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A review of post pandemic healthcare design
15 Jul 2022
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Priya Priya Boby
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Prof Dr Prabjot Prof Dr Prabjot Sugga
Priya Priya Boby
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Disciplines
Architecture
Interior design (interior architecture)
Keywords
Covid-19 Virus
Pandemic Resilient Hospital
Healthcare
Healthcare Facilities Post Pandemics
Future Pandemic

Track: 

Future-proofing

Abstract

The emergence of the COVID-19 virus has forced humanity to rethink the design of hospitals and prepare for probable future outbreaks. Even before the pandemic, there was a causal link between the design of hospitals and the spread of nosocomial infections. Also, previous studies have revealed correlations between climate change and the increased rate of the spread of infectious diseases. Hence, this review created a framework of strategies for pandemic resilient and sustainable hospitals while emphasising the role of architects in health promotion. The study conducted a qualitative content analysis of existing studies on the design of healthcare facilities post-pandemic to build the framework of strategies. The research was organised into short, medium and long term measures for pandemic resilient design. The study has demonstrated that the framework for the space planning, ventilation and material specification of hospitals must be revised for pandemic resilient hospitals. The findings reveal that most of the design strategies that can control the spread of infection in a healthcare facility could also be a panacea for decreasing the carbon footprint of the hospitals. Nonetheless, the paper has established the need for further interdisciplinary study on design strategies for impending pandemics and applicable to all building typologies.

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Type of the Paper: Peer-reviewed Conference Paper / Full Paper

Track title: A Review of Post Pandemic Design of Hospitals

A Review of the Framework for Post Pandemic Design of Hospitals

Priya Boby 1 Prof Dr. Prabjot Sugga2 Prof Dr. Anil Dewan3

1 PhD scholar SPA Delhi1; priya.boby@outlook.com; 0000-0001-5158-6193

2 Associate Professor, School of Planning and Architecture, New Delhi

3 HOD department of Architecture, School of Planning and Architecture, New Delhi

Names of the track editors:

Firstname Lastname

Firstname Lastname

Names of the reviewers:

Firstname Lastname

Firstname Lastname

Journal: The Evolving Scholar 

DOI:10.24404/620f68305d583d481a24ddbf

Submitted: 15 Jul 2022

Accepted:

Published:

Citation: Boby, P., Dewan, P. & Sugga, P. (2022). A review of post pandemic healthcare design [preprint]. The Evolving Scholar | ARCH22.

This work is licensed under a Creative Commons Attribution BY (CC BY) license. 

© 2022 [Boby, P., Dewan, P. & Sugga, P.] published by TU Delft OPEN on behalf of the authors.

Abstract: The emergence of the COVID-19 virus has forced humanity to rethink the design of hospitals and prepare for probable future outbreaks. Even before the pandemic there was a causal link between the design of hospitals and the spread of nosocomial infections. Also, previous studies have revealed correlations between climate change and the increased rate of the spread of infectious diseases.  Hence, this review created a framework of strategies for pandemic resilient and sustainable hospitals while emphasising the role of architects in health promotion.  The study conducted a qualitative content analysis of existing studies on the design of healthcare facilities post pandemic to build the framework of strategies. The research was organised into short, medium and long term measures for pandemic resilient design. The study has demonstrated that the framework for the space planning, ventilation and material specification of hospitals must be revised for pandemic resilient hospitals. The findings reveal that most of the design strategies that can control the spread of infection in a healthcare facility could also be a panacea for decreasing the carbon footprint of the hospitals. Nonetheless, the paper has established the need for further interdisciplinary study on design strategies for impending pandemics and applicable to all building typologies.

