COVID-19 Planning Impacts

PANDEMIC CONSIDERATIONS Originally Published May 2020
FOR HEALTH FACILITY DESIGN Last Updated August 2020

PANDEMIC CONSIDERATIONS FOR HEALTH FACILITY DESIGN
INTRODUCTION

OUR APPROACH TABLE OF CONTENTS
We recognize that our clients are faced with many
uncertainties and change as the pandemic evolves. The thoughts are separated into the following categories: Reducing patient presentations at the facility pg 3
Our number one goal is to be there for our clients • Telehealth pg 4
offering the support, guidance and leadership that • Reducing patient presentations at the facility • Site Design and Planning pg 5
people expect from EUA. • Minimizing exposure and isolating infectious • Drive-Thru Testing

With the residual impact and the changing needs of the patients who present Minimizing exposure when patients present pg 6
market environments we support − workplace, industrial, • Improving the facility’s ability to reduce the • Vestibules and Entries pg 7
learning, healthcare, science + technology, living and • Registration Areas pg 8
community − we continue to refine our approach, services spread of infection • NEW Registration Kiosks
and solutions. With safety and well-being at the forefront of • Providing surge capacity for high
these industry sectors, we are researching, innovating and Improving facilities to reduce the spread of infection
sharing ideas on how we can deliver design solutions to volume episodes
support our clients’ unique and evolving needs. • Waiting Areas pg 9
Planning a building that seeks to fully address all aspects
Our design experts are asking probing questions to of operations during a pandemic is a major undertaking. • Clinic Planning pg 10
achieve desired flexibility, quantify capacities and assess This level of consideration is often not a part of typical
technologies that deliver forward looking and high- project discussions. We understand that the physical and • New Clinic Planning Models pg 11
performing design solutions. At EUA, we are passionate financial impacts of implementing these strategies may
about what we do. We believe that design has the ability to not be possible for all projects. However, it is important • NEW Exam Rooms pg 12
elevate people’s potential. Now, more than ever, our pace to be intentional about the decisions each organization
of innovation remains ready to serve our clients. makes around pandemic planning for each project. A • Hospital Lobby Planning pg 13
thoughtful and intentional approach will help the health
THIS GUIDE system leverage resources to effectively address the next • Emergency Department Entry Sequence pg 14
As we continue to support clients with their healthcare facility pandemic situation.
needs, our team is looking ahead to how design will be • Elevators pg 15
impacted by the current COVID-19 pandemic response. We Your inbox is probably full of predictions of what the
know our clients need to anticipate future disruptions and worldwide pandemic will mean to our daily lives. We don’t • Materials Management pg 16
patients are anticipating changes in the way they receive have a crystal ball, so we chose to look at tangible ways
care when in-person care restarts. Our healthcare team is that our approach to healthcare design can and likely will • Restrooms pg 17
looking ahead to how design must evolve in response to the change as we move forward. Our approach isn’t one size
challenges highlighted by the COVID-19 pandemic. fits all. We are committed to bringing ideas and options for • NEW Interior Finishes pg 18
you to evaluate and decide what is right for your situation.
We look forward to discussing these ideas with you in a Providing surge capacity for high volume episodes
virtual design meeting until we can meet in person.
• Inpatient Nursing Unit pg 19

• NEW Outpatient Surge Capacity pg 20

The NEW flage denotes topics added in August 2020

For more information, contact:

Paul Stefanski at 414.291.8198
or visit eua.com

Pandemic Considerations in Health Facility Design | EUA 2

REDUCING PATIENT PRESENTATIONS AT THE FACILITY
TELEHEALTH

One game changer resulting from the pandemic is POSSIBLE IMPACTS TO CLINIC PLANNING MODULES
relaxed restrictions on the reimbursement of telehealth.
It has become a major strategy to reduce facility visits PRIVATE OFFICE PHYS EXAM EXAM EXAM VITALS
that increase the risk of transmission. Patients are more WITH 2.5 EXAM:PHYS OFFICE EXAM
receptive to receiving care in this on-line environment Current state where all care occurs in the exam TEAM
and will want to continue with the newfound convenience room. Maintains the physician demand for WORK PHYS
and flexibility after the pandemic subsides. Planning private offices for virtual visits. Doesn’t increase OFFICE
considerations will hinge upon the certainty of the space; combines offices and telehealth. SUPPORT EXAM TOILET
reimbursement environment.

1 IT IMPACTS TELEHEALTH EXAM EXAM EXAM TELE- VITALS TOILET
WITH 2.5 EXAM:PHYS HEALTH
Added audio/visual equipment in many spaces Move telehealth rooms to the ‘front’ so they TEAM
• Provider offices are seen as a care delivery space. Provider WORK
• Exam rooms offices are combined in an open team work
• ICU / inpatient rooms environment. SUPPORT EXAM EXAM TELE-
• Pharmacies – virtual medication checks HEALTH
(where regulations allow)
TELEHEALTH SUPPORT EXAM EXAM VITALS
Amazon Echo video calling devices are being WITH 2.0 EXAM:PHYS TELEHEALTH
used to communicate between physician/staff and Dedicated telehealth rooms with a combined TEAM
patients, to decrease foot traffic into the room and provider and staff open work area. WORK
minimize staff exposure. Exam:physican ratio reduces due to increased
virtual visit use. TELEHEALTH EXAM EXAM TOILET
• Less risk to all individuals
• Reduces quantity of PPE required over time

due to fewer direct patient interactions

2 INFRASTRUCTURE IMPACTS TELEHEALTH TEAM SUPPORT EXAM EXAM VITALS
WITH 2.0 EXAM:PHYS WORK EXAM
Increase planning for flexible, multi-purpose rooms Telehealth rooms double as smaller offices for TELEHEALTH / TELEHEALTH/ EXAM TOILET
for use by physicians, specialists, consultation and providers. Exam:physican ratio reduces due to OFFICE OFFICE
video visits. increased virtual visit use.
TEAM SUPPORT
Reduce exam room demand since some visits WORK
occur virtually from the provider office or from off-
site facilities. For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 3

