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Three Thoughts on the State of Healthcare Design for Highly Infectious Contagions

By Greg Lavriha

magnified image of Ebola virus

Magnified and digitally-colored image of Ebola virus particles. Photo: National Institute of Allergy and Infections Diseases (NIAID)

I had the opportunity to speak at the “Designing for Highly Infectious Contagions” seminar, hosted by Kent State University’s Elliot Program for Health Care Design. I presented alongside some impressive contributors to the field: Patrick Casey, AIA (The University of Texas System); Chris Woolverton, PhD (Kent State University); and Gerald McDonnell, PhD (STERIS Corporation).

All of the speakers dovetailed their presentations to complement each other. We all had different areas of expertise and were able to cover the subject matter more effectively as a team. Parts of the seminar were highly technical – delving into topics such as the nature of infections and transmission, work practices in a BSL 4 lab environment, and methods of decontamination/disinfection.

In terms of the state of design, here are three takeaways from the seminar.

1) Hospitals Face a Twofold Challenge: Room Design and Work Practices

Per CDC guidelines, research spaces have four clearly defined biosafety levels with clear room design and work practices. Someone entering one of those spaces knows what they’re getting into.

Hospital patient care areas do not have an equivalent to the biosafety levels. Additionally, given the nature of hospitals, staff don’t know who’s going to walk in the door at any given time. A patient could have the flu or have Ebola, and they could be placed in the same type of room. But while a nurse with a healthy immune system is not likely to be endangered by a flu patient, the same is definitely not true for a nurse who comes in contact with an Ebola patient.  Healthcare professionals have always had challenging and sometimes hazardous jobs. Highly infectious contagions make it more so.

2) Hospitals Responding to the Room Design Challenge

The University of Texas and several other facilities have constructed biocontainment critical care units, with a construction cost of around $600 per square foot. The goal is to house critical, highly contagious patients in a safe way. Because there are no standards for room design or work practice, design is based on the consensus of the design and infection control professionals involved.  

There are larger hospitals around the country that want to incorporate biocritical containment, and the CDC is working on white paper guidance for biocontainment critical care units.

3) Take a Team Approach to Building Biocontainment Areas

The team approach is necessary to build effective and efficient patient isolation areas.

Why? Because hospitals are complex in many ways. They are architecturally complex. Established hospitals may have numerous buildings of varying ages joined together. There are infrastructure limits (e.g., emergency power, electrical, or mechanical capacity). There are facility standards – both internal and external – that must be met. They operate 24/7, with people coming and going at any hour. Patient flow causes challenges as well, because often the ideal location from a nursing perspective might be a challenging location from a design or construction standpoint.

Hospital building projects need the input of all project stakeholders – owner, nurses, architect, engineer, and contractors – who understand the different aspects of hospital operations and the construction process.

(You can view the presentation slides here.)





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