Keywords: Covid-19 virus, pandemic resilient hospital, health promotion, healthcare facilities post pandemics, future pandemics

1. Introduction

1.1 What is the need for the study  

The correlation between wellbeing and architecture was identified before the COVID-19 pandemic (Guenther & Vittori, 2008 & Logan et al., 2010). In fact, in every 100 hospitalized patients 7 in developed countries and 10 in developing countries get 1 healthcare-associated infection (WHO,2020). The past pandemics inspired sanitary, housing and urban planning reforms while SARS-CoV-1 initiated changes in building design and drainage in Hong Kong(Pinheiro & Luís, 2020).

The COVID-19 infected patients in Wuhan, China, may have spread the virus in hospitals, which progressed to stress the healthcare infrastructure in 2020(Capolongo et al., 2020c; Dietz et al., 2020). Eventually, the fear of contracting COVID-19 in hospitals, led to patients postpone their hospital appointments (Emmanuel, 2020).

The pandemic timeline depicts a surge in the frequency of infectious pandemics. Since 2000, humanity has faced 5 pandemics while in the 20th century only 4 pandemics occurred (Le Pan, 2020). Studies have demonstrated that global warming has changed the epidemiology of the vectors and caused rapid mutations(Epstein, 2002; Priyadarsini et al., 2020; Wu et al., 2016). Also, the changes in climate patterns have modified crop yield patterns and accelerated the development of the pathogens (Priyadarsini et al., 2020). In fact, on 13th May, 2022, the Monkeypox virus was detected in 12 countries, emphasizing the need for pandemic resilient hospitals (WHO, 2022).

1.2 Current gap in the Literature

The study created a framework of strategies for pandemic resilient and sustainable design of the hospitals while highlighting the role of architects in health promotion. Previous research explored design guidelines post COVID-19 (Amran et al., 2022a; Emmanuel, 2020; Luis, 2020) but further research is needed to strengthen the framework of health promoting design (Amran et al., 2022a; Miedema et al., 2019). This review creates a hierarchical framework for pandemic resilience and sustainable hospitals. 

2. Theories and Methods

The Dimensions database identified 155 architecture journals using the search string “post pandemic design of hospitals” published from 2010 to 2022. Figure 1 shows the bibliometric network generated using the VOS viewer which depicts the common keywords were Covid, space and architecture. (Navaratnam et al., 2022) utilized a similar methodology to visualize literature on healthy buildings. Hence, this research elaborates on the keywords: pandemic, architecture, space and ventilation to create a framework for pandemic resilient hospitals.

 Figure 1 Bibliometric network for keywords “post pandemic design of hospitals Source: VOS viewer

The PRISMA technique was used to understand the literature review (figure 2). The criteria for paper selection were that the research should focus on the design of hospitals and be published in the past decade. The themes ventilation, space planning and
materials to address the most pressing problems regarding hospital design.

Figure 2 PRISMA technique (Source: authors)

Figure 3 Steps in the methodology (Source: authors)

The authors have produced a graph depicting the duration for the strategies from short, medium and long term measures. The pandemic resilience and sustainability is quantified on the scale 0 to 5, 0 depicts the least contribution; 1 reduces the risk of spread; 2 signifies reduction of transmission among people, 3 means reduce transmission though surface and 5 depicts pandemic resilient solutions that are sustainable.

3 Results

3.1 History of past epidemiological disease

Epidemiological disease Regions affected Social behavior and recommendations Built environment response Citation
Infections ailments in Roman empire _ _

Introduction of infrastructure.

Isolation tents near hospitals

(Belfiglio, 2017; Pinheiro & Luís, 2020)
Black death in 14th century Worldwide pandemic with mortality of 50–75 million people worldwide. The quarantine protocol was enforced and travel was restricted. Creation of dedicated hospitals to separate the patients infected with plaque. (Murphy et al., 2022; Pinheiro & Luís, 2020)
Cholera in 19th century Between 19th and 20th century it caused millions of deaths. Quarantine measures were enforced at the ports.

More focus on sanitation with improved sewerage systems.

Florence Nightingale proposed pavilion models with more ventilation, daylight and hygiene.