Pandemic Considerations in Health Facility Design | EUA

REDUCING PATIENT PRESENTATIONS AT THE FACILITY
SITE PLANNING

As healthcare facilities become fully operational there will UNSCREENED SCREENED
be varying approaches to accepting patients. In order to
prevent and control the passage of pathogens into the C PATIENT PARKING EXIT
building, organizations will need to consider all traffic B D A
coming on site; including patients, staff, vendors and
materials. Utilizing the parking lot can be key to managing SERVICE
who and what is entering the facility as well as keeping I
unnecessary visitors outside of the building. The scale of
the facility will also impact what is possible. ENTER
A
The following considerations can be applied to all project
types to help ensure a safe and efficient facility. STAFF PARKING H E J
F
A Single point of entry and exit promotes one-way PATIENT
traffic flow on the site. TRANSFER CLINIC

B Gatehouse staffed to give direction, provide patient G
tracking device or smart phone technology to allow
patients to wait outside of clinic or dispense PPE as F Entry to clinic for pre-registered and screened H Patient transfer for any patient needing hospitalization
needed. Locate to allow space for queuing of vehicles patients. Patients arriving early may be asked to wait is directed through a separate door to avoid cross-traffic
after entering site. in their vehicles until their appointment time to reduce with incoming patients and staff.
congestion in waiting areas.
C Drive-thru testing should be identified during site I Service traffic is separated from other traffic to ensure
planning. Drive-thru testing can be used to avoid G Staff entry with temperature screening and efficient deliveries with minimal time on site.
having potentially infectious patients enter the building disbursement of required PPE. Staff lockers and
until after they have been screened by a provider. See changing are also available. J Materials / vendor entry includes a screening point to
page 5 for additional information on drive-thru testing. ensure delivery personnel meet PPE protocols.

D Number parking stalls to allow parking assignment For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 4
if staff needs to meet a patient prior to entering the
facility. For urban sites provide outside ‘waiting’.

E Drive-thru services for pharmacy and lab allow
patients to receive services without entering
the building.

Pandemic Considerations in Health Facility Design | EUA

and proceed directly to Step 5 (Consultation) and Step 6 (Education)o.f suIfppslipesa.ce allows for a second lane of traffic, and for staff

Appendix 7. Clean / Dirty Space Layoutto be positioned on the opposite side of the vehicle traffic, a second Step 6 (Education) Isctoantiokneycan be deployed to handle

additional patient follow-up conversations (not shown in diagrams below). It will require staff to cross in front of the car to
REDUCING PATIENT PRESENTATIONS AT THE FACILITYspTheealakyotuot otfhSteatidonrsiv3e(Cr,ollseoctiosna)faendty4 (sPhroocueslsdingb)earce ocrnitiscaidllyered.
important to limiting cross-contamination of test samples, supplies, 3-space layout
DRIVE -THRU TESTING DETAILSand staff. Illustrated here are three potential layouts for Collection POSSIBLE VARIATIONS
(labeled Dirty Area) and Processing (laLbIeNledECAleRan Area). Each has its
own benefits and drawbacks:

PROCESS FLOW - The 4-space layout preserves separation of Clean and Dirty areas PROCESSING AR“ELA“OshPaTpIOe NS
throughout, but requires the most space to deploy. The two entry tents
OOVVEERVVIIEEWW on the left allow personnel to don/doff PPE away from the active testing 4-space layout
and processing zones where contamination risk is highest, and away
from where the personnel from the Clean and Dirty sides interact when
the transfer a collected test sample on the right side of the tents. It
places hand washing/sanitizing and clean glove supplies convenient in
locations convenient for swapping gloves between test samples.

0 Awareness - The 3-space layout combines the two entry tents from the 4-space

Making testing availability known 5 6layout into one common tent - labeled here as Anteroom/Buffer Zone.

If not approved for testing 0 Awareness Patient requires It is a more efficient layout, but has staff from the Clean and Dirty 5 6 Tested
1 Screening mPaetdiiecnatl hatatsenottihoenr symptoms sides overlapping, which will require more care in managing cross- Not tested
Consultation Education
Identifying patients for testing contaminatiCono.nsultation Education
4
- The 2-space layout is the most space-efficient, but eliminates brings
don/doff of PPE closer to the active testing and processing activities, Processing
which then requires even more care in managing cross-contamination
Criteria for testing will be dynamic of supplies.
and will be infoPramtieedntbhyaCsDoCthoerr symptoms
1 ScreeningIf not approved for tePsattiiVneagnrtiadboleesdneoctimsioenet other public health guidance, Icon key 3
critemriaakfionrgtepsotiinntg patient demand, availability of
supplies (test kits and PPE), and Clean area Collection

health system capacity 4

Variable decision Processing 2

2making point Intake Intake

Registering patient for testing Tested 1
Not tested
Criteria for testing will be dynamic Dirty area Screening

2 IntakePatiVeanrtidaboelesdneoctimsieoentand will be informed by CDC or 4-space 3layout Appendix 7. Clean / Dirty Space Layout
critemriaakfionrgtepsotiinntg other public health guidance,
patient demand, availability of
supplies (test kits and PPE), and
health system capacity

