Implications Of COVID-19 On Healthcare Design

As the healthcare industry begins to navigate the new realities of a post-pandemic world, we’re seeing changes, both large and small in scale, across healthcare design. During the initial response to the global coronavirus crisis, healthcare facilities had to adapt in order to accommodate the influx of patients, as well as provide healthcare equipment such as ventilators and other personal protective equipment (PPE). Now that the early wave has subsided in some areas, we expect to see shifts in priorities as healthcare organizations move forward.

Required thermal temperature scans, negatively pressurized spaces, dedicated entrances for fever patients, HEPA filtration systems, and expansions to existing storage capacity are just some of the changes that could become the “new normal” following the coronavirus pandemic.

Here’s a look at some of the ways health systems are adapting their facilities now, which will benefit both the patient and the caregiver to help with the next viral outbreak:

  1. Negatively pressurized spaces

In response to the Ebola outbreak in 2014, some hospitals created “Ebola rooms,” which are negatively pressurized spaces to treat and safely quarantine patients who have tested positive. Fortunately, at that time, the U.S. didn’t experience as large a spread as initially anticipated, but these rooms were still available for such an event.

When COVID-19 patients began to trickle in starting in late February, many hospitals took this idea and quickly created separate zones for patients who were testing positive for the coronavirus. These spaces quickly became overwhelmed and the transition between the perceived clean and contaminated areas dissolved. With the delay in time to process tests, patients were assumed to be positive, which quickly overwhelmed some facilities’ ability to accommodate patients awaiting results.

Moving forward, facilities need to plan for more negatively pressurized isolation spaces within hospitals that can be designed for normal everyday operation, but can flex quickly to address a larger capacity of undiagnosed patients. These adaptable spaces should be designed to accommodate swift shifts in layout and safety, such as medical/surgical patient room floors converting to COVID-19 ICU floors under negative pressure.

  1. HEPA filtration

Another example of how facilities are starting to adapt is by introducing more HEPA filtration systems throughout. Some HEPA filtration systems state they’re able to capture 99.97 percent of particles that are 0.3 microns or greater in size, ensuring that the air in a particular space is extremely sterile. Droplet nuclei are airborne for longer periods, and HEPA filtration in negative air systems is designed to make spaces safer by capturing or filtering these particles while the air is being recycled through the system.

Traditionally these filtration systems are utilized in areas such as surgical operating rooms where sterile procedures are performed, but hospitals are considering installing the infrastructure in other areas of the hospital, such as intensive care or critical care units, in order to help with infection control.

One of FCA’s healthcare clients removed portions of window systems across two floors of its existing building and installed exhaust fan systems to create negatively pressurized patient rooms to treat COVID-19 patients. In order to stay one step ahead for the next pandemic, we will see similar types of alterations happening at a larger scale.

Looking to the future, architects may be considering designing removable sections in patient room windows so that they can quickly accommodate through-wall exhaust fans, a stop-gap measure that’s short of full HEPA filtration. This could allow entire patient room floors or specific units to be designated COVID-19 units for infected patients. Also, the addition of pandemic switchover HEPA filtration to ICU/CCU units will add another level of protection.

In the future, we’ll also see less open-bay treatment spaces in emergency departments and more dedicated, private, negative-pressure rooms so that healthcare workers can help contain the potential spread of the virus. One lesson we’ve learned is that protecting the caregivers is just as important as the patients, and preventing the spread of COVID-19 throughout the hospital setting is extremely important.

  1. PPE storage

With an increased need for PPE and readily accessible ventilators, hospitals are considering how to plan for storing both the day-to-day supplies for just-in-time use as well as long-term medical equipment needed for a sudden influx in cases, and how to efficiently and seamlessly integrate storage spaces within a hospital layout.

Designers will need to work with healthcare providers to ensure enough space is being allocated to accommodate storage that may be needed for future emergency situations. Keeping this storage sterile and out of COVID-19-infected air has been another emerging challenge, and we’re seeing a need to return to larger, centralized, positive-pressure clean utility rooms.  Conversions of oversized waiting rooms into storage spaces is an idea being considered.

One example of best practices may be found at neonatal facilities, which have a designated amount of storage space per baby required for bassinets and other equipment, as outlined by the Facility Guidelines Institute’s Guidelines for Design and Construction. Mandates for emergency storage spaces may soon appear in future versions of the FGI guidelines.

There’s a learning curve as the healthcare industry learns to adapt and implement these changes, but these systems will eventually be integrated into every design, which will allow facilities to be better equipped for future emergencies.

Aran McCarthy, AIA, is principal of healthcare at Francis Cauffman Architects (Philadelphia, Pennsylvania). He can be reached at amccarthy@fcarchitects.com.

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