DescriptionThe Ensuite - Bariatric is for a patient to wash, shave, groom themselves, shower and use the toilet, either independently or with assistance. The Ensuite is associated with the 1 Bed Room - Bariatric. The area and layout must accommodate two assisting nurses and a shower commode with bariatric capacity. The ensuite and bedroom should be planned as a unit, with the use of a ceiling mounted hoist is coordinated across both rooms.Hours of Operation24 hoursOccupancy1 patient; 1-2 staff assisting as requiredAdditional Considerations~ Bariatric bedrooms and ensuites are to be designed to accommodate patients up to 250kgs. The provision of super bariatric bedrooms and ensuites, for the management of patients up to 450kg, is generally restricted in jurisdictions to selected healthcare facilities only. This is to ensure that safe and effective care can be provided. Refer to HPU 340 Adult Acute Inpatient Unit for more information.
~ The door is to be fitted with a lock that has an occupancy indicator and emergency release hardware. An outward swinging door is recommended to mitigate risk of accidental barricade in the event of a fall or loss of consciousness. If an inward swing is provided, an emergency release and pivot hinge to allow for the door to open outward is required.
~ The floor finish at the entry to the ensuite is to be flush with the adjacent floor finish in the bedroom. The floor finish in the shower area must also be flush and continuous with the adjacent floor in the ensuite and is not to have a raised hob.
~ A tiled floor finish may be provided instead of floor vinyl, and it is recommended that where floor tiles are used, wall tiles are also used to achieve an appropriate join between floor and wall finishes.
~ The slope of the floor to the drain in the shower must meet the relevant Australian/New Zealand building code compliance requirements. When meeting these requirements, the slope of the floor is then low enough to have minimal impact on patients using walking aids, patients with impaired mobility/balance, and staff assisting patients on commodes, wheelchairs, etc.
~ Provision of reticulated medical gas outlets (e.g. oxygen and suction) may be considered depending on patient cohort requirements. Where provided, the location of the outlets should allow for use within the shower and on the toilet with standard tubing lengths. Mitigating contamination risk of medical gas outlets from toilet plume is to be considered (e.g. cover to outlets and associated attachments).
~ A patient lifting track is typically provided in the associated bariatric bedroom and continues to the ensuite. Requirements for the bariatric patient lifting track in both the ensuite and the adjacent bedroom must be confirmed at a project level and are to suit clinical service requirements and local WHS policies for patient handling. Configuration (fixed track, traverse track, etc.), installation (recessed or ceiling mounted), weight rating/safe working load (SWL), and extent must also be confirmed by project teams to inform requirements for the ceiling structure, door width and clearances in the ensuite. The door height and frame must be designed to accommodate linking between tracks. Selected track and lifter equipment must meet local infection prevention and control (IPC) policies and cleaning requirements.
~ Selected toilet pan must be able to support patients weighing up to 250kg. While most toilet pans are able to accommodate this weight, pans that are slightly wider and longer, such as those typically selected for accessible toilet configurations, can be fitted with bariatric toilet seats and provide support to bariatric patients and allow clearance for use of bariatric assistive equipment. Use of these toilet pans also allows the room to be used by other patients, including those with high assistance requirements, when it is not being used by a bariatric patient. Extra wide stainless steel toilets that are specifically designed for patients up to 450kg are often too large for other patients to use, reducing flexible utilisation of the bedroom and ensuite. It is therefore recommended that these toilets be used in super bariatric ensuites only.
~ Specific bariatric toilet seats are to be selected that are designed to accommodate patients up to 250kg and to flex in a way to reduce the risk of pinching between the seat and the pan. It is recommended that the toilet seat is coloured to achieve a minimum 30% luminance contrast between the seat and the toilet pan, the floor, and the adjacent walls to support patients with visual impairments.
~ The connection point of the hand-held shower is to be located, with consideration of the length of the hose, to ensure that the shower head is not in reach of the toilet bowl. Risk mitigation strategies (e.g. reduced pressure zone devices) to be used where this cannot be achieved.
~ Grab rails are to be securely fixed to the wall with the structural support required to meet weight ratings/SWL that must be confirmed at project level (generally accommodating patients up to 250kg for bariatric patient rooms). Space for staff assistance to both sides of the toilet is provided in this Standard Component and therefore drop-down grabs rails for use by patients with or without staff assistance have been indicated. Additional structural support requirements are to be confirmed at project level to accommodate the downward force on the drop-down grab rails. It is recommended that drop-down grab rail products with fold down support legs are selected for increased support and strength.
~ A shower curtain and track are not shown in this Standard Component due to provision of the ceiling mounted lifter track. Hinged curtain tracks that fold against the wall may be considered, and inclusion is to be confirmed at project level to suit local work, health and safety (WHS), and IPC policies. Where provided, operational models for cleaning and maintenance must be considered.
~ In-wall structural supports are to be provided for the basin and other relevant fittings to meet weight rating/SWL and downward force requirements.
~ The handwashing basin should include a detachable shroud to enclose pipe fittings. The shroud should be a separate element, rather than being integrally moulded with the basin. This separation ensures there is access to the plumbing (i.e. P-trap or S-bend) for maintenance, without requiring the removal of the entire basin. Refer to ‘Part D: infection Prevention and Control' for more information.
~ The use of commodes, mobile patient transfer equipment and sit-to-stand equipment is to be considered when finalising fitting selection. It is recommended that the set out of the toilet suite and grab rails is tested with assistive equipment that is being considered or has been selected to ensure appropriate clearances, including coordination with the height of the toilet seat and the toilet lid. Clearance from the equipment to the grab rails should ensure there is no risk of pinching or finger entrapment.
~ Operational models and IPC policies for use of a patient’s own mobility/transfer equipment, and any associated considerations for the design of the ensuite, are to be confirmed at project level.
~ With provision of drop-down grab rails to both sides of the toilet, inclusion of an integral toilet paper roll holder and nurse call button are recommended due to reach to wall mounted fittings being impractical. This may mean toilet paper stock differs in this ensuite compared to others where dispensers may be selected for jumbo roll, or interleaved tissue stock.
~ Mobile duress coverage is to be assessed and planned at a department level and coverage of all patient areas is to suit local security and WHS policies and operational service requirements.
~ A power outlet to support grooming, such as shaving and drying hair, is shown as optional. Local policies around provision and maintenance of electrical outlets in wet areas are to be confirmed to inform inclusion of a power outlet within the ensuite. Where provided, the outlet is to be located to comply with Australian and New Zealand Standards regarding the minimum distance from any water sources (i.e. basin spout and shower).
~ Layout of ensuites should consider the positioning of plumbing fixtures in relation to fire and smoke walls in an overall department configuration to minimise the impact of penetrations required for pipework.