(Emmanuel, 2020)Tappero  and Tauxe (2011)
Tuberculosis(TB) Emerged in the 19th century with mortality rate of 2 billion people. Social isolation was enforced.

Sanatorium was introduced for treating patients with TB.

The usage of natural and mechanical ventilation. Install UVGI fixtures with ceiling fans for air mixing. 

WHO (2018); Pinheiro and Luis (2020)
1918 influenza pandemic (influenza) Mortality rate of 50 million people during 1918-1919. Social distancing and use of masks. The gyms, state armouries, parish halls and other facilites were converted into wards. (Horimoto & Kawaoka, 2005)
SARS-Cov-1 Prevailed between 2003-2004 with infection rate of 8000 cases and 800 mortalities. Quarantine and social distancing Improved ventilation and drainage systems. (Pinheiro & Luís, 2020)
Ebola virus disease 2014-2015 affected West Africa

CDC tool kit was used to assess the readiness of the hospital to an infectious disease.

Early diagnostic procedures.

Provide self-selected staff that treat and isolate Ebola patients.

Designated treatment centers for treating Ebola virus.

1 way traffic flow: PPE donning room to patient room and exit to PPE doffing room.

Negative pressure ventilation and high efficiency particulate filters,

(Meyer et al., 2018)
Nipah virus Prevailed in south Asia from 2018-2019.

Ensure availability of medication.

Notably, zoo nautical surveillance is necessary, epidemiological and lab data needs to be shared globally.

Point of care labs were built for screening the public. (Menon & George, 2021)

Table 1 Lessons for hospital design from past pandemic Source: Authors

3.1 Short-term measures

3.11 Conversion of structures to healthcare units for pandemics

During the peak of the coronavirus pandemic, the healthcare facilities were unable to accommodate the large influx of patients, thus countries such as the United Kingdom transformed buildings into temporary healthcare structures (Gbadamosi et al., 2020). However, the probability of cross-infection increased as the HVAC did not meet the ventilation requirements of a hospital: fresh air, individual thermal comfort control and air filtration (Morawska et al., 2020; Xu et al., 2020). Hence, future public spaces will need more efficient HVAC and flexibility for conversion into emergency healthcare spaces (Megahed & Ghoneim, 2020). 

3.2 Medium term measures

3.21 Ventilation in hospitals

To avoid the spread of virus particles through the air and reduce the build-up of carbon dioxide, recirculation of air must be avoided; HVAC systems should use outdoor air (Popovich et al., 2019). Notably, HVAC that uses 100% outdoor air may use more energy than a system that uses recirculated air (Morawska et al., 2020). However, (Megahed & Ghoneim, 2020)(Memarzadeh et al., 2004) point out that the ingress of outdoor air into space may bring in virus-containing particles that may cause infections. Hence, the fresh air intake needs to be filtered before entry and sourced from an uncontaminated outdoor area. ASHRAE (2020) recommends that the supply air intake should be located near the doorway or adjacent to the exterior window with ceiling mounted supply to allow the air flow from the entry where the workers are to the visitors area.

Mixed ventilation is recommended as it reduces energy use and allows flexibility. To reduce cross contamination uniform ventilation is not recommended; instead, each room must have its own ventilation system (Smolova & Smolova, 2021). Numerous authors recommend the implementation of a high air change rate and low-level openings to reduce air contamination (Bhatti & Wahab, 2021; Emmanuel, 2020; Morawska et al., 2020).

The corridors in hospitals should be open-ended to allow ventilation. To further promote ventilation, an upper ventilation opening in the dividing wall in the corridor and a ventilation louver on the doorstep can curb the circulation of hot air. Additionally, the courtyard layout is recommended to enhance ventilation, create an ecological space that speeds up recovery and admits daylight (Emmanuel et al., 2020).

