POST COVID LESSON LEARNT PLANNING & DESIGNING OF HOSPITAL

Hospital planning and designing has undergone many changes to match contemporary clinical challenges in last few years, specially after coming of accreditation bodies like NABH, NABL, JCI, QAI etc.

Outbreaks of infectious disease are becoming more frequent now these a days, as the world becomes more vulnerable, rising global temperature and good connectivity from one country to another country create more favourable conditions for transmission of diseass. However, in current century as corona virus disease (COVID-19) has struck a severest blow to even the best and benchmarked health systems worldwide, this evolutionary phase has forced to think the hospital planner, designer and architects to plan the hospital in a new way. As the virus spread across continents, it was clear that the new normal called for new approaches in hospital building design and architecture. Now this is a need that hospital infrastructure should be built in such a way so it can solve the purpose of providing healthcare services during the tough time. This is also a basic principle of disaster management to first secure the healthcare infrastructure from the disaster or outbreaks or any other calamaties to extend their full support to the needy people during any kind of calamaties. Faulty design of healthacre buildings will lead to spread of the diseases amongst the occupants of healthcare building and further spread in the community.

Our healthcare infrastructure is lacking in dealing the airborne/droplet infectious diseases and one major component of healthcare infrastructure is availability of proper isolation rooms/wards/ICUs to deal with the airborne/droplet disease like TB/MDR TB, Swine flu, SARS, Influenza, COVID 19 etc.

Lots of new upcoming hospitals are planned but they are lacking in proper planning and designing in terms of zoning to control the infectio. Efficiently planned and designed hospital can save the money and serve the actual purpose of building a hospital to control the spread of infection. If we have a good healthcare infrastructure in terms of ventilated health care buildings, proper screening room, isolation rooms / wards etc. which can handle the all kind of patients including COVID 19 efficiently. Hence we can prevent the spread of disease along with protecting our health care professionals and non-infective admitted patients up to certain extent.

Hospitals to be planned and design to meet the current and future demands and ensuring patient, staff, visitors and environmental safety. Healthcare experts are working to help with creative ideas on how to adapt their facilities during and after this global pandemic. There are many strategies that could be utilized to make safer healthcare buildings, which should comply the infection control recommendations of distancing, washing hands and avoiding contact etc.

1. Site selection:

The following parameters to be kept in mind while selecting the site for the hospital:

• Hospital site should be in geographically safe zone.

• Accessibility to good approaching road.

• Site area must have direct sunlight, therefore avoid high rise building nearby.

• Ensure flow of fresh air i.e. environmental pollution free (No near by noise and smoke emitting industries and dirty river/sewer etc.)

• General sanitation including proper drainage of rain water.

• High Tension (HT) wire not crossing the site.

• Soil condition suitable for construction, not land filled area.

2. Zoning concept :

Zoning to be followed in hospitals for better utilization of resources, infection prevention, separation of dissimilar activities, and separation of dirty and clean material in the hospital zones, proper screening rooms, triage and holding areas for patients.

Hospital zoning to be followed in the hospital: OPD, IPD, diagnostic, emergency, and support services.

Critical zoning to be followed for OT complex, CSSD, Kitchen, Laundry, isolation rooms/ward etc to control and prevent the infection.

Screening rooms and fever clinic to be designed along with triage and holding beds.

3. Natural ventilation & sunlight:

Most of the healthcare buildings are lacking with natural ventilation and sunlight. Many offices, mall, institutional buildings and hospital buildings are labeled as Sick Building Syndrome due to improper natural ventilation and sunlight.

Studies have proven that natural ventilation and sunlight enhance the recovery of the patients and increase

the productivity of the health care professionals. Natural ventilation and sunlight has tangible benefits like saving energy and excellent day lighting and intangible benefits like enhanced air quality, better infection control, improved productivity, health and well being of the occupants.

4. Seperation and Physical distancing:

Planning of spaces that allow for physical distancing in design will be paramount. Healthcare entrances like OPD, IPD and emergency will need to consider queuing in line (Approx 6 feet) with physical distancing and temperature screening requirements.

Sufficient space should be planned for waiting and sub waiting areas for the patients. Its always better to give the different waiting and subwaiting areas for cohorting the patients.

5. Use of Information Technology:

Smart information technology continues to impact in providing healthcare to patients, and certainly with due course will see more technology integrated into healthcare. Physicians are using virtual appointments at a higher rate to accommodate patients. Telemedicine has also aided in the monitoring of ICU patient rooms, providing distancing and connectivity to help and treat patients. Transferring more of the paperwork into a digital format will decrease paperwork passed around, making one less touch point between staff and patients. Telehealth services will also continue as physicians and patients have gotten more accustomed during the pandemic.

6. Patient, staff/visitors and supply flow:

Operational planning should clearly describes circulation of patients, visitors, staff and supplies for distancing, separation and proper flow. Even though clinical teams do interact with patients, providing offstage staff circulation could decrease exposure. Corridors should be widened (at-least 8 feet) so that a twoway flow could occur with the appropriate amount of distance.

Provision of the triple (three) corridor system, i.e., clean, contaminated, and potentially contaminated corridor, is recommended in hospital settings.

7. Materials, Surfaces & Contactless environment:

The floors of the hospitals must be slip resistant and should be made up of easy-to-clean materials that promote cleanliness. Using smooth or low texture flooring and proper installation keeps dirt and fluids from slipping beneath the surface of the floors.

Use of copper alloy surfaces play a crucial role to reduce infection load in the healthcare settings. It is preferable to install the copper fixtures like faucets, doors and cabinets handle, hand grab bars in washroom, bedside tables, toilet flush handles and IV poles etc.

The surfaces play an important role in transmission of pathogens in hospital. The surfaces in the clinical areas should be smooth and impervious to substances.

Creating a touch less or contactless environment in the healthcare settings can prevent cross infection and contamination up-to certain extent. Organization should make an effort to create a touch less environment like touch less hand-wash, drinking water, foot operated doors and touch less disinfectant dispensers etc.

8. Surge design:

It is recommended that new medical/ surgical patient units should consider using the concept of “Acuity adaptable rooms” to provide future flexibility during patient surges, and existing units can be adapted to surge as needed.

Acuity adaptable rooms are cuttingedge hospital rooms that can allow care to flex to a higher level as needed in the same room. These units that can flex up to ICU-level care can be used faster to accommodate severe disease patients. Provision of medical gases and suction, patient monitoring, ventilators, and other requirements would all meet ICU-level care.

PPE donning and doffing area should be considered at the entrance of each unit.

Provision of hand-free clinical sink (washbasin) to be given in all clinical areas and nursing station. Bio medical waste storage facility to be designed properly along with sufficient parking space. The width of the corridor shall be at least 2.4 m for easy mobility of staff, patients, and equipment.

Closing Remarks :

Healthcare planner/designers should be involved with healthcare architects and they must take a leading role in creating safer healthcare spaces in a post COVID 19 era. Following standard practices like physical distancing, washing hands, use of mask in hospital environment and avoiding contact will sick people will help in reducing the infection in healthcare settings.

Dr Parvez Ahmad, has more than 20 years of experience in healthcare planning & designing. Recently he has written a book “Air borne infection control – Planning and designing of hospitals” focusing on COVID 19 & other airborne/droplet infectious disease. Book is available on Amazon (www.amazon.in), simply type in search column “Air borne infection control – Planning and designing of hospitals” to get a book.