Variable decision Collection Appendix 7. Clean / Dirty Space LayoutHigh transitiaTmhnpedolsarttyaaofnfu.tttIoollfulSismttariattiitnoegndschr3eor(seCs-oaclrleoencthttiaromenei)npaaonttidoenn4to(iaPfltrleoascyteossusatimsnDfgpoe2)lresa-sCir,goessnllpcuerIpcnaitptsiicclotiaeientlsluy,ltae yfooruHtealth 2020
3-space layout
making 3point Collection 2
(labeled Dirty Area) and Processing (labeled Clean Area). Each has its
Obtaining test sample from patient Intake

1 own benefits and drawbacks:

3 Collection - The 4-space laTyhoeultapyroeusteorfveSstasteiopnasra3ti(oCnoollfeCctleioann)aannddD4ir(tPyraorceeasssing) are criticallyTested 3-space layoutTested
4 Processing throughout, butirmeqpuoirrteasntthtoe lmimoisttinsgpaccroestso-dcoenptloaym.inTahteiotnwoofetnetsrtystaemntpsles, supplies,
on the left allowapnedrssotnafnfe. l Itloludstorna/tdeodffhPerPeEaarewathyrfereompottheentaicatlilvaeyoteusttsinfogr Collection 56
Conveying test sample to analysis and processing z(olanbeeslewdhDeriretycoAnrteaam) iannadtioPnrorcisekssisinhgig(hlaebset,leadnCdlaewanayArea). Each has its
from where the poewrnsobnenneelfiftrsomantdhderCalwebaancaknsd: Dirty sides interact when Consultation Education

5 6ltpohlcaeactteriasonnhssafnceodr nawvcaeosnot-lhhilneeTirnncohtghttuee/efgsdo4halr-etonssefuitpwtstiaat,zalcsibplnoeaupgwmtlianarppygenleoeqdgruusloctooinlrpveneertansehsnesetblhegrteerlioovtgmwvedhesetooesnsssnutei/dCdppsteooppeanfaosrlsfiatcefuPteslstitPhoaatceEntmooiotnaopdnewvfleneeCpatsnslly.eoiE.efaydIrn.tnuotcmTaianhnttiedohnetDwiaroctyteivnaetrretyaetssetnintgs 4
4and processing zones where contamination risk is highest, and away
from where the personnel from the Clean and DPirtoycessidsiensg interact when Processing
- The 3-space lathyoeuttracnosmfebrinaecsotlhleecttwedo teensttrysatemnptlseforonmthteherig4h-tspsiadceeof the tents. It
4 Processing 3layout into one cpolmacmesonhatenndtw-alashbienlge/dsahneirteizainsgAanntedrcoloeman/Bguloffveer sZuopnpel.ies convenient in 3
6 Education
It is a more efficileonctaltaioynosutc,obnuvtehnaiesnsttfaofrf fsrwoamptphinegCgleloavneasnbdeDtwiretyen test samples. Collection
Informing patient of best practices 5 Consultation sides overlapping, which will require more care in managing crosCso-llection
contamination.
6 Education Intervening on complex cases If screening No tested No tested
7 Follow Up by phone, - The 3-space layout combines the two entry tents from the 4-space 2
5 Consultation remove this
z Diversion step on site 2layout into one common tent - labeled here as Anteroom/Buffer Zone. Intake

Transferring to alternate sites - The 2-space laItyoisuat ims othree emffoicsitesnpt alacyeo-uetf,ficbiuetnht,absusttaeflifmfrionmatethsebCrilnegasn and Dirty
don/doff of PPEscildoesserotvoertlhaeppaicntgiv,ewtheiscthinwgilalnredqpuriorecemssoirnegcaacrteivinitimesIan,ntaakgeing cross-
which then requciroensteavmeinnamtioorne.care in managing cross-contamination
of supplies.

Screening -doTnh/edo2f-fsopfaPcIPecEloacynloouskteeristyothtehemaocsttivsepatecest-ienfgficainedntp,rboucteeslsiimnginaactetisvibtireinsg, s

which then requires even more care in managing cross-contamination
of supplies.

R E F E R E N C E S 7 Follow Up z Diversion Design Institute for Health 2020 Icon key 1 25

esign Institute for Health 2020 4 Screening
All information compiled from: Design Institute for Heath, https://static1.squarespace.com/

static/5a7f5d63e45a7c1f4ef0d7a7/t/5eaadcd32ff52116d10120ce/1588255980126/CDOeVsIDig-1n0I+nDsrtiviteu-te for Health 2020 8
Thru+Testing+Guide+V3.pdf Accessed 5/8/2020.

