Keeping it Clean

The New Norm for Safe Hospitals, Labs and Public Spaces

How safe are we when we step outside our front door?

Protecting our health and wellbeing is on everybody’s mind for obvious reasons. Will wearing a mask save us from contagion? Will keeping six feet apart from others protect us if the spread is airborne?

Risk needs to be mitigated. Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, told biotech executives at a conference this June that COVID-19 is his “worst nightmare” that “in a period of four months, has devastated the whole world.” Things could get much worse before they get better.

Of course, there’s a lot of focus on scientists around the globe who are working on vaccines and treatments for COVID-19, and all those frontline healthcare workers in the hospitals, but what about the buildings they work in and care for patients? The pandemic has turned the construction industry on its ear.

Personal Protective Equipment worksite requirements aside, what goes into the design and construction of hospitals and labs? How do people meet the ultra-high standards that are essential to keep these spaces safe and sterile for doctors, nurses, scientists, support staff and all those vulnerable patients? And consider the increased demand for new construction potentially on the horizon.

The #FlattenTheCurve movement is not just about decreasing the number of people who catch COVID-19, but “preventing overburdening and collapse of the healthcare system,” Forbes reports. The U.S. has only 2.9 hospital beds for 1,000 people, one of the lowest ratios among all of the world’s high-income countries. The nation needs to prepare for the next healthcare crisis with expanded facilities, more hospital beds and more labs for testing and R&D.

Constructing hospitals and labs can be very different from most other building jobs. To start, these buildings have special requirements that increase the complexity. This not only includes designs to accommodate unique equipment and workstations, but space for employees to navigate around patient beds as they do their work caring for people.

Then there are a myriad of technical requirements and protocols, such as managing the disposal of biological materials, sanitization of water lines, and coordinating fume hoods with the building’s HVAC system – just to name a few considerations. And because of all these specific requirements, the planning and design teams have to be in perfect sync with the actual construction teams well before the shovels are in the ground right through to the opening of the facility.

Who is involved? Well, in addition to the architects and designers, there are the engineers, the construction managers, the plumbing and electrical specialists, HVAC experts and the lab directors who should be part of the conversation throughout the construction. Not surprisingly, coordinating all of these people can be complicated, especially when teams are also trying to stay on time and within budget.

One of the more interesting subsets of labs that handle the particularly nasty viruses are biosafety Level 3 labs. These have negative pressure rooms that block viruses from escaping if they are accidently released. The rooms are now well-known in hospitals that are treating patients with contagious infections.

According to the World Health Organization, a recognized authority on battling infectious disease, a negative pressure system ventilates the air out of a room at a minimum of six times an hour. The principle here is that air tends to flow from high pressure to lower pressure. So in normal systems, air and particles can circulate throughout a contained system in a building, literally traveling from one end to the other. This is problematic if you are working with viruses that can be airborne.

So to prevent these viruses from leaving the secure room, negative pressure is introduced to create pressure that is so low, the air literally has nowhere to go, so the risk of microbes or other bugs escaping the room is greatly reduced.

When the air is flushed out on a regular basis, it can also be scrubbed through various types of filtration methods such as impingement, where air particles collide with fibres and remain attached to the filter, and electrostatic, where the particles with negative charge are attracted to the filter with positively charged fibres. Some filters also use ultraviolet light to destroy anything contained in the air.

How do you know if a room is truly at negative pressure? Tests using smoke and tissues can be used to make sure the room is fully sealed. Basically a smoke pellet or tissues are placed near the bottom of a door and if the tissue or smoke blows toward the room, it is negatively pressured. However, these tests do not guarantee that the room is at continuous negative pressure, so electronic monitoring can also be included to confirm the room is properly sealed.

All of this safety is not possible without the HVAC system that keeps the room at the ideal pressure. A specialized HVAC team is required to set up this kind of system. Sometimes the rooms are converted from pre-existing rooms that are already in an isolated part of the building and have the structure in place to create a negative pressure room or a separate exhaust system that does not connect to the rest of the building. An anteroom can also be constructed so that there is a series of airtight interlocking doors that further secure the room.

In top labs around the world, like Canada’s National Microbiology Lab in Winnipeg, scientists working directly with deadly microbes have an added level of safety in the form of dedicated breathing air supply attached to full-body suits. They also take chemical showers to decontaminate the suits. And there are layers of negative pressure zones, making sure the air always flows back into the lab when any doors are opened.

Another important question is, how do personnel keep rooms clean and safe after someone with a virus has been in them?

The first areas of concern are the high-touch areas like bedside handrails, nurse call buttons, telephones and remote controls, and all handles and bathroom surfaces. You have to think of where the patient lays in the bed as the hot zone where contamination is most likely to happen and the further you move from the patient, the less risk there is.

When it comes to cleaning, especially when it comes to COVID-19, the Centers for Disease Control (CDC) has specific protocols. This includes closing off the area where the sick person was for 24 hours, which is the new “safe” timeframe. Soap and water is used as the starting point, followed by chemical disinfectants and bleach. The U.S. Environmental Protection Agency has created a list of 357 disinfectant products that work against the virus.

This should be standard practice for cleaning hospitals, but the new pandemic era that we are living in means changes for other spaces as well. How clean is that hotel room you’re planning to stay in? Or that massage treatment room for stress and muscle pain relief? As the CDC says, “Cleaning of visibly dirty surfaces is a best practice for preventing COVID-19 and other viral respiratory illnesses.”

The good news in all of this is that these techniques appear to be effective in eliminating the virus from surfaces, so it becomes that much more necessary for cleaners to be thorough and to use the proper protocols on a regular basis.

And not only does this impact hospitals, it is now part of our daily lives. Think about grocery stores, offices, hair salons and so on. Cleaners may soon require certification so that standards can be maintained across businesses.

There is no question that this pandemic has heightened the awareness of how science and healthcare buildings are designed and cleaned. Looking to the future, there may be far wider implications as we try to keep businesses open and running and live in the new reality that the pandemic brings.

From Here to There

Throughout history, humans have been limited by simple logistics – how to get from here to there? For thousands of years, venturing out of one’s village required braving wild and rugged terrain. Travel was inherently dangerous. Roads were rough and rudimentary, if there were any at all.

September 20, 2020, 1:01 PM EDT