3.22 Typology Configuration for Enabling Disease Containment

The contact between infected and non-infected must be minimized by avoiding vertical and horizontal connections. Capolongo et al., (2020a) recommend that hospitals should have pandemic treatment areas consisting of the main body connecting to supporting areas with separate vehicle access. However, the drawbacks are the increased land, energy consumption and increased materials for the larger floor area. Hence, the authors recommend that facilities for Covid-negative patients can have multiple levels, but the COVID-19 treatment zones should be a stand-alone building with different access and separate sanitization points for staff and COVID-19 patients.

3.23 Functional Programme, Access and Flows Management

The hospitals must have different routes for the COVID-19 infected patients, suspected COVID-19 and non-infected patients to reduce the spread of infections. However, signage to guide patients on which route to use may not be sufficient so an access card system may be introduced to ensure the segregation of footfall in corridors. Furthermore, the corridor width should be a minimum of 2600mm allowing 1000mm intervals in social distancing and 300mm freeboard as people do not move in a straight path (Emmanuel, 2020). Additionally, benches and ledges must be avoided in a corridor to discourage conversation, poorly ventilated corridors and waiting areas must be avoided. Instead, the priority should be to reduce waiting time in hospitals to avoid the spread of viruses (Emmanuel, 2020)(Emmanuel et al., 2020).

3.24 Selection of antivirus materials

 Studies have demonstrated that the COVID-19 virus has different survival times on various surfaces(Emmanuel, 2020; Garg, 2021; van Doremalen et al., 2020). Doremalen et al. (2020) retort that COVID-19 can last up to 3 days on plastic and steel while on cardboard it can last up to 1 day and survives for 4 h on copper surfaces. Hence, frequently touched surfaces such as balcony rails, staircase handrails and bed rails should have copper infused or plated materials. However, the cost of copper may discourage designers from specifying it. Hospitals must use antibacterial paints and prefabricated furniture, while sensor-controlled lifts, sinks and taps can avoid contact altogether (Garg, 2021; Emmanuel et al., 2020). Also, carpets and rugs should be avoided as they harbor viruses and their cleaning products reduce indoor air quality (Pinheiro & Luís, 2020). To allow flexibility, electric wiring should have Polyvinyl chloride (PVC) conduit to enable the installation of electrical points and appliances (Garg, 2021).

3.25 Air filtration

The air filters reduce the viral particles' air concentration and curb the deposition of viruses on surfaces (Horning and Davis, 2020; Memarzadeh et al., 2010)). Also, the filtration of air in the COVID-19 wards may reduce the viral load and speed the recovery process. The HEPA (high-efficiency particulate air) filters can remove 99.97% of particles greater than 0.3 microns, but ULPA (Ultra-low Penetration air) filters can capture 99.99% of particles larger than 0.12 microns. Additionally, air filtration will remove any other pollutants in the air but requires frequent replacement and the used filters must be carefully disposed of carefully to avoid the spread of the virus.

3.26Ultraviolet germicidal irradiation

Ultraviolet Germicidal Irradiation (UVGI) has a wavelength of 253.7 nm and possesses antimicrobial properties. However, it should be used carefully as it poses a health risk to the eyes and skin. Nonetheless, while more research is conducted to determine the effectiveness of this technology in irradiating the COVID-19 virus, UVGI may be installed in unoccupied areas to minimize adverse health effects (Megahed & Ghoneim, 2021). Hence, UVGI may be mounted in deep louver enclosures at a height from the floor to reduce exposure to the eyes and excess reflection from the ceiling and in the duct of the HVAC for disinfecting contaminated air.

3.27 Humidification

Indoor humidity levels are a significant factor in the spread of infections. The low relative humidity in a cool climate may prompt the droplets to evaporate at a fast pace, creating particles with smaller sizes that may move longer distances and infect more people (He et al., 2022)(Feng et al., 2020). While in humid conditions, the size of the viral drops increases and falls from the atmosphere, reducing the chance of transmission.  Ahlawat et al., (2020) retort that humidity less than 40% reduces the respiratory immunity of humans as the mucus in the throat and nose turns dry and viscous, reducing the ability to eliminate viral aerosols. Hence, relative humidity of 40%-60% is recommended for the health of occupants and reducing the survival of the pathogens(Condair Ltd., 2007; Mousavi et al., 2021).

