go on line. This
would allow staff to consult each patient’s
ECH anywhere at any time.
At the present time, the hospital has a total
of 16 tablet PCs, which are used by the
members of the nursing staff every time
they accompany a physician on patient
rounds. On the touchscreens of these
digital notebooks, nurses take note of all
the information dictated by the physician
(prescription changes, test requests, nutrition). At the same time, they can facilitate
all the information the physician asks for
15
Personal digital assistant
16
Computer halfway between a laptop and a PDA,
with a touchscreen that can be written on
from the patient’s clinical history.
At Son Llàtzer, everything is computerized;
there are computer applications for each
of the tasks and procedures involved in all
the functions of the health staff. Access to
clinical information from anywhere means
communications between different areas
of the hospital are speedy and automated,
which makes it possible, for example, to
share test results or check the results of an
analysis. The main benefit of computerization here is better patient service.
The integrated network enables patients’
daily routine to be transmitted throughout
the network, enables several doctors to
hold parallel consultations, enables X-ray
and endoscopy images to be transported,
enables tests to be requested and enables
controlled access by Internet to the development of all cases. Reports are signed
electronically.
The advantages of this entire system result
in greater speed of information transmission, greater data security, process automation, a considerable improvement in
physicians’ knowledge of request status
and intra-hospital use of images. All these
elements, plus the guarantee of secure
patient data protection, make Son Llàtzer
a standard setter in the development of
the ECH.
Hospital patients and users can hook up
to the Wi-Fi network through their laptop
computers, mobile telephones or PDAs
completely free of charge. The public
Internet access system was introduced
gradually, first in the ward specializing in
cancer treatment and long-term patients,
and afterwards it was extended to the rest
of the units, including the lobby and cafeterias. Previously, patients could go on the
Internet from their hospital rooms (subject
to authorization).
The hospital also has a new communication service made up of six information panels, which furnish centre users
constantly with up-to-the-minute Outpatient Clinic information.
Propagation of the system outside
the hospital
This technology is not just the hospital’s tool alone; it is also intended to be
made available to all centres that can take
advantage of the instrument’s progress.
With the next step in its technological
evolution, Son Llàtzer made it possible to
send information about its patients electronically to the primary health centres
253
with which it is partnered. This includes
the results of tests such as electrocardiograms and scanner images. All these
technologies allow doctors and nurses
to spend more time with their patient,
who receives a higher quality of health
care, while hospital administration time is
saved.
As mentioned previously, almost all
processes are performed paper-free on
PCs, PDAs and tablet PCs over a wireless
internal network, with the possibility of
text messaging external patients, doctors
at the health centres in partner neighbourhoods and emergency ambulance units.
Thanks to the network, long-distance
travel is avoided. Also, patients can see
part of their own records over the Internet
or by mobile telephone.
Welcome to “E-hospitalization”
Through the wireless network, the hospital’s medical team can gain access to all the
clinical patient information the computer
system holds. In December 2005 this way
of getting the most out of Son Llàtzer’s
technological platform was transferred to
at-home hospitalization, utilizing the principles of mobility beyond the borders of
the building by means of the application
of 3G technologies(17) and complementary
security solutions.
The unit of professionals that initially
participated in this program comprised
specialists in internal medicine, nurses,
social workers and administrative personnel.
When medical staff make house calls with
their tablet PCs, they can connect to the
hospital network through a VPN(18) IPSec(19)
basic Internet connection, which permits
the VPN connection to be controlled
directly and allows the type of desired
authentication to be defined.
With this arrangement, the working protocol clinical staff use in the home environment has been made more agile. Tasks
do not have to be done twice, and there
are no gaps in the information obtained.
Staff can also give prescriptions and place
orders on line.
17
Third-generation mobile telephony, with the
possibility of transferring voice, data and non-voice
data (downloading programs, e-mail and instant
messaging)
18
Virtual private network
19
Internet protocol security
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Some special departments
Surgery area
The hospital has operating theatres
equipped with the most modern technical
facilities (full computerization, completely
automated tables, highly effective lighting
technology, latest-generation electric scalpels, classic instruments and laparoscopy
instruments of tested quality, highly reliable anaesthesia equipment), with special
attention paid to active and passive safety.
The laparoscopic technology provides high
resolution with the possibility of capturing
images for the computer system to save.
The surgery area has a YAG laser, an
argon green laser, an argon red laser, a
posterior vitrectomy suction cutter with
an endophotocoagulation feature, digital angiography, corneal topography, an
ultrasonic scalpel, a system for sealing
blood vessels and tissues, a choledocoscope, a sentinel node detection system,
surgical ultrasound equipment, etc.
Musculoskeletal system
The Musculoskeletal System Area takes
care of preventing and treating (through
the application of medical or surgical treatment) lesions and pathologies related with
the bones, joints and muscles involved in
movement.
computerized management of its digital
image file through the RIS/PACS (Radiology Information System/Picture Archiving
and Communication System), which are
integrated with one another and at the
same time with the ECH.
Requests come in via computer to the
RIS and are then sent to and archived at
workstations so the radiology specialists
can prepare the requested reports. Hospital physicians as well as the primary health
physicians whose centres are connected
to the network can consult the radiology
images and patient reports.
There are ten workstations (nine of which
have twin monitors) featuring maximum
resolution for the greatest possible reliability.
The “star” of the Radiology Department
is a latest-generation apparatus, a 64-slice
multidetector CT scanner that allows
high-resolution studies to be performed
very quickly.
The CT scanner is a non-invasive method
of diagnosis that uses ionizing radiation
(X-rays), although study protocols are set
to give patients the minimum dosage of
radiation. Radiology specialists and the
hospital’s specialized technicians ensure
that the apparatus is used correctly, to
avoid unnecessary testing and radiation.
Traditionally, the study and treatment
of such complaints used to be divided
among the different departments taking
care of medical treatment (the Rheumatology Department) or surgical treatment
(the Traumatology Department and the
Orthopaedic Surgery Department), with
Rehabilitation as a separate department.
In this hospital, these services have been
integrated into a single functional area, so
the study of a patient with musculoskeletal impairment is more fluid. The fact that
the professionals share their knowledge in
daily clinical meetings of the three departments also bolsters the advantages.
When a scan is performed, the patient
is placed inside an apparatus (The experience is not claustrophobic) which has
a tube that spins at great speed with
multiple detectors around its circumference. The table on which the patient lies
moves gradually forward while radiation is
applied.
Relationships with the family physicians
who belong to the primary health system
in the zone the hospital covers are also
regarded as highly important. Therefore
update courses and programmes are run,
visits to health centres are encouraged
and action protocols are mapped out. All
these activities are coordinated with the
primary health centres.
This apparatus, which began to be used at
Son Llàtzer in the summer of 2008, helps
in the diagnosis of patients with all kinds
of pathologies, primarily coronary, neurological, vascular or digestive pathologies.
Radiology
The Radiology Department is equipped
with the most modern technology and has
This system of diagnosis has been used
since the early 80s to study all parts of
the body, but the method’s technological revolution came about with 64-slice
CT scanners, which enable diseases to be
diagnosed in a very early phase.
Where surgery is called for, a CT study
offers so much information that, with
the reconstructed image on hand, the
operation can be carried out with a highly
precise knowledge of the location and
dimensions of the pathology.
This CT scanner has a very high negative
prediction value for coronary diseases,
which means that it almost never gives
false negatives: When the diagnosis
concludes that there is no lesion, this
assertion is true in 95% of all cases.
For some subjects, studies made with this
CT scanner require close cooperation with
physicians from different specializations.
For that reason, there is a working group
in which radiologists and cardiologists
participate to analyze cases and decide,
for example, what patients with atypical chest pain ought to be subjected to
catheterization, or whether the 64-slice
CT scanner ought to be used as the first
option to study patients.
Use of this technology is also quite advantageous for unstable patients, generally
from the Emergency Department and the
ICU, because they spend less time in the
room than when tests are performed with
a conventional CT scanner. In addition, a
64-slice study is a full-body affair, rendering it unnecessary to X-ray patients piecemeal. So, with a single test, the location of
serious lesions can quickly be ascertained.
Blood donation
This is a service aimed at hospital staff and
the relatives and friends of patients who
are due to receive a blood transfusion,
who are the people most aware about
donation –health professionals, because
they suffer scarcity of blood reserves
daily, and a patient’s loved ones, precisely
because they love the patient.
To provide enough blood for the hospitals
of the Balearic Islands and cover the blood
reserves needed for surgery, cancer treatments, accidents and other daily hospital
emergencies, more than 150 blood donations are needed each day.
As a curiosity, the hospital has an autotransfusion programme for all patients
who have to go through surgery and may
need blood. Autotransfusion consists in
drawing blood from the patient him- or
herself a few days before the operation,
so the patient’s own blood can be administered to the patient when needed.
Palmaplanas Clinic,
Palma de Mallorca
Background
The territory of the Balearic Islands is of
high strategic interest due to its welldeveloped tourist industry and its attrac-
tive health market. It is the leading health
market in Spain, a market where private
industry holds a share of over 20%, when
the Spanish average is 15%.
Furthermore, it is one of the highest percapita income territories of the country,
with a population growth rate of 16% as
opposed to the Spanish average of 6.2%
(between 1999 and 2003). The Balearic
Islands welcome ten million tourists a year,
and to that figure must be added the sizeable collective of retirees who make their
main home or second home in the area
(some 62,000 foreign residents).
Palmaplanas Clinic has behind it more
than 80 years’ history. The first Planas
Clinic, founded by a prestigious family of
doctors who gave it its name, was opened
in November 1927 to an activity that only
grew as the years went by. Soon the clinic
outgrew its quarters, and a second clinic
was opened in 1936. The third, named
“The New Planas Clinic”, appeared in
1967. The fourth, the Palmaplanas Clinic,
was opened on 1 October 2003.
As the facilities are privately owned, both
centres could not be kept open and in
operation at the same time, so the owners
were forced to concentrate the move
into a few hours of a single day. A great
moving operation was carried out, with
an ambulance programme that had to
function without the slightest hitch. The
first patient moved was the only hospitalized patient in the ICU that day. He was
followed by the other 33 hospitalized
patients, all in ambulances. A total of
seven medical vehicles were mobilized, in
each of which there rode a member of the
medical staff.
This latest clinic, which is managed under
a concession, incorporates departments
that its predecessors did not, such as the
Nuclear Medicine Department and the
Rehabilitation Department, experiencing a
34.3% increase in 2005.
The clinic has 167 rooms: 150 single
rooms, 10 double rooms, five suites and
two grand suites. Each floor has two
nurses’ desks that monitor the condition
of each patient and a spacious waiting
room for relatives and friends.
It also possesses eight operating theatres
plus a C-section operating theatre, four
delivery rooms and an ICU with ten individual compartments. It is outfitted with
a large emergency area, another area of
7,200 square metres for the Outpatient
Clinic with 28 doctors’ offices, and an
advanced image diagnostics area with a
Nuclear Medicine Department, in addition
to a laboratory, an endoscopy unit and
a full list of medical and surgical services
and specializations.
To give an idea of the extent to which this
clinic sets the pace in high-level healthcare,
suffice it to say that in May 2007 4,000
surgeons from all over the world hooked
up to the clinic as one of the activities of
a medical conference held in the United
Kingdom, to observe and comment on an
operation performed in one of the Palmaplanas Clinic’s smart operating rooms.
General description
Conceptual vision
In the design of the architectural outline of
the building, it was found that the majority of the hospital areas (such as operating theatres, the Emergency Department, hospital wards, laboratories, the
Outpatient Clinic, administration offices,
the pharmacy, kitchens, supply rooms,
the laundry, waste facilities, staff rooms,
installed systems) followed highly interdependent structures of operation, such that
it would be necessary to intermesh them
all as much as possible in the minimum
space. Achieving this would facilitate
the efficacy and speed of activities while
reducing their costs.
Furthermore, of all the areas mentioned,
only the hospital wards would require a
centralized architectural outline, since
their units (which were to be the most
numerous units in the building) would be
the scene of activities that would require
similar types of care. It was therefore
considered that this area, which occupies the three top floors, would require a
cross-shaped distribution, the cross being
formed by the hallways lined with rooms.
For one thing, such a layout would give
a long visual distance from each window
with respect to the building itself, and for
another thing the distances for gaining
access to the units from the centre of the
cross, where the nurses’ desks and stair/
lift clusters were to be installed, would be
reasonable.
The value pinned on the building’s functional aspect and economic rationality (as
is only to be expected in a private initiative) did not restrict the attention paid to
other, less specific aspects, such as natural
ventilation and light for almost all rooms
and overhead light in most of the hallways
linking the different areas of the ground
floor.
255
This has been achieved by finding empty
spaces among the building’s component
parts, in the obvious places on the upper
floors as well as in spots of the quadrants of the ground floor. This focus on
natural light, which is a good feature for
any building but is especially calming in a
clinic, is clearly accentuated at the main
entrance, where natural light is made into
the decreasing protagonist for the full
height of the space.
Physical location
The clinic has a total floor area of 31,648
square metres (with an additional 4,000
square metres of reserve construction
capacity), broken down into a basement,
a ground floor and three hospitalization
ward floors. The project also included a
2,100-square-metre service building and
41,388 square metres of lot development
work.
The building forms part of a larger health
complex (87,000 square metres in all),
together with two office buildings and
a geriatric care centre, plus an aboveground car park designed to accommodate a vehicle influx of the volume that a
pole of attraction of this type can create.
Its accessibility is excellent. All the most
sensitive areas –the main entrance, the
Emergency Department, the Outpatient Clinic and the outpatient hospital
services– can be reached from the clinic’s
own 750-space car park.
The clinic stands out for its environmental
friendliness, as it consumes a minimum
amount of energy and features wellcared-for green zones, and it stands out
too for the high level of comfort achieved
on the basis of natural light, low sound
levels and warm materials. These points
are significant, because a patient’s mood
is of vital importance in his or her recovery.
The clinic’s location is as important as the
clinic’s environment. The entire design
and construction of the building were
studied in minute detail: the accesses,
the entrances, the traffic and even the
panoramic views. The clinic is strategically
sited off the side of a main road (the urban
motorway encircling Palma) between two
major exits to the city, with direct exits
from the motorway and from the Valldemossa road; this is very close to the Manacor road (the most heavily travelled road
on the island) and in a very important area
of urban growth.
The location, between the two most
256
important industrial parks in Palma, about
12 kilometres from Son Sant Joan International Airport and about eight kilometres
from the commercial port, means good
supply routes for construction materials
when they were needed, and now for
hospital consumables.
Distribution by floors
Basement
The basement has an area of 10,486
square metres. In it are located a good
portion of the general services and clinic
maintenance services. It holds transformer
rooms, emergency generator sets, vacuum
compressor pumps, HVAC facilities and
pressure pumps.
It also houses the clinic kitchens and
computer rooms, as well as a 75-space
indoor car park.
Likewise, it encloses a zone of the Outpatient Clinic, a zone of the Nuclear Medicine Department, a zone of the Rehabilitation Department and, lastly, a special zone
to be used by a risk prevention company
as offices and training rooms.
