10 hospital design changes, post COVID

Incorporating video-conferencing in OPD rooms, use of anti-bacterial and non-porous materials, and touch-free controls would be looked at

Hospital Design, Virtual OPD, Anti-bacterial materials, Rajesh Sivan, Sivakumaran J, Arun Mathur, Rang Emi, Touch-free controls

With India's COVID-19 count crossing over 2.16 lakh mark, the hospital infrastructure in India is being stretched to the limits. However, general patients are afraid of visiting hospital due to the fear of contacting the novel Coronavirus. Also, hospitals are adopting stringent measures as well as abiding by guidelines laid out by the Government to ensure that their doctors, nurses, front line staff as well as patients visiting the hospitals are well protected.

Design features like touch-free control of lighting, sensor-based taps and other building functions will be explored.

In the past, the designers have always kept in mind the safety of the patients and caregivers while designing hospitals.  However, experts predict that post-COVID-19 there would be an increased emphasis on patient safety in hospital design and thus an array of changes are expected to be incorporated in healthcare facility configuration.

The OPD consultation rooms would further need to incorporate elements for video-conferencing solutions.

Some of the expected design changes in hospitals are:

OPD consultation rooms with video-conferencing solutions:  With the Government issuing guidelines on telemedicine two months back, most hospitals have switched to tele consultations during the lockdown- and it is something that is expected to become a part of the OPD design in the times to come.

Arun Mathur, General Manager, Narayana Health Project Consultancy

Says Arun Mathur, General  Manager, NH Healthcare Project Consultancy, “In the near future, patients would prefer to avoid going to hospitals unless really necessary. This would probably result in more of video consultations rather than visiting OPD in hospitals. This may result in OPD being less crowded and, maybe later-on, proportionately shrinking in comparison in layout designs. The OPD consultation rooms would further need to incorporate elements for video-conferencing solutions.”

Rajesh Sivan, Head of Real Estate and Projects, Asia Healthcare Holdings

Echoes Rajesh Sivan, Head of Real Estate and Projects, Asia Healthcare Holdings, “IT infrastructure will play a major role in the design like creating virtual OPD rooms. The patient to doctor interface and doctor to staff interface will need to be more through A/V controls. Widely available technologies such as video chat and virtual reality headsets will need to be incorporated to have the patients stay connected to friends and family.”

And the increased use of telemedicine could possibly be an opportunity to tap international patients- giving a boost to medical tourism.  "The initial consultations can be over video conference, initial tests reports shared for teleradiology, and patients requiring procedural intervention could come down to the country, " says Mathur.

Review of air-conditioning systems:  Experts caution that with the possibility of the virus spreading through the recirculation of air-conditioned air,  the use of air conditioning in non clinical areas would be

Says Arun Nalapat, Founder Principal, Arun Nalapat Architects, “As most hospitals are completely airconditioned, and return air is not often ducted in Indian hospitals, it would not be easy to create air tight temporary partitions within existing hospitals. While COVID-19 is spread by droplets and not really airborne in the sense that it will not float around in the air for very long, the next virus may not be so; in which case air conditioning systems can spread it rapidly across the whole hospital.”

He suggests that hospital lobbies can become non air conditioned, semi open, well ventilated spaces. “As long as you can make them comfortable and spacious,  people will tend to feel safer in such spaces than in air-conditioned ones. This has been tried out successfully in some hospitals with success but expected to become more common,” says Nalapat.

Use of fresh air: Another important area in the design would be the air quality. Designs will have to ensure proper zoning and exhaust system to take out air especially from intensive care area and isolation areas.  "The air exhausted will have to be let out in the atmosphere after proper treatment / filtration, so that microbes are not let open and pose danger to others outside the building," says Sivan.

Sivakumaran J, COO, KMCH

“Hospitals can take efforts to bring more fresh air from outside, so that the concentration of the virus in the indoor air could be diluted. This could be done by opening the damper to outside air of the air handling unit. Higher air humidity can reduce the air bone transmission of viruses,” says Sivakumaran J, COO, KMCH.

Copper, known for its anti-microbial properties, is being preferred.

Use of anti-bacterial material: Anti-bacterial materials need to be considered for elevators, hand rails, door knobs, etc as these are frequent touch points in a hospital set up.  Few manufactures have already innovatively introduced anti-microbial coatings into the floorings, facade, paints and furniture.