3.3 Long-term measures

3.31 The location of hospitals

Green building codes deduced that the location of a hospital defines its accessibility and is preferably is located in the center of the city (USBGC, 2017).

However, locating hospitals along the edges of the city reduces the crowded areas while allowing access (Capolongo et al., 2020a). However, the distance should be maintained to reduce GHG emissions (USGBC, 2017).

4. Discussion

Table 3 summarizes the measure that can be implemented for Covid-19 benefits with its implications on sustainability.

Built Environment system Measure Covid-19 benefits Implication on sustainability Recommendation by authors
Structure Conversion of structures to healthcare units for pandemic During the wave of infections countries converted unused public spaces to treatment centers (Gbadamosi et al., 2020). However, these spaces were not designed with the requirement of a treatment facility in mind. The use of existing facilities is sustainable as it requires minimal resources; reducing the carbon footprint. The existing hospitals can have spaces for expansion to utilize during emergencies.
Space planning Functional Programme, Access and Flows Management Avoid vertical and horizontal connections (Capolongo et al, 2020). Instead separate treatment areas are recommended. Increase carbon and building footprint due to the increase in the materials and energy (Pinheiro & Luís, 2020).

The minimum dimensions of the treatment areas must be revised to curb air borne transmission.

Introduce courtyards and atriums to encourage ventilation without increasing material requirements.

Movable partitions can be used to demarcate treatment at existing facilities.

Retain online consultations for mild illness to reduce overcrowding in hospitals. 

Asymptomatic patients with airborne illness may be transferred to temporary medical facilities or self-contained at home.

Circulation Studies demonstrate that the width of corridors must be increased to 2.6m (Emmanuel et al., 2020). Increased materials required for construction. The length of the passage must be minimal for easy movement.
Flexible design Create lung spaces to accommodate expansions, reconfigurations or isolation areas (Capalongo et al., 2020). USGBC(2017) recommends the use of shell and soft space for the flexibility of the hospital. The challenge is to ensure that the spaces are not underused (Garg and Dewan, 2020). Hence further study is needed to establish the area required for the flexible spaces.
Evidence based design Biophillic design strategies: view to nature, fresh air and natural sounds are encouraged for speeding the recovery process(El Sayed et al., 2021). The improvement in IEQ may be effective against many infectious diseases similar to COVID-19 (Lai et al., 2009).

At least 50% of the site area’s vegetation excluding the building area should be restored or protected with native vegetation (LEED, 2009).

Derive health benefits for patients and staff by providing 5sqm per inpatient for at least 75% of inpatients (LEED, 2009).

The existing terraces can be converted to gardens.
Services Conveyance Provide signage on elevators to implement social distancing and reduce air borne transmission (Luis, 2020). Increased energy usage from the increased number of trips (Pinheiro and Luis, 2020). Use touch free controls for lifts and create separate lifts and
Humidification Authors recommend a 40-60% humidity to reduce aerosol transmission (Condair Ltd., 2007; Mousavi et al, 2019; Gola et al., 2018). Improves the indoor air quality (USGBC, 2020). The building codes for hospitals must be updated to account for post pandemic issues.
Aeration in hospitals

Avoid recirculation of air (Popovich et al., 2019).The ventilation for each room must be separate to avoid cross contamination (Smolova & Smolova, 2021). Avoid close ended corridors (Emmanuel et al, 2020).

Heat recovery units ensure 100% separation between indoor and outdoor air (Morawska et al., 2020).

Natural ventilation is encouraged to reduce energy demand and improve the comfort and mental health of patients (USGBC, 2017; (Eijkelenboom et al., 2021).

Dedicated elements such as wind cowl, wind catcher and double skin may be used to enhance airflow (Creurer, 2020.).

