Response to COVID-19 Working Protocols and Clinical and Pharmacy Projects 2020
As we move into the post COVID 19 era, we will be seeing changes to the design and construction of commercial projects specifically targeted at improving the safety of and aimed at the reduction of potential pathogen spread in facilities such as health care offices, pharmacies, medical and dental clinics, physiotherapy clinics and similar consultation offices.
The architectural and design industry will undoubtedly begin to develop new design guidelines which will eventually be enacted into building codes, but like everything else with respect to regulation changes and adoption, this is going to take some time to become mainstream. Until such time as a blanket set of code based design parameters is brought into effect, there exists numerous current design tools which can be applied to make facilities safer for both the user and the service providers. Over the years, the standard practice for design has always been to follow the lateral design processes wherein accepted, basic design applications including air handling/filtration, HVAC distribution, material finishes and spatial organisation/separation are based on a standard of practice that is carried forward without much thought for situations such as global pandemics. This year, however we have been shown that this lateral process needs to change, and applied design practices reassessed to address a new era we find ourselves in.
This reassessment of design application is something we are looking to implement on projects going forward with new recommendations to our clients aimed at making their facilities safer for both staff and patient. Our experiences with applied environmental safety controls began over three decades ago, initially with consulting projects to the food industry where we learned about applications to airflow control, liquids management and spatial positioning as it applied to the storage, handling and contamination control around perishable food products. From there, as our business evolved into consulting to the pharmacy industry, we learned the protocols required for designing safe pharmaceutical environments including drug compounding facilities where technicians are required to handle highly toxic and concentrated forms of Scheduled pharmaceuticals and cytotoxic drugs which can easily become airborne during processing. In designing various types of medical clinics as well as dental practices, the requirements of patient circulation, sterilization processes and treatment room standards became the new focus of our design criteria. All of the above experience accumulated together in a knowledge base that we now see as becoming an essential part of all projects going forward from 2020.
In our planning for this new approach to design application, we are looking to utilize these various design applications in our health care projects going forward. Briefly, we have broken down these protocols into four descriptive categories:
Separation and distancing with efficiency and effectiveness.
Air flow management and air quality control.
Reduction of fomites in construction and finishing.
Maintenance and cleaning, cleaning efficiency.
1. Separation and Distancing with Efficiency and Effectiveness.
As we’ve all now witnessed, the rapid installation of acrylic shields in retail spaces to protect cashiers and service personal and customers/clients from airspace cross contamination is a hard reminder of the passive manner in which we share our unseen contamination. In medical and dental office waiting areas, out of necessity, require patients to share small floor areas for sometimes extended periods of time, and now, many of those patients may present a contagion hazard of some degree. When clinics re-open to general use, the waiting areas will be first areas where contact contamination will need to be addressed. The practicality of having each patient sit in an acrylic box will simply not work, however there are other means by which we can reduce risk. When possible, splitting off segregated seating areas for those who are coming in with suspected contagious conditions would be the first logical step. Secondly, by breaking up larger seating areas with baffles or screens (can be decorative in nature) to restrict the direction of airflow and provide directional containment, and finally, using separated seating groups for family members to remain together but isolated are all steps to help to reduce exposures. These design protocols can be applied with design sensitivity to avoid creating waiting areas that are not intimidating or inhospitable to the typically already anxious patients. Protection for the reception staff is achievable with the use of counter distancing, barriers and airflow which can all be applied without creating an unwelcoming or impersonal patient/staff interface. Along with consideration to waiting areas and treatment rooms, professionals requiring sterilization facilities within their respective practices should now expect to see better defined in-out work flows for contaminated/sterilized equipment and waste flow processing.
2. Air flow management and air quality control.
The basic rule for heating and cooling any airspace has always been to dump in the required volume of tempered air and then balance that with an outflow return air system. This basic approach has not evolved in decades, a classic example of lateral design application. Air itself has very controllable fluid like properties which are well utilized in specialized environments such as clean rooms and surgical theatres. Laminar flow properties are applied to specific zones to supply clean, uncontaminated air to a specific location in a room, and then potentially contaminated air is directed away and exhausted without being allowed to remix with the clean air. This same principal of airflow control can be applied to waiting areas as well as dental operatories and medical examination rooms resulting in reduced exposure to both patients, medical and dental professionals and their support staff. Air quality control can also be enhanced with upgraded filtration systems and as well, by providing increased air volumes above the accepted standards, serves to reduce the contaminant density and the subsequent potential for infection spread.
3. Reduction of Fomites in Construction and Finishing.
The COVID 19 pandemic has triggered a massive degree of study into the survivability of the viral particles on various surfaces under varied conditions. Secondary to this is the potential for those viral particles, once settled onto surfaces, to then be reintroduced back into the air by various means thereby creating an extended infection hazard. These principals of infectious particle retention and redistribution apply to all manner of bacteria and virus particles, and this specific issue has been addressed by many manufacturers of building materials and finishes from door hardware to flooring materials. Finish material and equipment specifications going forward should now include specifics on material performance pertaining to microbial disinfection and retention as well as the ability to easily sanitise the respective surfaces.
4. Maintenance and Cleaning, Cleaning Efficacy.
Typically, janitor rooms are an afterthought in most space planning however now, the importance of these rooms is magnified in the general operation of facilities in order to meet higher degrees of ongoing cleaning protocols. The typical janitor room usually consisted of a rarely used mop sink, a few floor mops and generally a lot of non janitorial related storage. This is going to change. Janitor rooms should now be looked at as the hub of facility sanitisation protocols. The rooms will need to be readily accessible, more central in location and better equipped to meet the demands for facility cleaning. In the overall finishing of clinics, the use of as many seamless finish materials and the elimination of fomites as mentioned in protocol #3 will become essential to good clinic and design. Finally, within the facility, focused areas can be sanitised after business hours thru the use of other available technologies such as UV light exposure; such systems that can be discussed in the early design stages.
As we progress into 2020 we will be looking at the above design approaches and discussing with our clients the degree to which these ideas can and should be applied to their new and even existing facilities. Adaptation of design to keep us ahead of this current pandemic as well as what will inevitably be future, similar scenarios will be of massive benefit to health care practitioners at the patient/doctor/pharmacist level.