Furthermore, there is still space scheduled
for future enlargements of the operating
theatres and other possible services.
The garage is a dual-use zone: It is used
as a vehicle-parking facility, and it also
houses the installed systems of this zone
(exhaust, HVAC, etc.) and pipes and
services running to adjacent zones.
The vehicle doors are motorized, with
remote control opening and a chain drive.
This motorization system is recommended
for large doors or doors with highly
demanding open/close cycles.
Service Rooms
The plumbing pump room is found in the
basement. All components related with
water in the clinic are centralized in this
room: the osmosis unit, the decalcifier,
the impeller pumps (for drinking water
and irrigation water), the fire pump set
and the hot water accumulator tanks (four
tanks holding 5,000 litres apiece).
This room has been built to be lower than
the rest of the basement. It is adjacent to
the clinic’s existing cisterns: a hard water
cistern, a decalcified water cistern, a fire
protection water cistern and an irrigation
cistern.
Other rooms include those holding the
vacuum pumps and medicinal gases. The
emergency supplies of the main gases are
concentrated there, with their manifolds
and cylinders. Outside the clinic stands the
medicinal gas shed, which contains the
main tanks of these fluids.
There is also a series of sections scattered
about the entire basement belonging
to the building HVAC system. Most of
the HVAC units are clustered there (the
units for the Outpatient Clinic, operating
theatres and a good part of the ground
floor), although there is other equipment located on the service floor. The
HVAC units for the hospitalization floors,
however, are housed on the roof.
The emergency generator set room and
the main control panel room are also to
be found in the basement.
The emergency set has the capacity to
generate 1,450 kVA, enough to power all
the sensitive zones of the clinic (operating
theatres, ICU, He compressor for the NMR
machine, etc.) and a good part of the rest
of the power needs (part of the lighting,
electrical outlets, etc.). It goes into operation in less than eight seconds, so it has
built-in heaters to enable it to start up
immediately.
Ground floor
There are 11,909 square metres of floor
space on the ground floor, where most of
the common rooms necessary to provide
public service are to be found: the cafeteria, the Radiology Department, the ICU,
the Emergency Department, operating
theatres, laboratories, administration, etc.
The ground floor bears the shape of a Latin
cross whose sides are joined by squares
with special uses (the Surgery Block, the
laboratories, the Outpatient Clinic and the
entrance).
This floor contains almost all the things
that make the building unique: the main
entrance, built with a semi-pyramidal glass
roof borne up by a structure combining
metal beams and concrete columns; the
skylights in the ward hallways; the emergency exits, made of aluminium frames
and glass or with red Alucobond(20) panels
and glass windows with structural silicone
glazing. All these features endow the
building with a great deal of natural light
and a character of its own.
One characteristic of the cafeterias (like
most of the rooms in the building) is the
20
Two sheets of aluminium with a central core of
polyethylene in between, which combines lightness
with high breaking strength, so it is very easy to
handle; ideal for light ventilated outer walls
great luminosity provided by the two wide
glass window walls, in the public cafeteria
as well as the clinic staff cafeteria.
Main entrance and main lobby
Half of the sloped roof lies on the outside
of the building and is used as a porch and
porte-cochere; the other half lies inside
the building, forming part of the lobby.
Access to this lobby is gained through two
automatic doors that open onto a closed
intermediate space (antechamber), a
metal and glass cube from which another
two automatic doors provide passage to
the lobby.
Once inside the lobby, the first thing that
draws one’s attention is the pyramidal
cupola stretching across the top of the
lobby. This pyramid, measuring 4.5 by 4.5
metres at its base, is made of laminated
glass with a chamber in the middle, held
together just by silicone, without any
frames; for safety reasons and due to
the breadth of the thing, it was decided
to install aluminium frames along the
protruding edges.
Also worth stressing in this zone are the
corner trim that peeks into the lobby
from the hospitalization wards, the granite staircase with their stainless steel and
glass handrail, the cluster of lifts and, of
course, the information desks.
Outpatient clinic
The Outpatient Clinic is formed of seven
tablets separated by outdoor zones decorated with planters and joined by hallways with skylight roofs. This arrangement allows the hallways to offer natural
overhead lighting and the offices to offer
views, yet without wasting a great deal of
space. In addition, the planter-lined hallways can be used as evacuation paths.
Another characteristic of these zones is
the use of aluminium frames and glass
to separate one zone from another, and
the use of round columns as a decorative
element.
The medical suites for the non-staff physicians whose services are used by the
Psychology Department , Internal Medicine, Urology, etc., are located in this part
of the clinic. There is a total of 67 suites,
each equipped with a doctor’s office, an
examination room and a washroom. And
there is even space for another eight- to
ten-suite enlargement in future.
• Dentistry: This is made up of 17
compartments with dentist’s chairs,
waiting rooms and space for enlargement or for a dental laboratory.
sions when that was possible thanks to
the great size of the building.
• Ophthalmology: This zone includes a
LASIK(21) room, waiting rooms, examination rooms and doctor’s offices. The
LASIK room is regarded almost as an
operating room, so it is equipped with
a technical panel, medical gas outlets
(vacuum, medicinal air, nitrous oxide...),
HVAC units with absolute filters, a presurgery area with surgical scrub sinks,
etc.
Job correlation hinged in the enlargement
of several zones. For example, in the initial
design, there was no outpatient clinic (on
the ground floor or in the basement), yet
an outpatient clinic was contracted later,
when the rest of the work was already
quite advanced.
Hospitalization wards
Hospitalization is divided into three
storeys, each of which is made up of two
wings and a central body. Each storey has
a floor area of 3,084 square metres, so
the total floor area of the hospitalization
wards is 9,252 square metres.
The general shape of the storeys is the
same. There are some minor differences
between the first and second storeys
(which are identical) and the third, consisting in the existence of a neonatal cot zone,
a number of double rooms and a number
of suites on the third storey.
On the first and second storeys, there
are 55 rooms (apiece), plus a lobby and
common areas (dirty, clean, storerooms,
etc.). The central lobby of each floor
contains the information desks and the
lift cluster and provides access to the main
stairway as well as the service, maintenance and common rooms (chair storeroom, janitorial zones, mattress storeroom, dirty, clean, doctor’s office, etc.).
On the third storey, each of the sittingroom suites is actually two rooms that can
be separated by sliding doors. The sliding
doors and the systems installed in both
rooms (headboards, etc.) make it possible
to use these rooms as separate single
rooms or as sitting-room suites.
The neonatal cot zone was built as a
roomy zone with separations formed by
screens of aluminium, glass and phenolic
board.
Aspects of construction
Works execution
Works began in July 2001 and were
completed in a record 26 months.
The job schedule was traditionally structured in line with the main tasks, overlapping some jobs with others on the occa21
Laser eye surgery
257
with special conductive glues and
connected to the operating theatre’s equipotential earthing system.
3) The PVC top flooring; this too had to
be laid using conductive glues so that its
contact with the copper mesh would have
the low resistance dictated by regulations.
Vinyl Wall Coverings
When the terrain was cut, it presented
good cohesion, so no timbering work was
necessary. Due to the definition of the
foundations (with different zones with
footings of widely varying thicknesses
and dimensions), the decision was made
to excavate the entire clinic area right to
the bottom, except for the area of the
Outpatient Clinic, where advantage was
taken of the consistency of the terrain,
the standard thickness of the footings (60
centimetres) and the separation between
footings to dig shafts and ditches for the
footings and braces.
A good part of the clinic’s walls were
covered with a vinyl wall covering
comprising an underlying layer of cotton
coated with a vinyl layer printed with
water-based dyes. This wall covering is
durable, immune to bumps and scratches,
washable, fireproof and bacteria resistant.
The structure was built in a reticular distribution with concrete columns and caissons, and slabs joined by pins to create
structural joints with the possibility of
movement.
The installation process was to screw or
rivet strips of wood to the wall and adhere
the finishing boards to the wooden strips
with two-sided adhesive tape.
Almost all the public zones of the clinic
were finished in granite (main entrance,
main lobby and Radiology Department
lobby, ground-floor halls).
Some materials used
A clinic, as a building intended for special
uses, calls for the use of materials that
meet stringent demands. So, some materials have been employed that may be
considered normal, because they are used
in almost all building work (concrete, brick,
mortar, etc.); and some special materials
have been used, “special” in that either
they are designed for extraordinary application in hospitals or they provide a most
un-ordinary finish.
Conductive Flooring
The special characteristics of operating
theatres, the high-tech zone and the ICU
mandate the use of a special type of flooring that meets the electrical conductivity
specifications set by codes. In the Palmaplanas Clinic, a conductive flooring was
used that featured rolls of a vinyl material
(two millimetres thick), built up in several
layers:
1) An underlayer of terrazzo, to provide
the required flatness and strength
2) Copper mesh adhered to the terrazzo
Phenolic Board
Zones that might be damaged by passing
gurneys or other wheeled objects were
clad with a material that stands out for its
hardness: phenolic board.
Mineral Resin
A special material made of a matrix of
resin and materials was used for the sinks
(normal and scrub) and showers. This
material is solid, with no pores or perceptible seams; thermoformable; resistant to
most chemical products, heat and impact;
approved for contact with foods; antibacterial; and requires no special care.
It can be attacked only by strong concentrated acids (such as concentrated sulphuric acid), ketones, chlorinated solvents
and paint-stripping products that are a
mixture of strong solvents.
One of the advantages of this material is
its maintenance, as it is easy to care for.
The only thing it needs for daily cleaning
is soap and water or a cleaning solution
containing ammonia. Also, scratches,
burns and minor stains can be repaired
easily with a scouring pad.
Magnetic Shielding
The NMR (nuclear magnetic resonancing)
room had to be shielded against magnetic
charges, that is, converted into a Faraday
cage, by means of copper sheeting on all
walls. In addition, no ferromagnetic material of any sort could be used inside the
room.
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Barite Block Walls
Operating Theatres
To achieve the proper radiological protection in the zones where such protection
is required (CT, NMR, RX, etc.), a special
type of building block made of barite was
used. Barite is a mineral with a high X-ray
absorption capacity.
Each operating theatre is equipped with a
patient preparation room, a medical team
preparation room, a storeroom and the
operating theatre proper.
The six-centimetre-thick barite facing wall
has an X-ray attenuation factor (for X-rays
at voltages of between 100 and 150 kV)
equivalent to that of a 3.7-millimetre-thick
lead sheet.
This special brick is rabbetted on all four
sides for building walls with mortar or
glue, the traditional way, with all vertical and horizontal seams overlapping.
Facing walls constructed with this kind of
brick can later be plastered or rendered.
The brick weighs about 170 kilograms
per square metre and is in addition nonflammable.
A single facing wall of this brick can form
the walls of a radiological unit, without
the need to line the walls later with lead
sheeting and cover the whole assembly
with drywall for an attractive finish. Additionally, the barite block wall’s acoustic
insulation against airborne noise is good
to 48 dBA(22), the same as is obtained with
a 15-centimetre-thick wall of solid bricks.
Some specializations
Surgery block
The Surgery Block has an area of 1,860
square metres and has room for:
• Eight operating theatres for major
surgery plus one for C-sections
• Four delivery rooms
• One operating theatre for same-day
surgery
• Two endoscopy rooms
This was the most special zone of the clinic
to build, as the cleanliness and sterilization specifications required in the Surgery
Block made a different kind of construction necessary.
Air filtration all throughout the surgical
zone is provided by pre-filters (90% efficacy), intermediate filters (95% efficacy)
and end absolute filters (99.99% efficacy),
save in common zones where absolute
filtration is not used.
22
Decibels with A-scale weighting: units of loudness
adapted to the sensitivity of the human ear,
because they are filtered, removing part of the low
frequencies and the very high frequencies
The medical team preparation room has
a surgical scrub sink provided with radar
taps, so team members can scrub their
forearms without having to close the taps
by hand.
Behind this zone lies the operating theatre.
The room is fitted out very specially:
• Conductive Flooring (already
explained)
• Technical Panel (in operating theatres,
delivery rooms and LASIK rooms): It
must be possible to control the humidity, temperature and pressurization
conditions of the operating room from
a central point that also controls lighting and has built-in instruments such as
an analogue clock, a chronometer, an
X-ray film viewer, a hygrometer, a thermometer, a gas alarm, pushbuttons for
perimeter lighting, voice and data jacks
and an intercom unit
• Lamps and Surgical Carts: These are
special lamps and carts bearing all the
implements necessary for C-sections
or other operations; they feature gas
outlets, control over the environmental conditions of the operating rooms,
a computerized communication system
with digital X-rays (TFT monitor), etc.
• Doors: The doors to the operating
theatre must be airtight enough to
ensure that the room can be overpressurized; the doors are motorized,
opened by an elbow, and can be manually opened
• HVAC system: The humidity and
temperature must be very strictly
controlled, and the air must be changed
at least 15 times per hour
Sterilization
The sterilization room is situated in the
Surgery Block, and it is equipped with two
steam sterilizers, one formaldehyde sterilizer and two ultrasonic washers. Dirty
materials are brought in through one door
and sterile materials are extracted from
the other (which opens onto the clean
zone).
Resuscitation
This room has eight stations, each outfitted with medicinal gases; it also possesses
a control and cleaning zone (with a
bedpan sterilizer).
Delivery Rooms
This zone, adjacent to the operating
theatre zone, is made up of normal delivery rooms and one room for delivery by
C-section, a control desk and cots and
incubators. The delivery rooms are sterile
zones, but they are less solicited than the
operating theatres; the C-section room,
for example, has a technical panel and
conductive flooring, but it does not have
individual preparation rooms.
Intensive care unit
General ICU
The General ICU is divided into ten individual compartments and a central control
section. The compartments are separated
from one another by aluminium screens
with glazed doors to enable monitoring
and high-pressure laminate in the separations between compartments to afford a
certain amount of privacy. Each compartment has its own toilet room.
NICU (Newborns)
In November 2004 a new unit was opened
for the first time to cover an important gap
in Balearic Island healthcare, for up until
that time only one hospital had a newborn
ICU. That facility was overcrowded, sometimes forcing sick babies to be moved to
similar units on the mainland.
This unit, part of the clinic’s Paediatrics
Department, was created with the objective of rendering assistance in high-risk
births, for newborns in general and for
sick babies, in addition to providing intensive monitoring for high-risk newborns.
Because it is so highly specialized, the
NICU can care for newborns with serious
pathologies, providing high-frequency
ventilation (one air change every eight
hours) for babies with less than 28 weeks’
gestation and weighing less than one kilogram, apart from offering services such as
haemodialysis, haemofiltration and heart
surgery.
It has a range of infrastructure, the foremost features of which are the baby isolation facilities, medicinal gas outlets and
the air change rate mentioned above.
The NICU is equipped with five incubators, four cots and two radiant-warmed
cots. The medical staff is specialized in
paediatrics, and the nurses are experts
in newborn care. The unit has a portable
basic radiology laboratory, newborn ultrasound facilities and a blood bank with
preservation capability.
