When Facing a Pandemic, Consider Patient Isolation at Four Scales

How the Coronavirus Outbreak Should Change the Way We Think About Designing for Isolation

March 26, 2020

Architect, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

This post was co-authored by Kerianne Graham and Sarah Markovitz.

 

Right now hospitals across the country are working hard on creative solutions to increase capacity and prepare for a surge patients — or address the surges that have already happened. Recent outbreaks of SARS, MERS, Ebola and other viruses indicate that, especially with the growth of world travel, the likelihood of these pandemics increasing is becoming a greater possibility.

To create a well-functioning hospital that has the flexibility to care for surges of infectious patients, while protecting other patients and staff, we have to think bigger than the patient room. As hospitals seek to manage COVID-19 in the short term, many are currently in the process of building new facilities focused on the long term. Regardless of where a healthcare system’s facilities are in their life cycle, it’s important to think of isolation at multiple scales:

1. The Room
Standard hospital design includes a provision for isolating infectious patients within a select number of individual rooms per unit, with dedicated mechanical systems, anterooms and the ability to create negative air pressure to protect the rest of the hospital from airborne infections within the room. On top of this, design that puts additional focus on infection prevention includes strategies to eliminate pathogens, reduce touch and improve personal protection compliance.

2. The Unit or Floor
Planned isolation rooms typically only account for a handful of the total rooms on a patient floor and are not typically cohorted, or grouped together. As we’ve learned from previous outbreaks — and are further understanding from the current one — increased demands for isolation may include the need to cluster a population of patients and further protect staff. To make this possible, spaces should be thought of with the ability to close off a full portion of a unit or even a full floor by negatively pressurizing the whole area. By creating a sub-unit or floor dedicated to the care of patients with infectious disease we can heighten staff awareness and precautions, limit access to only the very few people who are needed to care for the patients, increase the efficiency of staff overseeing this special population and decrease the cost of the HVAC system by consolidating it in a limited area.

3. The Building
Flexibility at the scale of an entire hospital building can also help control infection. Consider alternative places for triage to protect other patients and staff; for instance, enclosed ambulance entry courts could feature exterior plumbing and electrical hookups so the hospital can build a temporary, tent-like structure with separate, protected pathways: one for staff to enter and don protective gear, and another for patients to enter and exit to wherever they will receive care. Spaces such as recovery rooms (PACUs), emergency department (ED) sub-units and observation units can be adapted to accommodate more standard patient care — as long as headwalls are designed to accommodate surge capacity — so that the ICUs and patient floors that can be switched to negative pressure can remain available for care of infectious patients.

4. The Network
Finally, for healthcare systems that have multiple hospitals and greater resources, what if one building (or multiple buildings) could be designated the center at which to isolate a patient type — coronavirus patients, for instance — and allow other sites to remain open for the general population? Steward Health Care in Boston is doing this by converting its 159-bed community hospital in Dorchester to focus only on COVID-19. Planning for these full-building conversions allows a system to keep the most at-risk patients in the safest, most appropriate healthcare environment.

Planning and designing with these scales in mind can help give a healthcare system the flexibility it needs to function not only during the day-to-day, but also during unpredictable and rapidly-changing events when patient care is most critical.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy Sean Airhart/NBBJ.

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How to Convert College Dorms to Support the Fight Against Coronavirus

With Hospital Space at a Premium, Eight Strategies to Adapt University Campuses

March 25, 2020

Principal, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. Here are some thoughts and observations which we would like to contribute to the discussions that are going on during the COVID-19 pandemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, a heartfelt thank you.

This post was co-authored by Bryan Langlands, Cathy Bell and Paula Buick.

 

With the number of global coronavirus cases increasing each day, health centers are more burdened than ever before, witnessing severe bed shortages for critically-ill patients. At the same time, housing at many higher education institutions now stands mostly vacant — with hundreds of thousands of students home for social distancing and instruction now delivered online.

There are a lot of discussions about using student dormitories to help assist with the COVID-19 pandemic. In New York, Gov. Andrew Cuomo has announced that the Army Corps of Engineers has selected sites for temporary hospitals on college campuses to increase bed capacity (and the National Guard, overseen by the Federal Emergency Management Agency (FEMA), is building four temporary hospitals in the Javits Center). Washington State and California are exploring options too. While student dormitories are well-suited to certain alternate healthcare uses — from housing clinical staff to treating low-acuity patients — there are important elements to consider when exploring how to convert them for coronavirus treatment, such as building codes and frameworks. Here are a few takeaways.

 

Potential Uses for Dorms During the Coronavirus Epidemic

Monitor “well” people rather than sick patients. Most dormitories don’t have the required medical infrastructure in place — such as appropriate electrical power and emergency backup, and medical gases for an intensive level of care. Instead, they may be better suited to serve as places for healthcare workers to monitor otherwise-stable, quarantined individuals that require isolation so they can be observed and not infect others. In New York, SUNY is currently quarantining students and staff returning from study abroad programs in designated dorms. In addition, to help free up beds in hospitals for COVID-19 patients, dorms could provide space for rehab or post-surgery physical therapy patients.

Expand screening centers. To minimize coronavirus cases in the ER or even a primary care clinic, student dorms could serve as a first point of contact for coronavirus screening, helping supplement drive-through testing and out-of-hospital triage tents. This would help alleviate the volume of patients showing up at hospitals, which should be used for the sickest of patients.

Offer housing for healthcare workers. Due to the virulent nature of the coronavirus, many healthcare workers don’t feel comfortable going back home to their families or roommates in the evening and need a nearby place to rest between shifts. Student dormitories could provide a safe and convenient option.

