COVID-19 RESPONSE MODIFYING EXISTING HEALTHCARE BUILDING SYSTEMS

The COVID-19 pandemic will require changes to select parts of infrastructure within healthcare building systems, including hospitals, urgent care clinics, and other medical facilities. Healthcare providers are being advised to isolate COVID-19 patients both from the rest of the building’s patient population as well as from the health care providers that support these patients. 

Typically, infectious disease patients represent a limited portion of a hospital’s patient population. 

However, as result of this pandemic, healthcare providers may need to make changes to the ventilation systems supporting the areas of a hospital (or other medical facility) where COVID-19 patients are located. 

 THE CHALLENGE 

» Under typical operating conditions, healthcare facilities provide for patient isolation in select rooms. However, these facilities may need to update building systems ventilation systems to support an effective response to substantially increasing patient loads. 

» With the prospect of considerable increases in patient load, hospitals will need to consider a substantial expansion of isolation spaces on a wing-by-wing or building-by-building basis, providing for mechanical isolation of infected patients 

» Outside of select isolation areas, patient spaces traditionally operate with slight positive pressurize, in relation to other adjacent spaces and the outside. 

Little regard is paid to isolation of individual patient rooms within the facility 

» Reversing space and building pressurization will require an informed strategy of modifying building air 

handling systems to create as much isolation space as the existing systems can support. 

THE CONCEPT 

Isolation of patient treatment rooms requires that the airflow from the ventilation system draw air from clean spaces outside the treatment area (patient room) into the room. The air drawn into the room should then be filtered and exhausted to a safe exterior location. 

» ASHRAE/ASHE Standard 170-2017, Ventilation of Health Care Facilities, indicates the pressure difference required to maintain a negative pressure is 2.5 Pa or .01” water column. 

» As you begin to change standard patient rooms to isolation spaces, the negative pressure relationship between the rooms and the adjacent corridor and the patient rooms to any adjacent patient or support spaces becomes complex. It is not enough to simply make each room negative to the corridor because you could be creating paths for pathogens to move from one room to another. 

» Operating Rooms must remain positive to their surroundings. Compounding pharmacies need to remain negative to their surroundings to their adjacent clean spaces while isolating the pharmacy from the COVID-19 pathogens. In implementing modifications to any adjacent wings and/or spaces, the hospital team must insure that these spaces are not compromised. 

» While a hospital may want to isolate one wing for the control of the spread of the COVID-19 virus, the building must continue to maintain individual isolation for the control of both COVID-19 and airborne infectious diseases that healthcare facilities deal with on a daily basis. 

CASCADING COLLATERAL EFFECTS 

The compounding effect of changing the pressurization of a facility is complicated. In order to change pressure relationships on a wing or building scale, it will require that the building operators take the following issues into consideration: 

» The capacities of the installed equipment, 

» The implemented control strategies of that equipment and 

» The air distribution systems that will be adapted to this new isolation strategy. 

While facilities and clinical staff are discussing re-purposing spaces and portions of facilities, it will be important to include support of engineering teams that can both quantify existing system capacities and implement short term modifications and longer term facility upgrades to allow for improved and expanded patient isolation. Through a strategy of immediate system adjustments, supported by physical modifications, improvements in patient isolation can occur very quickly as the crisis develops. This kind of thoughtful modifications to your facilities will be a critical element to managing the infection control potential of any virus whose primary transmission mechanism is by aerosols. 

NV5 RESOURCES ARE AVAILABLE TO HELP 

NV5 encourages you to reach out to professionals who can provide assistance in modifying your building systems or cleaning your facilities. 

NV5 has available and qualified staff for your needs: 

» Industrial hygiene experts that help develop and execute decontamination protocols. 

» Consulting engineers who can assist in identifying building system modification options and in making short term 

adjustments to achieve incremental improvements in patient isolation. 

» Commissioning engineers and technicians that can support confirmation that the modified facilities can provide a safe 

and reliable short term solution to the capacity challenge of this virus. 

» Building operations monitoring that can improve the visibility and ongoing effectiveness of the modified systems. 

Energy Efficiency in Hospitals: Lower Costs and Increase Comfort

Energy efficiency measures in hospitals can reduce the total amount of energy used each year and lower utility costs.

At the same time, new building controls also provide ideal environments for patients, staff, and visitors without excess energy use. Building Automated Systems (BAS) work to maintain temperatures and lighting at optimal levels, providing constant comfort and safety and keeping energy costs down.

Energy Audits help you determine your current energy usage – where you use it and how much. Then a hospital facility can be assessed to find way to adjust or upgrade building systems – to increase energy efficiency and improve indoor conditions throughout.

Alares Hires Fabrizio Cornali, PhD as Senior Structural Engineer

Boston, MA. – March 12, 2020 – Alares hires Fabrizio Cornali, PhD as Senior Structural Engineer

Cornali brings his extensive structural engineering experience with specific expertise in seismic evaluation and design. He has worked with both government agencies and private industry. Cornali has his Doctor of Philosophy (Ph.D.) in Engineering and Applied Sciences from the University of Bergamo, (Tufts University). He also has a Master of Science (M.Sc.), and a Bachelor of Science (B.Sc.) in Building Engineering.

In his role Cornali will manage the structural engineering department with a focus on seismic upgrade design. Currently he is working on several seismic upgrade projects for the Department of Veterans Affairs. Don Maggioli, CEO of Alares said “We’re very excited to have Fabrizio on board. His depth of experience, knowledge and management capabilities will complement our growing team of seasoned engineers.”

Alares achieves measurable results in design, energy, environmental and commissioning.

For more information, contact Carol Costello at 617-481-6390.

MODIFYING EXISTING HEALTHCARE BUILDING SYSTEMS FOR COVID-19 RESPONSE

The COVID-19 pandemic, having 10 to 30 times greater mortality rate than influenza, will require an expansion of isolation treatment spaces within existing hospitals and healthcare clinics were given the substantially increasing patient loads.

Airborne Infection Isolation Rooms

Your objective will be to develop isolation spaces that achieve a negative space pressure, direct airflow from clean to dirty areas, exhaust all airflow, and maintain temperature/humidity between 70-75ºF/less than 60%.

To change airflow and pressure relationships within your building, you will need to consider the following:

• Installed ventilation and base building equipment capacities

• Implemented control strategies of the equipment

• Air distribution systems to be adapted to this new isolation strategy.

Through a strategy of immediate system adjustments, supported by physical modifications, improvements in patient isolation can occur very quickly as the crisis develops.

Additional Considerations

• Administrative controls and adequate personal protective equipment for operations support teams

• Prepare all HEPA units and Stackhouse’s for adapting standard patient rooms for small scale surges

• Bifurcate high traffic areas and suspected COVID-19 patient proximity from high risk patients

Alares/NV5 Resources Are Available to Help

Alares/NV5 has design and commissioning engineers available who can assist in qualifying building system capacities and make short-term adjustments to achieve incremental improvements in patient isolation. Please contact NV5 professionals at david.mannix@nv5.com or in 651-634-7356 for assistance.