Helping healthcare clients prepare for a global pandemic

COVID-19 Healthcare Series: Part 2

March 2020 was the month life changed for all of us. What first emerged as a flu like illness in a distant province of central China, quickly morphed into a global pandemic, spreading across international borders with frightening speed. COVID-19 has since turned out to be the biggest disruption to our everyday life in decades.

In New Zealand however, through decisive government action and mobilising a world class public healthcare system, at the time of writing, the worst of the health crises witnessed overseas appears to have been averted. Although planning continues in case there is a possible second wave.

Beca is pleased to have played a part in preparing hospitals for a potential influx of COVID-19 patients and we now have some valuable experiences that can be applied to healthcare facilities anywhere in the world.

By working closely with various DHBs (district health boards) and private healthcare providers across the country, we were able to assist facilities to prepare for an anticipated patient surge in a number of practical ways. This included providing advice on air conditioning and ventilation (air-movement), medical gases system capacity, regulatory advice on adapting physical spaces including fire engineering requirements, and guiding emergency building code compliance pathways.

A longstanding partnership with healthcare providers

Beca has over 20 years of specialised knowledge, understanding and experience of the hospital and healthcare environment, including the specialist requirements of campus infrastructure and acute clinical facilities. We have developed building services leadership and expertise in this sector through experience on many of New Zealand’s major healthcare developments, coupled with our proactive research and benchmarking of overseas trends.

So, when it became clear hospitals and medical facilities required rapid adaptation in the face of the COVID-19 pandemic, several clients turned to us for help, knowing we already had engineers experienced in the healthcare sector ready to go.

Delivering with clinical best-practice front of mind

Within the healthcare sector there is limited guidance on how to design hospitals and clinics to respond to a pandemic. Instead, hospitals and medical clinics have traditionally been configured to respond to isolated cases and small outbreaks of infectious disease, by provision of a few isolation rooms. So, from early March 2020, we began compiling emerging best practice advice on COVID-19 from international learned technical societies, including the World Health Organization and the UK’s NHS, along with HVAC engineering specific organisations such as CIBSE (UK), ASHRAE (US) and REHVA (Europe).

We developed a series of generic and schematic concepts of how individual rooms and entire wards could be adapted to provide the necessary separation of COVID-19 patients from other patients, public and staff. We discussed this information with our local health providers, enabling them to plan from a clinical perspective how their existing facilities may best be adapted. Subsequent supporting advice specific to each facility was also provided upon request - covering HVAC, fire engineering, medical gases and regulatory compliance.

Another key factor observed through international experience was the need to prepare hospitals for a significant increase in oxygen usage (approximately five times normal usage was modelled) to treat COVID-19 patients, for which we developed a detailed study methodology to address the key constraints of storage, equipment and pipeline distribution capacity.

Some examples of work carried out across Auckland, Counties Manukau, Bay of Plenty, Waikato, Mid-Central, Taranaki, Canterbury and Southern DHBs include:

• Reviewing oxygen pipeline and storage capacity based on anticipated ventilator/CPAP use
• Assessing spaces that could be easily converted/separated from other spaces for cohorting of COVID-19 patients
• Assessing options to separate triage emergency departments and waiting areas
• Creating temporary ante-rooms
• Assessing existing negative pressure isolation rooms against current best-practice design guidelines
• High-level advice on the proposed conversion of multiple wards for cohorting of pandemic patients
• Providing advice on ward conversion for a pandemic caused by an airborne transmitted disease (e.g. TB, measles)
• Accelerated completion and commissioning of new ICU bed spaces
• Conversion of all/parts of ICU departments to negative pressure (inward airflow)
• Advising on temporary partition types, placement and egress
• Assisting with assessing and communicating temporary works with local territorial authorities (Councils)
• Fire engineering advice for conversion of admin space to staff sleeping areas
• Temporary conversion of operating theatres to negative pressure, to enable surgery on COVID-19 patients

Valuable lessons learned

By forming a rapid response team who were guided by best practice clinical guidelines, we were able to increase the capacity of hospitals across New Zealand for an influx of COVID-19 patients, which thankfully has not eventuated at the time of writing. Valuable lessons were learnt throughout this process which we will discuss in Part 3 - that introduces recommendations for future hospital design.

This is part 2 of our COVID-19 healthcare series. Stay tuned for more insights we’ve gained on helping our healthcare clients prepare for one of the biggest challenges they’ve ever faced!

The full series can be viewed here:

• Part 1 - Supporting healthcare facilities
• Part 2 - Helping our healthcare clients prepare for a global pandemic
• Part 3 - Valuable lessons for future hospital design