Provide stable shelter for the homeless. Over half a million people in the U.S. are homeless. California Gov. Gavin Newsom has dedicated $50 million in funding to lease hotels, motels and other facilities for social distancing and quarantines. Dorms, like hotels and motels, can be converted into temporary housing for the unsheltered, where they can receive coronavirus screenings, stay for a period of time, sleep, shower, receive meals, and have access to other health and public services.

 

Key Elements to Keep in Mind Regardless of Use

Consider proximity to adjacent medical services. Is the available dormitory close to a hospital or medical center? Location is important, given staff availability and supplies. Dispersing staff to ultra-remote areas could strain already burdened healthcare systems.

Address building guidelines and codes. Examine the approval and permit process already in place, and determine what else may be needed to successfully deliver the project. For instance, all hospitals overseen by the Massachusetts Department of Public Health require beds located in alternative acute inpatient areas to be spaced at least six feet apart from one another, to contain medical gases (an oxygen outlet and vacuum outlet per bed) and to provide accessible hand washing sinks and privacy partitions.

Develop a systematic framework for conversions. The Army Corps of Engineers is refining a “cookbook of models” — with blueprints recently approved by FEMA — to convert alternative buildings for healthcare use in under a month. To determine a facility’s readiness, the first step is to conduct walk-throughs to assess existing layout and infrastructure conditions such as plumbing, electricity and ventilation. It’s important to evaluate a dorm room’s ability to be isolated and to create an environment required to keep the coronavirus from spreading. This includes: the ability to use self-contained air conditioning units to create “negative pressure rooms”; the ability to maintain the negative pressure seal at each room’s entrance by covering it with plastic and a zipper; and the ability to have a nurses’ station located in the hallways. Another key element to consider is the facility’s accessibility: Is the entry level floor at-grade, or is there a ramp wide enough to take a bed or gurney? Are the elevators, and doors to rooms, sized for bed and equipment movement?

Create a strategy for the short term and long term. It’s critical to address the current situation while planning for the future. Establish a rigorous strategy to convert the dormitories for healthcare use as well as protocols for transitioning them back to student housing. Will there be a residual stigma that will need to be addressed?

While the decision to temporarily convert student dorms is complex and should be taken with care, time is of the essence as healthcare facilities face extreme strain. Although there is no “one size fits all” approach, repurposing student housing can offer much-needed space and other resources to help alleviate these pressures.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy Scott Web/Pexels.

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How Modular Construction Can Supply Beds in the Coronavirus Crisis

Advancements in Rapidly Deployable Inpatient Architecture Are a Key Solution as Hospitals Scale Up

March 24, 2020

Healthcare Partner, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them however we can as they courageously care for the sick. So we’re posting design ideas based on work with several clients across the U.S., in the hope that we can to contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

 

The unprecedented challenge of the COVID-19 pandemic puts tremendous strain on healthcare infrastructure in the U.S., with staff and patients at elevated risk. A recent study found that in a moderate outbreak scenario, hospitals in 40% of American markets would not have room for all COVID-19 patients, even if they emptied all beds of other patients. While authorities are responding with strategies to address the national bed shortage, such as New York’s plan to create 8,000 new hospital beds in two weeks, there will be an ongoing need to increase inpatient surge capacity nationwide.

Quick Response with Rapid Inpatient Units

A rapid-response inpatient unit can be set up in a range of converted spaces, including military bases, schools, dormitories, office spaces, and arenas. Additionally, temporary structures such as tents, modified shipping containers and even purpose-built semi-trailers/RVs can be utilized. One such approach, the U.S. military’s Deployable Rapid Assembly Shelter, provides a turnkey system combining portable enclosure and high-output HVAC provisions. These and other mobile approaches are particularly compelling for virus response because they enable a healthcare structure to be delivered precisely to the point of greatest need, and can be moved from one hotspot to another in direct response to viral transmission patterns.

Yet in many ways, the building enclosure around a temporary ICU is the easier part to construct and deploy. The more challenging step is the construction of the life-support medical engineering systems that support patients within that enclosure.

Using Prefabrication for Increased Adaptability, Configurability and Speed

One solution may be an unconventional approach to ICU unit design and construction that maximizes the potential of prefabricated patient room components. These components act as a highly adaptable chassis for an ICU’s most complex engineering subsystems, including the life-support headwalls that deliver data, power and medical gases via a highly adaptable “plug-and-play/motherboard” framework. Rather than building these components conventionally at the job site, the modules can be prefabricated in a dedicated off-site assembly plant and then delivered and installed with significantly improved schedule, precision, cleanliness and efficiency.

Prefabricated building components can be installed up to 50% faster than similar conventional construction methods; the speed afforded by this prefabricated approach has clear applications for rapid crisis response. Our research in this field benefited greatly through a partnership with the Ministry of Health in Christchurch, New Zealand, after the devastating earthquake there in 2011 required the design of a state-of-the art replacement hospital. And the research was pushed further still in response to the Ebola crisis in 2015.

With these global events acting as a catalyst for innovation, headwall components can now be developed for prefabricated delivery, as well as for life-cycle demountability, enabling continuous reconfiguration and redeployment. In a conventional healthcare setting this flexibility allows caregivers to calibrate their work environment more precisely to need, and in a crisis situation — like COVID-19 — it could enable rapid ICU fit-out for a variety of temporary enclosures. These systems achieve their increased flexibility by incorporating features such as quick-connect fittings, flex piping, scalable technology management, adaptive leveling and panelization (rather than relying on conventional wet-joint sheetrock). Overall, the design leverages a great deal of manufacturing logic from the demountable furniture systems incorporated in corporate workplace projects.

The capacity issues that face the healthcare sector in the current crisis are daunting and cannot be addressed by conventional approaches and thinking alone. Modular construction offers one potential path forward, which may help hospitals respond more rapidly and effectively to the challenges ahead.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

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