Pandemic Considerations in Health Facility Design | EUA 4-space layout

For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 5

4-space layout

MINIMIZING EXPOSURE WHEN PATIENTS PRESENT
VESTIBULE DESIGN

1 SIZE 4 INFECTION CONTROL A Entry canopy - Add temporary enclosure for additional
weather protected queue space.
In cold climates undersized vestibules will fail to Building entry doors should be hands free. This
keep out the cold and wind. They need to be larger requires motion activated door operators (no push B Hands free - Doors with automatic operators.
so the doors in sequence have time to close and, plates) or sliding doors at all entry points. Even
ideally, are not aligned with the prevailing winds. under normal operations this ensures visitors are C Floor markings - Visual cues to encourage proper
A larger vestibule can accommodate additional not touching door hardware surfaces that have physical distancing in queues.
functions and equipment. Consider space for not been wiped clean. To encourage regular
wheelchairs, waiting, valet stations and seasonal use, intentional and convenient locations for D Flex space -Space for screening as patients enter.
equipment in cold climates. This ‘extra’ space may hand sanitizer stations and mask dispensers are
prove useful when additional screening is needed important at the entry. E Thermoscan - Consider space for temperature screening
during a pandemic. equipment and staff as patients enter.
NORMAL OPERATION
2 SCREENING Wheelchair Storage, Seasonal F Security - Remote door release between screening and
Equipment, Seating, Valet Station clinic.
Healthcare organizations strive to pre-screen
all patients before they arrive at facilities during G One-way traffic - Provide a second exit path after the
a pandemic. Even with pre-screening, in-place visit is completed.
providers will confirm and screen people entering a
facility. Wheelchair staging areas and valet stations PANDEMIC OPERATION
located adjacent to vestibules are opportunities Staff, PPE, Contactless Screening
to safely position staff and monitor entry points.
Temperature screening can also take place in this SCREENED SCREENING Separate staff access to
sheltered space before patients approach non-clinical UNSCREENED AREA Screening Area
staff and other patients in the registration area.
D Staff F
3 PHYSICAL DISTANCING
E
A small vestibule offers no chance for physical
distancing when people enter and exit at the same REGISTRATION & CLINIC
time. Consider a larger vestibule with additional 6 FEET
circulation space that allows for physical distancing. A
When possible, have well patients leave from
another door so there is a one-way flow of patients ENTER DROP-OFF CANOPY B 6 FEET EXIT
through the facility. OR TEMPORARY G
STRUCTURE
Pandemic Considerations in Health Facility Design | EUA
VESTIBULE
C

For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 6

MINIMIZING EXPOSURE WHEN PATIENTS PRESENT
REGISTRATION

Pre-screening and telehealth will play a big part in reducing 1 PROMOTE PHYSICAL DISTANCING 2 INFRASTRUCTURE AND PLANNING
the number of patients who need to enter a facility, but for
those who need in-person care, safety is a priority. After Patient to staff separation may include glazing Planning will consider placing a negative pressure
decades of moving toward an open hospitality model for screens between registration staff and patient to multi-purpose room adjacent to registration to isolate
registration in healthcare settings, we will be revisiting the prevent transmission. Depending on the facility, these patients with symptoms of an infectious disease. During
need for better separation between patients and staff. This could be fixed panels or movable barriers. regular operations, this room can function as an office
may take the form of permanent fixtures in the design or or consult room.”
temporary movable barriers for times of heightened risk. Patient to patient distancing can be encouraged with
In almost any scenario, registration will require additional interior design cues. Consider visual indicators in the Mechanical system design in waiting areas will aid
measures to protect users during face-to-face interactions. flooring (stripes, color blocks, etc.) to promote safe in removing potential airborne contaminants and limit
queuing distances while improving patient privacy. transmission. Placing return air grilles near the floor will
The extent of these measures will depend on the help draw contaminates away from patients and staff.
organization’s goals for each site during seasonal flu Staff to staff separation will increase with wider
or pandemic scenarios. Focus should be on separation registration stations to ensure a minimum 6’ spacing
between the registrar and patient, managing physical and sufficient physical distancing between staff.
distancing between patients and physical distance
between staff.

A

DC A

E
B

A Glazing separation between patient and staff B Distance cues in flooring C Negative pressure room D Exit to exterior when possible E Low return air grilles at registration
Pandemic Considerations in Health Facility Design | EUA For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 7

MINIMIZING EXPOSURE WHEN PATIENTS PRESENT
REGISTRATION KIOSKS

Utilizing registration kiosks can reduce the amount of face to GENERAL CIRCULATION QUEUING SPACE
face interaction required when receiving patients. This can
reduce exposure to staff and as well as overall staffing needs. QUEUING SPACE
Consider planning a staff station in proximity to kiosks to
assist customers with check in. B
A
Kiosks can also be used for temperature screening.
Contactless kiosks are now available that can perform up to 6' MIN.
1,500 temperature checks per hour.
KIOSK ELEVATION
Millwork or furniture systems can be used to separate kiosk A Hand Sanitizer provided at each kiosk.
stations. Consider future flexibility with partitions, outlets and B Glazing for high partitions to allow staff visibility
lighting.

1 PROMOTE PHYSICAL DISTANCING

• Plan locations of kiosks to allow distancing
between patients checking in and adjacent
circulation. Kiosks should be spaced a minimum of
six feet on center.

• Consider layout to allow for universal usage by
patients with strollers, walkers and wheelchairs.

• Partitions between kiosks increase a sense of
privacy and protection between stations.

• Tall partitions should be transparent on upper
portions to allow sightlines for staff visualization
and to improve lighting.

• Queuing space for waiting patients.

2 SANITATION

• Hand sanitizer provided at each kiosk.

• Staff attendant to clean kiosk touchpoints between uses.

• Trash can in each kiosk station for disinfectant wipes.

Pandemic Considerations in Health Facility Design | EUA For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 8

IMPROVING FACILITIES TO REDUCE THE SPREAD OF INFECTION
WAITING ROOMS

Waiting rooms will see a great deal of redesign from an Traditional Setup Physical Distancing Partitions
operational and physical standpoint. After years of moving 46 Waiting Chairs 16 Waiting Chairs 25 Waiting Chairs
toward a hospitality model with soft seating in small clusters (65% Reduction) (46% Reduction)
we may see a trend toward hard surfaces that are easier to Retractable, wipeable surface, customizable
clean. Always specify furniture with non-porous surfaces and print, mobile design Clear upper panel, frosted lower panel, All clear partition, mobile, wipeable surface
fabrics that are easy to clean/wipe. freestanding and wipeable surface

1 OPERATIONAL CHANGES For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 9

• Schedule visits to minimize the need for waiting.

• Limit patients to a single visitor or one
caregiver during appointments. This should be
communicated during appointment confirmation
calls to ensure only the appropriate people attend
a visit.

• In-car waiting where patients can remain isolated
until they are notified by phone.

