Originally published in Medical Construction & Design. By Jason Costello, AIA, EDAC, associate principal and partner at Margulies Perruzzi Architects
September 20, 2017 – Restrooms are universally used spaces, but their design in healthcare settings can vary widely based on patient population, room location and layout, and safety concerns. For designers, patient restrooms in hospitals pose the greatest design challenges to ensure that the spaces support healing, comfort, and calm for patients and provide ease of maintenance, infection control, and safety features for facility managers.
The design of healthcare restrooms is similar to that of commercial restrooms with respect to durability, cleanability, and accessibility – but that’s where the parallels end. Given consumer choice in healthcare, medical facilities are designing restrooms with a comforting, home-like feel. Gone are the institutional-looking lavatories of old; today’s healthcare restrooms incorporate new products and technologies that provide a level of hospitality that patients increasingly seek.
Designing restrooms to optimize the patient experience
Whether renovating or building anew, hospitals and healthcare facilities are listening and responding to their patients, visitors, and staff by creating patient rooms and restrooms that are accessible and comfortable for everyone. The trend toward “increased capacity rooms and restrooms” that address weight limitation of plumbing fixtures and a continued focus on improved accessibility, provide the extra space and accommodations that people with mobility challenges and dexterity disabilities need.
Restrooms in healthcare fall into two categories: public restrooms that serve patients and visitors, and clinical toilet rooms that support the clinical functions required of various programs within the facility.
Public restrooms consist of a mix of gang toilet rooms and individual restrooms. These restrooms are often associated with public amenities and waiting areas, and demand a high level of design and finish materials. Porcelain tile walls and flooring provide excellent durability and cleanability for these high-use spaces. A new trend is the use of solid surface materials for the toilet portions, providing a clean modern look while maintaining excellent cleanability and resistance to cleaning chemicals and standard abuse in this environment. Often, gang toilet rooms are supplemented with private toilet rooms designated for family use, gender neutral, and accessibility compliance.
A key challenge with all public toilets is addressing the weight limitations of porcelain wall mounted toilets and the associated weight of users. The risk of injury and breakage can necessitate post-installation fixes of “wood block” supports. This issue requires a critical design phase discussion between infection control, housekeeping, and facility engineering to select a solution that works for all concerned – and avoids a post-occupancy fix.
The second category of healthcare restrooms – dedicated clinical toilet rooms – are designed to accommodate specific clinical needs across a wide spectrum of acuities:
-Medical/surgical patient rooms are often much more like hotel room toilets, complete with shower and hospitality-style finishes with hospital grade durability. As a large number of hospitals are converting semi-private patient rooms to private rooms, toilet rooms are also being renovated to meet current standards. In an effort to minimize demolition costs, hospitals are considering fiberglass reinforced plastic (FRP) panels that can be installed over existing materials and provide a new seamless enclosure for the shower and entire toilet room. Further, careful attention is required in the design of the threshold and flooring transitions between the patient room, the toilet room, and the accessible shower to control water within the room and to minimize the risk of slips and falls.
Specialties such as orthopedics may require larger room sizes to accommodate patients with mobility issues. On the maternity floor, private post-partum rooms are being updated with hotel-like amenities, including storage in patient toilet rooms and lighting sconces in new beauty areas.
-Intensive care unit (ICU) patients are often bedridden and unconscious, leading some hospitals to eliminate the patient toilet and replace it with a soiled utility room with a flush sink for bed pan washing and a hand washing sink. This design decision results in a significant reduction in the space required in lieu of a full toilet room. However, as patient families are increasingly invited into the ICU, the incorporation of a full patient toilet room is often provided to accommodate the presence and convenience of the family.
It is well documented that the healthcare environment has a direct impact on patient healing. The location and design of patient rooms, and even patient restrooms, can contribute to a patient’s healing response. Patient restrooms located along an interior wall (inboard) frees up the window line for natural light and exterior views, features shown to help improve patient mood and health outcomes. While they offer more patient privacy, inboard restrooms also reduce the nursing staff’s line of sight visibility to patients. Exterior wall (outboard) restrooms are always specified for intensive care units.
-Outpatient clinics, and their associated toilet rooms, take a variety of forms. If a toilet room is used for specimen collection, it will require a specimen collection cabinet with pass-through adjacency to the testing lab. If a clinic handles drug testing, designers may configure the room to have only a toilet, with a handwashing sink located outside the room or an in-room sink with a remote shut-off water function to comply with government testing requirements.
These variations of clinical toilet rooms require understanding the unique programmatic needs of the individual departments and modifying the design to satisfy them.
Innovation in healthcare restroom materials and fixtures
While new products and technologies for restroom design become increasingly available, healthcare organizations can be hesitant to try something untested in the medical environment. Tile and grout may be tried and true, but grout is still a cleaning issue and tiles can pose a slipping hazard. New restroom materials and fixtures need to pass several standards – and expectations – for hospitality aesthetics, cleanliness, and safety.
For example, there is a growing interest in using prefabricated toilet modules for new patient rooms. Prefabrication in a controlled manufacturing environment provides a better-quality product that can also expedite a tight construction schedule. While the units offer compelling benefits, their use is typically limited to new construction, rather than renovations, due to the access through a building required to install them.
Minimal-seaming products for flooring and solid-surface walls continue to provide a combination of sophistication and functionality for healthcare restrooms. Smooth and seamless wall cladding and large-format porcelain wall panels can create a hospitality feel in the shower, while sheet flooring has become a great alternative to tile, providing a grout-free, easy to clean surface. One-piece seamless sinks with backsplash are a popular choice and offer an anti-microbial surface and sleek look. To reduce infection, automatic fixtures – such as touch- or hands-free faucets, toilets, urinals, and hand dryers – are a given. And while the new low-flow toilets are great for water conservation, old pipes may not have the adequate slope for the low flow fixtures so consult an engineer before installing them in an existing building. A final consideration is a recent rise in legionella cases that have been attributed to stagnant areas of the supply piping, which although not directly a design challenge for the toilet rooms, should be considered if renovating a significant portion of the building.
Bariatric units, as well as bariatric rooms on standard floors, require special consideration for their toilet room design. A bariatric restroom tends to be 20 percent larger than a typical healthcare restroom, allowing for larger clearance of patients and assisting nurses as well as fixtures and doors. A common mistake is that bariatric toilet rooms can double as ADA toilet rooms from a compliance standpoint; however, the bariatric clearances differ from ADA and additional provisions are required to comply. Due to weight load, bariatric toilets use floor-mounted, non-porcelain models with structural floor supports. Grab bars and sinks in bariatric restrooms need steel reinforcements, especially if they are wall-mounted. The introduction of a patient lift into the toilet room for these programs requires a transfer or a customized door frame to accommodate the lift track.
There are many variables in the design of healthcare restrooms, and their size, specifications, and materials will differ based on patient population and usage. Healthcare environments tend to provoke anxiety in people, so the trend toward hospitality design in healthcare spaces, including restrooms, will only accelerate. The choice of colors and finishes can impact patient comfort and satisfaction with a facility, and the choice of fixtures and materials can impact long-term maintenance and infection control. The design team would be wise to collaborate with facility management and environmental services to design patient restrooms that meet everyone’s goals.
About the author
Jason Costello, AIA, EDAC, is an associate principal and partner leading the healthcare studio at Margulies Perruzzi Architects. Consistently ranked as one of Boston’s top architectural and interior design firms, Margulies Perruzzi Architects services the healthcare, corporate, professional services, research and development, and real estate communities. For more information, please visit www.mp-architects.com.