Bio-Containment Unit Designed for Flexibility

Case Study:

BioContaiment Unit A Deeper Look As biological threats increase; bacteria and viruses develop resistance to drugs and vaccines; and widespread outbreaks become more commonplace, biocontainment and airborne infection units will become critical to the prevention of epidemics.

A flexible care space adjacent to the Emergency Department that can flex between observation, airborne infection critical care and biocontainment unit is a potential solution.

Challenge To provide appropriate facilities to care for patients sickened by hazardous conditions brought on by bio-terrorism and largescale disease outbreaks with the flexibility to use the space for less emergent needs as needed.

THE NEED In response to the recurring threats of infectious disease outbreaks presenting major risks to public health and safety, Array was engaged to create a Bio-Containment Unit (BCU).

As one of their region’s largest hospitals, they will integrate the Unit into a facility that is a hub for advanced critical care and well-suited to serve as an Ebola Treatment Center. The Unit is designed to ensure the safety of patients and staff, provide a versatile environment capable of both bio-containment and airborne infection control, as well as enable leading-edge treatment methodologies.

PHASING The construction team is completing the project in three phases. Phases 1 and 2 relocate the Admissions Testing Center and a specialty administrative office suite and the third and

Solution

final construction phase creates the BCU, accommodating the multi-functional patient care unit as depicted in floor plans to follow.

A multi-phased construction effort will put in place a Unit

UNIT LOCATION

designed to handle airborne

The BCU is designed to occupy 6,500 SF of the first floor. Staff determined this location is

disease and other potential

ideal with its proximity to the Emergency Department triage area, first floor entrances and

disasters as well as serve as

elevators to the lower level loading dock. This first floor location is important to staff as it

a much needed Observation

will allow the Hospital to quickly convert the space from an observation unit or airborne

Unit when census demands.

infectious disease critical care to a BCU. A reception station is located at the entrance of the Unit to control all access and serve as a communication conduit. A large designated work area for clinicians is located to provide them direct visibility to the patient rooms.

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\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ FLEXIBLE DESIGN The flexible design of the BCU patient rooms allows the Hospital to use the Unit at all times and minimizes downtime when transitioning between normal operations and special isolation use. The patient room size and the modularity of equipment and casework allows for a quick transformation from patient room to support space, or from a double observation room to single critical care patient room. Patient rooms are designed with utilities and finishes required under each circumstance, and clinicians and administrators from several departments were integral in developing this comprehensive design that accommodates each scenario.

The space can be configured in three modes:

1

2

3

Serving as an observation unit

Converting into a seven-patient

Converting into a two-patient

for up to 15 patients, with seven

airborne infection isolation

biocontainment critical care unit

semi-private rooms and one

critical care unit.

complete with lab and support

private observation room.

spaces for decontamination, including two ensuite autoclaves.

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Flow of Treatment CONTAINMENT & SAFETY PROTOCOL There are three major areas within the BCU to ensure patients and staff safety. These areas can convert quickly between three areas: BCU Doffing, Patient Room Pressurization and Staff Workstation.

Within the BCU Doffing area there is a shared anteroom/ doffing room that will accommodate cold and warm zones, providing one-way flow to the patient rooms. Staff will don personal protective equipment (PPE) in a separate donning room and access the patient room from the cold zone of the shared anteroom. Exiting the patient room from separate doors within the anteroom/doffing room’s warm zone, staff will doff (remove) their PPE, directly assisted by

a helper while a reader within the room’s cold zone calls out step-by-step instructions. A watcher outside of the anteroom/doffing room observes the process for safety.

Hand washing, the last step of the doffing process, will occur in the room’s cold zone. Trash is processed for safe transport across the corridor to be sterilized in autoclaves.

Equipment and re-usable PPE are processed in the decontamination room.