• Isolate unwell patients in an exam room rather
than waiting with others.

• Digital marketing displays replace traditional
brochure racks.

• Face masks should be worn by all visitors and will
be provided if they do not come with one.

• Self-rooming protocols to avoid waiting rooms

2 PHYSICAL CHANGES

• Remove accessories like magazines and toys.

• Additional tissues, waste baskets and hand
sanitizers readily available/visible for visitors.

• Demountable partitions may section seating
zones for various patient groups. Provide zones for
1-2 chairs and spaces for wheelchairs. Research
is needed on the effectiveness of this strategy, but
may provide comfort that physical distancing is
being maintained.

• Sub-wait areas near exam rooms reduce crowding

Pandemic Considerations in Health Facility Design | EUA

IMPROVING FACILITIES TO REDUCE THE SPREAD OF INFECTION
CLINIC PLANNING

The heightened awareness of the need to protect staff C ISOLATION/ STAFF MOVEMENT
and patients during an infectious disease outbreak has TRANSFER
sparked new thinking regarding patient and staff flow in the
clinic setting. Variations on current planning models can TRIAGE CLINIC A CLINIC B CLINIC C
contribute to safety and potentially minimize transmission (UNWELL) (WELL) (WELL)
of communicable illnesses during a pandemic or the annual
flu season. REGISTRATION D EE E
CLINIC WAITING F
1 PRE-SCREEN AND PRE-REGISTER B EXIT

Limit in-person visits during a pandemic. VESTIBULE
Organizations will need to pre-register and screen A
all patients before they arrive at the facility.
ENTER
2 TRIAGE AT THE FRONT DOOR
UNSCREENED SCREENED
Sort well and unwell patients immediately upon
arrival. Divert anyone showing symptoms of a A Vestibule may be used as a screening station for D Vertical circulation is located past the point where
contagious condition directly into treatment areas, temperature taking and donning PPE before patients patients clear screening and registration.
bypassing waiting and registration areas where well enter the clinic.
patients are directed. Thermoscanners and PPE E Clinic pods can be assigned by acuity level and
are provided in the vestibule for added protection of B Registration is staffed as a triage point to move isolated from one another. This minimizes the
well patients. symptomatic patients into a dedicated assessment chance of well patients and staff crossing paths with
area and away from any common waiting areas. unwell patients. Provide separate HVAC systems for
3 ONE-WAY PATIENT FLOW each clinic pod.
C Transfer routes are planned to shift severe cases to
Separate waiting and registration and establish isolation facilities or hospitals for specialized care. F Separate exit for patients leaving the clinic to avoid
alternative means to monitor waiting areas. passing back through the registration area where
Create circulation paths for one-way flow to reduce unscreened patients will be present.
the need for well and unwell patients to cross
paths. Well patients are discharged without passing For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 10
through registration area.

Pandemic Considerations in Health Facility Design | EUA

IMPROVING FACILITIES TO REDUCE THE SPREAD OF INFECTION
NEW CLINIC PLANNING MODELS

“LIBRARY” MODEL FOR CLINICS NORMAL OPERATION

New clinic planning models may look to the local public COMMUNITY REGISTRATION CLINIC
library as a model for an adaptive building that will remain
operational during a pandemic. Many new libraries have ENTER CLINIC
community rooms that are accessed after hours while EXIT VESTIBULE WAITING
securing the main library functions. A clinic arranged with this
model would place community spaces (meeting and group
therapy, physical therapy or even staff break rooms) with
access to the clinic main entry. Under normal operations this
layout would make a large room available to the public for
community events or after-hours clinic education programs
while the larger clinic remains secure. During a pandemic, the
community rooms would be converted to serve as a buffer
between screened and unscreened patients.

This conversion will allow: ISOLATION/ PANDEMIC OPERATION
TRANSFER
A Pre-register and pre-screen all patients. CE

B Convert community spaces to an triage area that is B F CLINIC
separate from the clinic. TRIAGE TEMP
SUPPORT/
C Clinic is entirely dedicated to screened patients. & TREATMENT
REGISTRATION
D During pandemic, well patients are discharged
through a separate exit to maintain one-way flow. ENTER

E Staff can enter without passing unscreened patients. VESTIBULE CLINIC D
F Registration area can be converted to additional A WAITING

treatment space or support space for staff during
pandemic operations.

UNSCREENED SCREENED EXIT

Pandemic Considerations in Health Facility Design | EUA For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 11

IMPROVING FACILITIES TO REDUCE THE SPREAD OF INFECTION
EXAM ROOMS

Exam rooms are the main contact point between providers G ED
and patients. Reducing the potential spread of infection HF
can be accomplished through minimizing touch points and
maintaining a simple and organized space. B

1 PROCESS C

Bring all services to the patient to avoid unnecessary A
trips to other rooms. This includes vitals such as
weight and height, consultations, after visit summaries A Scale / stadiometer in exam room E Touchless soap, faucet, paper towel in close proximity
and future appointment scheduling. B Printer in room for after visit summary F Foot pedal trash with lid
C Consult table for non-exam appointments or scheduling G Gloves/PPE near hand washing
2 CASEWORK D Open casework H Occupancy sensors

Switch out hardware to allow for touch free access or
remove doors/hardware completely and use open shelving.

3 HAND WASHING

Switch to touchless faucets, soap and paper towel
dispensers. Locate soap, paper towels, trash and
gloves in close proximity to avoid unnecessary water
drips on counters and floors.

4 AUTOMATIC CONTROLS

Reduce frequent touch points by using occupancy
sensors for lighting and mechanical controls.

5 NEGATIVE PRESSURE

Some facilities may choose to upgrade mechanical
systems to provide a limited number of negative pressure
exam rooms that could function during a pandemic.

