A Rethinking of Hospital Design

This story, written by Barbara Sadick, first appeared in the 2022 Edition of  U.S. News & World Report Best Hospitals. It is reprinted here with their permission.

When Jason Schroer, Director of Health at HKS, an international architecture firm based in Dallas, saw hospitals being deluged with COVID-19 patients, he empowered his teams across the globe to provide pro bono design services to help hospitals manage the flood. That work ran the gamut from putting up temporary walls to creating triage centers to converting convention centers into field hospitals. “This is a pivotal moment that will impact how hospitals will be designed going forward,” Schroer says.

This is a pivotal moment that will impact how hospitals will be designed going forward.

Because it’s financially prohibitive to build new hospitals to accommodate the next pandemic, which might not occur for decades, the ability to convert existing spaces quickly is the focus today for architects, engineers and designers. Orlando Regional Medical Center in Florida had a head start, having been influenced by the 2014-2016 U.S. Ebola outbreak to open a new area of the emergency department, designed by HKS, in 2015. Flexible pods that normally are used for patients with less severe conditions and injuries can, at the flip of a switch, be converted to negative airflow rooms where the air pressure is lower than the air pressure outside the room. When doors are opened, contaminated air doesn’t flow out. Instead fresh filtered air flows in, and exhaust systems remove contaminated air, filtering it before it’s pumped outside. The 12 negative pressure airflow rooms can easily be converted to 25 single rooms with separate entrances. During the current first true test, the negative air-flow rooms have made staff feel safer while treating patients, says Patrick Cassell, director of emergency services.

Surge ready

As has been seen, even corridors, lobbies and conference rooms may be needed for patient care in a pandemic, Schroer notes. “That means we should think about placing infrastructure such as oxygen and medical gases, pipes and wiring in alternative spaces that can be hidden from view, but easily accessible behind wall panels,” he says. Being “surge ready” means having water, electric, and medical hookups available to convert even parking lots and adjacent structures into field hospitals, says Bill Scrantom, the Americas health care leader at Arup, a global engineering and consulting firm.

Anterooms between hallways and patient rooms, where caregivers can wash their hands, sterilize equipment and put on and remove protective gear, create greater separation between clean and contaminated air. But be-cause costs typically prevent all rooms from being “designed to the highest contagion standard,” Schroer says, health systems need to strike a balance between rooms designed to be convertible for treating pandemic patients and rooms dedicated to normal operations.

Providing adequate room airflow and proper disinfection of surfaces is key to preventing the spread of infection. Scrantom points out that direct ultraviolet light will kill germs on surfaces, but can be used only when rooms are empty because it can cause skin burns and eye injuries. Antimicrobial surfaces like copper and silver provide limited defense against viruses like COVID-19, so regular disinfecting regimes are crucial.

Proper airflow

Air filtration systems continually clean the air, while ventilation systems bring in fresh air. Air should be constantly circulating in order to dilute concentrations of pathogens, and although plastic barriers can help protect people from direct sneezes and coughs, they can also obstruct good airflow. Placing infectious patients in closed rooms under negative pressure isn’t absolutely required for COVID-19, but could be vital for the next novel coronavirus.

“Establishing one-way circulation for infectious patients from building entry to patient room is also important,” Scrantom says. “This keeps un-infected individuals out of harm’s way and keeps the containment pathway well understood for cleaning.” 

Since physical interaction between patients and hospital staff should be limited to avoid infection spread, patient rooms and nurse stations will be designed with virtual care technology, experts say. Caregivers will be able to closely monitor and communicate with patients without always having to enter the room. Scrantom says hospitals will also be equipped to monitor less ill patients in their homes.

Finally, much attention is being paid to finding ways for health care workers to relax and relieve stress. Schroer says offering access to rooms with windows that overlook gardens is a good start. “Ideally, we’d like to see designated spaces to recharge” that allow staffers to turn down sound or lighting and have privacy for reflection. “It’s important,” he says, that “we focus on healing the healers.” –Barbara Sadick