As medical equipment, it also possesses
a transport incubator, pulse oximeters,
EKG (electrocardiogram) heart frequency
monitors, respirators, intravenous infusion pumps, a crash trolley and intubation
equipment.
Emergency room and outpatient
hospital services
In an area of 786 square metres there is
a total of seven general and six paediatric emergency compartments, fourteen
outpatient hospital rooms, a plaster room
and a suture room.
The emergency compartments are
equipped with medicinal gas and space
for the physician to examine the patient
(gurney), in addition to a zone for the
physician’s use, with data facilities
connected to the rest of the clinic.
The outpatient hospital rooms all have
headboard gas facilities and their own
toilet rooms.
Nearly all the outpatient hospital rooms
and emergency compartments have natural light. The inner zones are left primarily
for the service rooms (dirty, clean, maintenance and installed systems).
The paediatric emergency zone has a
waiting room designed especially to make
children’s stay more pleasant. There is a
play area with video games, slides and
drawings. In addition, the physicians and
nurses wear bright uniforms of different
colours (Some children are terrified by
the sight of a classic white-coated doctor,
making a thorough, relaxed examination
difficult).
Other specializations
Radiodiagnosis
In addition to the regular functions available at all image diagnostics departments,
this department specializes in the treatment and diagnosis of vascular, medullary
and cerebral lesions and diseases of the
lacrimal bone.
Oncology
This unit allows cancer patients to be
seen immediately without having to travel
to reach the different specialists they
need, eliminating unnecessary delays and
appointment systems or waiting lists at
the different offices. The same also occurs
during hospitalization, since the patient
can be tracked simultaneously by different specialists without ever losing the
advantage of a single integrated report of
proceedings and a single integrated tracking process.
Aesthetic Medicine
This department’s usual activities have to
do with elective plastic surgery. In most
cases this involves non-surgical treatments and thus requires no anaesthesia.
In addition, the department takes care of
reconstructing deformities and correcting functional deficiencies by means of
transforming the patient’s body; there the
goal is for a person who was born with a
congenital defect or who has suffered an
accident involving loss of the function of
a certain limb to attain normalcy in both
limb appearance and limb function.
The departments’ members cooperate
closely with the rest of the departments
to address their specific reconstructive
needs, such as wound repair, oncological
skin surgery, burn treatment, reparatory
microsurgery and the reconstruction of
diverse zones of the body.
Customer Service for Foreign Patients
The clinic has a specific department
providing customer service for foreign
patients. The department is manned by
a team of people thoroughly experienced
in hospital care for tourists, and they take
care of such patients as soon as they enter
the clinic, handling all the arrangements
and translating between patients and
clinic staff. This team is conceived as a
nexus between the patient, the hotel and
the patient’s travel agency.
Alterations to and
enlargement of
Nuestra Señora de
Candelaria Hospital,
Tenerife
Background
Nuestra Señora de Candelaria Hospital
(NSCH) is situated inside the municipal
limits of Santa Cruz de Tenerife, and it
was opened in 1966. Together with the
nearby Ofra Hospital (for long-term hospitalization) some 900 metres away, the
two institutions make up what is known
as the Nuestra Señora de Candelaria
University Hospital (NSCUH), a level-three
public hospital of general scope.
259
Well connected to Tenerife’s North and
South Motorways, the hospital complex
is oriented toward providing medical
care for the southern zone of the island,
and it is the lead hospital for the islands
of La Gomera and El Hierro. In terms of
specialized out-of-hospital care, however,
it covers the entire island.
In addition to the populations assigned to
the hospital, each year 3.5 million foreign
tourists rush to Tenerife. This means (on
average) some 100,000 additional people
on the island each day, not counting other
tourists from the rest of Spain.
The enlargement and
alteration steering plan
NSCH is a hospital complex whose
component pavilions were built at different points in time and have felt the effects
of continual transformations.
The need to renovate the complex’s structure convinced the Spanish Health Institute back in 1986 to draft a Construction
Steering Plan. However, the plan only
addressed the wear and tear on the buildings without promoting the functional
renovation the hospital needed in order to
deal with twenty-first-century healthcare.
After powers in health-related matters
were transferred from the national
authorities to regional authorities, the
Canary Island Health Service decided that
the Steering Plan ought to be thoroughly
analyzed to determine whether it would
enable the institution to implement all
the tasks entrusted to it and, moreover,
whether a future hospital could feasibly
be constructed on top of the pre-existing
structures.
All throughout 1995 a multidisciplinary
professional team studied the healthcare needs of the population residing in
the geographical areas whose healthcare
coverage was assigned to NSCH.
On the basis of the estimate of those
needs and the hospital’s other functions
(teaching and research), a Functional Plan
was drafted, which was approved in 1996.
The old Steering Plan draft was unable to
satisfy the needs thrown into stark relief
by the new Functional Plan.
The challenge was to find a design that
could satisfy the healthcare requirements
and at the same time be applied without
interrupting hospital services or diminishing the hospital’s capabilities; plus, it had
to reduce as much as possible the nega-
260
tive environmental impact on users and
hospital staff.
A number of basic objectives were accordingly set up, and achievement of those
objectives guided the process of drafting
the new Steering Plan. Said objectives
were:
• To concentrate activities into large areas
devoted to the care of patients of similar needs, providing the hospitalization
areas with greater privacy and making
the areas of technical healthcare activity
efficiently functional
• To reduce unnecessary patient travel
• To shorten the length of the healthcare
cycle as much as possible
• To boost efficiency through the physical
structure of the building
• To favour the work of multidisciplinary
teams to improve the quality of the
healthcare given, at the same time
fostering teams’ professional development
• To generate a comfortable framework
for the interaction between hospital
users and the professionals who attend
them
• To adjust the installed systems to guarantee safety, energy savings and environmental friendliness
The new Steering Plan eliminated the way
the hospital was initially conceived (based
on pavilions organized by specializations),
giving way to a structure that placed the
priority on clustering similar activities in
differentiated structures.
Thus, NSCH (i.e., not including Ofra Hospital) surged from the 739 beds it used to
have to 853 hospital beds, but a great deal
of the growth focused on units that were
seeking to mend shortcomings in specific
areas: the ICU, affecting the patients in
the most serious condition; single rooms
for the selective isolation of infectious
and/or immunosuppressed patients; and
patients with acute psychiatric pathologies, thus covering a healthcare need not
yet addressed by this hospital.
NSCH also gained 138 beds devoted to
diagnostic and therapeutic procedures
performed on an outpatient basis. This
makes it possible to care for a great
number of patients without hospitalization. Some especially important action in
outpatient services is being done in the
field of same-day surgery, which enables
the patients of nearly 4,000 operations a
year to return home on the same day as
their operation.
tional images to be obtained.
Fifty more rooms were opened for the
Outpatient Clinic (there used to be 87)
and for the application of diagnostic and
therapeutic procedures by specialized
clinicians. Because of this increase, organizational measures and the outpatient
hospital services cited above, more and
more patients can receive these forms
of healthcare without being cut off from
their normal environment.
Conducting a full transformation such as
the one described without interrupting
the healthcare process necessarily meant
a phase strategy had to be applied, to
enable the necessary moves to be made
so that the action in each sector of the
hospital could be tackled gradually.
Lastly, the central services were considerably increased in all areas, with the implementation of newly built units providing
the following:
• Two surgical areas for hospitalized
patients and one for same-day surgery
with 23 operating theatres, as opposed
to the 16 formerly available
• One Emergency Department with 28
emergency care compartments
• One radiotherapy unit capable of applying brachytherapy and external radiation
therapy techniques with three linear
accelerators, and space set aside for
another
• One Image Diagnostics Department with
21 rooms (a notable increase in capacity), including areas for interventional
vascular radiology with two rooms, and
high-tech areas with two scanner units
and one nuclear magnetic resonancing
unit
Phase strategy
Altogether, the changes were to increase
the hospital’s area to 120,188 square
metres (51,303 square metres of new
construction and 66,792 square metres of
alterations).
Phase 0
Phase 0 consisted in a number of preliminary operations oriented toward creating
the right infrastructure and safety conditions for a risk-free start on the main
work. The operations involved the laundry, the kitchen and the Nuclear Medicine
and Radiation Therapy Departments. They
covered an area of 6,800 square metres,
of which 2,600 were newly constructed
and 4,200 were alterations.
Phase 1A
• Remodelled area: 15,654 square metres
• New-built area: 12,288 square metres
• Starting date: 29/11/94
• One haemodynamics and catheterization laboratory with one room and the
possibility of adding a second if healthcare needs give grounds for expansion
• Completion date: 30/4/99
• One Clinical Neurophysiology Department with seven rooms
• Alterations to the former School of
Nursing, fully remodelling the extremely
shabby outer walls and making the
building over for a different purpose;
it was to be used mainly as an outpatient clinic, save for level 5, which would
continue to be a school of nursing
These structures were rounded out with
supporting areas, such as the areas
devoted to radioactive waste holding and
treatment, and communications nodes.
Some of the new services made landmarks in the medical history of the Canary
Islands, because they included in their
structures some absolutely new special
equipment. For example, in the summer
of 2007, NSCH installed the Canary
Islands’ first PET(23) unit, a device that also
featured combined CT (computerized
tomography) technology enabling highquality combined morphological/func23
Positron emission tomography
In this phase several activities were
performed:
• Alterations to the Maternity and Children’s Pavilion, tearing down and
replacing the two side components (the
North Tower and South Tower), in addition to altering the interior to hold two
new nursing units
• Alterations to the left wing of the
General Pavilion, for medical support
services
• Building of a new energy station, a
research laboratory, a haemodynamics unit, a blood bank, an eleven-storey
block adjacent to the General Pavilion
with four panoramic lifts, a small lobby
and two restrooms
• Demolition of the old laundry and power
plant and creation of a new main access
to the hospital
• Construction of two car parks, with 600
and 200 spaces, respectively
With the creation of the North and South
Towers, the hospital switched from having
its rooms scattered around the different
buildings to having them centralized in
the eleven storeys of the towers and the
Maternity and Children’s Pavilion, creating
a U-shaped block that is covered by two
nurses’ desks.
Phase 1B
The following things were done:
• Construction of the north wing of the
Maternity and Children’s Pavilion
• Five-storey enlargement of the Medical
Support bridging unit
• Construction of the diagnostic, clinical and treatment support buildings
(Surgery Block, Obstetrics Block and
Radiology Department)
• Remodelling of the old General Home
to include Radiation Therapy, adult ICU,
paediatric ICU and NICU (newborns)
• Interior alterations to five storeys of
the Nursing School to adapt them for
Outpatient Clinic use
• Enlargement of the Emergency building
• Construction of three sets of premises
(bunkers) for linear accelerators
Concentrating the hospitalization units
in the new building enabled the necessary space to be freed up in the former
General Home to implement the new
central services, the surgery units and
intensive care units and the units performing diagnostic and treatment procedures,
by specializations.
It was in this stage where the most important technological additions were made
to the hospital’s systems and permanent
(non-mobile) equipment. Furthermore,
the Outpatient Clinic services were gathered together to enable easy access from
the outside and at the same time to create
a two-way indoor connection with the
central services most highly in demand:
radiodiagnosis, centralized sample extraction and the central file of clinical histories.
Phase 1C
Phase 1C was basically a supplement
to Phase 1B. It encompassed new-built
zones intended for laboratories, delivery
rooms and technical areas but was mainly
oriented toward completing the aspects
of Phase 1B having to do with special
systems, items of permanent equipment
and communications technology (generator sets, laboratory furniture, sterilization machinery, surgical booms, surgical
lamps, ICU headboards, wheeled cabinets
and a heliport).
Phase 1D
The last stage of work, termed “Phase
1D” and scheduled to last until 2010,
concerns the things to be done in the
peripheral buildings of the complex:
• Traumatology and Rehabilitation, where
the teaching and research structures,
auditorium, major same-day surgery,
rehabilitation and the complex’s administrative spaces are located
• The Emergency Room
• The School of Nursing, which is being
gradually altered into an Outpatient
Clinic as new locations are readied for
its current occupants
Description of the new
hospital
The initial hospital consisted of one
central building and large blocks around it
devoted to hospitalization, the Emergency
Room, the Outpatient Clinic and other
specializations. The new hospital increases
the height of some of those blocks and
fills in spaces in between with new blocks,
in addition to completely altering the
buildings inside, both structurally and
functionally.
Hospitalization (maternity and
261
children, north and south towers)
These are 11 storeys having some 1,800
square metres apiece.
• Basement: The Maternity Emergency
Room is located here, with its delivery rooms, high-risk operating theatre,
examination rooms, monitoring rooms,
admissions desk, storerooms and other
supporting facilities
• Ground Floor: Concentrated on the
ground floor are paediatric hospitalization and paediatric surgery, a laundry storeroom and dispensing station,
a telephone switchboard and a small
kindergarten
• Floors 1 to 9: The hospitalized patients
of the different specializations are situated on all these floors, in L- or U-shaped
wings. All floors have two nurses’ desks,
two dirty rooms, two clean rooms, two
preparation rooms, two small sitting
rooms, two assisted bathrooms and two
patient lounges, in addition to a men’s
changing room and a women’s changing room, two restrooms, two supervisor’s offices and one conference room.
The rooms are double, with a window,
so they are filled with light. They are
all equipped with oxygen and vacuum
outlets and have air conditioning. The
total number of beds is 790, 50 more
than before the alterations.
The North Tower Enlargement is a ninestorey building situated on top of a portico
structure, wall-to-wall with the northern
units of the hospitalization wards whose
control stations it shares.
On each of its floors, six rooms have
been laid out (all single save in the unit
for patients held in custody). The creation
of the North Tower not only signifies new
growth for the centre’s hospitalization
capacity, but also enables some patients to
be isolated when necessary and provides
support for specific activities that require
special security conditions. The total area
of this building is 3,320 square metres.
Medical support
• Basement: The basement contains the
pharmacy with its storerooms, offices
and sterile zone for the preparation of
cytostatic drugs (24)
• Ground Floor: Lobby and main entrance
• Floors 1 to 4: Medical support offices
In Phase 1C, the building finished and
24
Cancer treatment drugs used in chemical therapy
262
reinforced for additional storeys in Phase
1A was enlarged upwards by three full
storeys and two half storeys to house
more offices. The building now has eleven
storeys. There is also a unit on the roof of
the fifth storey to serve as a balcony for
the Psychiatry Department.
Surgery block
• Basement: This 1,119-square-metre
floor is devoted to compact files of clinical histories as well as file offices.
• Semi-Basement: The semi-basement
contains part of the main lobby, the
cafeteria, the rubbish storeroom and the
building’s rubbish pick-up point.
• Ground Floor: With a floor area of 859
square metres, the ground floor encompasses the Paediatrics Department
and the paediatric outpatient hospital
services. It possesses a school, offices,
clean and dirty zones, storerooms, a
wound treatment room, restrooms,
changing rooms and a projection room.