Pandemic Considerations in Health Facility Design | EUA For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 12

IMPROVING FACILITIES TO REDUCE THE SPREAD OF INFECTION
HOSPITAL LOBBY PLANNING

Hospital entrances and lobbies are typically large spaces that STAIRS REGISTRATION
orient users, allow for waiting and gathering and serve as a
hub to connect major public circulation. This confluence can UP REG. WAITING
create opportunities for transmission if not properly managed. ELEVATOR C
Consider separating these functions and compartmentalize DN
where possible. Reduce cross-traffic between zones and LOBBY
promote one-way traffic flow. B

1 PRE-SCREEN PUBLIC
CIRCULATION
Patients who suspect they may have an infectious
condition are instructed to use separate facilities or RESTROOMS
designated entrance. GREETER

2 REDUCE CROSS TRAFFIC VESTIBULE
A
Consider visitor movement. Promote one-way traffic
flow where possible. Clearly demark circulation paths A Screening protocol for arriving patients and visitors will
in flooring. be dependent upon the prevalence of infectious disease
cases. Visitors could be screened outside of the building
3 COMPARTMENTALIZE in temporary facilities or in the vestibule.

Remove registration waiting from visitor traffic entering B Provide ample standing area for visitors to maintain
and exiting through lobby. physical distancing as users exit the elevators with visual
cues to separate circulation from elevator queuing.
4 DISTANCE
C Registration area is moved out of the main lobby traffic to
To help manage queuing of larger patient volumes, allow physical distancing and reduce cross traffic.
include a registration waiting area with space for
physical distancing measures. Provide ample space
for standing traffic at elevators and registration.

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IMPROVING FACILITIES TO REDUCE THE SPREAD OF INFECTION
EMERGENCY DEPARTMENT ENTRY SEQUENCE

Entry sequences for the Emergency Department are EXIT D SMOKE EXIT
more complex than other hospital entry points. For COMPARTMENT
new and existing construction, look for opportunities to INFECTIOUS C NON-INFECTIOUS
reduce cross-traffic, promote one-way throughput, and ZONE ISOLATION ZONE
compartmentalize for containment.
EMERGENCY EMERGENCY
1 REDUCE CROSS -TRAFFIC DEPARTMENT DEPARTMENT

Consider movement of visitors. Promote one- B
way traffic flow where possible. Clearly demark
circulation paths and standing areas in flooring.

2 COMPARTMENTALIZE INFECTIOUS PATIENTS REGISTRATION BEHAVIORAL
Remove registration and waiting traffic from flow of HEALTH

visitors entering and exiting through lobby. TRIAGE ED ENTRY HOSPITAL

3 DISTANCE SECURITY

Waiting areas will need more space for physical NON-INFECTIOUS PATIENTS
distancing measures. Provide barriers to minimize
transmission. Provide ample space for standing
traffic at registration.

4 SEPARATE VESTIBULE WAITING
A
Patients who suspect they may have an infectious
condition are instructed to use separate facilities or ENTER
designated entrance.
A Patient screening in the vestibule or immediately C Isolation area to sequester potentially infectious
Pandemic Considerations in Health Facility Design | EUA before entering the building. Potential infectious patients.
patients are separated and routed to a dedicated
pandemic evaluation area. D Utilize smoke compartments and cross corridor
doors in conjunction with separate air handling units
B Registration should be close to behavioral health, to separate the infectious patient cohort and create
triage, and isolation for efficient intake. zones of containment.

For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 14

IMPROVING FACILITIES TO REDUCE THE SPREAD OF INFECTION
ELEVATORS

Elevators are challenging to use while maintaining physical ELEVATOR
distancing measures. Different cab sizes will dictate the 6 FT B
appropriate number of occupants. Organizations will be
looking to provide a comfortable and safe experience 3 CONTROLS & FEATURES C
for patients and staff needing elevators in their facilities.
Besides the clear need for hand sanitizer stations at the • Motion activated call buttons remove a Exit B
call buttons, some additional approaches to consider are: touchpoint LOBBY Enter
A
1 LIMIT USE • Use technology such as your phone, voice
commands and facial recognition in lieu of call A Queuing for waiting passengers should be clear of
• Promote stair use for staff and visitors where buttons. passengers exiting the elevator.
possible to reduce elevator traffic. For new
planning considerations, locate visible open • Consider enacting “Sabbath mode” were cars B Visual cues to support physical distancing of passengers
stairs to promote public use. Stairs should be are programmed to stop at every floor to avoid in the lobby and elevator.
sized for two-way traffic and may be larger than pushing buttons.
the code minimum. C Hand sanitizer at call buttons, provide technology or
• UV lights to purify the air and surfaces when the assign staff to reduce touch points while controlling traffic.
• Limit occupants to maintain physical cab is unoccupied.
distancing.
• HEPA quality air purification systems.
• Attendants may be needed to call elevators,
reduce touch points and control traffic. • Concierge style elevator call technology; you
never have to touch a button and it forces
2 SEPARATE patients/visitors to check in with concierge/
registration in order to access the elevator
• Provide visual indicators in flooring that banks.
demark elevator unloading and standing areas This check-in could also alert the facility that
a patient has arrived and gets them into the
• Social norms that give the right of way to exiting medical records system - reducing wait times
passengers before new passengers enter need and the need for waiting space.
to be promoted in signage.

• Assign up / down elevators for more efficient
passenger movement and physical distancing
while queuing.