The patient rooms are negatively pressured to protect adjacent spaces. One hundred percent outside air is supplied via laminar flow diffusers along the room perimeter to minimize mixing the room’s air. A return diffuser is located just above the patient’s head, thus drawing contaminants away from providers and patients.

HVAC CENTRAL SYSTEM DESIGN FEATURES:

HVAC DISTRIBUTION SYSTEMS

• Air handling systems are dedicated to serve only the

• Increase room total air changes per hour (ACH) to

Bio‑containment Unit. All spaces in the unit are fully

20 for the bio-containment patient rooms from the

exhausted and provided with 100% outdoor air.

minimum of 12 ACH per FGI/ASHRAE 170 required for

• High plume dilution “laboratory” type exhaust fan with upstream Bag-in/Bag-out HEPA filtration bank features high velocity nozzle for diluting and dispersing hazardous exhaust.

• Systems to include redundant equipment, including a four-fan supply fan array with one redundant fan, and a fully redundant exhaust fan and associated HEPA filter bank.

• Heat recovery devices were not included to eliminate any risk of cross contamination between supply and exhaust air streams, or contamination of maintenance staff during equipment service/repair.

an airborne infectious isolation room.

• Each room provided with supply and exhaust terminal unit equipped with digital controls to control airflow and space pressure.

• Each room provided with local digital room pressure monitors to track and control pressure differentials between: – the patient room to the corridor – the patient room to the anteroom/Doff – the corridor to the anteroom/Doff • Each room provided with a local mechanical pressure differential indicator as a secondary visual monitor of pressure differential.

• Exhaust air registers located on the headwall directly above the patent bed location to capture airborne contaminants as close to the patient as possible.

• Laminar/uni-directional flow (ASHRAE Group E) air devices provided, positioned around the perimeter of the bed.

Above: Bio-Containment Exhaust Fans Left: HEPA Filter Bank PAGE 4 | case study: biocontainment unit

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\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ EMBRACING TECHNOLOGY This design paves the way for future readiness by

Who We Are

combining technology and flexibility. The Unit

ARRAY-ARCHITECTS.COM

incorporates technology, including two-way video chat, to connect patients with caregivers, family and friends.

Cameras monitor both patients and staff.

SIMULATION MOCKUP Array collaborated on a simulation mock-up of this BCU for exhibit at HITT Contracting’s Co|Lab, a space dedicated to bringing ideas to life which aims to serve as a hub for research and testing of emerging materials, approaches and technology that will rapidly transform the construction and real estate industries. The mock-up serves as proof of concept for the project and establishes a platform for demonstrating the intended use of the space to other institutions as well as soliciting peer-topeer feedback on a critically important and growing area of specialized healthcare.

We Are Healthcare Architects We are a team of architects and designers with unique backgrounds, but we all have one thing in common - we share a strong desire to use our expertise and knowledge to design solutions that will help people in moments that matter most.

This focus makes us leaders in our field. There’s a degree of compassion, empathy, and sensitivity that goes into every project that we touch. It’s designing a nurse station with sight lines to every patient. It’s building a Behavioral Health facility without corners, so that patients are safe. It’s translating the operational needs through the technical details to fine tune the lighting system in a neonatal unit so caregivers can match the lighting to each baby’s stage of development.

It is a deeper understanding, honed through relationships spanning decades..

Together, we discover optimal solutions with our clients. It is our four decades of specialization that allows for effective communication, collaboration and precision in the complex, changing world of healthcare.

Array’s Knowledge Communities We believe strongly in sharing our expertise and knowledge with others. We invite you to explore each of our thought leaders and share your thoughts with the healthcare design community.

Click here to visit our Thoughts page.

CLICK HERE to learn more about how Isabelle is sharing her expertise with the Facility Guidelines Institute.

SUMMARY The flexible design minimized downtime of the space and allows the client to make the best use of their space.

The staff of the Bio-Containment Unit work cohesively as critical care clinicians with specific training in the donning and doffing process and transitioning to Bio-Containment standards as necessary.

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