Extreme Makeover: Dialysis Edition

by Kayla Sloan

Bringing a new function into an existing building can always be a challenge. As fads and designs change throughout time, so do building and health codes. Sometimes it is possible to get the existing building grandfathered in in some areas that are technically infeasible to upgrade to new building code standards such as ADA regulations. To do this, though, the less technical the project is, the better.

When it comes to healthcare, you have not only the building codes, but also the health department codes and regulations that govern the final design. Because of this, you have the inherent nature of an extremely technical project on your hands. Not only do you need to adhere to federal, state, and local guidelines, but sometimes the program will not function without said guidelines. So even if the City would allow for something typically to be “grandfathered” in, for the program, it is not feasible. While adaptive reuse is normally associated with historic preservation and buildings of civic importance, it can also be viewed as an overall sustainable practice. If the bones of an existing building are still structural, why demolish, waste materials, and build new?

Even if a building had a similar function, though, in its previous life, adaptive reuse is not always easy, and hurdles need to be overcome. This was the case at our dialysis project in Avon, CT. Although the building was originally a medical office building and quite attractive to look at from the outside, the transition to a dialysis center was not extremely smooth. Both are healthcare related, but doctors’ offices are much more like a typical office building and do not have the level of complexity of other treatment facilities. Firstly, the building was wood framed from walls to the floors and roof. The process of dialysis utilizes a large amount of water and accompanying this is the high chance of water spillage and leakage. In a concrete and steel framed building, it is much easier to control water leakage from spreading to other floors of a building. Typically, we would utilize an epoxy or sheet vinyl flooring to create a seamless membrane with floor drains flashed into it. Most drains and poured / adhered membrane flooring are designed to work with a concrete structure, and the clinic is located on the second floor. To further narrow down the options, the concentrates used for dialysis are corrosive, so only plastic drains can be utilized. This created a special condition in which we had to create ledges for the drains to sit on with special flashing into the flooring. Our only option for a wood subfloor was to go with a sheet vinyl flooring as an epoxy flooring can crack if the subfloor deflects. Even this option required the addition of a liquid waterproofing membrane applied to the subfloor (3/4” and 1/4" plywood), then a layer of concrete board, followed by a skim coat and the sheet vinyl adhered on top to fully protect the floor below from any possible water leakage and meet the requirements for the flooring manufacturer’s warranty.

To further complicate things, the water treatment room which houses large drums of water amongst various other heavy equipment, had to be located on the second floor of the building with the clinic. The typical wood framed floor which was fine for a normal day to day load for a doctor’s office would not support the weight we were going to be bringing into the space. This required a new wood bearing wall with concrete footing below the room to be built and poured to support the weight and prevent the joists from deflecting.

Another obstacle encountered with the wood framed floor was the client’s desire for an in-floor scale. Once again, these are designed to be installed in concrete floors, however, they provide the best option for a scale since they are level with the ground and prevent trip hazards. It is much easier for staff to push a wheelchair or stretcher onto a floor level scale rather than up a small ramp to a normal scale. To make this possible, we had to cut some of the existing floor joists and sandwich the two remaining ends with additional joists. In the cut, a small pit was framed, and concrete poured within in it to house the scale.

One final hurdle apart from the wood framed floor was the presence of an enormous number of windows. Natural light is great for your wellbeing and health, and if I were sitting in the same place for four hours at a time being dialyzed, I would love to be able to look outside and feel the sunshine. However, for this specific client, there is a prefabricated chase mounted to the wall with data and power run through the wall. For this to be a seamless installation, all windows must be above 4’-0” AFF to provide mounting room for these components. Unfortunately, at this location, there were windows as low as 24” on the treatment floor which we had to cover with a new low wall. Luckily, all the windows had integrated blinds that could be closed prior to blocking them off, but it is always disappointing when you must cover a window.

Although the building served well for a medical office, it needed a bit of improving and ingenuity to house a dialysis clinic. If the client is willing to put in a little bit of elbow grease and funds, rarely is it impossible to give an old building new life.