Pandemic Considerations in Health Facility Design | EUA For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 15

IMPROVING FACILITIES TO REDUCE THE SPREAD OF INFECTION
MATERIALS MANAGEMENT

Many facilities do not have separate spaces to receive, TEMPORARY FACILITIES - MOBILE UNIT ADJACENT TO
break down, and disinfect supplies properly. Hospitals RECEIVING
and surgery centers use this type of zoning, which can
be scaled appropriately for all facilities as needed during VENDOR CLEAN
pandemic situations. DELIVERY GOODS IN

1 SAFE MATERIAL HANDLING RECEIVING AND BREAK DISINFECT CLEAN STORAGE
HOLDING DOWN
PROTOCOLS
Institute safe material handling protocols. Outside DIRTY OUT HEALTHCARE
packaging may be removed prior to allowing goods FACILITY
into the facility. Delivery frequency may be reduced
to avoid extraneous trips and unnecessary contact
at the site. Establish clean-in and dirty-out pathways
to avoid cross-contamination.

2 TEMPORARY FACILITIES A Designated entry for staff and vendors. Doors may be UNSCREENED SCREENED
controlled by on-site staff or a remote security station.
When space is not available in the building, use SERVICE ENTRY STAFF LOCKERS
temporary facilities like trailers, pods or tent B Vestibule for staff and vendors. VESTIBULE E
structures for break down and disinfection of goods.
Separate processes for food handling may require C Testing and triage area adjacent to vestibule for AB
mobile refrigeration. screening and donning required PPE.
C MATERIALS
3 STAFF AND VENDOR ENTRY D Separate goods entry may be provided to avoid vendor SCREENING
access to the larger facility or for staff safety in a busy
SEQUENCE loading area. D
Establish a clear process for vendors and staff
to enter the facility. Depending on the risk, some E Staff changing facilities including showers for staff HEALTHCARE
organizations may temporarily restrict vendor to decontaminate before returning home. Give special FACILITY
access to facilities. For those who allow access, attention to staff shoe storage to prevent transmission
careful screening is likely to occur. from footwear.

Pandemic Considerations in Health Facility Design | EUA For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 16

IMPROVING FACILITIES TO REDUCE THE SPREAD OF INFECTION
RESTROOMS

Public Restrooms are seen as spaces with a high risk of OUT IN
transmitting infection during a pandemic. Visibly posted
cleaning policies and hands-free features can put users Sensor faucets Sensor operated toilets Foot Pulls when doors are required
at ease. Additional strategies can further reduce points for
infection. Hands free towel dispensers Full height partitions Hands free door operators

1 MAZE ENTRANCES For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 17

Maze entrances reduce user touch points. Where
doors are required, provide hands free door
operators or manual foot pulls.

2 HANDS-FREE DESIGN

Sensor-operated toilets, faucets, soap and paper
towel dispensers can greatly contribute to infection
prevention. Although initial costs may be higher, the
long term benefits for health and safety, even during
normal operations, are important to consider. These
fixtures can be hardwired to reduce maintenance
concerns.

3 INCREASED CLEANING &

MAINTENANCE
• More frequent cleaning may be necessary to

ensure high-use touch points are sanitized on a
regular basis.

• Attendants in large public restrooms can monitor
and restrict access to ensure compliance with
physical distancing requirements.

• Additional HVAC maintenance and inspection
to ensure exhaust fans are working properly to
remove air from this high-traffic area.

• Automated cleaning functions.

• Full Height toilet partitions can decrease air
movement between stalls and contain aerosolized
particulates associated with toilet flushing.

Pandemic Considerations in Health Facility Design | EUA

IMPROVING FACILITIES TO REDUCE THE SPREAD OF INFECTION
INTERIOR FINISHES

Healthcare will continue to require durable and resilient 2 REDUCE TOUCH POINTS 3 INTEGRATE TECHNOLOGY IN
surfaces to prevent hospital acquired infections (HAI’s). THE CLEANING PROCESS
Material selection criteria continues to include non-porous Now is a great time to embrace the “less is more”
surfaces that are bleach cleanable, wipeable and easily mentality in our waiting and patient rooms to reduce • Ultraviolet light treatment and hydrogen
disinfected. the number of touch points that require cleaning.
• Avoid printed brochures and marketing peroxide misting can help provide a terminal
1 FACILITY MATERIAL UPGRADES
materials. By transitioning to digital display clean after traditional surface wiping. These
Cleaning regimens and procedures will continue boards that rotate through material. This
to influence material selection. Facility material reduces surface clutter that may get handled procedures must be done in a vacant room or
upgrades will be advanced to improve infection by anyone in the room, saves money on
control: printed marketing materials and delivers your by an individual equipped with the proper PPE
• Replace porous or worn surfaces at high message during pandemic situations when
printed materials are typically removed. or with the assistance of robots.
touch surfaces like furniture armrests and • Touchless / automatic fixtures such as room
countertops. lighting, sink faucets, soap and hand sanitizer • Clinics may add technologies more
• Replace curtains with glass or polycarbonate dispensers, toilet flushing devices and door
partitions hardware should be considered. common in hospitals like humidification
• Increase resilient flooring use in more areas. • Occupancy sensors for lights remove the
light switch touchpoint. systems and UV filtration in HVAC systems.
EUA Best Practice Recommendation
EUA recommends that facilities use manufac- • Occupant data collected from lighting controls

! turer resources like yearly product cleaning and systems can be leveraged to develop cleaning
maintenance training. Manufacturers provide this
service for free to ensure their products perform and disinfecting schedules.
to their fullest potential.
4 ANTIMICROBIAL ADDITIVES

Currently there are not enough consistent studies
that prove these options to be truly effective long
term without review and certification from the EPA
and FIFRA. Most coatings are surface applied rather
than integrated into the material, meaning that after
regular cleaning the antimicrobial performance
coating can wear off and be less effective.