• Floor 1: On this floor lie the 444-squaremetre Urology Department and the
342-square-metre
Neurophysiology
Department.
The interesting points of the Urology
Department are the spaces devoted to
urodynamic testing and especially the
lithiasis area (where there is a device that
employs a laser to destroy kidney stones).
This department also has examination
rooms, offices, reporting rooms, dirty
rooms, clean rooms, storerooms, changing rooms, rooms for special technology
and waiting rooms.
The
Neurophysiology
Department
contains the sleep treatment zone and
the electroencephalography and electromyography rooms, which have the unique
feature of boasting chicken wire embedded in ceilings, floors and wall cores to
form a Faraday cage, with independent
earthing connections to avoid interference with the machinery. The rest of the
unit is composed of facilities for testing
evoked potentials(25), offices, storerooms,
waiting rooms, clean rooms, dirty rooms,
restrooms and changing rooms.
• Floor 2: The Sterilization Department is
located on floor 2, connected directly to
floors 3 and 4 (operating theatres) by a
lift and a staircase. Floor 2 has a floor
area of 859 square metres divided into
25
Neurophysiological devices that record the brain’s
provoked responses to sensory stimuli that may be
visual, auditory or electrical tactile
three major zones, washing, packaging
and storage, separated by two sanitary
barriers.
The washing zone contains a huge cart
washer, a large tunnel washer and a small
washing machine. The interesting thing
about the tunnel washer and the small
washing machine is that they sit at the
first sanitary barrier; that is, the washed
instruments pass into the second (sterile)
zone, where they are packaged to go into
the sterilizers (five steam sterilizers and
one ethylene oxide sterilizer, which sterilizes at a higher temperature to eliminate
certain bacteria).
After travelling through these two-door
sterilizers, instruments move into the
completely sterile storage area, and there
they sit, ready to be transported by lift to
the clean halls on floors 3 and 4, where the
operating theatres are. From there they
will be delivered through a delivery hatch
or stored in one of the two-door instrument cabinets each operating theatre has.
The rest of the department has a disinfection area, cleaning-product storerooms,
a textile storeroom, restrooms, changing rooms, an ironing zone, a packaging
zone, a staff lounge, offices and a steam
header room.
• Floors 3 and 4: Each of these
925-square-metre floors possesses six
operating theatres. The model applied
to the surgery ward calls for a clean hall,
an operating theatre and a dirty hall.
An operating suite is made up of the operating theatre proper, the patient preparation zone, the medical preparation zone
and a shared dirty zone for every two
operating theatres. The rest of the floor
is made up of rubbish-holding facilities
with two cargo lifts for rubbish, a general
storage zone, a dirty storeroom, support,
coordination, dictating, an office, supervision, a restroom, a traffic hall, a clean hall,
a sterile hall, an access control station, bed
waiting, a clean transfer zone, personnel
locks, a personnel lounge, a clothing lock,
outside bed waiting, same-day patient
waiting, a contact office and a family
waiting room.
• Floor 5: One part of the floor has
been outfitted to hold air-conditioning
machines for the operating theatres and
the chillers, and the other part of the
floor houses the anatomical pathology
laboratory offices.
• Floor 6: This has the anatomical pathology laboratory, and on the adjacent
roofs are air-conditioning units for the
operating theatres.
• Floor 7: Computer unit.
• Floor 8: On this 478-square-metre floor
are located the Psychiatry Department’s
offices, as well as changing rooms, restrooms, therapy rooms, waiting and visiting rooms, etc.
Surgery support
Up to Phase 1C, work in this building
focussed on the area from the ground
floor to the fourth storey. In the end, in
Phase 1D, alterations were made to the
basement that had been built in Phase 0.
• Ground Floor: Offices for the admissions desk, photocopiers and customer
service; the rest is lobby.
• Floor 1: Offices and special rooms
belonging to the Pulmonology Department.
• Floor 2: On this floor, 841 square
metres were built for dialysis facilities,
encroaching on part of the Surgery
Block for the dialysis room. The unit is
made up of the control station, patient
waiting area, plasmapheresis, the
CAPD(26) plasmapheresis control station,
a restroom/changing room, a dirty zone,
infectious patient PD, functional tests,
clean technologies, a chronic patient
room, an acute patient compartment,
preparation and weighing, restroom/
changing rooms for infectious patients,
an equipment repair and storage room
and the osmosis treatment room.
• Floors 3 and 4: On the 225 square
metres of each floor, two post-operative
resuscitation units have been prepared:
one for simple operations where the
patient stays only a few hours, and
another for more complicated operations where the patient may even
remain for days. Offices for supervisors,
physicians on duty, the department
head, a conference room, a lounge and
a storeroom are also found here.
Alterations to the school of nursing
These alterations consisted in the complete
interior demolition of the building, leaving
the structure and foundations standing,
and improving the building by creating
semi-wings for the Outpatient Clinic, with
a control station in the middle of the two
semi-wings.
26
Continuous ambulatory peritoneal dialysis
Enlargement of the emergency
building
The structure was built for two twostorey buildings having approximately 300
square metres apiece, to flank the already
existing Emergency building. This included
the walls of one building and the finish
work on the ground floor of the other,
where three generator sets, a transformer
substation for the Emergency Room and
an electrical panel room were located.
The system consists in filling the drill hole
through these sleeves at a pressure and
with a quantity determined and preset in
advance, until the sleeve cannot open any
more. That will indicate that the terrain has
been improved in that pressure-grouted
area, whereupon operations move on to
the next sleeve.
built with a 30+5-centimetre waffle slab,
and the Obstetrics/Radiology Block was
built with a slab measuring 30 centimetres
along the edge, due to the change in fire
regulations and the weight of the apparatuses to be installed (magnetic resonancing unit, scanners, X-ray machines,
gamma chambers, etc.).
The floor structures between storeys were
30+5-centimetre reinforced concrete
waffle slabs with seven-metre spans.
Linear accelerators
Obstetrics and radiology block
Maternity and children’s building
In order to begin the construction of this
building between the old General Home
and the North Tower of the hospitalization wards, the old Surgery Block had to
be demolished first.
This building has a metal structure, with
beam-and-block flooring measuring 18+5
centimetres along the edge. It presented a
special feature; when the demolition work
was completed and the site’s condition
was checked, recalculations were found
to be necessary. As a result, the columns
had to be strengthened with welded flats,
and some had to be braced with diagonal
struts; and the beams had to be reinforced
with halved HEB beams welded onto the
bottom.
This new block gradually went into operation starting in June 2006. It has 12 floors
(basement, semi-basement, ground floor
and nine above-ground floors) and 20,260
square metres, and it houses the radiation
therapy unit, the nuclear medicine unit,
the radiodiagnosis unit, the gastroenterology procedure area, laboratories, haematology and the blood bank, the obstetrics block and physicians’ bedrooms, as
well as most of the new ICU and NICU
(newborns). The hospital heliport is situated at the top.
This heliport can be used by 14-metre helicopters, which are the ones most often
flown to transport the sick and injured, so
the platform that has been provided is 28
metres in diameter. The landing surface
has been strengthened considerably to
withstand the impact of one of these
aircraft if it falls.
Structure and foundation
North and south towers
After an exhaustive study of the terrain,
it was decided that the foundation for
these buildings would be a concrete slab
with micropiles, the slab edge to be 90
centimetres and the micropile length, 12
metres for the North Tower and 16 metres
for the South Tower, because in the latter
case there was a larger quantity of slag.
The type of micropile used is what is
known today as “Ropress”, the trade
name for what was initially called
“Tubfix”(27). This micropile has the special
feature of being made of grout injected
under pressure through sleeves set every
metre in the steel tube (This operation is
called “pressure grouting”).
27
Micropiles ending in a pressure-grouted bulb
263
Medical support building
When the interior and façades of this
five-storey building were demolished, the
structure was analyzed, and in view of the
results it was decided to apply an anticarbonation treatment to the concrete in
the columns and hanging beams.
Furthermore, given that in Phase 1B this
building had to have five storeys added to
its height, the structure was reinforced.
This consisted, first, in strengthening the
foundation with a slab with micropiling,
but leaving the slab separated from the
existing footings; and, second, reinforcing
the footings by increasing their depth of
edge and installing micropiles.
These micropiles were hindered by the
storey’s three-metre clearance, so they
had to be driven with a special micropiling machine. To reinforce columns and
beams, a reinforced concrete casing was
cast. The concrete was poured through
four drill holes in the floor structure,
where the column reinforcements were
inserted.
Surgery block and obstetrics/
radiology block
In these newly designed buildings, a slab
was cast with micropiles, like in the previous buildings, with the sole variation of
the micropiles’ using a system filling them
with mortar instead of grout.
As for the structure, the Surgery Block was
This zone stands out from the rest in
terms of foundation and structure, due to
the thickness of its walls and ceiling slabs,
but above all due to the use of concrete
containing barite. The barite aggregate
density, between 3.8 and 4.2 tonnes
per cubic metre, yields concretes with a
density of between 3 and 3.2 tonnes per
cubic metre.
These concretes are extremely heavy
and therefore extremely difficult to cast
in formwork and impossible to pump.
Furthermore, concrete lorries cannot carry
more than 2.5 or 3 cubic metres, so works
progress slows down considerably.
Concrete of this sort is rather simple
to prepare, but special care must be
taken with the proportions, especially
the proportions of barite aggregate and
water. Therefore it is fundamental to
weigh samples from each lorry and check
their density.
Façades
The outward face the hospital shows has
a compact appearance of great volume,
arranged into steps as necessary to avoid
creating an oppressive sensation. This is
aided by the creation of courtyards, which
improve the amount of light inside.
The façade is ventilated, with Trespa
phenolic board cladding(28). In crosssection, the façade is made up of a wall of
vibrated concrete blocks measuring 50 by
25 by 20 centimetres, with waterproofed
rendering on the outside, over which is
placed an aluminium auxiliary structure
every 90 centimetres, attached to the
block and to the floor structure with stainless steel bolts and special plugs.
This type of phenolic board (There are
many types on the market) was chosen
due mainly to the fact that it was the only
one tested successfully for 6,000 hours’
sunlight in a climate similar to that of
the Canary Islands without showing the
effects.
28
Made up of a core of cellulose fibre impregnated
with phenolic resins and an outer (decorative)
surface, also impregnated and pressed at a high
temperature (150°) and high pressure (90 kg/cm²)
264
At the cluster of panoramic lifts, a curtain
wall was erected with safety glass set with
silicone vertically and aluminium transoms, held by metal frames to the edge of
11-storey-high free-standing reinforcedconcrete walls.
Installed systems
Wiring
The demolition of the previous industrial
building, which housed one of the transformer substations and through which ran
part of the 6,000-V lines, forced a thorough remodelling of the medium-voltage
wiring.
A transformer station was built with two
800-kVA transformers and one 1,600-kVA
transformer for the 6,000-V air conditioning, with the possibility of upgrading to
20,000 V when the hospital input was
changed. An 800-kVA generator set was
installed as well.
The wiring alterations to be done went
hand-in-hand with the work to improve
the new hospital spaces, because each
change involved new low-voltage wiring.
Each of the existing transformer substations was powered at 6,000 V, which
simplified the new layout and maintenance of the hospital’s wiring but complicated the operation of the generator sets,
since there was no way of separating the
loads that ought to be connected to the
emergency power system.
The switchgear is of the type housed in
prefabricated metal booths, while the
transformers are housed in masonry cells
for easier access.
Once the ground plans of the buildings
had been studied, taking account of the
departments the buildings were to house,
the buildings were divided into ward subpanel sectors for each department. Each
of the sub-panels is divided into two cabinets: one mains/group cabinet and one
UPS cabinet(29). From the sub-panel electricity is carried to the different sections
through mesh cable trays in the hallways,
branching into the rooms in corrugated
pipe after transition in a junction box.
The low-voltage wiring is organized into
five vertical lines autonomous from one
another. In each line there are in turn
three types of power lines:
• Uninterrupted supply, connected to a
UPS unit, such that, if the power supply
29
Uninterrupted power supply
ever fails, there is not even a microblackout; these lines are preferably used for
powering computers, and they run all
over the hospital
• Normal mains/generator supply (constituting the bulk of the hospital’s power
consumption); if the power fails, the
generator units take up the slack in 20
seconds
the main drains without passing through
any grilles.
One special system that ought to be
underlined is a dialysis water treatment
(reverse osmosis) plant utilizing in-line
units and resin tanks and salt tanks for the
sterilization machine supply water.
Air conditioning
• Non-essential supply; in the event of
a power failure, the generator sets do
not automatically take over (This will
be done later, manually, for overload
prevention and selective actuation); they
are devoted exclusively to the air conditioning and a new pair of bed lifts in the
Maternity and Children’s building.
The air-conditioning system consists of
five cooling units, two of them with heat
exchangers, situated on the roofs of the
buildings and connected to one another.
The heat exchangers produce part of the
necessary hot sanitary water, and the
rest is produced by two parallel back-up
furnaces.
The wiring in rooms and other areas runs
through partition walls made of Pladur
panels and dropped ceilings. The cable
used is halogen-free.
In the wards, there are two-zone HVAC
units and low-silhouette fan-coils to
handle the ventilation and return air for
each room. At the spot where these apparatuses meet, outside air is added, which
is mixed with the return air from the
rooms. Furthermore, there is an independent exhaust system for toilet rooms that
travels vertically through utility shafts. The
entire air-conditioning system is computer
managed.
In the storey containing the operating
theatres, insulation panels were especially
used to shield against electrical risks, and
there is one battery per operating theatre.
Inside the operating theatres a technical
panel was installed with a built-in clock/
chronometer, speaker, PA, voice and data
station, negatoscope(30), gas outlets and a
display for controlling pressure, humidity
and temperature. The indoor luminaires
are airtight screens for a sterile environment and halogen downlights whose
intensity can be adjusted at the technical
panel.
This system of insulation panels was also
introduced in the Dialysis Department and
in PACUs(31).
Plumbing
Cold water and hot sanitary water pipes
are clustered into accessible utility shafts,
one per four rooms. The pipes used in
Phase 1A were galvanized for risers and
copper for horizontal lines, although this
was changed in Phase 1C to Fusiotherm(32)
pipe for hot water and PVC pressure pipes
for cold water.
Rainwater and sewage are collected
separately, so there are two independent
systems. The sewage flows through a
grille before it is sent to the main drain,
and the rainwater system goes straight to
30
Light screen on which X-ray film is placed in order to
see the transparent images on the film
31
Post-anaesthesia care unit
32
PVC-free polypropylene pipe that requires no
adhesives; ideal for fluids up to a working pressure
of 20 bar and a temperature of 95º
In the Surgery Block, the PACU and the
dialysis zones, an air-conditioning system
has been installed with two-pipe chillers and wall-mounted console fan-coils,
with a primary air unit on the roof from
which ducts lead to the different floors or
departments.
