FIGHTING COVID-19
the number of hospital-acquired infections. However, the behaviours of users and external actors are critical to the success of any engineering intervention. These complex interactions mean that a systems approach to reducing the rate of hospital onset infection is crucial.’ It continued subsequently: ‘There are engineering design and technology dimensions to infection transmission in hospitals informed by the characteristics of the disease, how it spreads, and the design, use, and maintenance, of hospitals. Providing advice on a COVID-19-specific response relies on an understanding of the disease’s transmission, on which information is still emerging. An international roundtable of engineering academies on PPE, convened by our Academy, called for better global sharing of data and evidence on virus survival times to try to build consensus on treatment standards and temperature thresholds for disinfectant.’
Conclusions passed on to SAGE Among the engineering and built environment topics considered, in terms of their potential impact on virus transmission, were hospital layout, materials specification, drainage, plumbing, and ventilation, room and equipment decontamination, hand hygiene, effective PPE, respiratory protective equipment, and environmental design. A summary of the ‘wide-ranging engineering interventions’ examined was ‘compiled at pace’ and fed into the Scientific Advisory Group for Emergencies (SAGE), which has been advising the Government throughout the pandemic.
Potential engineering solutions The Rapid Review’s general, and more specific, conclusions included: n The scale of the COVID-19 outbreak has ‘highlighted clinical needs that much of the engineering community may not have previously been aware of, resulting in industry-academia partnerships to adapt existing technology and prototype new ideas’.
n ‘To ensure the efficacy of solutions’, scientists and engineers must work with social scientists, psychologists, and users, to fully understand the behavioural aspects of how people use buildings and how technologies for infection control can help. The engineers also need to work with clinicians, healthcare practitioners, and patients, to understand ‘how solutions play out in practice on busy wards or care homes with competing demands’.
n There are a range of intervention points where engineering design and technology can play a role – identified as hand hygiene, environmental design,
A biomedical engineer designs a medical device.
A projection of blood cells.
personal and respiratory protective equipment, and environmental decontamination.
n Implementing the ‘classic engineering design solutions’ incorporated in the Department of Health’s Building Notes ‘may prove challenging or disruptive at a time of crisis’.
Ventilation
In the UK, natural ventilation can prove highly effective, allowing access to fresh air at high air change per hour rates to increase the dilution. Local extract ventilation, and avoiding recycling of air from one space to another, could also
help limit airborne infections. The Federation of European Heating, Ventilation and Air Conditioning Associations (REHVA), has published ventilation guidance for COVID-19,2
which
includes practical modifications that both healthcare and other buildings can make to help control COVID-19. The Specialised Ventilation for Healthcare Society has issued guidance on healthcare ventilation focusing on theatres and other controlled spaces. Ventilation of all hospital spaces, including waiting rooms, should be assessed.
Layout
Hospitals and field hospitals should have high ceilings, with a mixture of narrow plan and open plan spaces. The layout, pressurisation of the space, fresh air supply, and extraction process, must all be considered to deliver effective hospital ventilation strategies. Natural light can have beneficial effects on patients’ health and the healing process, and help reduce errors in administering medicines and ‘other mistakes related to staff’s visual performance’. For field hospitals, where infectious patients will be in multibed rooms, anterooms may need to be used when ‘doffing’ PPE to reduce levels of environmental contamination. The creation of a temporary negative- pressure multibed ward for emergency use has been tested in San Francisco.3
Clinical waste disposal
Adequate facilities should be in place to store waste, plus arrangements for waste to be removed for incineration or rendering safe. Colour coding helps with segregating different types of medical
September 2020 Health Estate Journal 17
©RAE/‘This is Engineering’
©RAE/‘This is Engineering’
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