COVID-19 and Healthcare Facilities: a Decalogue of Design Strategies for Resilient Hospitals
Keywords:
COVID19, Hospital, Healthcare facilities, Built Environment, flexibility, resilience, evidence based design, user centerdness, digital innovation, patient safetyAbstract
Background and aim: The COVID-19 pandemic has upended the global healthcare systems. The surge in infections and sick critically ill patients has tested the resilience of healthcare infrastructures and facilities forcing organizations to quickly adapt and embrace emergency solutions. The paper proposes a decalogue of design strategies applicable both to new hospitals and to the refurbishment of existing hospitals. Methods: The authors conducted observations at hospitals, during public health webinars and through experts working groups from March to May 2020. Results: In this commentary, the authors present a list of strategies for creating critical care surge capacity and exploring design strategies for healthcare design for resilient hospital facilities. The strategies are organized into two tiers: I) design and II) operations. The (I) Design phase strategies are: 1) Strategic Site Location; 2) Typology Configuration; 3) Flexibility; 4) Functional program; 5) User-centerdness. The (II) Operation phase strategies are: 6) Healthcare network on the territory; 7) Patient safety; 8) HVAC and indoor air quality; 9) Innovative finishing materials and furniture; 10) Healthcare digital innovation. Conclusions: Hospitals, health care systems, and institutions urgently need to assess their resources, identify potential bottlenecks, and create strategies for increasing critical care surge capacity. The COVID-19 pandemic disrupted healthcare operations and accelerated the processes of innovation and transformation. The design and operational strategies can enable the achievement of resilient hospital facilities. Further multidisciplinary researches is needed to validate the strategies empirically.
References
WHO. Hospital Readiness Checklist for COVID-19. World Health Organization Regional Office for, 2020. Available from: https://www.euro.who.int/__data/assets/pdf_file/0010/430210/Hospital-Readiness-Checklist.pdf
Impact of the Covid-19 pandemic on healthcare systems?. Deloitte France. Available from: https://www2.deloitte.com/fr/fr/pages/covid-insights/articles/impact-covid19-healthcare-systems.html [Accessed: 18th June 2020]
Barach P, Fisher SD, Adams MJ, Burstein GR, Brophy PD, Kuo DZ, et al. Disruption of healthcare: Will the COVID pandemic worsen non-COVID outcomes and disease outbreaks? Progress in Pediatric Cardiology. 2020; 101254. doi:10.1016/j.ppedcard.2020.101254
AIA’s COVID-19 Task Force Creates Design Guide to Retrofit Buildings for Alternative Care. ArchDaily. Available from: https://www.archdaily.com/937331/aias-covid-19-task-force-creates-design-guide-to-retrofit-buildings-for-alternative-care [Accessed: 21st June 2020]
Dell’Ovo M, Capolongo S, Oppio A. Combining spatial analysis with MCDA for the siting of healthcare facilities. Land Use Policy. 2018;76: 634–644. Available from: doi:10.1016/j.landusepol.2018.02.044
Dell’Ovo M, Frej EA, Oppio A, Capolongo S, Morais DC, de Almeida AT. FITradeoff Method for the Location of Healthcare Facilities Based on Multiple Stakeholders’ Preferences. In: Chen Y, Kersten G, Vetschera R, Xu H (eds.) Group Decision and Negotiation in an Uncertain World. Cham: Springer International Publishing; 2018. p. 97–112. doi:10.1007/978-3-319-92874-6_8
Capasso L, Faggioli A, Rebecchi A, Capolongo S, Gaeta M, Appolloni L, et al. Aspetti igienico-sanitari in ambito urbanistico: conflittualità nelle norme urbanistiche nazionali e locali in tema di sanità pubblica. Epidemiologia & Prevenzione. 2018;42(1): 60–64. doi:10.19191/EP18.1.P060.016
Miedema E, Lindahl G, Elf M. Conceptualizing Health Promotion in Relation to Outpatient Healthcare Building Design: A Scoping Review. HERD: Health Environments Research & Design Journal. 2019;12(1): 69–86. Available from: doi:10.1177/1937586718796651
Capolongo S, Cocina G, Peretti G, Pollo R, Gola M. Horizontality and verticality in architectures for health. TECHNE - Journal of Technology for Architecture and Environment. 2019;17: 152–160. Available from: doi:10.13128/Techne-24028
Capolongo S, Buffoli M, Nachiero D, Tognolo C, Zanchi E, Gola M. Open building and flexibility in healthcare: strategies for shaping spaces for social aspects. Annali dell’Istituto Superiore di Sanità. 2016;52(1): 63–69.
Mosca EI, Herssens J, Rebecchi A, Capolongo S. Inspiring architects in the application of design for all: knowledge transfer methods and tools. Journal of Accessibility and Design for All. 2019;9(1). doi:10.17411/jacces.v9i1.147
Mosca EI, Capolongo S. Towards a Universal Design Evaluation for Assessing the Performance of the Built Environment. Transforming our World Through Design, Diversity and Education. IOS Press Ebooks; 2018. p. 771–779.
