Preparing Your Facilities for the Future – COVID and Medical Office Buildings

This was originally posted in The MOB Scene at Revistamed.com.
A special thanks to Jacob Scoggins from GHLA for partnering with Kat Baxter to write this article.

In a post COVID-19 world, it is critical that building owners and operators establish trust with tenants-providers and patients by demonstrating a commitment to reduce risks of transmitting infectious diseases.  While so much of what is needed to combat a highly-contagious virus is operational in nature through a strong and robust infection prevention and control program, there are a myriad of architectural and interior design interventions that can be deployed.  

For owners, modifications to the physical plant are a tangible, immediate way to establish themselves as a preferred partner among tenants.  Additionally, buildings that have already been modified to reduce the risk of transmission will likely be leased at a premium compared to those that have not been upgraded.

Modifications to the physical plant can also help reduce the operational strains that have overburdened providers during this health epidemic.  Equally important, taking a proactive approach to reducing the risk of transmission will help establish trust with existing and potential patients. 

Building Entrances and People Movement 

• Increase Entrance Points to Reduce Congestion – 1

Building entrances tend to be an area of congestion in any building. Creating well-thought-out entrance and exit points that flow with the interior circulation paths is recommended to avoid undesired congregating. Dedicated staff entrances should also be provided that are separate from the main entrance to any building. Most importantly, adequate space for a pre-screening station must be created at the main entrance point. 

• Create a Circulation Flow to Reduce Patient Interaction – 2

Circulation through the floor plan will be critical to avoid or reduce close interaction between patients or building occupants. Operators should pay close attention to people entering and leaving specific areas of the facilities to avoid close contact. 

• Minimize Travel Distances – 3

Reducing the walking distance a person must travel to enter and exit the facility will minimize the exposure between patients and staff. Providing more convenient pathways for staff will also cut down on fatigue.

• Rethinking the Open Concept of Staff Use Areas – 4

Many facilities have reception, billing or staff work areas that are directly open to lobby or patient care areas. Operators should consider providing physical separation between such spaces by adding glass partitions. Care should be taken to create a feeling of openness while reducing staff to the exposure of potentially infected patients. 

• Wayfinding

Clear, strategically placed signage will help direct staff and patients through the desired circulation flow of the building.  It is critical that wandering is reduced in order to limit areas of exposure.

• Digital Displays at Exterior for Check-In – 5

Operators should consider installing exterior digital displays showing check-in wait times and order of patients. This system allows patients to wait inside their vehicles until it is their time to be seen. Digital displays could also act as marketing or information tool to provide updates or healthcare recommendations while people wait. 

• Drive-Through Screening and Testing Areas – 6

Where possible, it is recommended that buildings incorporate drive-through testing and vaccination to reduce the number of people who need to enter and exit the building.  

Lobbies and Areas of Gathering 

• Increase Lobby Space – 7

Lobbies and waiting rooms are typically a byproduct of the treatment areas within MOB’s. The minimum required floor area is given to increase space for billable functions. Providing additional waiting space will be critical to encourage social distancing while waiting. People will not feel comfortable waiting in the typical, cramped waiting rooms. Partition walls, both opaque and transparent, should be strategically placed to reduce large groups. 

• Furniture Selections and Placement – 8

Appropriately sized furniture with a well-designed interior layout will promote reasonable social distancing. 

• Flooring Design in Common Use Areas – 9

Flooring design can encourage social distancing and proper building circulation while creating unique and interesting floor patterns. 

• Tele-Medicine Space – 10

Telemedicine services reduces risks for staff and patients, however in order to have an effective consultation it is critical that a telemedicine room be thoughtfully designed to incorporate diffused and supplemental lighting to reduces shadows, allowing the patient to clearly identify facial features of the provider.  Finishes in the room should be neutral and a background wall in an accent color with a light reflectance value of 30-40% should be incorporated.

• Employee Lounges – 11

Providing handwashing facilities and locker space near the employee lounge entrance allows staff to recharge and consume meals with a reduced the possibility of disease transmission.  

Touchless Devices

• Hands-Free Sink Faucets – 12

While price points can vary based of features and functionality, all major manufacturers have hands-free sink faucets that can meet any design aesthetic. Battery powered units may be best for retrofit conditions, but hard-wired units are typically the best approach for new construction, as it reduces maintenance. 

• Light Switches with Occupancy Sensors – 13

Most spaces will require a simple replacement of a light switch with an all-in-one switch and occupancy sensor, but larger, more complicated spaces may require a sophisticated system. The design of the switch is also important. Seek products that are easy to clean with few projections or joints. 

• Programmable Wi-Fi Thermostats for HVAC

Wi-Fi thermostats are incredibly affordable and should be used where possible. These units allow for the temperature settings to be controlled by a smartphone without touching the device.

• Hands-Free Bathroom Accessories – 14

Providing hands-free paper towel dispensers, soap dispensers and sanitizer dispensers should be implemented. Many suppliers will provide devices for free if using their products. Placement of the devices should be carefully reviewed to avoid impacting ADA handicap accessibility clearances or proximity to electrical devices. 

• Implement a Building Automation and Control System for All Electrical, Plumbing and HVAC Systems

Building automation systems allow the building owner or facilities manager the ability to control building systems within the facility remotely. The cost of such a system varies based on the complexity and number of devices controlled. There are added energy reduction benefits with these systems that could save costs with lower energy and gas bills. 

Building Finishes 

• Easy to Clean and Sanitize Furniture Frames and Finishes – 8

In high traffic areas it is recommended that furniture frames are a metal finish with removable seating.  The removable seat allows for the entire chair to be easily cleaned and a metal finish will not deteriorate if harsh chemicals are used for sanitation.  Fabrics should be anti-microbial and bleach cleanable.

• Easy to Clean and Sanitize Floor Surfaces – 9

Sheet vinyl flooring is easy to clean, reducing the burden of maintenance staff while also eliminating seams where dirt and germs can live and spread.

• Install Paddle or Push/Pull Type Door Hardware – 15

These types of door hardware reduce the surface area required to grasp in order to operate and are typically easier to sanitize as there are fewer crevices. 

• Use Automatic Opening Doors Where Possible – 1

There are various options of automatic opening doors that can be used. Typically, horizontal sliding doors tend to work the best with less maintenance. However, in retrofits, or conditions where swing-doors are desired, there are surface mounted automatic openers that can be used. Occupancy sensors should be considered for swing-door configurations to ensure the opening door does not injure anyone within the swing clearance. 

HVAC Design 

• Properly Test and Balance the HVAC System

Airborne viruses can be better contained if the HVAC system is balanced correctly.  Quite often, systems are not balanced accurately, creating improper distribution of air.  Certified personnel should regularly test and balance the system to ensure the design air flow is met. 

• Increase the Total Air Changes Per Hour

Increasing the total air changes per hour replaces the interior air more frequently. This reduces the number of airborne particles and creates a fresher interior environment. 

• HEPA Filters or Filters with a Higher MERV Rating

Higher quality air filters remove a greater quantity of airborne particles.  While this may not directly reduce viral transmission, it does achieve the goal of creating a healthier indoor environment.

The challenges we’ve have faced over the last 6 months have been greater than anyone anticipated. The future holds great opportunities to implement design techniques that create better interior environments for both patients and staff. In order to future-proof their assets, it is vital that building owners and providers partner with experienced design professionals who understand the unique challenges of the healthcare environment.