Experts suggest more use of copper- based products, especially which are used for direct touch (such as washroom fittings), and hardware like door handles, railings, door knobs, etc. “Copper has long been known for its anti-microbial properties. The toxicity mechanism of Copper ions makes it an ideal product for curtailing infections which spread through touch surfaces, as is considered the case for COVID-19 virus. The cost of these might be slightly expensive, but adoption may start from installing the same in isolation facilities, etc,” says Mathur.

Use of non-porous materials: The material changes to opt for are products that are non-porous, wipeable and cleanable, such that they are not effected by regular fumigation and spraying of disinfectants.

"The products that would gain application would be PVC, UPVC, Glass, Poly-carbonate, high-pressured laminates etc. Gypsum-based products would probably get modified with addition of lamination layers to comply with these requirements," says Mathur.

Others predict that the use of cloth fabric as furniture upholstery and curtains will decline. Easy-to-clean and sanitise synthetic materials will be used widely.

Touch-free controls:  Now the designers will focus more to ensure that there is minimum hand contact with either the patients, amongst the staff and also various other touch points.  “Design features like touch-free control of lighting, temperature controls, sensor-based taps and other building functions will avoid touching surfaces,” says Sivan. Functional hospitals with minimum shutdown time can also easily install sensor taps in toilets, occupancy sensors for lights, etc.

Automatic doors and e-switchable privacy glass: In running hospitals, automatic sliding doors or swing doors can be incorporated in place of conventional doors in high traffic areas. Innovations in foot operated latches and handles can easily be developed and used extensively,  point out experts..

Rang Emi, Founder Helix Architecture

Says Rang Emi, Founder, Helix Architecture, “Smart facade glazing systems (which allow occupants to electronically control the quantity and quality of daylight into the interiors) will be explored by some. Such glass technology allows doing away with fabric blinds which harbour germs and are not easy to clean and sanitise."

Flexibility in design: The future hospitals should also have more flexibility for pandemics and other outlier events that create temporary surges in demand every five or ten years. "It may be possible for some hospitals to build some degree of flexibility into their operational systems - design and compartmentation strategies to enable negative pressure in a certain inpatient ward zone as and when the need arises," says Rang. However, such strategies will also have to be in sync with relevant fire and life safety regulations. “The design should have the ability to quickly convert the regular beds into an ICU ward. It should be temporarily having capacity to expand during emergencies and contract when they are over,” says Sivakumaran.

There are already a number of products under the pre-fabricated products range that are already being utilised for the construction of healthcare facilities. The use of such products would probably gain wider use, such that it allows more flexibility to modify spaces for quick conversions for space requirements for epidemic outbreaks.

The parking areas could be designed in a way that they could be converted to a containment zone. "Some hospitals can convert their car parking garages (basements or multi-level car parks) into temporary COVID treatment facilities, as is already being done in many parts of the world," says Rang.

Wider corridors: Future hospitals could have more physical barriers between public and staff within the facility. “Space standards could increase - e.g., all inpatient corridors could be mandated to be at least 10'0" wide instead of the current 8'0" minimum width. Even OPD and other hospital corridors could be mandated to be at least 10'0" wide,” says Rang. 

However, such measures may not be practical in all situations, especially small healthcare facilities, nursing homes, clinics, etc. Number of people that can be allowed to be waiting in hospital lobbies may be limited to a certain maximum with specific minimum spacing between seats. So, future waiting lobbies could be in smaller clusters.

Design of emergency and seating areas: The emergency care area originally designed for patient triaging and attendant waiting now needs to be redesigned to prevent the spread of the virus. “There needs to be design to route all the patients, attendants, visitors and others through a channel, where sanitising tunnel and thermal fever screening cameras are fixed. There should be a separate complex to treat the positive cases and facility to quarantine the staff every shift,” says Sivakumaran.

Many hospitals are exploring increasing the seating spaces, so that individual seats can be provided at a distance to maintain social distancing. Nurse station design is being looked into, so that the care givers also maintain adequate distance. To adopt the social distancing concept, the new design needs to give more space between the beds. Instead of placing ICU beds as a common ward, the design will have individual cabins with proper air circulation system in place to avoid any infection spread.

According to experts, if living with the disease is what we eventually end up with, there would be a certain impact, certain measures, which will become part of our lives, and so also in how hospitals are designed. “However, if the disease starts fading out, or if a vaccine is found soon, or if accurate tests which generate instant results are invented and so on, things could more or less continue as they are,” says Nalapat.