Medical Construction & Design

JUL-AUG 2018

Medical Construction & Design (MCD) is the industry's leading source for news and information and reaches all disciplines involved in the healthcare construction and design process.

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32 Medical Construction & Design | J U LY/AUGUST 2018 | MCDM AG.COM BY ERIN PEAVEY & DAN THOMAS When the Ebola epidemic caught the world by surprise and exposed potential weak points in readiness for certain types of infectious diseases. These events, often thought of as once-in-a-lifetime, are on the rise as the world becomes more connected and the changing climate is shifting and expanding disease zones. Although outbreaks often come from unintentional harm, such as travel-borne illnesses and lack of child- hood vaccination, the threat of intentional harm (e.g., bio- terrorism, anthrax) is also a reality we must prepare for. Throughout the 80s, isola- tion rooms across American hospitals were outfi tted with anterooms. These spaces were thought to serve as a critical infectious disease buff er, pro- viding space for proper hand- washing, donning (putting on) or doffi ng (removing) personal protective equipment. These anteroom spaces provided an air buff er designed to keep the air from the infectious patient from mixing with the clean zone of the hospital, but did not address proper unidirec- tional staff fl ow for decontami- nation. Anterooms also separated staff from being able to easily monitor a patient's condition and were seen as obsolete as technology advanced and room pressurization could be utilized without them. However, the recent Ebola outbreak showed the need to have dedicated space that supported eff ective infection control procedures. To address what this looks like, it was important to start by understanding proper decontamination protocols. These include: 1. Non-contaminated staff dons personal protec- tive equipment while being watched by trained colleagues in proper donning procedures 2. Patient is transferred into an isolation room either directly or through securing them in an air-sealed stretcher, which provides oxygen to the patient but will not contami- nate the air 3. Patient is placed and cared for in a negative- pressure infectious isola- tion patient room (e.g., hot zone) designed for maximum cleanability 4. Patient waste is removed through designated protocols (e.g., autoclaves, red bag) 5. Staff leave patient room through a decontamination space (e.g., warm zone) that includes doffi ng (i.e., remov- ing PPE) monitored by trained staff , along with showering, changing clothes 6. Following decontamina- tion procedures, non-infected personnel can move back into the public area (e.g., cool zone) Any movement of the patient should be limited and stabilizing, and then transfer- ring a patient to a designated biohazard facility, such as the Centers for Disease Control, is standard protocol. New approaches to long-standing goals When designing for emerg- ing infectious diseases, three overarching goals come into play, namely control disease spread (i.e., reduce chances for infection to be spread), minimizing disruption to care (i.e., minimized harm to overall facility function and patient care) and fl exibility for everyday use. Addressing these complex needs requires a new way of thinking about the challenges. "Ironically, EDs are con- tinuing to use old paradigms," says David Vincent, AIA, ACHA, LEED AP, designer and director of HKS Team ED. "But more than any other area in the hospital, EDs must have the capability for the unknown." This recently drove an interdisciplinary group of physicians, clinical nurses, architects, designers and contractors, in HKS-led interactive charrettes to ulti- mately develop the concept of the Highly Infectious Disease Suite with Exit Room. These rooms were further vetted and assessed by infection control professionals and, to preserve client anonymity, prototypes have been placed in two confi - dential locations. The HIDS is made up of four components, namely the patient room, ante room/don- ning space, exit room/doffi ng space and decontamination space (with shower). Typically, the ideal location for these EMERGING SOLUTIONS FOR EMERGING DISEASES Designing for resilience in the face of infectious diseases Infection Control ISSUE FOCUS KEY ROOM FEATURES HKS led an interdisciplinary team in exploring how the patient room can best serve to mitigate the threat and spread of infectious disease and found universal needs that became the key room features.

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