Implications Of COVID-19 On Healthcare Design

By Aran McCarthy | July 21, 2020

    

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.

2. 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.

3. 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.