In the operating theatres, an air system
was installed that sweeps from the sterile zone toward the clean zone. The
system consists in an HVAC unit to which
an automatic variable flow regulator is
connected in series with a box containing a cooling battery, a heating battery, a
humidifier section and absolute filter; air is
distributed from this box at the humidity
and temperature requested by the operating theatre, through stainless steel ducts.
The control system enables the operating theatre air-conditioning system to
be run at less than maximum efficiency
(i.e., outside its regular operating mode);
thanks to its speed variators, it can also
be left in maintenance or cleaning mode.
Medical gases
An auxiliary supply station with nitrous
oxide and oxygen, a vacuum supply station
with pumps and tanks and a compressedair supply station with two air compressors and medical air were provided.
In operating theatres, surgical carts and
anaesthesia carts were installed. The latter
carry built-in gas outlets, electrical outlets,
voice and data jacks, monitor stands and
a motor that blows the anaesthetic gas
outside through a dedicated system of
pipes.
In the ICUs and PACUs, anaesthesia carts
like the ones described above but including a nurse call button were also installed.
Pneumatic transport
A pneumatic transport system was implemented and coupled to the system already
in place in the hospital, reaching the laboratories, the Emergency Department, the
operating theatres, PACUs and the dialysis unit. Twenty transit stations and two
terminal stations were installed. Each
nurses’ desk has a station.
Fire detection
Initially, ion detectors were installed in
each room or section, as well as in the
hallways. They are fully controlled by a
computer running a specific program.
In the rooms of the south hospitalization
wing, as well as in the enlargement of
Medical Support, the same system was
followed; however, in the Surgery Block
the system was changed from ion detectors to optical heat detectors, so a new
control system had to be assembled to
cover all detectors, taking account of their
different operating characteristics.
Alterations to
and enlargement
of Canary Island
Tenerife
Background
Canary Island University Hospital (CIUH)
is a level-three public hospital of general
scope, and it dates back to 1971. It is one
of the two main hospitals of Tenerife and
is located inside the municipal limits of La
Laguna, near the North Motorway.
It is responsible for the health area termed
“Tenerife North”, which encompasses
11 cities and towns in the north of the
island (342,000 inhabitants) and provides
support for patients on the island of La
Palma (86,000 inhabitants) when La Palma
General Hospital is overwhelmed.
Apart from its healthcare commitment,
the hospital has been engaging in tasks in
the research field for more than a decade,
together with the La Laguna University School of Medicine, with whom the
hospital has created a Joint Research Unit.
Its top-priority activities include: molecular pathology of rare diseases, neurodegenerative diseases, genome instability
and cancer, epidemiology of colorectal
cancer, inflammatory response in rheumatic diseases, nosocomial infections(33)
and community infections, and physiopathology and prevention of complications
in kidney transplants.
The hospital is an accredited national lead
hospital for pancreas and kidney transplants, and this fact endorses it as one
of the three centres in Spain for training
specialists in transplants of this sort.
In response to the aging of its systems
and the lack of space for new departments and technologies, CIUH faced the
dilemma common to many hospitals: to
move to a new building or to tackle a
complicated process of internal renovations. Being conveniently positioned next
to the island’s main motorway and physically connected to the School of Medicine,
the hospital opted for renovation.
The enlargement and
Accordingly, many years ago the CIUH
Works Steering Plan was begun, an ambitious process of phases of work aimed at
defining what the new hospital was to
be. The phases and their current state of
completion are as follows:
• Phase 1 (completed): NEA building
(operating theatres, the Emergency
Department, the ICU and sterilization)
and two evacuation towers
265
• Outpatient and <24-hour hospital beds,
from 52 to 142
• Sanitary area per bed, from 76 to 170
square metres
• Outpatient Clinic rooms and areas for
diagnostic and therapeutic procedures,
from 110 to 214
• Emergency healthcare stations, from 9
to 23
• Operating theatres, from 14 to 21
• Image diagnostics rooms, from 16 to 23
• Linear accelerators, from one to three,
with an extra reserve unit anticipated
Phase 1. NEA building and evacuation
towers
The CIUH renovation programme began
with the construction of a large area
termed “the NEA Building”, which
contains the Emergency Department, the
ICU, operating theatres and the Sterilization Department, in addition to two
evacuation towers, one at each end of the
hospitalization building, and a heliport on
the last floor of one of the towers.
This is Phase 1 of the Steering Plan, and
it is already completed and in operation.
It was in turn tackled in two stages:
• Stage 1: Annexe for new departments Operating theatres, the Emergency Department and the ICU
Ground-floor hospitalization
ward
• Stage 2: Evacuation towers
Changing rooms
Sterilization
Heliport
Equipment
Lift apparatuses
Soiled clothing and rubbish
transport
NEA building
• Phase 2 (coming to an end): SameDay Activity Building
• Surgery Block
• Phase 3 (designed): Enlargement and
remodelling of CIUH, currently in the
technical supervision process
The new block consists of 14 operating
theatres, pre- and post-anaesthesia areas,
a unit control desk, changing rooms,
storerooms, staff lounge areas, etc.
The change, in different figures, means:
• The floor area will have increased from
71,000 square metres to over 135,000
square metres
• Total beds, from 603 to 809
33
Infections contracted in hospital
The operating theatres are divided into:
Ten multi-purpose theatres for scheduled
surgery, one for urgent surgical activity
and three for specific surgical activities
(heart, traumatological and ophthalmic
surgery).
This block displays a clear division between
266
clean zones and dirty zones. The patient
transfer station contributes decisively to
the barrier. The station was conceived
as a double-lock system. Patients are
wheeled into it in beds, and, through the
transfer station, they are transferred to a
wheeled operating table before they can
gain access to the clean+ zone. The Sterilization Department is connected to the
surgery block by two goods lifts.
• One surgical cart
• An anaesthetic gas aspiration system
• A computer connection
• A telephone connection
The Surgery Block has the following
entrance and exit circuits:
In the resuscitation room, each of the beds
has two compressed-air outlets, three
oxygen outlets, three vacuum outlets, one
monitoring outlet and six electrical outlets.
The reception desk is wired for computers,
telephones and PA.
Entrances:
• Emergency Department
• One for the hospitalized patient, through
the transfer station
The Emergency Department is arranged
into an adult emergency area and a
paediatric emergency area, with different
patient traffic paths. Obstetrical emergencies are handled separately. The layout
of the compartments in the adult zone
enables patients with medical pathologies
to be set apart from patients requiring
surgery.
• One for staff, through the changing
room
• One for clean or sterile material
• One for Area reception and internal/
external communication
Exits:
• One for the hospitalized patient, from
the operating theatres to the postanaesthesia resuscitation room
• One from the resuscitation room to
outside the Area
• One for staff, to the changing room
• One for clothing and dirty material
Dirty material must leave the Surgery
Block without crossing clean zones.
To reduce patient handling to a minimum,
patients are wheeled in their beds to the
patient reception zone. A patient enters
the block through the transfer station and
is placed in the pre-surgery waiting zone.
Once the patient has been moved to the
wheeled operating table, his or her bed is
moved immediately to the post-surgery
resuscitation rooms, where it will await
the patient.
This unit’s control station is centralized,
such that the same healthcare team can
reach all patients.
Each operating theatre has the following
complement of equipment:
• One anaesthesia gas cart (CO2, oxygen,
compressed air, nitrous oxide, vacuum
and carbogen(34), the latter only in the
heart surgery theatre)
34
Gas yielded when oxygen is mixed with 5-10% CO2;
it stimulates the respiratory system and is used in
general anaesthesia, collapse following anaesthetics
and intoxication with depressants (barbiturates,
opium, etc.)
The organizational system is a blend in
which a typical Emergency Room medical structure coexists with a structure
the hospital’s regular departments use
to render services, although reception is
shared by both. All conventional radiology
work generated by this unit is done right
inside the unit.
On the basis of current demand, and
in view of the difficulty of successfully
obtaining a system for communication
with the Central Radiodiagnosis Department, another scanner room and an ultrasound room were considered necessary in
the Emergency area. The two respond to
the demands of the Emergency Department and the ICU, respectively.
All urgent surgery generated in this unit
is performed in the emergency operating
theatre, located in the Surgery Block.
The department has a patient observation
unit with individual monitored compartments, physically in close proximity to and
functionally dependent on the department. Patients are not supposed to remain
in this zone for more than 24 hours,
provided that the possibility of drainage
exists.
There is also a result waiting room with
armchair seating for six to eight people
and an open observation zone with four
or five beds, for patients being attended
to in the patient classification and distribution room.
there is a specific space in the Emergency
Department devoted to exitus or fatal
outcome(35). This space is shared with the
ICU, and its location lies in a zone separated from the healthcare area.
Analytical testing can be done in the
Emergency Department’s laboratory, situated in the central laboratory area, to
which the department is linked by pneumatic transport and by computer.
• ICU
This is an oval room with a naturally lit
central courtyard and a central zone with
a nurses’ desk from which the 24 individual, independent cubicles are supervised
through a monitoring system. It provides
care for critical patients with medical and
surgical pathologies and is easily reached
from the Emergency Department and the
Surgery Block. It also has a mechanized
system for transporting blood samples
and laboratory results.
The ICU compartments are good for
multiple uses. They can be closed and can
be viewed directly from the outside and
from other compartments. Each compartment has three oxygen outlets, three
compressed-air outlets and three vacuum
outlets.
Each compartment is lit by a modular ceiling lighting system and a direct and indirect headboard lighting system. It moreover possesses a connection for at least six
electrical plugs, all earthed, and has a tap
for staff to wash their hands.
There is a system of sound and visual
alarms that can be triggered from each of
the compartments and detected from any
zone (conference room, on-duty physicians’ rooms, lounges, etc.) within the
same area. This mechanism is used only in
emergency situations, such as if a patient
undergoes cardiopulmonary arrest.
The ICU compartments also have drainage facilities and deionised water facilities
appropriate for use in dialysis treatments.
• NEA Systems
The garden situated across from the
Emergency Department entrance was
excavated to enlarge the building for
machinery and maintenance. This makes
maintenance and sterilization rooms run
by the corresponding departments available to the Surgery Block as a whole.
35
To prevent the patient compartments
from becoming temporarily blocked,
Exitus or, more correctly, exitus letalis, is a Latin
expression used in medicine to indicate that the
disease has progressed toward or led to death
Above these rooms sit the block’s HVAC
machines, which are supplied by the chillers located on the roof of the Sterilization
Department.
The system uses all outside air, supplied
by zones from the different HVAC units.
The exhaust flows are channelled directly
outside by two vertical ducts, one situated next to the goods lift for shipments
to Sterilization, and the other next to the
cafeteria service lift.
Water, gas and wiring systems run alongside the air ducts in the cavity above
the dropped ceiling. Ducts generally run
through the hallways, preferably the dirty
or service hallways. Operating theatres are
always kept clear of any systems they do
not themselves require that may have to
be opened for servicing.
Evacuation towers
To comply with fire protection standards,
two evacuation towers were designed for
the Hospitalization Block.
The South Tower is cylindrical in design,
52 metres tall, with an outer radius of 9.2
metres. It is a reinforced concrete structure clad with aluminium. At the top it
is crowned by a circular slab of concrete
that holds a heliport 27.6 metres in diameter, which can withstand 24 tonnes of
dead weight and an additional 19 tonnes
of supporting structure, which is made
entirely of aluminium.
Inside this tower there is a spiral ramp
that ensures the possibility of evacuating patients in their beds even should the
bed lift fail or prove insufficient to meet
demands.
In addition to the ramp, the heliport
surface is equipped with a secondary
escape route at the end opposite the
ramp, in the event of a fuel spill followed
by a fire. For this escape route, there is
a two-flight fire escape designed so that
there is a platform between flights that
can be reached from the landing, where
one of the fire protection equipment units
is located.
This fire escape leads from the heliport
surface to the machine room situated
below the heliport. The evacuation path
travels through this floor to another staircase situated at the opposite end, which
leads to the main rooftop level.
From that level to the safe outdoor space
there is not only the exit through the
South Evacuation Tower itself, but also
two alternative fire escapes in the centre
of the Hospital Block. The outdoor path to
the closest is 30 metres long.
For fire extinguishing, there are duplicate
units spraying foam activated by a water
jet. Each unit is situated at the start of one
of the evacuation routes, the fire escape
and the ramp. The water pressure is from
seven to eight kilograms per cubic centimetre, and the minimum flow rate is 250
litres per minute. There is also a 45-kilogram dry powder extinguisher at the top
of the ramp.
As further means of fire prevention, the
heliport surface is split crosswise into four
leaves with a 1% outward and downward
grade toward an gutter completely ringing the heliport to catch any liquid spillage.
This gutter is set with four drainage points
leading to an oil/water separator tank situated on the machinery mezzanine floor.
This tank has a 125-millimetre discharge
line that is carried vertically along one of
the tower’s utility shafts to the subfloor of
the storey where the tower touches earth,
and from there it is shunted to the drains.
Phase 2. Same-day activity building
This building includes the units devoted
preferably to same-day care, backing up
the areas that render diagnostic and therapeutic services, and especially those units
that avoid hospitalization by enabling the
patient to return immediately to his or her
regular social environment.
In response to the growing demand for
radiation therapy services for pathologies
that require treatment so urgently as to
render waiting lists out of the question,
and given the previous insufficiency of
physical resources at CIUH to deal with
said demand, the decision was taken to
include the Radiation Therapy Department
in this phase.
Likewise, the need to speed up the
care involved in surgical processes and
to reduce surgery waiting lists made it
equally advisable to push the Major SameDay Surgery Area up to this phase of
construction.
These two departments could be included
in the new building because an additional
storey was constructed. Thus the new
departments were smoothly integrated
into the traffic of same-day and hospitalized patients, without having to wait for
the third phase of the Steering Plan.
267
Therefore, the Same-Day Activity Building
contains:
• Outpatient Clinic and diagnostic and
therapeutic areas belonging to the
different clinical specializations
• Outpatient hospital services
• Central services bearing a high same-day
load
• Radiation Therapy Department
• Major same-day surgery
The building consists of 13 storeys and
is made up of two geometrical bodies:
a rectangular body whose full height is
equivalent to that of the existing hospitalization building, with which it stands wallto-wall; and a shorter but broader sixstorey body laid out around a courtyard
and slightly trapezoidal in shape. There
are 35,000 square metres of floor area.
With the taller block attached to the hospitalization block, the connections to the
rest of the hospital are ensured. However,
because the height between storeys in the
existing hospital block was three metres
(not enough for the installed systems’
horizontal run) and the new one has fourmetre-tall floors, their floors connect at
the same height only once every 12 metres
(every four floors in the old building). All
other floors are connected by stairs.
Each floor is compartmentalized into at
least two fire sectors. The sectors are less
than 1,500 square metres if they are not
fitted with an automatic sprinkler system
and less than 3,000 square metres if they
are. The evacuation route in each sector
is less than 50 metres long (except for the
basement 2 file room, which is rated as
a high-risk zone and has an evacuation
route less than 25 metres long). All floors
have at least two exits to an especially
protected staircase, and all stairs are 1.5
metres wide.
