Independent Study

Surge Implementation of Airborne Infection Isolation Room (AIIR) Facilities for COVID-19 Treatment & Recovery Approach for a Transportable & Reusable AIIR Facility in a suburban University Campus Setting :: Miami University, Ohio Independent Study Graziella Pilkington May 2020

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ABOUT THIS DOCUMENT This document illustrates an approach to rapid (“surge”)

The author evaluates several industry Case Studies of surge health

design/implementation of reusable modular healthcare

care facility implementation in international infectious disease

facility capacity in response to airborne viral pandemic.

context and evaluates these Case Studies for applicability to the

The proposed application is created to be temporarily

suburban University Campus Setting use case.

implemented in geographic infectious disease hotspots in

The author then presents her approach for a Transportable/

Suburban and College-towns across the United States when

Reusable Airborne Infection Isolation Room Facility

local hospitals need overflow Isolated Intensive Care Units and

or “Temp-AIIR”.

where Airborne Infection Isolation Rooms (AIIR)1 are required.

Design and development considerations for designers/

When the pandemic disease in the hotspot locality is under

implementers of Temp-AIIR facilities are summarized.

control and there are enough regular hospital beds to provide

Resources, references, and further readings are provided

for confirmed positive patients, this facility can be transported

in the Appendix.

to the next hotspot location.

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CONTENTS

What are Airborne Infection Isolation Rooms (AIIR)?

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What are Airborne Infection Isolation Rooms (AIIR)?

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Design/Implementation Challenge: Surge Implementation, Transport, Reusability

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Negative pressure isolation room, an AIIR is a singleoccupancy patient-care room used to isolate persons with a suspected or confirmed airborne infectious disease.

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MASS DESIGN GROUP: architectural firm

Environmental factors are controlled in AIIRs to minimize the transmission of infectious agents that are usually transmitted from person to person by droplet nuclei associated with coughing or aerosolization of contaminated fluids.

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JUPE: hospitality

AIIRs should provide

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CURA PODS: shipping container module

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negative pressure in the room (so that air flows under the door gap into the room); and

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an air flow rate of 6-12 ACH (6 ACH for existing structures, 12 ACH for new construction or renovation); and

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direct exhaust of air from the room to the outside of the building or recirculation of air through a HEPA filter before returning to circulation (MMWR 2003; 52 [RR-10]; MMWR 1994; 43 [RR-13]). 2

Industry Case Studies – International Experience

Approach for a Transportable & Reusable AIIR Facility (Temp-AIIR) in a suburban University Campus setting: Miami University, Ohio

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Design Considerations

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Resources

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DESIGN/IMPLEMENTATION CHALLENGE

Create a surge implementation module for a small population in University/College town setting (base case: ~21,000 students/faculty/staff Miami OH)3 .

Due to the highly contagious characteristics and mobility of the virus, the design/build solution or module must be transportable and implemented wherever necessary– domestic or international.

The designed module must also be affordably reusable and provide long term economic value.

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source: MASSDESIGNGROUP.ORG/COVIDRESPONSE

CASE STUDY: MASS DESIGN GROUP MASS Design Group, an architectural firm based in Boston, MA has specialized in healthcare designs and infectious disease control specifically in developing countries for the past 10 years.

Plan (right) is a design for a temporary tent clinic, highlighting specific controls to limit the spread of contagion within the makeshift facility.

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MASS highlights the importance of major elements in the design such as foot traffic circulation/congestion, material selection, ventilation, resilience, and dignity for patients.

Tents can be erected on a variety of sites, but this design would be best for a very temperate climate. This is because of its lack of mechanical equipment for heating and cooling capabilities.

The design relies on natural ventilation to dilute the contaminated air. Natural ventilation is a great alternative for a lower budget and temperate climate.

This module can be assembled very quickly but the medical equipment may be coming from another source which would slow down the process of opening the facility for use. It would be ideal for all the medical equipment to come as a package with the facility.

Patients are separated by partitions but there are still 9 beds in each ward, making the healthcare workers more vulnerable to becoming ill.

MASS also has resources on Spatial Strategies for Restaurants in Response to COVID-19 and Redesigning Hospital Spaces on the Fly to Protect Healthcare Workers.

CASE STUDY: MASS DESIGN GROUP

source: MASSDESIGNGROUP.ORG/COVIDRESPONSE

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CASE STUDY: JUPE Jupe is a flat-pack housing module. The designs are beautiful and dignified and can be used for several causes. The flatpack system means that the unit can fold down for transportation.

Up to 24 units can fit on a 40’ flat bed. This is an extremely efficient system. Jupe offers three different units: Rest, Care, and Plus.

source: jupe.com

The design team includes veteran innovators across industries and professions including healthcare professionals, frontline ICU and ER doctors, architects, crisis response experts, auto designers, IOT experts, and modular building innovators.

The footprint of the REST is 8.5’x13’ (111 sq ft), slightly smaller than a standard 2-person dorm room. The CARE is twice that (222 sq ft) and up to 10 units can be connected as needed can be added side-by-side to make a bigger space.