Brambilla A, Capolongo S. Healthy and Sustainable Hospital Evaluation—A Review of POE Tools for Hospital Assessment in an Evidence-Based Design Framework. Buildings. Multidisciplinary Digital Publishing Institute; 2019;9(4): 76. doi:10.3390/buildings9040076
Ulrich RS, Zimring C, Zhu X, DuBose J, Seo H-B, Choi Y-S, et al. A Review of the Research Literature on Evidence-Based Healthcare Design. HERD: Health Environments Research & Design Journal. 2008;1(3): 61–125. doi:10.1177/193758670800100306
Elf M, Anåker A, Marcheschi E, Sigurjónsson Á, Ulrich RS. The built environment and its impact on health outcomes and experiences of patients, significant others and staff—A protocol for a systematic review. Nursing Open. 2020; doi:10.1002/nop2.452
Buffoli M, Rebecchi A, Gola M, Favotto A, Procopio GP, Capolongo S. Green SOAP. A Calculation Model for Improving Outdoor Air Quality in Urban Contexts and Evaluating the Benefits to the Population’s Health Status. In: Mondini G, Fattinnanzi E, Oppio A, Bottero M, Stanghellini S (eds.) Integrated Evaluation for the Management of Contemporary Cities. Cham: Springer International Publishing; 2018. p. 453–467. doi:10.1007/978-3-319-78271-3_36
Capolongo S, Mauri M, Peretti G, Pollo R, Tognolo C. Facilities for Territorial Medicine: the experiences of Piedmont and Lombardy Regions. TECHNE - Journal of Technology for Architecture and Environment. TECHNE - Journal of Technology for Architecture and Environment; 2015; 230-236 Pages. doi:10.13128/TECHNE-16128
Odone A, Saccani E, Chiesa V, Brambilla A, Brianti E, Fabi M, et al. The implementation of a Community Health Centre-based primary care model in Italy. The experience of the Case della Salute in the Emilia-Romagna Region. Annali dell’Istituto Superiore Di Sanita. 2016;52(1): 70–77. doi:10.4415/ANN_16_01_13
Mauri M. The future of the hospital and the structures of the NHS. TECHNE - Journal of Technology for Architecture and Environment. 2015; 27–34. doi:10.13128/Techne-16100
Oppio A, Buffoli M, Dell’Ovo M, Capolongo S. Addressing Decisions About New Hospitals’ Siting: A Multidimensional Evaluation Approach. Ann Ist Super Sanita. 2016;52(1): 78–87.
Gola M, Fugazzola E, Rebecchi A. Mapping and Programming Healthcare Services for New Health Perspectives. In: Capolongo S, Gola M, Rebecchi A (eds.) Healthcare Facilities in Emerging Countries. Cham: Springer International Publishing; 2018. p. 89–111. doi:10.1007/978-3-319-72398-3_6
Faroldi E, Fabi V, Vettori MP, Gola M, Brambilla A, Capolongo S. Health Tourism and Thermal Heritage: Assessing Italian Spas with Innovative Multidisciplinary Tools. Tourism Analysis. 2019;24(3): 405–419. doi:10.3727/108354219X15511865533121
Brambilla A, Maino R, Mangili S, Capolongo S. Built Environment and Alzheimer. Quality Evaluation of Territorial Structures for Patients with Dementia. In: Bevilacqua C, Calabrò F, Della Spina (eds.) New Metropolitan Perspectives. Knowledge Dynamics and Innovation-driven Policies Towards Urban and Regional Transition. Switzerland: Springer International Publishing; (in press).
Capolongo S, Rebecchi A, Buffoli M, Appolloni L, Signorelli C, Fara GM, et al. COVID-19 and Cities: from Urban Health strategies to the pandemic challenge. A Decalogue of Public Health opportunities. Acta Bio Medica Atenei Parmensis. 2020;91(2): 13–22. doi:10.23750/abm.v91i2.9615
Brambilla A, Rebecchi A, Capolongo S. Evidence Based Hospital Design. A literature review of the recent publications about the EBD impact of built environment on hospital occupants’ and organizational outcomes. annali di igiene medicina preventiva e di comunità. 2019;(2): 165–180. doi:10.7416/ai.2019.2269
Marsilio M, Prenestini A. Making it happen: Challenges and transformations in health care processes, people management, and decision-making. Health Services Management Research. 2020;33(2): 53–54. doi:10.1177/0951484820906314
Mosca EI, Herssens J, Rebecchi A, Strickfaden M, Capolongo S. Evaluating a Proposed Design for All (DfA) Manual for Architecture. In: Di Bucchianico G (ed.) Advances in Design for Inclusion. Cham: Springer International Publishing; 2019. p. 54–64. doi:10.1007/978-3-319-94622-1_6
Jamshidi S, Pati D. A Narrative Review of Theories of Wayfinding Within the Interior Environment. HERD: Health Environments Research & Design Journal. 2020; 193758672093227. doi:10.1177/1937586720932276
Gola M, Settimo G, Capolongo S. Indoor Air Quality in Inpatient Environments: A Systematic Review on Factors that Influence Chemical Pollution in Inpatient Wards. Journal of Healthcare Engineering. 2019;2019: 1–20. doi:10.1155/2019/8358306