The pollutants and microorganisms are also eliminated improving the indoor air quality (Pinheiro & Luís, 2020).

The view from the window improves wellbeing( Pinheiro & Luis, 2020).

USGBC(2017) suggests that optimum PM2.5: 15 µg/m or lower and PM : 50 µg/m or lower.

The climatic conditions of the site and the spatial requirements should be considered during the design of the HVAC. However, in extreme climates hybrid ventilation is required. The wall window ratio can be used for designing the openings.

The BIM simulation can assist the design of HVAC early in the design process (Luo et al., 2020).

The air changes per hour should be 24ACH to reduce the concentration of the pathogens in 10 minutes rather than 12ACH which takes 20 minutes(Qian et al., 2010).

Air filtration Use HEPA filters of MERV 17 or higher to remove viruses and other particles(Elias & Bar-yam, 2020; Mousavi et al., 2021). The HEPA filters remove dust and other pollutants; improving the indoor air quality (Horning and Davis, 2020; Memarzadeh et al., 2010). The filters must be maintained and replaced frequently for maximum performance.
Bipolar ionisation This can reduce the pathogens in the air (Navaratnam et al., 2022). It is less costly, can be installed easily and causes a pressure drop in the AHU (Zeng et al., 2021).
Ultraviolet germicidal irradiation Can be installed in the HVAC ducts and PPE lockers to eliminate the virus.

The UVGI increases the energy demand and may be harmful to eyes if not installed well(Chen & Keeffe, 2020).

However, UV light is less expensive than mechanical ventilation and more effective than ionization (Escombe et al., 2009).

Hence, further studies are required on the height the UVGI lamps should be mounted, the wavelength of the UV light and the installation of the light (Escombe et al., 2009).
HEPA filters It is effective in removing bio aerosols but MERV is a safer option.

It needs frequent maintenance, high pressure drops and increased energy consumption(Tellier, 2006).

The filters may reemit the virus during replacement (Assadi et al., 2022).

Indoor environmental quality Encourage daylighting Previous studies have conflicting views over the efficiency of sunlight in eliminating viruses (Atkinson et al. 2016). However, the introduction of windows into the wards and passages may control and prevent infections (Amran et al., 2022b).

A minimum of

10 footcandles (fc) (110 lux) and a maximum of 500 fc (5,400 lux) in a clear sky condition on September 21 at 9 a.m. and 3 p.m (USGBC, 2017). Introducing apertures for daylight also afford occupants a view to outdoors.

UVC light of 260-265mm has the most germicidal effectiveness which is eliminated from natural daylight (Kowalski, 2009; Antoino and Sanmartín, 2018). Hence, the use of UVGI lamps is an alternative.
Interior finishes Selection of anti-virus materials The material specifications must use materials such as copper, antibacterial paints and prefabricated furniture while sensor controlled lifts, sinks and taps can avoid contact altogether (Garg,2021; Emmanuel et al, 2020).

The manufacturing process for metals is carbon intensive (Liu et al, 2017).

Copper finish has high cost and high maintenance cost (Navaratnam et al., 2022).

Hence, further research is needed on the materials that are antibacterial and low carbon.
Site The location of hospitals Locate hospitals along the edges of the city to avoid overcrowding (Capolongo et al., 2020d).

The GHG emissions from the vehicles pose a risk to the environment as longer distances have to be traveled.

LEED (2009) encourages development with ½ miles of services,

Create a 15 minute city that allows access to amenities via bicycling or walking to reduce carbon emissions.