All the exit doors to the evacuation facilities are swinging doors mounted on
pivots, and they incorporate a round glass
window 40 centimetres in diameter. The
fire stability of the building’s entire structure is 180 minutes.
Where the floor structures meet the outer
walls, there is a one-metre-high strip of
reinforced concrete, and if the wall in
question marks the limit between two fire
sectors, the strip is 1.3 metres high.
The points where the wiring utility shafts
cross floors are sealed with bags of an intu-
268
mescent material, to avoid weak points in
the compartmentalization scheme.
Phase 3. Enlargement and
remodelling of CIUH
Because the hospital had to fulfil its
healthcare missions as a local hospital and
as a lead hospital without neglecting its
role as a teaching and research facility and
its hand-in-hand work with the university,
the dimensions and the functional and
structural characteristics of the hospital
had to be adapted accordingly.
On that basis, work was begun to prepare
the design for the construction of the new
CIUH. That design is now prepared and in
the technical supervision stage.
The design will imbue the hospital with
structural conditions similar to those
of any of the other big hospitals in the
Autonomous Community of the Canary
Islands, giving CIUH a place among Spain’s
most avant-garde specialized healthcare
centres.
Description of the
construction work
The first phase of the construction work
began in December 1996. Some important
problems arose to complicate matters:
• Interference with hospital activity in
diverse zones, which greatly hampered
job planning
• Need for complete evacuation of
sections in use in the ground-floor
hospitalization ward
• Very demanding standards for finishing
work, making exhaustive checking of
works performance necessary
• Simultaneous action on many fronts,
which meant focus was scattered all
over the site
• Relations with international suppliers and industrialists (especially from
Germany), giving rise to rather complex
negotiations
In general, all the floors encountered the
same problem with the installed systems,
especially as regards connections with
the part of the hospital that remained in
operation. As a result, many jobs were
rescheduled to be done outside normal
working hours. In the operating theatre
zone, there was in addition the extra
difficulty posed by the huge quantity of
systems running through the dropped
ceiling and inside the operating theatres.
In the second stage, the two evacuation
towers were built. First came the erection
of the cylindrical tower, for which special
formwork had to be made. This tower
was clad with aluminium, and a curtain
wall was installed in one lateral area. In
addition a wing wall was added as a windbreaker.
The heliport at the top was made of a
sturdy but light material (aluminium) so
as not to overburden the tower structure.
In Phase 2, the construction of the SameDay Activity Building took place. This
building covers all the same-day services
rendered by CIUH except Outpatient
Clinic services. Its construction involved
an enlargement of the hospital that could
only be built after widening the existing
lot.
Work necessarily had to commence with
lot development. This had to be done
in several phases, in order to keep the
accesses to the hospital clear at all times.
Work started in November 2003, when
a new drive was built to the Emergency
Department so the previous street could
be eliminated.
At the same time, the new distribution
station for the medium-voltage line was
built to replace the previous station,
located inside the lot. All the systems
crossing the lot (medium voltage, low
voltage, telecommunications, telephone,
sewage and other utilities) were diverted
simultaneously.
There was one difficulty, stemming
from the need to make this construction
compatible with the construction of the
parking building, and that was the need
to respect the number of parking spaces
available at the time. This lack of space
was a very important hindrance, since it
complicated all the logistics for storing
building materials and positioning the
cranes and construction sheds.
Some 120,000 cubic metres of basaltic rock had to be cleared for the building. When the clearing work was well
advanced, the architectural supervision
team suggested building an additional
basement. This meant the structure and
foundations would have to be recalculated. But in addition two important problems arose:
• The increase in the excavation depth
posed a real risk in the vicinity of the lot,
since there was a twelve-storey block
nearby. To prevent layers underneath
the block’s foundations from shifting, it
was decided to install a micropile foundation wall temporarily anchored to the
terrain at an approximate distance of
some 14 metres from the block, and the
building’s basements were redesigned
to lie 14 metres away from the block.
Later the structure itself would brace
the micropile foundation wall, and
the temporary anchors would cease to
perform their function.
• The height of the perimeter retaining
walls grew by five metres (an additional
basement) to 16 metres, and after the
foundations were recalculated, it was
decided to place four 14-metre-deep
micropiles for every metre of wall, as
foundations.
The foundation system chosen for the
building uses pile caps to transfer the load
to the ground through micropiles.
The façade was built with a curtain wall
containing permanent infills and a small
quantity of modules that can be opened
(16,000 square metres in all). On the
façades exposed to the sun, protection is
provided by a double façade formed by
glass that filters out ultraviolet and infrared radiation; this wall is ventilated and
separate from the inner wall, which is
glazed with transparent glass silkscreened
with a pattern to prevent those outside
from seeing in.
On the walls not exposed to the sun, the
façades have but a single wall, also with
silkscreened glass. In all cases the glazing
is double with an air chamber to prevent
radiated heat gains or losses.
Same-day activity building.
Installed systems
Wiring
The building is equipped with its own
transformer substation, connected to
the existing ring that powers the current
hospital building. Three power transformers were installed, two 1,000-kVA
transformers and one 1,600-kVA transformer, with a transformation ratio of
20,000/400-240 V, located in basement 2
in their own enclosure.
For emergencies, there are two 400-V
generator sets producing 1,250 kVA
apiece, also located in their own enclosure
in basement 2.
At the building’s centre of gravity in basement 2 sits the main electrical panel, from
which power is distributed to the secondary panels distributed vertically and by
floors throughout the building. For special
power supply needs, there is an uninterrupted 100-kVA power supply system
located next to the main panel but in a
separate room.
Power is supplied through an isolating
transformer in the premises where operations are performed and in hospital beds
containing anaesthetized patients.
In premises where extremely weak signals
(on the order of millivolts or less) are
measured, the compartment is lined with
conductive material to form a Faraday
cage.
The building is equipped with a combined
earthing system: one system to make the
medium-voltage wiring safe, another in
the low-voltage wiring to protect people
and a third to protect data-processing
equipment, although the third is joined to
the second at a point.
Fire protection system
This installed system is composed of a fire
detection and alarm system and fire-extinguishing systems.
The first is made up of a latest-generation
analogue station that can aim each fire
detector and can even tailor thresholds to
each specific zone. This facilitates locating
a fire in its initial phase and avoids false
alarms in premises that contain a certain
amount of environmental pollution.
The system is supplemented by closedcircuit TV for monitoring the movements
of people in strategic spots of the building
and at the building’s entrances. For evacuation, it is equipped with optical/acoustic
alarms and PA facilities.
The fire-extinguishing system is made up
of a pump set equipped with an electrical
pump with an output of 100 cubic metres
per hour at 100 mWC and a service pump
to keep the system overpressurized at 70
mWC. The system is supplied by CIUH’s
outside mains, drawing on two supply
cisterns capable of holding 1,000 cubic
metres of reserve fire water.
There are two extinguishing systems: a
sprinkler system and an FHC system,
supplemented by portable multi-purpose
powder and CO2 extinguishers on premises where there may be a risk of electrical
fire.
The fire detection station is integrated into
the hospital’s general security system.
HVAC system
The HVAC system is centralized and is
composed of three cooling plants having
1,037 kW of cooling power and air treatment units that distribute the cold air
throughout the different zones of the
building. Each room or area can be regulated locally.
Heat production, for hot sanitary water as
well as building heating and post-heating,
is obtained primarily by heat recovery at
two of the cooling plants, with a maximum available power of 657 kW, and a
back-up furnace in case heat recovery is
too low, to guarantee that hot water is
produced at 50 °C and treated against
legionellosis.
All air entering the building is treated
in the units, and it is always distributed
through ducts made of sheets of galvanized steel, bonded and heat insulated,
with a variable air flow depending on the
demand for heat. The air treatment units
have an intake for clean outside air, with
an exhaust vent far from the intake. For
energy efficiency, all air treatment units
have free cooling.
There are premises dedicated to a specific
function (computers, UPS, security and
access control) for which autonomous
units have been installed so that the
central system can be shut down when
the hospital is closed to the public.
For simple, efficient building management, a control system has been brought
in and integrated with the control system
already existing in the rest of the hospital. It is based on a central station and
a network of autonomous distributed
controllers. These controllers are what
read the sensors and act on the field
equipment to stay within comfort parameters.
The operating times and set points are
configured in the central system and
installed in each controller so that, even
if communications with the central station
break down, the controllers will continue
to regulate conditions autonomously. Air
quality is checked by a sensor set in the
return passageways.
Plumbing
A pump set has been installed that guarantees water pressure all over the building. The building is divided by floors into
three pressure levels to compensate for
the height differences. There is sanitary
water available on all premises, and hot
269
sanitary water only in changing rooms
with showers and staff sinks in patient
service zones. The water supply comes
from a connection with the outside water
mains that was included in the lot development work, and it is drawn from the
general cistern machine room.
For the dialysis units, there is a system
divided into four zones, with polyamide
pipes and recirculation. The water supply
for this system comes from the hospital’s
central production facilities.
Medicinal gas system
Networks, divided into sectors by floors,
are set up for the different medicinal
gases: oxygen and vacuum for all areas,
medical air or carrier gas in specific zones
and nitrous oxide in surgery zones.
The supply of these gases is drawn from
the hospital’s general supplies of medicinal gases, except for the vacuum, which is
produced by an exclusive station installed
in the basement 2 machine room. At all
events, space has been reserved in the
same basement for a redundant system of
oxygen and another redundant system of
nitrous oxide, using manifolds, as well as
for the installation of two compressor sets
to produce medical air.
Communications system
Due to the public nature of the building,
where complex communication systems
have to be combined with workstation
mobility, a structured cable layout has
been installed composed of a vertical
network, which starts at the main voice
and data distributor located on premises
adjacent to the Data-Processing Department, and a horizontal network for
each floor, which starts at the secondary
distributor on each floor.
The digital telephone switchboard is
installed on the same premises as the
main distributor, with its equipment. The
internal twisted pairs for telephone service
run from the switchboard, and the outside
lines from the public telephone system run
to the switchboard
270
Alterations to and
enlargement of
Marqués de Valdecilla
Santander
Description of the hospital complex
What is now Marqués de Valdecilla
University Hospital (MVUH) is a hospital
complex with academic ties to Cantabria
University, and it comprises a total of 25
buildings clustered in three main groups:
Marqués de Valdecilla Hospital, Cantabria
Hospital and the Vargas Specialization
Centre.
Marqués de Valdecilla Hospital
• The General Hospital (or Home) (1973)
• Nine pavilions belonging to the former
Valdecilla Health House (1929)
• The University School of Nursing
• The Second of November Building
(formerly the Traumatology Building)
(2003)
• The Valdecilla South Building, which
houses the Outpatient Clinic (2008)
This hospital, which descends from the
Valdecilla Health House, still has its period
pavilions. In addition, it counts among
its assets a new H-shaped main building
whose ends house the 12-storey Second
of November Building and the General
Hospital, connected through floors 2 and
3.
The General Hospital (currently in the
process of being demolished) is formed
of two blocks set in a V shape. Each has
ten above-ground storeys and two belowground storeys.
The Second of November Building
possesses 12 storeys plus two underground storeys. On its roof is a heliport.
The communicating block between the
General Hospital and the Second of
November Building consists of five floors,
three above ground (Emergency Department and Radiodiagnosis Department,
operating theatres, offices and Haemodynamics Department) and two below
ground (transformer substations, heating
systems, sterilization facilities and other
general services).
What is now the University School of
Nursing was built by Cantabria University
under a 99-year cession agreement.
Other buildings in the group house
the laundry, the Pathological Anatomy
Department and the mortuary; pump sets,
the decalcification plant and the water
plant; the power plant, the maintenance
service and the chapel.
The lot on which the complex rests is large
and contains 111,000 square metres of
building-free space used for green zones,
drives and regulated parking facilities for
hospital personnel (700 spaces) and for
the general public.
Cantabria Hospital
About 500 metres away from Marqués
de Valdecilla Hospital stands the Cantabria Hospital, built in 1969. This hospital is made up of one main building for
patient hospitalization (nearly 700 beds),
with 12 above-ground storeys and one
basement, and three auxiliary buildings.
It currently holds the Maternity and Children’s Hospital and diverse medical and
surgery departments.
Since 1994 the Territorial Directorate
of the Spanish Health Institute and the
Primary Healthcare Directorate for the
local health area have been located on
this hospital’s premises. Between them,
the two occupy approximately 20% of
the hospital’s habitable area. The facilities
of the “061” call-in emergency line are
housed on the twelfth floor of the building.
Vargas Specialization Centre
This building dates back to 1973 and
stands 1.5 kilometres from Valdecilla
Hospital. It is a single building with seven
floors plus two service floors. The hospital’s Outpatient Clinic occupies this building, with the exception of the first two
floors of the building, which are ceded for
primary healthcare and were remodelled
in 1995. There are no available grounds
around the centre, which is a typical urban
building and thus occupies the entire lot.
History
Long ago, the Santander Regional Council used to fulfil its obligation to provide
free healthcare for the distressed of the
province at San Rafael Hospital, a solid,
late-eighteenth-century building with
350 beds. Over the course of more than a
century, this initially plentiful capacity was
gradually overwhelmed. The task of creating a new, bigger hospital was shouldered
by Ramón Pelayo de la Torriente, Marquis
of Valdecilla, who was already known for
his open-handedness in other realms. The
new hospital, opened in 1929, was called
the Valdecilla Health House (VHH).
From the very beginning, the marquis
steered the institution in a new direction:
First, the hospital would care for all kinds
of patients without distinctions; and,
second, it would stand out for the high
technical and scientific quality of its care,
which would become the seed for a genuine school of medicine and surgery. The
first department heads of the Valdecilla
Health House were named by a committee of experts whose members included
Ramón y Cajal and Gregorio Marañón.
The building’s structure was designed as a
huge sprawl of hospital pavilions in order
to separate the fields of specialization and
keep a better check on certain contagious
diseases. Half a century later, the term
“health village” was coined for this kind
of architecture.
Over time the task of managing the hospital was shifted to the Provincial Council.
And in the meantime, the Social Security
Institute opened its own health home,
the Cantabria Home, in 1969. This was
a 12-storey building that brought with it
the social novelty of eliminating collective patient wards. The Cantabria Home
had instead double rooms with a hygienic
toilet room for each room.
Between 1970 and 1973, three fundamental initiatives were implemented:
to renovate the VHH functionally and
architectonically, including the School of
Nursing; to convert the renovated hospital into the seat for the clinical classes of
the School of Medicine recently created
in Santander; and to reach an agreement
with the Social Security Institute to unify
the hospital activities run by the VHH
and the Cantabria Home. The result of
this merger was the Marqués de Valdecilla National Medical Centre, which was
outfitted with new departments and
services, more staff and greater physical
and economic resources.
Accordingly, the pavilions occupying the
front of the hospital grounds were demolished, and on the lot was raised what was
called the “new Medical/Surgery Block”,
known today as the General Hospital,
which was opened in 1973.
