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Safe and Resilient Healthcare Facilities

Considerations during design and operations

Chris Roberts – Global Solution Architect in Healthcare and International Director for the Health Care Institute (IFMA council)
Rahul Talwar – Global Business Development Manager for Healthcare

Disclaimer: The views expressed in this paper/presentation are the views of the author and do no necessarily reflect the
views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent.
ADB does not guarantee the accuracy of the data included in this paper/presentation and accepts no responsibility for
any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.
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Continuity of Services Pandemic Approach

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1. Is power outage the biggest concern?

66% of USA hospitals experienced a


power outage in the last 36 months,
with 12% having to close or relocate
patients1

Drought 4%
Earthquake 18%
Flooding 20%
Priorities' when
Hurricane 22%
designing and
Tornado 32%
building resiliency
Winter Storm 42%
Fire 53%
Power Outage 80%
Source: Health Facilities Management / ASHE 2018 Hospital Construction Survey
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2. Impact of an outage

Medical
Supplies
Sewage Clean
Disposal Water

Medical
Life Safety
Gases

Loss of
Food
Power
Clean Air
Storage

Electronic
Cooling Health
Records

Communic
Lighting
ation

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10 Things to consider

1 What are the core services that are needed to operate the
hospital?
• Select life safety and essential areas to be covered by backup
systems
• Design UPS on life support machines in areas of high
dependency

2 How quick do you need to restore power?


• IEC requires less than 0.5 seconds
• NEMA within 10 seconds

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10 Things to consider

3 How long do you need to operate as an ‘island’?


• Requirements normally recommend 48 to 96 hours
• New Royal Adelaide Hospital in Australia has enough fuel and
water supply to operate for 7 days
• Facilities in the USA are designing facilities with 18 day
capacity with full-power operations off the grid

4
Can you utilize renewable for energy and storage?
• Puerto Rico are building remote clinics with 100%
capacity from sustainable sources (solar)
• Solar and energy storage complement backup systems
• Microgrids offer resilience, redundancy and
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sustainability
10 Things to consider

5 Locate critical infrastructure services away from flood risk


areas – the basement!
• Texas suffered issues with clean water due to flooding of basement
pump rooms during Harvey
• Design fuel tanks and MV/LV equipment on second floor to reduce risk
of water damage – equipment that can operate in harsh environments
• Rehab clinic in Boston, MA has the first floor raised above the 500 year
old flood elevation in preparation for future rises in water levels

6 Fire’s are commonly caused from electrical faults


• Monitoring of bus bars for thermal temperatures and loading
of circuits
• Evacuation is the last resort, defend in place
• Fire sprinkle and suppression system
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10 Things to consider

7 The data center is a critical infrastructure


• Communications with other facilities is necessary to
coordinate patients and services
• Access to patient health records is essential to prescribe the
right treatment
• Cloud vs edge data center – disaster ready data bunkers

8 Thermal issues with arise in warm humid conditions


• Cooling will become critical for patient safety
• Essential to protect medical supplies
• CHP as part of Microgrid will provide cooling and
power
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10 Things to consider

9 Test, test and check


• Most common reason for the generator not starting is due to
batteries – check their health and functionality
• 2 day warning for Hurricane Harvey, this is not enough time to
run through all the safety checks - automate some of the checks
• Condition based and preventable maintenance regimes to focus
on high risk areas

Training and expertise with remote guidance


10 • Training and upskill local teams on how to respond
• Remote monitoring to support on site teams. UMRC NY
avoid a transformer explosion with remote diagnostics
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Conclusion

Resilience:
An organization’s ability to cope with situations with minimal losses.

Dependability:
A system’s capability to fulfil all operational performance
requirements, involving the concepts of reliability, maintainability
and availability

No man is an island unto himself and nor is a building, the


infrastructure serving the hospital is just as critical
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1 Various ways infections can be transmitted

1 Contact Transmission

2 Droplet Transmission

3 Airborne Transmission

4 Common Vehicle Transmission

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5 Vector Borne Transmission
10 Things to consider

1 How do you quarantine patients?


• Centers for Disease Control and Prevention specify the need for
AIIR (airborne infectious isolation rooms)
• Dedicated isolation wards – NHS and a 2009 influenza containment
report from IHF recommend this as a means to address
pandemics– locate away from public access and define staff and
equipment for ward

2 Is there an automated workflow to reconfigure


areas and wards?
• Modification of control strategy to negative pressure
to isolate areas
• Communication to staff and visitors to protect
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10 Things to consider

3 What is the ventilation control strategy?


• It may be a luxury to have mechanical ventilation system in
place
• Natural ventilation can achieve the air changes with help of
extraction fans – openable windows but not near traffic (air
quality and insect protection must be considered)

4
Essential the ventilation can achieve;
• Dilution to reduce contagion in the room
• Filtration to remove contagion outside of the facility
• Pressure management to ensure correct air pathway –
clear visual display for nursing staff is critical
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10 Things to consider

5 Hand washing is the basics


• Ensure highest level of hand washing is carried out
• Automate compliance with visual/audible alerts
• Hand washing stations positioned at ward and room entries

6 PPE for staff and visitors


• Surgical masks should be issued to patients to avoid
droplet transmission
• Use of ante rooms to prepare and remove safely
gowns, aprons and masks.
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10 Things to consider

7 Track the location of patients, assets and staff


• RTLS systems can detail where the patient has been in the
facility and which staff members and equipment they came
into contact with

8 Removal of waste and sterilization


• Safe removal of contaminated materials
• Automated guided vehicles (AGV’s) can be used to
collect soiled material to reduce cross contamination
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10 Things to consider

9 Test, test and check


• Monitoring of system operations to ensure compliance and
safety to others
• Testing of the systems to ensure they reconfigure safety if the
situation occurs

Training and preparedness


10 • Training of staff on how to respond in a situation
• Communication!

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