Table 3 Thematic analysis of literature Source: Authors

C:\Users\admin\Downloads\research questions.pptx (1).jpg

Figure 4 Covid 19 reduction strategies that are sustainable (Source:authors)

5. Conclusions

During the 14th to the 19th century, the world responded to pandemics through urban renewal, sanitary reforms and housing renewal (Piret & Boivin, 2021). The strategies such as the creation of dedicated spaces for treating infectious diseases, incorporation of UVGI in ventilation systems, prioritise daylight and create point care labs were effective in controlling cholera and Tuberculosis. The challenge is to avoid over designing for pandemic resilient hospitals to avoid escalating costs and underuse of facilities (Garg and Dewan, 2022).The authors recommended that the building codes should add a framework of design strategies for pandemic resilient hospitals.

The main challenge in post pandemic design is maintaining social distancing without increasing energy demand and GHG emissions. The authors recommend a courtyard layout to separate spaces while providing ventilation and day lighting (figure 4). The circulation space can be along the courtyard to encourage cross ventilation and buffer zones before entry can reduce the transmission of viruses.  Also, the perimeter around the courtyard can be an open air waiting area to reduce airborne transmission while creating a biophilic link. However, the courtyard must be designed after considering the climatic conditions of the area. 

Nevertheless, the challenge is to design hospitals that foresee an impending pandemic. Hence, further interdisciplinary research and simulations must highlight:

  1. The minimum dimensions of rooms required to reduce cross contamination;

  2. humidity levels;

  3. air change units for reducing viral particles in the air;

  4. low cost materials with antibacterial properties;

  5. The wavelength and voltage of UVGI required eliminating the virus.

The authors recommend that the research on pandemic resilient design should be extended to all building typologies and the framework of design strategies for hospitals must be constantly updated.

REQUIREMENT

HOSPITAL DESIGN PRE PANDEMIC

HOSPITAL DESIGN POST PANDEMIC

Location

The early hospital design was frequently a courtyard often located at the edge of settlements (Burpee, 2008; Tesler, 2018).

Reintroduce the courtyard layout for ventilation and link to nature (Emmanuel, 2020).

Spacing in hospitals should be at least 2000m to maintain social distancing.

Li et al (2020) recommends designing multi-level to replace the single level hospitals which depend on major hospitals which should be distributed with lower density within a certain distance.

The emergency department may be a pavilion to act as an independent unit in the event of a pandemic(Łukasik & Porębska, 2022) .

Material selection

Safety; Access; Fire Evacuation; Patient Care, and; Environmental Design were the selection criteria for finishes in the hospitals (Department of Health, 2014).

Materials such as copper based alloys should be used for its anti-bacterial properties to reduce transmission via contact (Garg, 2021; Emmanuel et al, 2020). Hence, the anti-bacterial properties of materials must be prioritised in the selection criteria.

Ventilation

All wards shall be provided with positive ventilation (except isolation ward) and fans (Ministry of Health and Family Welfare, 2012).

Hospitals should use natural ventilation (IS 2433, 2001).

Induce negative pressure in infected wards in cold while positive pressure should be induced in warm climates (WHO, 2020)

Use ante rooms to dilute air that moves when a door is operated (WHO, 2020).

WHO (2021) recommends hybrid ventilation but Wang et al(2013) retorts that operable windows achieving 12ACH prevented infections in Chinese hospitals during SARS.

Space planning

Waiting areas in the outpatient department had seating areas to make waiting comfortable (Peng, 2022).

There was less focus on the comfort of the patient and they were given rooms with numerous beds (Szafranowicz et al., 2015).

Benches and ledges must be avoided in a corridor to discourage conversation, poorly ventilated corridors and waiting areas must be avoided (Emmanuel et al, 2020).

Individual rooms are recommended to reduce transmission.

The trend is to follow evidence based design which prioritizes air quality, lighting and materials to speed up the recovery process (Capolongo et al., 2020b; Nioi et al., 2021).

Table 4 Hospital design requirements pre and post pandemic Source: authors

In conclusion, the authors view the Covid-19 pandemic as a motivation to the design community to rethink hospital design and implement strategies that are resilient.

Contributor statement

The main author was Priya Rachel Boby with co-authors Prof Dr. Prabjot Sugga and Prof Dr. Anil Dewan.

References

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