EUA Best Practice Recommendation
Due to the lack of current and consistent testing
results and unclear environmental impacts, EUA

! does not recommend antimicrobial additives.
EUA recommends following the CDC’s
guidelines for proper disinfection along with
manufacturer recommended maintenance and
cleaning procedures.

Pandemic Considerations in Health Facility Design | EUA For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 18

PROVIDING SURGE CAPACITY FOR HIGH VOLUME EPISODES
INPATIENT NURSING UNIT

There are a variety of approaches to separating patient SMOKE COMPARTMENT A SMOKE COMPARTMENT B
populations in a pandemic. Ideally, infectious patients will be
treated in an infectious isolation unit or specially designated A SUPPORT C SUPPORT B C
alternative care facility. Hospitals with multiple bed units can
segregate patient populations on separate floors or wings.
Not all facilities will have this capability. In those cases,
strategies can be employed to separate non-infectious and
infectious patients in the same bed unit.

NON-INFECTIOUS COHORT INFECTIOUS COHORT

1 SEPARATE INFECTIOUS PATIENTS 3 VENTILATE D

Hospital bed units are typically divided into smoke Provide a negative pressure relationship in the A Co-locate the non-infectious patient cohort on one side
compartments to facilitate defend in place strategies infectious side of the unit. Temporary window units can of the unit or, ideally, on a separate floor. If needed,
for fire events. This employs a system of smoke tight be installed in each room to create isolation rooms or temporarily convert single bed patient rooms to semi-
walls and cross-corridor doors to divide the bed unit. the entire smoke compartment could be converted to private rooms with physical dividers between beds.
These same tools can be used to prevent the spread a negative pressure nursing unit.
of infection from one part of the unit to the other. Use B Infectious patients grouped on one half of the inpatient
cross-corridor doors and walls to separate patient 4 RE-PURPOSE DEPARTMENTS unit. Acuity adaptable rooms will help to more effectively
populations. Create temporary barriers and doors treat these patients.
where this is not feasible. Before resorting to temporary surge facilities
organizations may consider re-purposing lower acuity C Elevators in each smoke compartment serve to allow
2 PROVIDE SEPARATE ENTRANCES patient care spaces for increased patient beds. separation of infectious patients from non-infectious
Departments to consider include: patients and staff during a pandemic event.
Entry onto a bed unit could be by way of an elevator
or an on-grade entrance. Establish separate entry • Rehabilitation Departments D Ventilate with temporary window units or modify existing
points to each section of a bed unit. Provide more • Perioperative Rooms infrastructure to create a negative pressure environment.
than one elevator, so one can be designated for • GI Suites
infectious patients. Separate infectious patients from • Infusion Centers
non-infectious patients, supplies and staff. Elevators
with front and back entrances can promote on-stage These spaces are often equipped with medical gases
/ off-stage flow and help avoid bringing patients and and emergency power. Re-purposing spaces within
supplies through public spaces. the hospital should allow for more efficient use of
existing staff, infrastructure and support services.
Pandemic Considerations in Health Facility Design | EUA
For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 19

PROVIDING SURGE CAPACITY FOR HIGH VOLUME EPISODES
OUTPATIENT SURGE CAPACITY

Advanced planning can allow an outpatient setting to be part REGISTRATION SUPPORT CARE
of a strategy to deal with pandemic surge capacity. Thoughtful TEAM
early planning will allow the facility to accept increased WAITING C
acuity levels that shift from the hospital. This shift will allow COMPARTMENT A
more space in the hospital for pandemic related cases D A COMPARTMENT B
while providing a dedicated location for necessary, but less
critical procedures while protecting revenue streams. Each EXAM & B
enhancement must consider the initial cost increase versus the TREATMENT E
future flexibility and operational needs during a pandemic.
2 PROGRAM ENHANCEMENTS A Corridor widths should be at least six feet in
1 INFRASTRUCTURE ambulatory centers. If necessary, this allows for
Enhancing the outpatient program creates additional stretcher and bed traffic for higher acuity patients.
ENHANCEMENTS flexibility for organizations to provide care to low
Enhanced infrastructure should be considered to acuity patients in the outpatient setting rather than B Soiled workrooms in lieu of soiled holding rooms offer
allow business occupancy outpatient facilities to the hospital as well as: increased flexibility with a minimal space increase.
function more like hospitals during a pandemic. • Creates organizational flexibility
Depending on the facility size the increased first • Allows cases to shift from a hospital to a C Exam Rooms and doors should be sized larger than
costs can be relatively low and provide higher levels code minimum to provide additional space for more
of safety and lower system operating costs during temporary facility in order to more quickly acute patients.
normal operation. Enhancements to consider include: restart revenue generating procedures as the
pandemic subsides. D Waiting Areas should allow space for temporary
• Structural system upgrades for higher fire • Provides increased flexibility and space during layouts for social distancing, screening and patient
resistive ratings for floors and columns to normal operations. triage needs.
meet hospital standards.
E Staff Lockers/Showers included in outpatient clinics
• Mechanical upgrades to allow capacity for so staff can change/shower prior to going home to
increased air changes for hospital use. Some loved ones.
rooms may be set up as negative pressure
isolation rooms. For more information, contact: Paul Stefanski at 414.291.8198 or visit eua.com 20

• Electrical upgrades to provide emergency
power or the potential to add emergency
power on a temporary basis.

• Compartmentalization to isolate portions of
the building for infectious patients.

• Medical gas provisions may increase to
accommodate higher acuity levels during a
pandemic.

R E F E R E N C E S (1) http://meanstheworld.co/well-being/how-to-make-

ambulatory-care-centers-more-adaptable

Pandemic Considerations in Health Facility Design | EUA