ARCHITECTURE COVID-19’s influence on facility design

COVID-19’s influence on facility design

Considering patient and provider safety

BY STACY L. COLLINS AND DAVE MOGA, AIA

There is no denying that the world is a different place than it was a few short months ago. A seemingly healthy economy has been leveled to its knees and daily patterns and behaviors have changed dramatically. There is not a single industry that has been unaffected by the COVID-19 pandemic—some positively, most negatively. As we emerge from the pandemic, many positive changes will follow. Some of these will involve rethinking health care facility design. These changes will vary based on specialties and where the care is provided.

What will the new health care environment look like? Changes in health care facility design will likely follow a three-stage process. There will undoubtedly be short, mid-term, and long-term modifications required as the health care industry moves to a new normal. One thing is certain: planning principles associated with the layout and design of medical buildings and clinical environments will change in a variety of ways.

Short-term solutions—emotionally driven

Social distancing, stringent hygiene practices, and isolation will be part of the new normal in clinics and hospitals. The importance and

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emphasis placed on these behaviors will require a needs assessment of each facility to identify potential gaps and vulnerabilities. Walking through existing spaces and viewing each area through the eyes of a patient or staff member will present the need for one or many of the following solutions:

Create spatial barriers between the patient and staff at the check-in desk.

Expand use of electronic check-in and self-check-in kiosks.

Reconfigure waiting areas to incorporate spacing and back-to-back seating arrangements versus those facing one another.

Implement cleaning stations in the public areas.

Plan for one-way traffic flow of patients into and out of the exam areas.

Adjust procedure schedules to allow time for room disinfecting between patients. This may require that clinic hours be extended with split shifts of staff to accommodate more visits per day.

Reconfigure existing underutilized exam space to accommodate telehealth capabilities.

When executed properly, these examples of proactive planning offer a comforting, safe, and welcoming environment that instills confidence in patients and staff alike.

Mid-term solutions—research influenced

As more research is gathered surrounding this pandemic, we will begin to see more complex solutions put in place that will provide comfort and confidence to health care administrators as they invest in modifying their facilities. These solutions may include:

Space plan modifications that create larger, more flexible waiting areas to meet distancing requirements while compressing other spaces to maintain the same footprint.

Medical Office Buildings may seek to develop accessible exterior locations to provide a canopy for drive-up testing.

Enclosing open patient treatment spaces such as infusion bays for control of airborne particulates.

An upgrade of materials and finishes may be required throughout to incorporate bleach-cleanable fabrics and surfaces. A recent Johns Hopkins report states: “So far, evidence suggests that the virus does not survive as well on a soft surface (such as fabric) as it does on frequently touched hard surfaces like elevator buttons and door handles.”

Ventilation, purification, and humidification play a key role in mitigating the spread of infections. Additional research will likely change requirements in this area and an assessment by a qualified HVAC partner will become necessary. Facilities will look to make modifications to the existing HVAC systems to improve air flow and filtration.

Research will continue to drive modifications that health care facilities will seek in the next 12 to 18 months. Rest assured, patients beginning to

make their way back to their normal well-patient visit schedule, and even Requirements to develop multiple and controlled building entries which those who seek specialty care, will approach that care and ultimately make may be identified for “well patients” and “potentially infectious patients” to a provider selection based on emotional and intellectual information gained be utilized based on the reason for a visit. as a result of the COVID-19 experience. Changes to the flow of patients throughout the facility. Although Long-term solutions—yet to be defined it is unlikely that flow in a building would As research and models continue to be developed be formally codified, the building code may and assessed, changes are on the horizon. The require that facilities be able to identify separate health care industry will look to advancements in routes for suspected infectious patients that technology that may change the level of interaction Medical buildings and clinical limit cross contamination. between the patients and care providers at different environments will change Waiting room size requirements may be times during a patient visit. in a variety of ways. altered to accommodate social distancing and

We have noticed a change in the preinclude sub-divided spaces to segment the registration process, with fillable forms being sent patient population. via email and submitted prior to a visit to reduce Modifications to HVAC system requirements wait times and interaction. This will most likely to address humidity control, increase ventilation, and become commonplace as facilities seek to reduce improve exhaust air from high-risk environments the number of patients in the facility at one time. The ability to check in will aid in infection control. This may be a significant challenge for some for an appointment with a smart phone or at a self-check-in kiosk will also existing buildings, since many mechanical systems do not lend themselves reduce interactions as the six-foot social distancing does not offer a great to changing functionality or control without replacing the entire mechanical deal of privacy during the check-in process. system. It is more likely that newly designed buildings would be required to

We anticipate future building code modifications may impact all building have more controllable HVAC systems to account for isolating and exhausting types and functions but will directly impact health care environments air from critical spaces. in response to the need for surge capacity and overall infection control measures. These potentially could include: COVID-19’s influence on facility design to page 344

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