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source: jupe.com

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Jupe Plus, “A Stand-Alone ‘light intensive care unit’ for patients in critical care.” is currently being designed but it will address the following: Donning and doffing chamber; Ventilator hookups; Toilet / sink / heat & A/C; Negative pressure capable; Simple, sanitary black-water disposal; Solar-powered / battery powered; Easy-access external pump/monitoring includes JUPE REST features: hospital or queen bed; Wi-Fi/network and IOT-ready; Air monitoring; Easy to clean/sanitize after use; Noise reducing machine; Climate controlled; Off-grid/micro-grid capable These units work autonomously, meaning there is no program designed for these units to work within a site or in a relationship to a hospital or community.

Healthcare workers would have to don/doff before assisting every patient. This is an inefficient circulation and program method.

Jupe “Rest”, the base single bed unit (no medical equipment) with soft top are $15,000 and up.

This module would be best for wealthy locations, where ICUs are not available due to a surge situation. The healthcare workers might be private providers only caring to a few patients.

The climate may need to be temperate, although there are heating cooling capabilities, the Jupe units do not seem to have insulation. There are also no windows designed in these modules which might effect patients and workers health– both physically and mentally. It is unclear if the equipment is pre-installed and shipped within the flatpack system of if they are installed separately. source: jupe.com

CASE STUDY: JUPE 5/15/2020

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CASE STUDY: CURAPODS Connected Unit for Respiratory Ailments (CURA) is a global open-source design using repurposed shipping containers to create emergency response plug-in Intensive-Care Units (ICU).

CURA was designed by an international task force including designers, Carlo Ratti Associati with Italo Rota, engineers at Jacobs, and health tech company Phillips for medical supply equipment.

Beth Israel Deaconess Medical Center Boston, MA source: senseable.mit.edu/cura-configurator source: curapods.org

The units work autonomously and are connected by an inflatable corridor. They arrive to the site fully equipped with all necessary medical supplies and can be rapidly deployed. The configuration of the units are completely flexible, and adaptable to the site. The module can be connected to an existing hospital, or work as its own field hospital

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Cura can be deployed and occupied extremely quickly but the manufacturing of the units to become fully equipped may take some time and involve skilled workers.

This module can be delivered to the site, with minimal construction, like tents. But unlike tents, this module does not put healthcare workers in vulnerable situations as it has biocontainment mechanical systems– a negative pressure ventilation system between the units and the inflatable corridor, so that no contaminated air is recirculated.

Although this module is very efficient by rapid deployment, and the reuse of shipping containers, it is not efficient in terms of transportation. Only one or two units can fit on a flat bed truck.

Meaning it would take up to 24 trucks to deliver 24 units, creating tons of carbon emissions in the process.

Hygiene is also a negative factor of this module as it is unclear where patients and workers use hygiene facilities and handwashing stations and if they are at separate locations. It is also unclear where the entrance and exits are for patients and staff especially regarding means of egress.

Cura would be best fit in a location adjacent to a hospital, where appropriate hygiene precautions can take place before entering the temporary facilities. As well as spaces for staff to rest are available.

CASE STUDY: CURAPODS

source: curapods.org

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PILKINGTON Approach for a Transportable & Reusable AIIR Facility

Suburban University Campus Setting :: Miami University, Ohio

1 12 72 144

QUAD UNITS AIIRs ICU BEDS

adaptable | transportable | reusable

PROGRAM OVERVIEW 5/15/2020

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CONTEXT •

AIIR installation is fast and easy. With little to no construction skills, erected on-site by simply unfolding the flat-pack system and connecting the assembly together.

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All units can be disassembled, stacked, and shipped with equipment securely packed inside.

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The AIIR dimensions are approximately 20’-0” x 10’-0” x 8’-0” with an octagonal circulation space/nurse’s station with a width of 24’-0” (see plan on pgs. 14-15 for details).

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Each unit will provide two ICU beds, and a compact bathroom.

There is also a separate worker’s station unit for staff entrance/exits, donning/doffing, and storage.

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COVID-19 patients are delivered via ambulance on central oneway drive, connected to unit garage entrance

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Units are linked by a covered walkway over site’s existing sidewalks.

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Extra supplies are stored in adjacent campus health center

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Hygiene and resting facilities are available for staff on campus in the adjacent rec. center and dormitories.

SITE 5/15/2020

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1 staff only entrance/exit vestibule separated from donning and doffing stations Each worker’s station serves 3 AIIRs, connected by covered walkways over the existing sidewalks.

1 2

2 cubbies/staff donning spaces for personal belongings and storage and to put on PPE

3 staff doffing space to take off PPE and dispose of properly

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5

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4 handwashing station 5 to AIIR 6 storage for medical supplies and PPE

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7 to walkway 8 Infectious Disease Zone (IDZ)

WORKERS STATION 5/15/2020

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1 Garage door for ambulance entrance

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2 Nurse’s station with task lighting, power outlets on floor. Easily cleanable surface.

