Healthcare Design - May 2016 - 55

LEO A DALY

moving forward. Right now, Leo A Daly is designing a
biocontainment unit in a major U.S. city using guiding
principles informed by this experience and developed
in collaboration with stakeholders.
The schematic design for this project reflects
lessons learned from the experience in Nebraska. It
responds to operational challenges experienced during
the treatment of Ebola patients, including the need for
a point-of-care lab, a stricter delineation between "hot"
and "cold" zones, and the need for an extra autoclave
as well as extra storage in the hot zone.
Flow between clean and dirty spaces is upheld
through the observance of cold and hot zones, with
all critical functions related to patient care and waste
processing located in the hot zone. Staff enters the hot
zone through an anteroom off the cold corridor, donning PPE before entering the patient room. From here,
staff has access to the patient room, waste-handling
and holding room, lab, and autoclave without passing
back into the cold zone. All contaminated waste is
either autoclaved or chemically decontaminated prior
to leaving the unit.
Redundant autoclaves are necessary in case of
equipment failure and to allow for surge capacity, permitting one to function if the other breaks
down. Ample waste storage is provided in the
hot zone pre-autoclave and in the cold zone
post-autoclave. Pass-through showers allow staff
members to shower out back into the cold corridor after their shift in the patient room.
Extra storage is provided in the cold zone for
tools and cleaning equipment in case a repair is
needed.
Because patients' family and significant others
are key to recovery and need the opportunity to
participate in care without entering the unit, a family waiting area is provided. Space is dedicated to
security personnel, too, limiting the opportunity for
the public to access the unit.
Overall, the success of the Nebraska unit reinforces the importance of including clinical staff in
the design and development of the unit to achieve
the buy-in necessary for effective operation. Fur-

thermore, by circling back with the unit's staff after
activation of the unit, the design team gathered valuable insights that can build upon the ideas presented
in the initial unit and increase the body of knowledge
available to the design community.
The success of these units is the result of the
dedication of clinical staff who are rigorously
trained to work in even the most difficult environments, and a design team's role in the process is
to support their efforts by providing an environment
where the only way to perform any task is both the
most efficient and safest. HCD

5: Leo A Daly used lessons
learned from activation of the
Nebraska unit for the design
of a new biocontainment unit
currently in development
in a major U.S. city, calling
for adjustments such as
enhanced separation of "cold"
and "hot" zones, with all staff
and materials following a
clean-to-dirty pathway.

Robert D. Counter, AIA, is director of healthcare for Leo
A Daly (Los Angeles). He can be reached at rdcounter@
leoadaly.com. Patricia A. Lenaghan, RN, MSN, NE-BC,
FAAN, is senior healthcare clinical and operations analyst
for Leo A Daly. She can be reached at palenaghan@
leoadaly.com.

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Healthcare Design - May 2016

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