While much of the American public sits at home under quarantine, hospitals are racing to prepare for an onslaught of COVID-19 patients. The outlook is grim. In a “moderate” infection scenario, in which 40% of adults catch the virus over the next 12 months, 40% of markets around the country would not have enough hospital beds to treat COVID-19 patients. So what can hospitals do right now to help as many patients as safely as possible?
We called Bryan Langlands and Sarah Markovitz, two designers and infection control experts at the architecture firm NBBJ. They help community hospitals and speciality centers mitigate and prevent infection. Here, they share three design techniques—from reimagining how hospital space is used to incorporating antiviral materials—that medical facilities can employ (and are employing) to treat patients during the COVID-19 crisis. They won’t fix critical infrastructure and equipment shortages, but they’re a place to start.
Convert existing treatment spaces
“For existing hospitals that have been built in the past 10 to 15 years, one would hope that leaders pushed for design that had the greatest amount of flexibility,” Langlands says. “When you’re dealing with a crisis, and you don’t have enough beds, [there] need to be spaces or infrastructure that isn’t designed for inpatient beds but can be used in a crisis.”
Most hospital formats have prep and recovery areas for patients undergoing surgery, with individual bays (or rooms) divided by thin cubicle curtains. Though patients with COVID-19 are ideally placed in private rooms as the virus is highly contagious and patients may require intensive care and ventilation, flexible hospital design allows for bays to be converted into rooms for treating respiratory infection. “If you have the foresight and budget and space, you would design those as all private enclosed rooms as opposed to open bays, but a post-recovery unit has all the gases and emergency power [to be used for respiratory patients],” Langlands says.
Part of the reason elective surgeries have been halted across the country is to increase capacity for COVID-19 patients; converting these spaces into emergency coronavirus units is an easily achieved first step.
Build pop-up facilities
Some hospitals, such as the Brigham and Women’s Hospital in Boston, are building pop-up triage tents. “We’re working with [clients] on building tents immediately outside their hospital and using these as triage areas to be able to quickly determine who is actually sick and needs to be admitted or who can go home,” Markovitz says. “We have designed several hospitals where there’s room for a tent to be put up, with plumbing and electrical needs . . . [This is] one adaptation that’s going into use quite a lot right now.”
Empty space in front of emergency center doors and under hospital overpasses is usually where these tents, which operate as preliminary vetting stations, go. That’s because healthcare workers typically evaluate whether to admit people to an emergency room, depending on whether they’re sick or well. “We want to keep well patients out of the emergency department,” Langlands says. “When you get into the emergency department, you do want to separate the crisis pandemic-type patients away from the pandemic patients. You want those two types of patients to have different flows.”
It’s also important for designers to consider how surfaces are treated within a hospital setting. Both choosing smart materials and reducing the amount of surfaces that patients and healthcare workers might come into contact with can help mitigate the transfer of pathogens throughout a building. “We’ve done a lot of studies about materials, and [you want to be] looking for seamless materials that don’t have any cracks—that can be easily washed down and don’t react easily to disinfectants—because disinfectants have to sit on surfaces for 10 minutes to do their work,” Markovitz says.
But the easiest way to keep bacteria and viruses from spreading is to limit how many things doctors and nurses have to touch. That means removing cubicle curtains, blinds, and other high-touch design features. “We’re using technology so that controls in the room don’t have to be done by hand,” Markovitz says. “The most touched surfaces are monitor screens and door handles, and all of these things can be turned on or off by remote control so there’s not a place for these microbes to land.”