Case study: Musgrave Park Hospital, Belfast
During the past few months, a new building has rapidly taken shape at Musgrave Park Hospital, south Belfast, home to one of Europe's leading and largest elective orthopaedic and musculo-skeletal centres and one of only five facilities in the world to have a custom hip-manufacturing unit on site.
In 2001-02 the Green Park Healthcare Trust received £3.83 million of funding from the Department of Health, Social Services and Public Safety to fund the building of two additional operating theatres. The trust's Estates Services Department, together with architect Hall Black Douglas, then spent five months designing, specifying and contracting the building works for the scheme. It included the refurbishment of about 1,400m 2of the existing building, in addition to 600m 2of new theatre accommodation provided by a modular theatre structure.
It is, in fact, the Northern Ireland Health Service's first modular theatre structure.
'We recognised the importance of modular design from the outset, given the time constraints of the project, ' explains architect Sarah Lappin.
Key to the project, she says, was the fact that the building work had to take place while the hospital's existing theatres remained operational. Musgrave Park Hospital previously had six theatres located in a singlestorey building, with a basement and with plant above.
That building dates from the 1960s and was constructed from concrete block walls with concrete stanchions and some steelwork.
Work started in March 2003, says Lappin, 'and is now basically complete'. Time was the key factor driving the design, she adds, and a modular 'flat pack' panel system built off an in situ concrete floor slab was selected as the best means of obtaining the modular form quickly and safely. Local firm Montgomery Refrigeration Systems supplied prefabricated panel units, each with a steel skin and rigid foam core, which locked together. The final finish was then applied on site.
Phasing was a major consideration at all times during the planning, design and building process. More than half the building work was completed while Musgrave's six theatres remained open, and at least one theatre was in operation throughout the works.
Internal demolition work included removing existing block walls, repositioning steelwork, breaking through into new extension areas and 'absorbing' non-theatre facilities into the project plan. All materials created by demolition had to be extracted from the site via the roof of the old theatres' recovery area during surgery hours, or through corridors after hours. Rubble was specially wrapped to cut down on dust and particulate transference, and to help avoid any contamination of 'clean' areas.
The refurbished hospital now boasts: two new modular theatre suites, one with natural light; a new staff room and changing rooms; an enlarged recovery room - with natural light accessed via skylights; a third more beds; a new fire escape; and a new staff courtyard garden.
Microbiological factors are paramount in such an environment, Lappin explains, and horizontal surfaces were kept to a minimum. Surfaces need to be easy to clean and without indentations, she adds, and special coatings, including Wallglaze, were used 'to reduce infection opportunities'. Walls in theatres and ancillary rooms have also been kept as seamless as possible, and tiling avoided 'as a means of strengthening infection control'. Lower walls are protected by 1.5mm-thick Gradus PVC sheeting, with wall rails from Yeomans Shield.
Ceilings are finished in plaster finished, Lappin says, since suspended ceiling tiles in a theatre environment are inclined to attract more dust and foreign bodies.
Replacing the old terrazzo flooring is an 'extremely hardwearing' vinyl from Gerflor, called Mipolam Esprit, which is designed to withstand the weight of heavy equipment.
Lead-lined doors, custom-made by Moffat, protect patients and staff from the X-ray equipment in the theatre suites. These are fitted with push-button, automatic operators from Dorma.
Natural light reaches parts of the building via skylights in the recovery ward and new windows in one of the operating theatres. Fluorescent strip lighting in the main corridor has been installed off-centre for the benefit of patients lying on trolleys.
Specialist laminar flow systems have been installed in theatres, and air conditioning installed in the patient recovery area. Signage is informational and unbranded, and colours in the theatre facility are mainly 'pale and relaxing' tones of blue and cream.
Theatre suites, including operating, scrub, anaesthesia preparation and utility areas, are colourcoded, and key doors are push-button operated to ease access with beds and to 'ergonomically compensate' for the weight of lead-lined doors.
A new, externally sited emergency escape stair is in western red cedar, and the adjacent staff room block has been rendered and painted an 'autumn red'. These finishes were chosen, Lappin explains, to complement the external finish on the existing building.
A small, low-maintenance courtyard for theatre staff has been built adjacent to theatres and a link hospital corridor. Inspired by Japanese gardens, it is finished in stone and provides 'a small area of natural light and greenery close to an otherwise sterile, controlled environment'.
Greenfield, whose practice, Guy Greenfield Associates, designed the extraordinary doctors' surgery in Hammersmith shortlisted for the 2001 RIBA Stirling Prize. 'I always go for aesthetics but keep cost and practicality in mind, ' he adds.
Consequently Greenfield favours natural flooring materials such as slate and hardwood. 'Cumbrian green slate is very practical and not slippery, even when wet, while hardwood floors in consulting rooms are both reasonably hygienic and warm and homely - creating the right environment, ' he says. 'Patinated zinc on reception fronts is indestructible and looks good, while white emulsion walls can be re-painted easily.'
'If I see a material or colour I like then I find out what it is, ' Greenfield explains, adding that he has recently taken to specifying Italian plaster finishes. 'I like feature walls, covered in an Italian pigmented-through plaster - called Marmorino - which is applied by specialist James Hamilton. It's a polished, stucco-like plaster finish made from pigmented marble dust and it's quite practical. You can wash it, and if you chip it, the colour is still there.'