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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