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3 Space for Air Handling Unit (AHU)

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4 Full bathroom 5 Outlets and light controls with dimming

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6 Separation of beds with partition wall ceiling height

7 Unit vestibule 8 Vent at each head of bed

AIIR UNITS 5/15/2020

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1 6 ’x 2’ clerestory windows for natural light & privacy 2 covered walkways between units over existing sidewalks

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3 (8) hanging LED lights at 7’ – 11’ daylight and occupation/vacancy sensors for energy savings.

4 garage door at ambulance entrance

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3

BUILDING SECTIONS 5/15/2020

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OTHER USES

• Transport to hotspot locations

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When the AIIRs are no longer needed in Oxford, they can be easily disassembled and transported to the next hotspot location. The module would be best for another college town type site.

• Student quarantine This module can be transformed into student quarantine housing for offcampus students arriving back to campus after traveling or break. This system will help to monitor student’s symptoms and whereabouts during their quarantine period.

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Homeless/Disaster Relief/Refugee Housing AIIRs can easily be transported and converted into housing after minor interior cosmetic changes.

2 Beds 1 Bath or combine units.

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Hotels Depending on a budget and buyer, the units can be transformed into “getaway” boutique hotels as they can be set on any site.

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DESIGN CONSIDERATIONS

PROGRAM

STAFF SAFETY

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Separate entrances/exits for patients and staff

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Ambulance entrance

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donning/doffing areas

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Handwashing stations (need access to water)

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Storage for PPE and medical supplies

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Means of egress

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One-way traffic

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Abundant space for social distancing

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Rest areas for staff

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Negative pressure ventilation system to avoid the recirculation of contaminated air

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PPE available and accessible

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Space for social distancing

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Places for rest & breaks

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Appropriate accommodations for hygiene, sleeping, mental and physical health

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Lockers for personal belongings to be stored while working

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DESIGN CONSIDERATIONS INSULATION

HVAC

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Units should be insulated with an appropriate R-value for the climate conditions and integrated with the ventilation system

relation to the corridor or adjacent room. Contaminated air

(passive / mechanical)

should be directed outside– not recirculated.

Tents will not have insulation– best for temperate climate,

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If a negative pressure situation is not possible, dilution

using natural ventilation and standalone HEPA air scrubbers.

strategies are important using natural cross ventilation in

Shipping containers can have Extruded Polystyrene Foam (EPS)

combination with stand alone air scrubbers with HEPA filters.

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easily installed.

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Infectious disease units should run on negative pressure in

Each AIIR will have its own Packaged Single Zone Air Handling

Temporary AIIRs can be designed using Structurally Insulated

Unit (AHU) with a HEPA filter and a single zone Mini-Split for

Panels (SIPS)

heating and cooling. These will control the temperature, humidity, pressurization, and air quality of each unit.

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The AHU has a space inside the unit next to the bathroom.

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The bathroom will also have its own exhaust.

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DESIGN CONSIDERATIONS PRIVACY

HYGIENE •

Separate facilities for patients and staff

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Clean facilities in between uses

Clerestory windows– no views inside from exterior

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Full compact bathroom in each AIIR for patients only

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Partitions between patients

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Handwashing station in Worker’s station

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Vestibule and door between circulation space and AIIR

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Staff showers and restrooms in adjacent Rec. Center and dormitories

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Lockers provided for patients and staff

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LIGHTING

REUSE

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Clerestory windows will provide patients and healthcare workers with plenty of natural daylight and privacy.

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Design for temporary ICUs, should have a post-pandemic plan

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No-touch occupancy sensors will light the central space

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Options are homeless shelters, disaster relief housing, boutique

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No-touch on/off switches with dimmer capability will light the units

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Task lighting will light beds for examination, handwashing stations, and nurse’s desks.

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Primary light source for AIIRs central space are (8) hanging LED lights at 12’ 5/15/2020

hotel rooms, tiny homes, community centers, farmers markets •

If units are not needed or implemented elsewhere, they should be stored efficiently and effectively for later use.

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Notes 1 Jeanne Anderson, Andrew Geeslin, Andrew Streifel, Airborne Infectious Disease Management, Minnesota Department of Health, Feb. 2007 2 CDC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007) 3 Demographics, City of Oxford www.cityofoxford.org/departments/economic-development/demographics

References -

“Rules of Thumb for Limiting Contagion in Makeshift Facilities.”, MASS Design Group, 13 Apr. 2020.

Jeff Wilson, Cameron Blizzard, Esther Choo, Cameron Sinclair, Jupe Health, April 2020 “COVID-19: Open-Source Design Helps Turn Shipping Containers into Intensive-Care Units at Record Speed.” Curapods, 18 Apr. 2020, curapods.org.

Sources -

“Coronavirus Treatment Center Sites with Testing”, Build Health International, 15 Apr. 2020, buildhealthinternational.org/covidinfrastructure-resources

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“Furniture and Equipment for COVID-19 Tent Clinics.xlxs” MASS Design Group, Mar. 2020

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A. Bhatia, “HVAC Design for Healthcare Facilities”, CED Engineerin

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World Health Organization (WHO) Centers for Disease Control and Prevention (CDC) The New York Times National Public Radio The Washington Post The Wall Street Journal 5/15/2020

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