Settimo G. Existing Guidelines for Indoor Air Quality: The Case Study of Hospital Environments. In: Capolongo S, Settimo G, Gola M (eds.) Indoor Air Quality in Healthcare Facilities. Cham: Springer International Publishing; 2017. p. 13–26. Available from: doi:10.1007/978-3-319-49160-8_2
Correia G, Rodrigues L, Gameiro da Silva M, Gonçalves T. Airborne route and bad use of ventilation systems as non-negligible factors in SARS-CoV-2 transmission. Medical Hypotheses. 2020;141: 109781. doi:10.1016/j.mehy.2020.109781
Li Y, Leung GM, Tang JW, Yang X, Chao CYH, Lin JZ, et al. Role of ventilation in airborne transmission of infectious agents in the built environment ? a multidisciplinary systematic review. Indoor Air. 2007;17(1): 2–18. doi:10.1111/j.1600-0668.2006.00445.x
Moscato U, Borghini A, Teleman AA. HVAC Management in Health Facilities. In: Capolongo S, Settimo G, Gola M (eds.) Indoor Air Quality in Healthcare Facilities. Cham: Springer International Publishing; 2017. p. 95–106. doi:10.1007/978-3-319-49160-8_9
Astley P, Capolongo S, Gola M, Tartaglia A. Operative and design adaptability in healthcare facilities. TECHNE - Journal of Technology for Architecture and Environment. 2015; 162–170. doi:10.13128/Techne-16118
Joppolo CM, Romano F. HVAC System Design in Healthcare Facilities and Control of Aerosol Contaminants: Issues, Tools, and Experiments. In: Capolongo S, Settimo G, Gola M (eds.) Indoor Air Quality in Healthcare Facilities. Cham: Springer International Publishing; 2017. p. 83–94. doi:10.1007/978-3-319-49160-8_8
van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New England Journal of Medicine. 2020;382(16): 1564–1567. doi:10.1056/NEJMc2004973
Bianchi CL, Sacchi B, Capelli S, Pirola C, Cerrato G, Morandi S, et al. Micro-sized TiO2 as photoactive catalyst coated on industrial porcelain grès tiles to photodegrade drugs in water. Environmental Science and Pollution Research. 2018;25(21): 20348–20353. doi:10.1007/s11356-017-9066-6
Capolongo S, Buffoli M, Riva MG, Tognolo C, Oppio A. Hygiene and emergency. Considerations and proposals for improving hygiene and health features of Advanced Medical Post. Annali Di Igiene: Medicina Preventiva E Di Comunita. 2012;24(5): 389–396.
Zanelli A, Campioli A, Monticelli C, Viscuso S, Giabardo G. Novel Textile-Based Solutions of Emergency Shelters: Case Studies and Field Tests of S(P)EEDKITS Project. In: Aste N, Della Torre S, Talamo C, Adhikari RS, Rossi C (eds.) Innovative Models for Sustainable Development in Emerging African Countries. Cham: Springer International Publishing; 2020. p. 111–122. doi:10.1007/978-3-030-33323-2_10
Buffoli M, Nachiero D, Capolongo S. Flexible Healthcare Structures: Analysis and Evaluation of Possible Strategies and Technologies. Annali di Igiene Medicina Preventiva e di Comunità. 2012;24(6): 543–552.
Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. Journal of Hospital Infection. 2020;104(3): 246–251. doi:10.1016/j.jhin.2020.01.022
Bassi A, Ottone C, Dell’Ovo M. Minimum environmental criteria in the architectural project. Trade-off between environmental, economic and social sustainability. Valori E Valutazioni. 2019;22: 35–45.
Capolongo S, Buffoli M, di Noia M, Gola M, Rostagno M. Current Scenario Analysis. In: Capolongo S, Bottero MC, Buffoli M, Lettieri E (eds.) Improving Sustainability During Hospital Design and Operation. Cham: Springer International Publishing; 2015. p. 11–22. doi:10.1007/978-3-319-14036-0_2
Settimo G, Bertinato L, Bonadonna L, D’Ancona P, Santarsiero A, Soggiu ME. Indicazioni ad interimper la prevenzione e gestione degli ambienti indoor in relazione alla trasmissione dell’infezione da virus SARS-CoV-2. Istituto Superiore di Sanità. Report number: Version of April 21, 2020., 2020 May. Available from: https://www.iss.it/documents/20126/0/Rapporto+ISS+COVID-19+n.+5_2020+REV.pdf/2d27068f-6306-94ea-47e8-0539f0119b91?t=1588146889381
Lanbeck P, Ragnarson Tennvall G, Resman F. A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance. BMC Health Services Research. 2016;16(1): 311. doi:10.1186/s12913-016-1565-5
Azzopardi-Muscat N, Brambilla A, Caracci F, Capolongo S. Synergies in Design and Health. The role of architects and urban health planners in tackling key contemporary public health challenges. Acta Bio Medica Atenei Parmensis. 2020;91(3-S): 9–20. doi:10.23750/abm.v91i3-S.9414
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