In that same year, the Social Security Institute constructed a huge 14-storey block
with a heliport on its rooftop terrace. This
was the Traumatology and Orthopaedics
Centre, and it also contained the general
services of the Surgery Department and
the Nephrology Department, including
the department’s dialysis unit.
As a consequence of the new situation
brought about under the agreement and
the characteristics of the new facilities
brought into operation, it was decided to
remake the Cantabria Health Home into
a maternity department and children’s
hospital.
In 1981 a design was approved to alter
and modernize the original Valdecilla
pavilions, including building drives, a full
reconstruction of the connecting gallery
and an updating of the service tunnel. The
design was altered in 1984 and concluded
in 1988.
In 1999, one entire façade of the Traumatology Centre collapsed. Because of this
sorrowful event, the Second of November Building was erected on the spot,
while arrangements were sped up for the
launching of the general alterations to
Valdecilla Hospital, by then revealed to be
urgent. At the end of that same month,
the public tender for the Steering Plan
and Phase I of the project to enlarge and
alter Marqués de Valdecilla Hospital was
opened.
In 2003 the new Second of November
Building and the first phase of the Emergency Department were opened.
In 2005 the bulk of Phase I was finalized
and Phase II was commenced. Both ended
in 2007, giving the green light to Phase III.
By early 2009, execution of the third and
final phase of the Steering Plan was in
progress; its completion is anticipated for
2010. All in all, the MVUH has been transformed into a highly specialized, high-tech
hospital and brought into the ranks of the
great teaching and research hospitals of
our country.
The MVUH covers the population of Area
I (300,000 inhabitants) and is the lead
hospital for Areas II, III and IV and the
extra-regional sphere.
The enlargement and
(1999)
Background
In 1999 the grounds of Marqués de Valdecilla Hospital hosted a variety of buildings
with different functions, constructed over
the course of the complex’s history and
created in accordance with the appearance of new needs according to the different health policy strategies active at the
time. These buildings were connected to
one another by a system of drives and a
system of tunnels, which were also laid out
in immediate response to specific needs
instead of any premeditated general plan.
The final result, then, was a complex
that was highly complex in spatial terms,
with physically run-down structures and
functional difficulties in many areas. This
contrasted with the high degree of development of the complex’s medical function
and the importance of the hospital within
the community.
The lot, whose elevation varies by 14
metres from the highest point to the
lowest, was included in the remodelling
of city streets called for in the General
Plan. So, by the time the General Plan was
completed, public streets rendered the lot
accessible right around its perimeter. This
was a considerable improvement on the
original accessibility conditions.
Both the buildings and the lot were
sufficient in terms of size, location and
geographical accessibility for patients from
Santander and the rest of Cantabria. The
hospital was moreover handily positioned
and connected for access by patients from
other autonomous communities.
The hospital’s facilities were widely scattered and some were duplicated as a
result of the origin of the hospital complex
as a merger of three institutions (the
Valdecilla Health House, the subsequently
constructed General Hospital and the
Cantabria Health Home).
Moreover, there was a lack of healthcare
coordination among the departments
residing in the two hospitals (the Maternity and Children’s Department and the
Gynaecology Department at Cantabria
Hospital, and the rest of the medical and
surgical specializations at the General
Hospital). The merger of Cantabria Hospital and the General Hospital required a
thorough remodelling of the building on
the Cantabria Hospital’s lot, maintaining
at all events the use of all current buildings on the basis of a radically different
functional distribution of spaces.
A 1996-1997 study of the complex’s
strength and stability proved that the
main building (the General Hospital) still
met and upheld its original design parameters. The hospitalization area contained
spacious, light-filled rooms and a mini-
271
mally suitable percentage of beds in single
rooms (11.2%).
The main problem, however, lay in the
upkeep condition and functionality of
the complex’s buildings, primarily the
General Hospital, which is where most
of the healthcare systems were housed.
Since the building’s construction in the
early 70s, no significant investments had
been made to remodel it and adapt it to
new health and organizational needs, nor
had any functional plan ever been drawn
up to rationalize the placement and use
of spaces in the buildings and on the lots.
As a consequence, the configuration
of the complex had undergone a policy
of accumulating patch on top of patch,
to address urgent operating needs in a
catch-as-catch-can way. The end result
was a building that was uncomfortable for
patients, visitors and employees, functionally inefficient, and difficult and costly to
keep up as far as reparative and preventive maintenance were concerned.
Approach
Over three quarters of a century after its
origin, the new MVUH was reconceived
under the same philosophy that inspired
its creation: to offer specialized services
for high-quality healthcare, and to ally
research and teaching for this task. And,
at the outset of the project, the hospital
centre actually still did maintain those
traits that characterized the original Valdecilla Health House, dictated by a complex
medical organization with a progressive
outlook espousing revolutionary techniques.
The task of improving the complex was
not easy. Not only the marquis’ original
idea, but also the hospital’s architectonic organization was to be kept alive.
This made it mandatory to maintain the
original pavilions, or at least to reproduce
them faithfully, with the resulting effort
that would require in construction. The
idea was to instil an important conceptual
change while maintaining the same architectonic model.
In the original construction of the 700-bed
VHH, a horizontal system of more than 20
three-storey pavilions had been designed,
joined to one another by a gallery and
a tunnel. The pavilion’s organizational
model and functional design, which were
truly novel for their time, had enabled the
VHH to perform a fourfold function highly
characteristic of a contemporary hospital: healthcare, teaching, research and
272
preventive community action.
To shift this pavilion-based approach
to accommodate the architectonic and
health reality of the early twenty-first
century, dominated by a new concept
where hospitals are open to society, it was
mandatory to effect internal modifications
in the different pavilions and recycle the
architecture to adapt the new facilities to
the needs of the times.
What was envisioned was to build a
hospital where environmental friendliness and sustainability are set up as one
of the fundamental bases of the hospital’s
design. That required minimizing environmental impact, using the appropriate
technologies to reduce energy consumption and constructing buildings that
would be in harmony with their surroundings and cost little to run.
The Steering Plan embodied the guidelines
of what had to be done in the complex for
a full alteration of the hospital facilities. To
reach the objective of full alteration, the
project would feature three phases, plus a
preliminary emergency phase to refurbish
the building that had been destroyed.
The objectives of the Steering Plan
focussed on:
• Functionally reorganizing the hospital
and its buildings as a whole, preserving
them as part of the historic heritage
• Improving coordination and communications among the different departments
• Facilitating access and traffic flow by
separating patient, visitor and service
itineraries
• Designing areas better suited to new
modes of healthcare
• Enhancing the comfort and privacy of
patients, relatives and professionals
• Creating new spaces for teaching activities
Steering Plan Outline
• Phase 0 (completed): Refurbishment
of the Traumatology Building (the
building involved in the 1999 accident,
which was later renamed the Second of
November Building); the incident drew
the public eye to the wear inflicted on
the hospital with the passage of the
years. The building was refurbished for
use as hospitalization wards.
• Phase 1 (completed): Demolition and
rebuilding of the old pavilion zone. It
contains approximately 60,000 square
metres, with the following areas:
- Radiology and Radiation Therapy
- Emergency, ICU, the Surgery Block and
Sterilization
- Administrative, maintenance and training services
• Phase 2 (completed): Outpatient Clinic
area, approximately 20,000 square
metres
• Phase 3 (in progress): Hospitalization
area
Phase I, implemented in accordance and
simultaneously with the Steering Plan,
encompassed all the hospital’s central
services. The main thrust of the proposal
consisted in the comprehensive refurbishment of all the pavilions within a
huge, newly designed area that would
be created underneath and between
the pavilions, capable of housing all the
general departments (Emergency, ICUs,
the Surgery Block, Radiology, Radiation
Therapy and Nuclear Medicine, etc.).
The Steering Plan was rounded out with
the proposed hospitalization and hospitality service areas in the northern zone
and the creation of a same-day service
and outpatient hospital service building
in the south. Thus, the central position of
the general departments, ideal because
so accessible from the rest of the hospital, was used to its full advantage for high
functional efficacy.
Therefore two parking zones were situated in the south and north respectively,
in addition to a third parking zone at the
Emergency Department entrance, with
the appropriate loading and unloading
spaces at the patient and rehabilitation
entrances. The public streets built under
the General Plan were used to split up the
traffic heading for the Emergency Department, supply deliveries, same-day patient
care and the public entrance to the hospitalization wards.
Connections were laid among the different buildings, above ground as well as
below. These paths were carefully studied to be safe and to keep different
types of traffic from interfering with each
other. The relocation of the departments
favoured the new connections.
Phase I
This phase was performed between January 2002 and April 2007. The execution
process was quite complex as a consequence of the need to act while the hospital remained in operation and as a result
of the very nature of the project itself.
Objectives
This phase encompassed the following
objectives:
• Changing the hospital’s image to palliate the confusion
• Maintaining all the central pavilions for
the good of the architectonic composition and history
• Creating a large area to house the
general departments: This singlestorey area would underlie a rooftop
garden that would redeem lost aesthetic
values. The underground area would be
functionally built using the basements of
the pavilions, and that functional quality would provide a satisfactory solution
to the proximity of the different general
departments to one another. The large
rooftop park would be a calming influence inside the hospital zone.
• Adapting the terrain: The difficulty of
steeply sloping terrain was turned into
an advantage to diversify and prioritize accesses. Stepped construction to
applied to soften the impact on the
urban environment.
• Clarity of general traffic circulation:
A fabric of traffic paths was woven on
the different levels for
- Internal services: Beds, food trolleys,
supplies and personnel
- External services: Visitors and sameday patients
Initial condition of the buildings
The hospital complex was originally
constructed pursuant to designs that
complied with all rules and standards
mandatory at that time. Because technical
standards for buildings, installed systems
and safety are drawn up with the precaution of becoming obligatory as of their
entry in force and are not retroactive, it
may be said that generally the hospital
and its buildings and installed systems
complied with the terms of technical
legislation, although they did not have
sufficient measures for dealing with catastrophic situations (no fire doors; no doors
fitted with panic bars; not all buildings
equipped with easily negotiated, wellindicated emergency stairs).
sites until the facilities could return to the
finished zone. The jobs were the following:
Regular maintenance involved the renovation of one or two hospitalization ward
floors, an operating theatre and an Intensive Care room each year, in addition
to minor improvements and sanitation
alterations. Any safety measures dictated
by newly approved legislation were implemented in the altered zones and were
extended to modifications when the
modifications were extensive enough to
so permit.
• New offices for maintenance staff and
trade unions
At all events, the preventive and reparative
maintenance work done was insufficient
to enable the hospital to adapt, modernize and adjust its physical conditions to
current demands for user and employee
comfort.
• Reorganization of vehicle traffic within
the hospital grounds so that each type
of traffic (ambulances, outpatients,
physicians’ private vehicles, etc.) would
have clearly defined entrances and exits
without blocking the works zone
The pavilions fit into two categories:
those that had been improved at some
point and were fit for use, needing maintenance without major investments, and
those that needed major remodelling. In
the remainder of the hospital, columns,
beams, bracing and stabilizing walls were
in good condition.
In 1996 to 1997, a strength and stability
study was conducted. Its conclusion was
that the buildings met their design parameters. The soil responded adequately to
the stresses placed on it, although some
points were detected where the soil had
shifted, creating cracks in partition walls.
This was in overstressed zones, however,
and most of the cracks had been corrected
and repaired with mullions.
Vertical surfaces (partition walls) were
preferably built of brick, although there
were some zones with mere screens and
some partitions made of wood. The latter
were to be eliminated and replaced by
partition walls or screens with aluminium
frames.
The external wall (aluminium and single
glazing) had water and air tightness problems due to flaws created as the wooden
frames underneath windows aged and
the slabs above sagged. Routine maintenance work was not sufficient to address
these items.
Preliminary jobs
Before actual works execution, a series of
complementary jobs had to be performed
that were not included in the design but
were necessary in order to rehouse facilities located inside the works zone at new
• Creation of new temporary parking
zones to compensate for the number of
spaces lost inside the works zone
• Erection of a temporary 120-squaremetre reinforced-concrete building to
rehouse the hyperbaric chamber and its
associated machinery on a temporary
basis
Affected services
• Twelve-kilovolt electricity lines that
crossed the lot at several points and
interfered with the scheduled work;
they posed a special hindrance in the
initial phase, because the excavation
work in their vicinity could not be got
underway until the lines were rerouted
elsewhere or replaced by other lines
• Gas lines to the kitchens and the power
plant
• Sewer lines; there was a municipal drain
(a 1.6-by-0.8-metre ovoid) traversing
the lot from north to south, collecting
water from all over the northern Valdecilla zone
• Drinking-water pipes to the General
Hospital and operating theatres
Description of works
One of the proposal’s basic ideas was to
preserve the pavilions, which are listed
in the municipal catalogue of protected
buildings. From the start the attempt was
made to maintain and renovate their original structures. Originally the plan was to
demolish only two pavilions and to rebuild
one of them afterwards.
However, the thorough geotechnical engineering study plus the painstaking analysis of the buildings’ pathologies revealed
just how unfeasible that option was. For
example, the foundations of the pavilions
were not as they were assumed to be, and
the façades were an utter hodgepodge
of solid concrete patches and did not rest
properly on the floor structures.
273
Moreover, demolition by hand would be
dangerous, and the façades could not
be braced. So, it was eventually decided
to raze all the pavilions to the ground,
to avert any occupational accidents of
any kind, and rebuild the pavilions with
façades to match the originals in complete
respect for the shapes and proportions
of all external building components and
decorative elements, which were originally made with materials less resistant to
the action of time than the kinds of materials now in use.
To do so, plans and sketches had to be
made showing the different details of the
pavilions and all special components such
as mouldings, handrails, flashing boards,
columns and roof bolsters. Moulds were
made of the hand-crafted components so
that shapes identical to the originals could
be cast. Moreover, the organization of the
frames around doors and windows was
maintained, so an exact reproduction of
the original pavilions could be procured.
All the precast parts were fixed to the
masonry façades with common anchoring
devices. The façades were then rendered
with a layer of single-coat mortar applied
to resemble dressed stone (just like the
original façades), and the precast components were painted. In some of the precast
parts, aesthetic function was combined
with structural function.
This solution stood as the safest and also
the most advisable from the economic and
works deadline standpoint. The fundamental difference between the previous
pavilions and the new ones –none at all to
the naked eye– is that the new ones are
more durable. They are unaffected by the
wet or other effects of the weather, unlike
the original pavilions.
Accordingly, a new structure was
designed, consisting in two reinforcedconcrete porticos on the east and west
façades of each pavilion, on which longspan (12-metre) prestressed concrete
slabs were to rest to bridge the distance
between façades, without any columns
standing in between. The tile roof was
then built, and the pavilion’s outer envelope was constructed with Termoarcilla
blocks and a final outer coating. This
quickly built structure would enable more
use to be got out of the pavilion area.
The outdoor zones and the courtyards
were addressed with semistructural walls
made of concrete poured into timber
formwork and faced with concrete.
