By Carleton Knotts, Advisory Specialist, Facility Management, Intalere
As we continue to work through the current COVID-19 pandemic, as well as plan for a possible second wave, many healthcare facilities are experiencing a surge of patients. Many of these patients should be placed in negative pressure rooms, isolation areas and the ICU. To manage the excess number of patients, and their specific therapeutic needs, facilities have begun repurposing existing space within their facility or adding satellite facilities such as tents and portable buildings. Let’s review some basic information that Facility Directors should consider as they are asked to provide additional patient space.
Top Line Responsibilities and Deliverables
What are the mission critical deliverables that you need to make sure you cover for the organization when it comes to preparing your facility?
- System Reliability & Functional Testing – When you “flip the switch” and go live, you will need to be sure that the system performs as intended, mainly through full testing practice to account for any unforeseen challenges.
- Geographic Resiliency – Make sure that the critical infrastructure you have set in place is impermeable to weather.
- System Capacity – The foresight to prepare for the capacity that may be needed is critical. Considerations include:
- O2 Farms
- Electrical Distribution
- Medical Gas
- Redundancy (N+1) Continuity of Service – N+1 redundancy is a form of resilience that ensures system availability and the availability to continue in the event of component failure. Components (N) have at least one independent backup component (+1).
Specific Actions to Take in Your Plan
Pursuant to the above areas, what are some of the specific actions to take to ensure your top-level deliverables?
- Normal and Emergency Power Distribution – Identify power panels that have capacity for landing new circuits for add-on equipment. Identify strategic locations to connect add-on utility and power such as generators and chillers.
- Onsite Energy Sources – Review and conduct additional inspections of emergency generators, boilers, domestic water and roll-up pads/locations for supplemental utilities. Make sure to account for fire safety considerations as add-on and new spaces are used. Check with the authority having jurisdiction (AHJ).
- Medical Gas Distribution – Identify connection points for added equipment and ventilators. Maintain or increase inventory of attic stock – PRVs, gas regulators, switches. Be aware of bulk O2 farm distribution freeze ups from higher flow/demand.
- Domestic Hot Water, Water Treatment and Management – Prepare for increased demand from handwashing and showering. Expect added demand from portable handwash stations in mobile sites, as well as an increase in potable water demand.
- Refrigeration (DX and Chilled Water) – Is your HVAC system capable of allowing continuous 100% outside air? If your system cannot run 100% outside air while maintaining appropriate temperatures and humidity levels, identify and prepare for shedding non-essential loads to meet this extra demand. If you cannot run 100% outside air for lengthy periods of time, can you perform a once-through full 100% outside air “flush”? This procedure will help clear your indoor air of pathogens.
- Humidification – Set operational controls of air handling units (AHUs) for local humidity factors. Consider the use of OA (outdoor air) economizers for this. Promote patient healing by maintaining relative humidity RH at 40-60% in occupied spaces.
- Building Automation, IT and Wi-Fi Capacity –The building automation system must be capable of full system control, with a robust IT backbone. As always, security for patient files is paramount. Consider whether your remote and temporary facilities will require Wi-Fi capabilities and what those challenges might entail.
- Ventilation and Filtration Systems –These systems should have the capability to provide 100% outside air, with OA/RA/EA damper control. Air handling units (AHUs) should be retrofit with 99.97% HEPA filters, an easy change as existing MERV 13 and 14 filters box frames are the same size. You can also retrofit AHUs with UV lights to destroy most pathogens. Review and adjust for common path of airside and VAV or CV, creating positive and negative pressure with BAS programming of dampers and fan speeds (CFMs).
Future Design Considerations
With this crisis hopefully soon in the rearview mirror, you will be able to implement the lessons learned into any future design considerations in order to be as proactive and fully prepared as possible. Your planning for the future should include:
- Consider building wide exhaust air capacity to meet or exceed supply air quantity.
- Consider variable air volume (VAV) vs. constant volume (CV) air distribution.
- Build flexibility into your chiller plant, meaning installing chillers to run in both series and parallel and having backup systems and contingencies.
- Consider adding auxiliary connections for temporary utility.
- Installing service pads for temporary utility equipment.
- Consider adding electrical distribution panels strategically located for temp services.
- Ensure robust electrical infrastructure to manage additional IT.
- Consider major energy movers and sources are above flood elevations.
- Planning entryways and exitways to accommodate social distancing.
- Additional stocking shelves and space to accommodate larger attic/reserve stock.
Whether your facility is in the midst of still dealing with needs or surge capacity during the pandemic, or you are looking to be proactive in dealing with what the future may hold, making sure your facility and space needs are “ready for anything” is of paramount importance. Time spent preparing now will have you well able to anticipate and respond to any future emergency needs.
My appreciation to Steve Friedman, PE, CHFM, Director, Facilities Engineering Design and Construction, Memorial Sloan Kettering, as much of this information is derived from his recent presentation at the Healthcare Facilities Virtual Symposium, April 17, 2020.
We Can Help
Intalere, the healthcare industry leader in delivering solutions designed for improved financial, operational and clinical health for our partners, can help with any of your facility management needs. Please reach out to us to see how we can help. Contact Customer Service at 877-711-5600 or firstname.lastname@example.org or your Intalere representative.