Healthcare Design - December 2014 - 38

An epidemic occurs when a disease affects a greater number people than is usual for the locality
or one that spreads to areas not usually associated with the disease. A pandemic is an epidemic
of worldwide proportions.

In 2009, the European Network of Infectious Diseases
(EUNID), a European Commission co-funded network of experts in the management of highly infectious diseases, created recommendations for high-level isolation units (HLIU).
EUNID defines a HLIU as a "healthcare facility specifically
designed to provide safe, secure, high-quality, and appropriate care, with optimal infection containment and infection
prevention and control procedures, for ... a small number
of patients who have, or who may have, a highly infectious
disease."
Though personnel undergo extensive training in order to
handle such virulent diseases, facility design must support
these best practices. While there's no current recommendation for a broad expansion of services, it's conceivable that in
the future every major city in the U.S. (or at least cities with a
major international airport) may have an inpatient unit that's
designed to handle highly infectious diseases, if necessary.
There are a number of design directives that can be
followed to create a permanent HLIU or a unit that can be
flexed to isolate highly infectious cases based on the current Centers for Disease Control and Prevention (CDC) and
EUNID guidelines. What follows are just a few; for a more
comprehensive list, go to HCDmagazine.com/infectiousdisease-design.
Design breakdown
Emergency department: Since the ED is the first portal to
a hospital, it's important to separate and triage suspected
infectious patients outside the main area to avoid
compromising the entire operation. Ideally, this would be
a permanent, separate waiting area with negative airflow
and a dedicated hazardous exhaust system. More likely,
though, the answer might be an adjacent open space or
parking lot that allows for tents or temporary mobile units
with access to all utilities (HVAC, power, medical gases)
until the risk is mitigated.
Storage: Adequate storage space for large equipment,
supplies of personal protective equipment (PPE), pharmaceuticals, and clinical supplies is a must. Also, there must
be an area for the temporary safe-keeping of deceased patients, large enough to contain and decontaminate trolleys,
sealable coffins, and other mortuary equipment.
Staff: There should be a separate staff lounge and office
area contiguous to the unit with changing and shower facilities, including a decontamination shower. Patient monitoring
requires a large amount of staff rotation and preparation, so
these areas are much larger than conventional critical care
units.
Family: Since the family can't remain with the patient and
they're in an extremely stressful situation, special waiting
areas should be developed with amenities that provide
comfort.
Finishes: Units need to be constructed for ease of cleaning and decontamination (seamless floors and walls, solid
horizontal surfaces) and be as airtight as possible (monolithic
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ceilings, sealed doors and windows) with other design features that enhance the ventilation system, such
as an interlocking door system with a cliniciancontrolled override function.
Patient room: The room needs to be sized the same or
larger than a typical private critical care patient room, large
enough to accommodate specialist equipment (mechanical
ventilator, hemofiltration machine, monitoring equipment)
and allow free movement of staff wearing bulky PPE. Each
room needs a private bathroom (toilet, handwashing sink,
and shower). Other details include a room door with an automatic closer, a hands-free lavatory, and a view window
for observation from an anteroom.
Anteroom: This is an area outside the patient
room (in a temporary setting, such as a nearby
patient room or a marked area in the hallway) where
clean PPE is stored and where healthcare workers
can don PPE before entering the patient room. If waste
passes through this area, it must be properly contained,
but preferably it's taken out via a separate route. The anteroom must also be large enough to store clinical supplies
(intravenous fluids and tubing, syringes, dressings, specimen containers) and also house a hands-free lavatory.
PPE removal area: This space should be close to the
patient room and separate from the clean area, a place
where healthcare workers leaving the patient room can
take off and discard their PPE. This space must be easily
disinfected and provide an area where workers can sit.
Leak-proof infectious waste containers for discarding used
PPE are required. This area should be adequate for packaging clinical specimens and for decontaminating outer
specimen containers, too.
Emergency response
Highly infectious diseases require extraordinary clinical
diligence that can't be supported by conventional critical
care isolation room or unit design, such as those described
in the current Facility Guidelines Institute (FGI) guidelines,
which aren't intended to protect against such virulent
diseases. In fact, comingling of these patients within a
hospital's existing units is highly undesirable.
If in the future there's a significant increase in highly
infectious disease cases, then freestanding facilities or
units in academic, tertiary hospitals may become a norm.
Likewise, hospitals without these facilities should develop
contingency plans to hold and isolate individual patients
until they can be transferred in a safe manner, or to handle
mass casualties. Criteria for the safe handling of Ebola and
other highly infectious patients are evolving quickly, and
the healthcare design community will need to respond with
best practices in subsequent facility design. HCD
Sheila F. Cahnman, AIA, ACHA, LEED AP, is founding principal
of JumpGarden Consulting LLC. She can be reached at
sheila@jumpgardenllc.com.

http://www.HCDmagazine.com/infectious http://www.HCDmagazine.com

Healthcare Design - December 2014

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