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 Edwin Beltran and Josie Briggs.
Chronic illnesses like cancer, diabetes and heart disease don’t stop just because the rest of the world is at home. As the coronavirus crisis surges, healthcare providers struggle with how to best serve patients in the hospital with non COVID-19 illnesses, without enabling the virus to spread. This challenge is particularly acute in common areas such as building entrances, waiting rooms and lounges, where infected and non-infected patients and visitors congregate and transmission risks may be elevated.
While immediate solutions can address the current surge of demand on hospitals, hospitals planning future construction or renovation can optimize their ongoing infection control efforts — whether every day or during a pandemic — through six key design considerations:
Material and Furniture Selections
Furniture and finishes in common areas can be a vector for infectious diseases like coronavirus. According to preliminary research, the COVID-19 virus can stay alive on steel and plastic for up to 72 hours, around 24 hours on more porous surfaces like cardboard, and only four hours on copper. Consideration of material selection, especially the use of antimicrobial surfaces like copper, can be an important strategy for reducing transmission risk. Surfaces that prevent or reduce the spread of pathogens, including rubber or linoleum flooring, should also be considered.
The easier a piece of furniture or surface is to clean and disinfect, the less likely it is to serve as a vector. Furniture pieces with seamless detailing that eliminates hard-to-reach crevices and can be cleaned on all sides will be less likely to host pathogens. Furthermore, smooth upholstered surfaces, such as seat cushions, are easier to clean if there is a gap between the seat and back cushions — debris falls to the floor for easy cleaning, and a hand can easily wipe the surfaces with a disinfectant.
Solid surface materials, such as Corian, can be shaped and made seamless, making them easy to clean when used as a table, chair arm or handrail. Additionally, all furniture materials should be durable and able to withstand stringent disinfection and cleanings protocols.
In recent years, there has been a trend within healthcare design to support a wide range of options for activity-based seating in waiting rooms. These arrangements can be moved or otherwise modified to create sufficient space between patients to minimize infection risk. However, consideration should also be given to the isolating effects such arrangements can have on patients and how to mitigate this impact through other measures. For instance, an array of small screened seating zones or connected rooms could support proper social distancing measures while still allowing for visual connection to others and the outdoors, reinforcing social connections and a link to nature.
In some healthcare facilities, waiting rooms are being used for triage, to divide patients into infectious and non-infectious populations. This requires specialized signage and seating areas to be grouped into sections with sufficient distance between them to support social distancing. Some facilities could have courtyards or gardens separating different waiting areas which can also serve to create separation between patient populations. Facilities may also consider incorporating medical gas outlets concealed behind sliding artworks, panels or other elements in lounges and waiting areas to support potential surge needs.
Another method of minimizing the risks of contact transmission is to employ touchless technology in common areas. This includes automatic doors and hand sanitizer dispensers, as well as sensor-activated faucets, soap dispensers, toilets and towel dispensers in common-area bathrooms, which can be a hot spot for contact transmission. For entertainment monitors and interactive information displays, voice activated command technology can be used to eliminate the need for touching surfaces.
Waiting areas and lounges in healthcare facilities aren’t typically a focus of specialized mechanical system design for infection control; however, given the current crisis and possibility of future outbreaks, it may be valuable to evaluate how methods typically applied to clinical spaces for air changes, filtration, or negative pressure may be incorporated within these areas to allow for more flexibility of use. This would require several challenges to be addressed: for instance, designing the space so it could be appropriately closed off from adjoining spaces to keep the appropriate pressure balance and control the flow of contaminated air.
Using Design to Uplift and Comfort
Hospital visits can cause anxiety at any time, but especially in a pandemic, under infection control protocols that, by their very nature, can be isolating and potentially dehumanizing. So it is important that healthcare common areas still serve to reassure and comfort patients, providing a sense of normalcy by giving them opportunities for respite, privacy and comfort. This is especially true for neurodiverse populations, who may require additional attention to issues such as color palette, lighting, temperature and varying degrees of shelter, privacy and “socialization.” The inclusion of elements like gardens, courtyards and views of nature can help alleviate anxiety and provide opportunities for positive distraction.
The coronavirus crisis sheds renewed light on the importance of healthcare facility waiting areas, lobbies and lounges. These common areas are on the frontlines of the pandemic fight as surge space for clinical overflow and as potential vectors for infection. Design has an important role to play in ensuring that these spaces play a more active role in preventing infection while optimizing their operational flexibility to consistently provide dignifying and humanizing settings in support of exceptional patient care.
How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at firstname.lastname@example.org.
Banner image courtesy Sean Airhart/NBBJ.Comment Follow nbbX