Three hospital types to handle a pandemic
Nandini Bazaz, Director, Architectural Services, HOSMAC India Pvt. Ltd, speaks, on howhospital designs would change, post COVID
How do you think hospital designs would change in India, post COVID? Please elaborate.
Hospitals will need to be flexible enough to take on the load of pandemics. Three hospital typologies which can be the way forward are as under:
Quarantine Facilities: These are to be set up which will hold suspect patients. In large cities, the metros, halls have been converted into these quarantine units by providing beds with basic infrastructure such as toilets, food and IV services. So large halls, schools, exhibition grounds, hotels are currently creating these quarantine facilities which is the way to go.
Isolation Rooms: These rooms are to hold patients who are identified as positive cases. Negative pressure air is maintained in these rooms which is directly exhausted and not to mix with the rest of hospital air. It will have reverse filtration system where the virus gets arrested before it is let out into the outside air. Gases such as oxygen will be a must in these rooms, suction required too, basic lab plus an X-Ray unit as Coronavirus is where we are dealing with the lung disease. Rest of the support system for this unit will have clean and dirty utilities, toilets, food and garbage disposal systems, etc.
Critical Care Units (CCU): Apart from oxygen and suction, we need ventilators support here as well. We need Stat Lab for taking oxygen levels, ABG analysis and electrolytes etc. Mobile X-rays with digital facility to be part of this CCU. Staff rooms and gowning areas to be planned distinctly larger to accommodate staff who need protection as PPE gowning can be a task which is carried out minimum 4 times in a day per shift. Disposal system for PPE required. Housing arrangements for staff if possible to be made. Alongside, we may need endoscopy and procedure room too.
It is known that in times of pandemics, an area is allocated which is deemed isolated in a hospital as patients diagnosed with contagious diseases need to be in containment zones. This may be located, as a best possible option, in proximity to the Emergency Department as cases which need attention are rushed to Emergency primarily. Decontam is part of Emergency Care Services department. The triage requires to be planned to accommodate differentiation between healthy, and virus-struck symptomatic patients, which may ask to allocate dedicated staff and support rooms for such detections and admissions.
Hence, first and foremost, an area is to be introduced in the hospital planning guidelines, which shall be cordoned off to enable this space to get essential services to check the spread of such contagious diseases which are out in the open. So basically, in the current scenario of the epidemic, different building blocks in hospitals have helped to separate out COVID-19 patients and one could practice to develop such modules.
Any novel concept in design that you foresee in hospital design in the coming years in India?
Large waiting areas for social distancing would be one. Wards where patient beds are lined up alongside one another will need to work with deletion of one in-between. Overall, the area per bed in the new post COVID era will be hospitals which will increase this ratio and hence will also increase the capital expenditure of the hospital.
A COVID hospital design (can be a stand-alone building) will have to have well defined types of isolation rooms planned into its fabric where medical gases will be key. A 100% exhaust of air in HVAC system to be installed for the isolation rooms. Placement of HEPA filter at extract air fan is also because concentrates of contaminated droplets (particles) are not to be thrown around onto the rooftop.
It goes without saying that patient care is paramount to all hospitals. However, the humans who actually are bestowed upon this training to aid the sick are often somewhat neglected. These are the people, who ought to be enabled and need proper care too, for them to perform at their best capacities.
Staff changing rooms need careful planning, as the doctors, nurses, assistants, lab technicians, cleaning help, morgue staff, all need to don Personal Protective Equipment (PPE), and manage the patients who are infected and immuno-compromised. Gowning and
How do you think functional hospitals can be modified to make it tackle such an epidemic/pandemic?
A floor of the inpatient rooms can be isolated, to convert the entire floor into negative pressure isolation rooms with reverse filtration. Patient is to be kept in a ventilated space in the isolation N rooms. Segregated, secluded, these rooms are to work as single patient rooms under direct observation.
Isolation Q (Quarantine) rooms are another type of isolation units where-in each Isolation Q room requires its own dirty utility room, a double door entry and an autoclave within each room. So each of the Q beds is to be ICU capable for dialysis and mechanical ventilation systems installed here.
A room will be required to be given for steaming facility of beds, mattresses along with sterilization. Effluent treatment plant (ETP) will be required for this hospital.
These quality enhancements, modifications in the typologies of isolation rooms can help tackle the pandemic more effectively.
What changes do you see in terms of materials used that makes the design more flexible? Please elaborate.
Pre-engineered building (PEB) will be a good contributor to erect such hospitals in short time. Walls in PEB can be erected as drywalls, through high pressurized laminates (HPL) and/or powder coated panels. Pre-insulated ducting and pipes to be utiliSed for faster installations, convertible AC systems, seamless floorings in vinyl and epoxy, etc would be of use for ease of construction, environment friendly and also re-modeling. A modular construction model will give us the flexibility required and allow us changes as design develops and also in times to comes for ease in alterations.
What changes do you see in terms of materials used that are infection-resistant? Please elaborate.
It will be necessary to follow, monitor plus implement the cleaning and disinfection protocols in the healthcare facility. Room disinfection equipment and tools are to be made use of in addition to manual cleaning such as ultraviolet germicidal irradiation or hydrogen peroxide/hydrogen peroxide vapor. Materials such as copper alloys that have antimicrobial properties to be used for high-touch surfaces like door handles, bed rails, cart clutch handles, etc. Regularly wearing gloves can go a long way to arrest the spread of infections; and being part of PPE dressing gear it is what enables a perfect shielding. Hands free wash basins, urinals and toilet seats can be installed. Hard floor surfaces in patient care areas resist contamination and are easily cleaned. Sanitisable walls, doors and floors to be installed, food packing/delivery can be robot delivered and handled, pneumatic chutes, tapestry to be carefully chosen for cleanliness, and more. Goes without saying that sinks and sanitizing liquids ought to be placed in convenient locations, thus promoting hand-hygiene observance.
How technology can be leveraged to deliver these changes?
In healthcare systems, enable oxygen supply ability to be installed in almost all nook and corners like dining halls, parking lots, waiting rooms, etc. Mobile hospital modules to be developed on and as when required basis like the current created by the Indian Railways and Indian Army. Utilize porta-cabins for holding suspect patients and also OPD rooms for diagnosis.
Emphasis might shift again to have sufficient public health facilities with improvement in asset quality like the critical care readiness. Government may think towards bringing in a change from a payer to a provider (could be transient via pandemic act). More funding for public sector healthcare to be in the offing.
Training of paramedics will need to go up manifolds. There shall be increase in telemedicine and home healthcare service deliveries, and critical care will also be a home delivery specialized service. Make-in-India will also be required to gain momentum so as to reduce heavy reliance on imports.
For fast construction, coordination of MEP services with the interior design works and the architectural spaces will be key. This is managed flawlessly when all consultants, engineers and architects work in the same software platform like Revit. Solving clashes, checking quantities, putting together each and every element which goes into the hospital, being able to construct a building in front on-the-screen is quite a feat which once accomplished, stays during the lifecycle of the facility to service it.