In light of the COVID-19 pandemic, many are asking questions about healthcare and the efficacy of reactions to the global spread. Previous public health crises have informed current responses, which changed and informed hospital design dramatically, specifically following the severe acute respiratory syndrome (SARS) outbreak in 2003, a viral respiratory illness within the coronavirus family. Infection prevention and control practitioners had long urged additional precautions for hospitals, however much of the decisive change was not seen until after the SARS outbreak.
Healthcare administrators had to come to terms with a difficult reality, as many of those diagnosed with SARS were healthcare workers who contracted the disease while at work in healthcare facilities. From November 2002 through July 2003, over 8,000 people worldwide fell ill with SARS, accompanied by either pneumonia or respiratory distress syndrome, according to the World Health Organization (WHO). Of these, 774 succumbed to their illness. The increased concern regarding COVID-19 stems from multiple sources of concern, including the dramatically higher numbers, with more than ten times the confirmed cases compared to the SARS outbreak, with these figures increasing daily.
Because of difficult learnings from past outbreaks, new hospitals are designed with additional measures and are much safer as a result.
Single patient rooms with handwashing stations
New hospitals and major additions are built with all single patient rooms to ensure patients can be isolated, which helps to reduce the chance of hospital-acquired infections. This design is also improved with hand hygiene sinks at the entrance of patient rooms, with the additional safeguard that handwashing stations are in view of the patient so they can be assured that their caregiver has washed their hands. Sinks also have offset drains to prevent aerosolization of bacteria living in the drain (the biofilm) onto the hands. This model can be found at HSC Winnipeg Women’s Hospital.
Better supply storage
Between patients and room turnover, any supplies kept in the room must be discarded. Fewer supplies are now stored in patient rooms, and instead are stored on carts, restricted to only what is required to be brought into the room. This leads to a decreased likelihood of transmission of viruses onto packaging and other surfaces.
Strategic design is crucial when upgrading existing healthcare centres or designing new facilities. Triage areas in hospitals are home to undiagnosed patients carrying pathogens, viruses and other illnesses into the hospital. Walk-in entrances to the emergency department are now redesigned to protect nurses and other staff from the public until the patient can be identified as infectious. Additionally, seats in the emergency waiting rooms are spaced one meter apart to reduce the spread of infection and illness between patients, some of whom are already vulnerable. This model can be seen at the Woodstock General Hospital, designed by Parkin Architects.
Pandemic supply storage
Hospitals now keep their store of pandemic supplies in designated areas, which also includes pharmacies and emergency departments housed within pandemic designated facilities. These supplies, which include decontamination tents, are routinely examined, ensuring the disposal of any expired or non-sterile supplies, and that only current supplies are used.
Pandemic command centres
Command centres and media command centres in hospitals ensure a central location is created during an epidemic or pandemic for administrators to remain centralized and abreast of changing situations. Command centres are often co-opted in large education rooms or boardrooms for the duration of the outbreak, with media command centres located close to building entrances. This layout protects the privacy of patients and families while allowing the media an appropriate and accessible area to obtain information from health officials and experts within the hospital.
These improvements can be found in many of Parkin Architect’s projects, for example, the Sunnybrook Health Sciences Centre is home to The Women and Babies Program containing a specialized c-section operating room. It has a negative pressure anteroom in the event that a pregnant patient is contagious or ill, they can safely deliver and recover without risking the spread of illness to other expecting parents and their newborns. These measures are set in place to provide the best care under the most difficult circumstances, preventing the spread of illness and improving efficiency and safety for patients, workers and the public.
Designers and architects have learned from the lessons of the past how to improve the physical environment to support the work of hospital clinicians and staff, and as a result, hospitals are much safer places now than they were twenty years ago.