COVID Containment- Isolation ward Design considerations

While the corona-virus pandemic is full of unknowns, it made one thing clear that the current healthcare design has been rigid and lacks the flexibility to accommodate surge of patients and the safety of medical professionals treating them.

It has impacted the healthcare community and has changed the perspective of how a healthcare facility should be prepared for such situations.One of the most affected groups of the population being healthcare staff, we need to balance the focus between both patients as well as the safety of staff.

This objective will direct us to design spaces that provide the best environment for healthcare providers to do their job efficiently and effectively. Healthcare design focuses on containment of infection as a primary objective followed by the safety and convenience of the staff. In such cases, visitor movement is discouraged and should be designed to house any unnecessary equipment.

The following set of facilitation and design principles were developed for COVID-19 containment by following guidelines of the National Center for Disease Control and World Health organisation.

Facilitation and Requirements

Minimal and simple design that can achieve optimal output for both patient and staff.

Staff safety is equally important as patient recovery. Creation of buffer zones that act as transition spaces before entry or exit of the containment zone.

Isolation refers to the separation of individuals who are ill and suspected or confirmed of COVID-19. All suspect cases detected in the containment/buffer zones (till a diagnosis is made), will be hospitalized and kept in isolation in a designated facility till such time they are tested negative. It is important to make sure the isolation ward is not merged with COVID-19 ward.

COVID-19 infected patients to have single rooms preferably. While allocating spaces to house patients, it’s important to remember that not all COVID-19 patients require ICU. The severity has been varying from each individual. It is important to make sure all the units are flexible and convertible.

HVAC/ Ventilation

Patients can be isolated in individual isolation rooms or negative pressure rooms with 12 or more air changes per hour. In resource-constrained settings, all positive COVID-19 cases can be courted in a ward with good ventilation with a mechanical exhaust system.

As designers, we should consider integrating more flexible HVAC infrastructure so that spaces can be converted as quickly and efficiently as possible. Independent ventilation system enables providers to create a temporary setting for patient treatment areas that are safe for patients and staff.

Fire Safety

Emergencies need to be considered and exits need to be provided as per NBC norms.

Medical Equipment and Minimal storage

Removal of all non-essential furniture to ensure that the remaining furniture is easy to clean, and does not conceal or retain dirt or moisture within or around it.

Storage to be provided near each patient bed for personal belongings and non-critical patient care equipment

Common storage in the ward for stocking up cleaning equipment and supplies.

Disposal Methods complying to BMWM guidelines

Disposal of used PPE is just as important as using it efficiently. The covered colour-coded waste hold should be setup complying to BMWM guidelines. Trash hold area should store waste that is leak proof. This ensures the safety of the operator and the surrounding area.

Materials

Use of non-porous, non-absorbent and smooth materials ensure infection-free surfaces and are also easy to maintain. Material with anti bacterial and anti microbial properties can be used that cannot be cleaned on a regular basis.

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COVID-19 CONTAINMENT PLAN

The following plan has been developed based on the above design principles, NCDC India and WHO guidelines.

• The ground level structure that can be temporarily built to accommodate the 12-bed isolation ward and 3 single rooms for COVID-19 patients.

• Separate toilet and shower areas.

• Buffer zones to contain infection at every level.

• Isolation ward cubicles that can be converted to house COVID-19 patients.

• Communication room to avoid visitor entry and also ensure the well being of the patient/visitor.

• Design complying to hospital standards and fire norms.

In addition to designing flexible spaces, we should also consider creating spaces that can be easily segregated into a various levels of risk zones. This can reduce the risk to staff by allowing free movement and reducing the amount of necessary PPE.

Patient Entry/ Exit

As mentioned in NCDC guidelines, the patient is dressed in a mask, gown and covered in sheets and accommodated in a Negative Pressure Isolation cubicle/ room.

Staff entry and exit are seperate and should not be merged. All the transition spaces should have negative air pressure.

As health systems may not adapt to the new system immediately, we as design professionals should remember that the corona-virus pandemic will have long-term implications on how we design hospitals.