274
The need to prepare a structural design
entailed the execution of new foundations
also, which had to be adjusted to suit the
difficult conditions of the subsoil. These
poor conditions were the origin of certain
pathologies in the old buildings.
The initial design consisted of a geotechnical engineering study in which drilling and penetrometer readings showed
that there was apparently no rock. With
these results, a profile of the terrain was
mapped out and the foundation depths
for the different buildings were analyzed.
From the analysis of the terrain profile,
it was deduced that rock might appear
in the foundation zone underneath the
Nuclear Medicine Department.
In view of these contradictory data, it
was decided to perform one additional
penetrometer campaign rounded off with
drilling to demonstrate the compactness
of the rock and rule out the existence of
the kinds of caves typical of karst terrain.
Cantabria is karst, and in the particular
zone where Valdecilla Hospital is situated
there is a historical record of sphalerite
mines worked by the Romans, so there
could have been unknown tunnels. This
possibility had to be ruled out by drilling.
The last campaign showed that a major
part of the site rested on rock foundations, and very hard rock foundations
too, judging by the results of the simple
compression tests to which the sample
cores were subjected. And in addition, the
rock was extraordinarily compact.
Initially, the planned foundation was to
be built on the basis of auger-cast piles,
with an embedded length of between 0.6
and one metre. Given the extraordinary
hardness of the rock and the possibility (reflected by the penetrometers) that
there could be limestone strata typical of
karst terrain, using this kind of foundation
was inadvisable, for two reasons:
• The difficulty of finding machinery
capable of guaranteeing an embedded
length of the dimensions required in the
existing terrain
• The possibility that, if a limestone spike
were encountered, the pile might
become embedded in a non-perpendicular direction, with the ensuing high
possibility of deviation
It was therefore decided that the ideal
system would be to build all deep foundations of 180-millimetre micropiles and
to build shallow foundations on top of
surface-type rock using single footings.
In addition to refurbishing the old pavilions and restoring them to their initial
conceptual situation and lie on the terrain,
at the same time a great landscaped platform was created to heighten the timeless
historic aesthetics of the first Valdecilla
complex.
This structure, the hospital’s nerve centre,
can be seen only through its roof garden,
which reproduces the highly attractive
original pavilion gardens. It is endowed
with abundant natural light through
courtyards opening onto the garden like
pierced work, capable of illuminating the
constructed portion while maintaining the
desirable privacy of views in these internal
areas.
The pavilions house diverse complementary uses, focussing above all on more
internal medical uses (departments’
administrative units, physicians’ offices,
physicians’ housing, library and classrooms, etc.), thus putting the old structures, now obsolete for other functions,
to good use.
Reduction of the completion period
When Phase I was under way, the Cantabrian government asked for the completion periods to be reduced as much as
possible in order to shorten the overall
completion period of the Steering Plan by
two years. That would have meant shaving one year off the period for Phase I
(initially four years, and, though Phase I
eventually ended five years later, the vast
majority of the phase was finished in the
first three years, so it was possible to bring
forward the start of Phase II).
The work teams in all trades consequently
required more hands. At some times there
were as many as 400 operators working
on the complex at once, in many zones
but very close to one another, with the
management difficulties that involved.
With the exception of the critical starting
activities preceding all the rest of the work
(such as moving the services affected by
high-voltage lines and knocking down
two pavilions), the following was done in
order to comply with the demands for a
shorter deadline:
• The heating, HVAC, service and maintenance pavilion was finished in April
2003, because without it the rest of the
new zone could not be brought on line
• The Emergency area was finalized in
April 2003, decongesting the Emergency premises of the hospital
• The zone for Nuclear Medicine and
associated areas (top floor of part of the
operating theatres) was completed in
May 2004, so the new latest-generation
apparatuses (cyclotron and PET unit)
could be installed at their definitive sites
Nearly all of Phase I was concluded in May
2005, thus cutting the completion period
down by one year, which accounted for
25% of the total time the entire project
was scheduled to take.
Phase II
With Phase I practically finished, a start
was made on Phase II, which eventually ended in 2007. In Phase II the newly
created outpatient hospital services zone
was constructed beneath the row of traditional pavilions.
Phase II encompassed one rectangular
block-shaped building (the Valdecilla
South Building) for the Outpatient Clinic
and the psychiatric, surgical and medical
same-day hospital services (26 operating
rooms). In addition, there is a rooftop
cafeteria and a new underground car park
(520 spaces) stretching to the southern
edge of the property.
This new building holds the sector
with the greatest patient mobility and
the greatest technological and technical complement in the entire hospital. It
went into operation on 21 January 2008,
enabling the southern hospital entrance
to be opened, and that in turn enabled all
the zones of the hospital to be connected
to one another.
The layout of all areas is conceived so
that, first, access is facilitated as much as
possible for patients and their relatives
and, second, the departments and care
services that are interrelated are situated
in the closest proximity to one another,
with the goal of achieving greater efficacy
and speed in each of the processes and
appointments handled.
The three-storey
windows.
building
has
large
The surgical outpatient hospital services,
on the first floor, are connected with the
Surgery Block, the ICU, the Emergency
Department and the Radiology Department in the pavilions built in Phase I of
the Steering Plan, to facilitate same-day
access and adaptation to the environment
of major same-day surgery. There is a
patient area and an observation area.
The medical outpatient hospital services
are situated on the second floor. These
services encompass home hospitalization and its administrative area, and they
have a patient area, a short chemotherapy
treatment area, an inhalation room, an
examination room and diverse Outpatient
Clinic examining rooms.
The psychiatric outpatient services on the
ground floor are divided into two areas
that share an access but address separate functions: the adult area and the
children’s/teen area, devoted to anorexia.
Both are equipped with group therapy
and work therapy rooms, in addition to
psychiatric offices.
The public cafeteria for patients, relatives
and visitors occupies the roof of the building. It has a large patio from which one
can see the centre’s pavilions to the north
and the harbour area and Santander Bay
to the south.
The floor area of all the healthcare and
administrative areas is 18,651 square
metres, while the underground car park
occupies 15,448 square metres.
This phase also included some supplementary work, such as the construction
of a circular drain, development of the
lot around the School of Nursing and the
chapel, demolition of installed services
that have already been replaced, removal
of tanks and contaminated earth, sewer
lines in one of the pavilions and the Pathological Anatomy Department and a new
transformer substation for the introduction of the hospital’s electrical substation.
Phase III
This, the final phase of the Steering Plan,
has the fundamental objective of demolishing the General Hospital Building, its
Outpatient Clinic annexe and the retail
zone, replacing them with three fivestorey buildings and creating the hospital’s definitive main entrance, which
will provide access to the hospitalization
wards, the Obstetrics Block, the laboratories (centralized and roboticized), clinical
offices, the Pathological Anatomy Department, the pharmacy, medical deputy
directorates, hospitality services, etc.
The three new buildings, which will be
reached across a public square, will be
connected to one another by means of a
central corridor running through them at
two different levels, to facilitate internal
patient and staff traffic and to connect to
the Second of November Building.
For the main entrance to the new Valdecilla
complex, plans call for a huge glassed-in
space that will have mobile light-screening
systems and will be decorated with works
of art. Moreover, a streetlike lobby inside
will direct pedestrian flow to the different zones of the hospital. The admissions
block, the information desk, the cafeteria,
shops and retail space will line this street.
Underneath the floor will lie a service floor
(maintenance and HVAC) and a second
level of underground corridors that will
link the three new blocks with the Second
of November Building, the Emergency
area and the pavilions. Underneath this
level will lie the two floors that will be held
in reserve for future expansions.
The three new blocks will house 15 hospitalization wards with a total of 332 rooms,
which will hold 664 beds in double use.
Light and natural ventilation will take
priority in these rooms, as shown by the
fact that both beds in each room will face
the window.
About 120 of these rooms will be devoted
to intermediate care. Altogether, eight of
the 15 wards will be devoted to general
medical/surgical hospitalization, two will
be for Obstetrics, two for Oncohaematology, one for Paediatrics, one for Newborns
and one for Psychiatry. In the psychiatric
ward, there will be an indoor courtyard
so patients who must spend some time
in hospitalization have a place to stretch
their legs.
The nurses’ desk is situated in the centre,
so it can access the entire area easily.
When the execution of the Steering Plan is
complete, the new Valdecilla Hospital will
have around 1,000 conventional hospitalization beds.
Outside, the three hospitalization blocks
boast a ventilated façade clad with aged
copper sheets, which are highly resistant
to adverse weather conditions. It has also
been planned to incorporate photovoltaic
panels for electricity production. Cells will
be placed in the glazing to allow light to
pass while electricity is being stored.
Apart from environmental friendliness
and sustainability, another criterion held
foremost in mind is to make this a flexible hospital where growth is possible in
future.
The third phase was tackled during the
last quarter of 2007, with the opening of
new operating theatres, the outpatient
hospital services and the Outpatient Clinic
Building (Valdecilla South).
275
The General Hospital was completely
evacuated in February 2008. The examination rooms and the rest of the healthcare services were moved to the Valdecilla
South and Second of November buildings.
Work began in March 2008 to classify
the rubble and assess the existing equipment for possible reuse. At the same time,
the electricity was cut off and the interior
partition walls were knocked down to
facilitate the subsequent demolition of the
building (controlled demolition to reduce
dust and noise emissions).
A non-vibrating, noiseless machine with
shears was used to raze the building. The
opening and closing of the shears’ steel
jaws tore down the buildings and cut up
the building structures so the concrete
and steel could later be separated.
This third phase, which ends in 2010,
marks the closure of the entire project and
therefore addresses aspects of unification
and centralization, such as the electrical control system and the alarm system.
The development of the entire hospital complex is likewise finalized, with an
increase over the complement of parking
spaces available previously.
Some new features of the
hospital
“Wall-less hospital”
The “Wall-Less Hospital” project, which
involved computerizing the MVUH’s
home hospitalization service, started functioning in late 2007. In itself, it does not
involve any great improvements in care,
but it does enable an innovative attitude
and greater speed in medical processes
(requesting tests as well as waiting for
results), and it makes more efficient use
of resources.
Under this project, patients have seen
how the time they have to wait to receive
their diagnostic test results has shortened,
how repetitions are avoided and how the
hospital reminds them of their appointments by text messaging and/or e-mail.
And there is a novel system of radiofrequency identification that steers patients
to the appropriate examination rooms.
The digital imaging system has made
it possible to digitalize and file medical
images. This has been extended to the
Radiology Department’s services.
Hospital hospitality
Hospitality is a new resource that arose
276
in 2007 to complete some aspects of
humanizing the hospital. There are users
who do not require hospitalization but
must nevertheless remain in contact with
the hospital for the time being due to
their pathology. Some such users cannot
travel back and forth from their home
to the hospital every day. The hospitality
service is for these patients. The maximum
time of stay will depend on each patient’s
medical situation.
The hospitality area consists of 18 rooms,
eight doubles and ten singles, with a total
area of 600 square metres. Each room is
fully furnished, and there are two roomy
public lounges.
This is a pioneering system in Spain. The
experience “feels more like checking into
a hotel than a hospital”, as there is no
medical care involved at all. The Valdecilla
initiative is part of the hospital’s determination to cover the needs of numerous users who must travel from their
respective places of origin to the centre in
Santander in its capacity as the lead hospital in some specializations.
The requirements for using these facilities
depend on the criteria of necessity and
distance. Breastfeeding mothers whose
babies are hospitalized are given special
attention.
RDI
The hospital incorporates the most
advanced technology, for instance, highfield (teslas) MRI machines; four digital
angiography units: one biplane unit for
Interventional Neuroradiology, a singleplane unit for Peripheral Vascular Disease
and two for Haemodynamics and Cardiac
Electrophysiology; a full monitoring
system for the ICUs, which incorporates
an information procedure for paper-free
work; smart operating theatres; and a
high-performance liquid chromatography
(DHPLC) unit that enables genetic mutations to be analyzed at the molecular
level, very important for detecting breast
cancer, ovarian cancer and polyposis of
the colon with a familial component.
The integrated operating theatres have
diverse high-image-quality monitors, a
touchscreen for controlling the entire
operating theatre, audiovisual connections with other operators located in
diverse zones of the hospital, videoconferencing capability and the possibility of
real-time medical information sharing.
Nuclear Medicine
The nuclear medicine equipment is made
up of the following components:
• Cyclotron: A device that manufactures short-lived (< 3 hours) radioactive
isotopes that can be used intravenously
or by inhalation (gases) for early cancer
detection
• PET: Positron emission tomography
apparatus; it is used to diagnose cancer
• Synthesis laboratory: Here the
isotopes extracted from the cyclotron
are handled and prepared so they can
be moved inside the hospital or to other
nearby hospitals
• Radiology bunkers: Locations where a
patient is bombarded with high-energy
particles, for cancer treatments
• Brachytherapy: Treatment for gynaecological cancers, with the radiological
source inserted in the patient
The premises where the cyclotron, the
synthesis laboratory and the radiation
therapy bunkers lie are surrounded by
concrete walls of different thicknesses:
30 centimetres for the synthesis laboratory and the brachytherapy facilities, and
150 to 180 centimetres for the cyclotron
and the radiology bunkers.
The bunkers also have some areas that
have been built out of barium concrete
(concrete with a density of 3.3 tonnes
per cubic metre), which is needed to
absorb the high-energy radiation. In the
zones where the thickness is not sufficient (floor structure), an additional highdensity material (18-centimetre-thick steel
plates, since steel is about three times
denser than concrete) has been installed
to compensate.
Producing radiopharmaceuticals is not
the basic mission of the hospital’s Nuclear
Medicine Department, because it is the
part of the process that does not affect
health care, teaching or research. The very
technology involved in producing and
distributing radiopharmaceuticals makes it
necessary to perform this activity at night;
because the radiopharmaceuticals the
cyclotron produces have a short life and
must be used immediately, they have to be
available at the Nuclear Medicine Department first thing every morning. Thus, the
facilities are available for research activity
the rest of the day.
número
2009
número
4
2009
4
Hospital Universitario Reina Sofía. Córdoba
Hospital Rafael Méndez. Lorca. Murcia
Hospital Reina Sofía. Murcia
Hospital Clínico San Carlos. Madrid
Hospital del Sureste. Arganda. Madrid
Nuevo Hospital de Mataró. Barcelona
Instituto Guttmann. Badalona. Barcelona
Hospital General de Ciudad Real
Hospital San Agustín. Avilés. Asturias
Hospital General Son Llátzer. Palma de Mallorca
Clínica Palmaplanas. Palma de Mallorca
Hospital Nuestra Señora de la Candelaria.
Tenerife
Hospital Universitario de Canarias. La Laguna.
Tenerife
Hospital Marqués de Valdecilla. Santander
HOSPITALES
1995 - 2009
General Perón 36, 28020 Madrid
Balmes 36, 08007 Barcelona
Tel. +34 91 514 10 00
Tel. +34 93 496 49 00
Fax +34 91 514 10 12
Fax +34 93 487 97 92
www.fccco.es • fccco@fcc.es

hospitals

Transcription

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