May 1, 2020
By Paul Bubny
One of the most alarming – and deadly – aspects of the COVID-19 pandemic has been the speed with which the number of seriously ill patients overwhelmed hospitals’ critical-care capabilities. For that reason, conversion of non-medical facilities into spaces that can accommodate the treatment of severely afflicted patients has become a vital component of coronavirus care.
However, from design and engineering perspectives, such conversions present formidable challenges for owners or operators of commercial real estate.
Adaptive re-use projects are complex to begin with. Multiply the complexity for hospitals, then again for intensive care units (ICUs), and once again for COVID-19 ICUs. Because the coronavirus is so easily transmitted through droplets, engineering systems that are standard for regular ICUs can’t be used.
For example, HVAC systems have to exhaust air to the floor to prevent circulation of droplets and protect caregivers. Medical gas equipment has to accommodate the extra load on medical gas outlets, which, within a COVID-19 ICU, might all be used simultaneously. And speed is of the essence, given the rapid spread of the virus.
“What we’re seeing is that, because of the high infection rate, you really want to be treating these patients in an inpatient facility,” Tim Krawetz, New York City-based head of the healthcare practice at engineering firm Syska Hennessy, tells Connect Media.
Within these facilities, the best environment for seriously ill COVID-19 patients is Airborne Infection Isolation (AII) rooms. However, there are only so many AII rooms in existence, and that means coronavirus patients are often treated in standard ICUs.
“We’re seeing a lot of clients asking us how they can convert the ICUs to negative pressure”—an isolation technique used to prevent cross-contamination between rooms, Krawetz says.
Isolating the infection is just one consideration. Another is the use of ventilators.
“When you’re converting a facility to a COVID patient environment, you want to have a dedicated outlet, a dedicated circuit, to support the ventilator,” says Krawetz. “It has to be on emergency power—you don’t want those ventilators failing, because they’re what’s keeping patients in the game. The electrical requirements are high enough that the equipment should really be on its own dedicated circuit.”
Less widely reported is the need for dialysis machines. The virus, now less than six months old and therefore not fully understood, has the potential to cause some degree of kidney failure, hence the demand for the equipment. “Like the ventilator, it has a large electrical load,” Krawetz says. “And with that comes a plumbing requirement, because you have to purge the machines.”
Since the virus travels via water droplets—and that can mean droplets as fine as the vapor that comes out when you breathe on a mirror—“You have to be careful of what I call ‘hang time,’” says Krawetz. “Is it minutes, is it hours? They haven’t quite figured that out yet. So how that air is being treated is important.”
Krawetz and his team recently converted a couple of residential floors at North Central Bronx Hospital to COVID-19 use. Along with the other complexities, the change of usage triggered an upgrade to the fire alarm system used for those floors.
Complicating these upgrades is the fact that even amid the health emergency, the New York City Department of Buildings and the New York City Fire Department are still looking for “all of the regular site inspections, special inspections and sign-offs that they would perform on a regular project,” Krawetz says. “They understand that this is an emergency project, but they’re playing it by the book.”
With some states already moving toward easing social distancing restrictions and starting to reopen their economies, it might seem a little late in the day to begin a COVID-19 project. However, Krawetz says clients are looking ahead, under the assumption that it’s not over yet.
“We’re not even out of the first wave, and they’re already planning for the second one,” he says.
Among healthcare engineers at Syska Hennessy, sharing best practices related to COVID-19 projects has become the basis for daily phone calls over the past few weeks. “The initial idea was: what was somebody seeing in New York that they could share with other parts the country and save a step?”
Out of that, the firm is finalizing a checklist for converting a variety of facilities to COVID-19 use. Krawetz says the document will be ready just as calls about the second wave are starting to come in. That means that lessons learned on the first wave can be applied on the second.
“The key to success is sharing information.”
Pictured: Conversion of residential floors at North Central Bronx Hospital to COVID-19 use.
For comments, questions or concerns, please contact Paul Bubny