Canadian Institute for Health Information estimated that Canada would spend $308 billion on health in 2021, representing 12.7% of Canada’s gross domestic product (GDP)^[1].

With such investment, Canadians expect safe, efficient, and effective health care services.

The quality of health care services is advanced through the work of professional organizations, standards of practice, and regulatory licensing requirements. But what about the facilities, systems, and materials that support all this? There is strong evidence that health care environments, equipment, and processes can have positive effects on patient outcomes and the safety and well-being of staff^[2]. Even the best-trained medical professionals will struggle if their efforts are undercut by poorly-designed hospitals, unclean instruments, or inefficient support systems. That’s where standards can help.

The role of standards in the health care system

Standards are an important part of the total quality framework supporting health care delivery. By outlining requirements and best practices for performance and process, standards can help patients, staff, and visitors avoid injury from medical devices or acquiring health care-associated infections.

Based on evidence-informed design and practices, standards can also help build better health care facilities that last longer, operate more efficiently, and serve their users better. Standards can also promote innovation through the adoption of new processes into standardized procedures. For example, the CSA Z8000 standard for health care facilities design introduced requirements for deeper and better-designed hospital sinks. A follow-up research study confirmed that, together with other design elements, it had a dramatic impact on clinical outcomes^[2].

In addition, standards often complement government regulations. They can provide additional details and help support flexibility in how certain requirements are adopted by health care services, reflecting a wide spectrum of health care applications, scenarios, and availability of resources.

CSA Group standards for health care facilities

CSA Group has led the development and maintenance of health care standards for over 50 years. About 800 volunteer experts representing government, professional groups, industry, patients, and other stakeholders contribute their time and knowledge to the development of standards that help deliver health care services in safe environments. With 15 technical committees and 33 subcommittees, the CSA Group Health Care Standards program currently maintains a portfolio of more than 290 national and adopted international standards.

CSA Group standards for health care facilities (HCF) address various crucial aspects of their design, mechanical systems installation, commissioning, operation, and technology integration. These standards are highly relevant for day-to-day activities in any well-functioning facility.

Designing and building health care facilities

The flagship publication in the portfolio, CSA Z8000-18, Canadian health care facilities, provides recommended requirements and guidance for the planning, design, and construction of all types of HCFs regardless of their size, location, or range of services. While the Standard contains some very clear-cut requirements, it also allows for certain flexibility, acknowledging that every facility has its unique set of challenges.

Many concepts set out in the Standard, such as isolating infected patients and single-patient rooms, were informed by the SARS crisis of the early 2000s and challenged the accepted design practices at the time. Many subsequent Standard updates happened in a similar way – through learned experience, reflecting changes in the health care system. The expansion of the ambulatory care section of the Standard to accommodate more medical procedures outside the hospitals is just one more recent example.

The next edition of CSA Z8000 is anticipated in late 2023. The Technical Committee is considering various updates to address challenges HCFs faced during the Covid-19 pandemic, from better pandemic planning and more flexible building configurations to temporary facilities and field hospitals, surge capacity and resilience, operating room pressurization, and many other topics.

Learn more about the development and application of CSA Z8000

Mechanical systems in health care facilities

Installations of mechanical systems in health care facilities are far more complex than in regular commercial buildings. For example, plumbing installations in hospitals involve specialized water supply systems for operating rooms, laboratories, dialysis units, and so on. Similarly, hospital heating, ventilation, and air-conditioning systems must ensure adequate indoor air quality for patients and staff and reduce the risk of airborne transmission of harmful micro-organisms. All these systems are critical for patient and staff safety.

CSA Group standards, CSA Z317.1:21, Special requirements for plumbing installations in health care facilities, and CSA Z317.2:19, Special requirements for heating, ventilation, and air-conditioning (HVAC) systems in health care facilities, offer requirements for the design, construction, operation, and maintenance of these systems. These Standards help protect the health and safety of patients, staff, and visitors, and support positive clinical outcomes. The new edition of CSA Z317.2 which is currently under development will reflect insights gained during the Covid-19 pandemic. The updated requirements will address pandemic planning, operating room pressurization, and other topics.

Infection prevention and control in health care facilities

Despite declining rates of health care-associated infections in Canadian hospitals^[3], they pose a significant risk to patients, visitors, and staff. Cleaning and disinfection of surfaces are essential components of effective infection prevention programs in HCFs. CSA Z317.12:20, Cleaning and disinfection of health care facilities, is one of the standards supporting this area, applying to both manual disinfection practices and automated disinfection systems. The Standard outlines requirements for cleaning and disinfection processes and their frequency and includes additional requirements for specialized areas, such as operating rooms, emergency departments, hemodialysis units, or food preparation areas. The Standard also provides guidance on personal protective equipment and cleaning agents and technologies, and addresses quality management system development, staff education, and training.

New guidance for health care facility digital infrastructure

As in other areas of our lives, emerging technologies play an increasingly important role in the health care sector. Digital systems can help improve collaboration, efficiency, health outcomes, and patient experience, as well as save costs. As hospitals become more connected, integrating different systems becomes increasingly complex and critical to their day-to-day operations. The new standard, CSA Z8005, Special requirements for digital infrastructure in health care facilities, aims to address specific needs of the health care sector in this area. The Standard will provide a framework for the planning, adoption, implementation, and management of digital health technologies and infrastructure used in HCFs. Inter-system communication within HCFs and across the continuum of care is also an important topic included in the Standard. CSA Z8005 is anticipated to be published later in 2023.

CSA Group HCF standards help provide a broad and comprehensive framework for stakeholders to build better health care facilities and address the complex systems and procedures that take place within them. While they may not be easily visible, these standards are important to a well-functioning health care system and help enhance the safety and effectiveness of health care systems and services across Canada.

^[1]Canadian Institute for Health Information website, https://www.cihi.ca/en/health-spending (accessed in March 2022)

^[2]Infection Prevention and Control in Health Care Facilities, CSA Group, https://dev-www.csagroup.org/article/research/infection-prevention-control-health-care-facility-design/

^[3]Johnston, J. et al, Health care-associated infections in Canadian hospitals: still a major problem, CMAJ, September 09, 2019, https://www.cmaj.ca/content/191/36/E977