HOSPITAL CONSTRUCTION
the biggest thing to help us in future pandemics. The ability to separate patients is perhaps most important for reducing transmission.”
Appropriate donning and doffing space for personal protective equipment and handwashing sinks are other important touch points, along with flexibility – a key focus for best design practices moving forward.
Acuity-adaptable rooms Acuity-adaptable rooms – offering the ability to switch an acute care room into a critical care room with ease – allow for greater flexibility in a crisis, and less movement of patients. As the team at St. Michael’s Hospital anticipated a surge, this became an important tool for deciphering where best to place patients with COVID-19.
Air system flexibility is another factor, emphasises Michael Keen. Twenty years ago, most hospitals in Ontario didn’t have any proper negative pressure airborne isolation rooms, which are particularly vital when intubating patients. Through SARS and tuberculosis, facilities began retrofitting to build these rooms. The standard now requires one per floor; the new tower houses three per floor.
Monitoring the air pressure Negative pressure rooms are not always possible in some spaces, however. Michael Keen says that in a typical patient room it’s more of a balance of air moving in and out. Monitoring the pressure, and being able to adjust the supply of air inward to the room, are key areas of adaptability to enhance safety. “That flexibility with your HVAC system is an important piece that I think we will be
Replacing an old three-storey parking and storage structure, the new 17-storey glass façade building, The Peter Gilgan Patient Care Tower, ‘eases into the existing facility’, linking two older buildings constructed at different stages in the hospital’s life.
looking at in the standards a lot closer,” he says.
Since all rooms are grouped in a common air system, another element is ensuring that air is not recirculated from one room to the other. Being able to adjust systems on ‘100 per cent outdoor air in, and 100 per cent air exhausted out’, is an important feature. “Most systems aren’t designed for that, because in the cold of winter or heat of summer that’s when it can be most difficult bringing the outdoor air in,” adds Michael Keen. “As we moved into the summer, we found there was a burden of that heat on the system. “Luckily,” he continues, “ours have that flexibility, but that’s definitely something that needs to be considered for situations
in the future.” Specifying materials might also need a look-over. With input from the hospital’s Infection Prevention and Control (IPAC) department, the design team was able to procure ceilings, flooring, and furnishings, that are easily cleanable, explains Frank Panici. He suspects that industry will need to re- examine chemicals used to sanitise, and whether such materials ‘hold up.’ “I think this will spur another conversation about how we are using these materials, and whether they are IPAC controlled,” he said in a recent webinar. “We’re trying to balance that with the patient experience, and make sure that we provide exceptional spaces that can deliver care.”
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August 2021 Health Estate Journal 31
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