Earlier in the year, Jeffrey Brand was one of the participants at a conference on hospital design and infrastructure, organised by Informa Middle East. Brand made a presentation on operational and project factors, during which he stressed on key aspects that ought to be considered while carrying out hospital renovations.

Jeffrey Brand, Principal and Executive Director at Perkins Eastman

The factors he identified included challenges to renovations, such as infection control, safety, phasing and cost. One way of overcoming the challenges, he said, was to develop a comprehensive and detailed analysis of issues like MEP requirements and site opportunities. He also identified different measures that can be taken to mitigate different “construction negatives”. To control dust, for instance, he explained that airtight physical barriers must be erected, negative pressure air locks should be used and ducts should be blocked. For infection control, he highlighted the need for the hospital infection control committee to be involved in the project and for work supervisors to be properly trained and certified.

Brand, who is based in New York City and whose multi-disciplinary design firm has carried out assignments at Duke University Hospital and New York Presbyterian Hospital, among other sites, also shared several tips on how to plan for renovations, which included understanding structural and MEP requirements; isolating services to prevent disruption to existing functions; accepting that “no plan survives contact with reality”; establishing protocols for emergency scenarios; anticipating noise levels and working out ways to limit noise-making activities to short intervals; and involving all stakeholders in the planning process.

At the end of his presentation, Brand shared more of his insights on the topic of hospital renovations in a one-on-one interview with Climate Control Middle East. Excerpts from the interview…

When it comes to healthcare facilities, how would you compare renovation projects to new constructions? Which, would you say, are more challenging, especially when taking into account sustainability and IEQ concerns?

Renovations are more challenging. The exterior wall, if it’s an older building, may not meet current sustainability standards, and of course, any material that might be contaminated during construction must be remediated. For air handling, you’d want to make sure that you can meet all the standards for air changes. If you’re doing a bed tower and you have isolation patients, you must be cognizant of the need for negative pressure and the need to protect them from airborne pathogens. HVAC systems play a really big role in how you prevent infections from jumping from one patient to another.

I don’t think that there are any more risks in renovations. It’s just that often, when you’re renovating, you’re somewhere in the middle of the hospital, and systems connect through your space. The question becomes: if I’m renovating a particular floor, how do I get the rest of the hospital to function while I’m connecting to the HVAC ductwork? To give you an example, when we did the surgical suite at Duke, we had to vacuum out the ductwork to make sure that there was no dust. Even though we protected it, we could still get dust, so we had to take extra care during construction to prevent dust, and when we were done, we still had to clean everything up.

Moreover, you’re often dealing with lower ceiling heights and ductwork that is very big, because the original design is old, and now you need more air changes. The challenge is often getting under a beam and low ceiling height, and being able to provide enough air to the places you want to provide. That’s the challenge, but it’s not an impossible obstacle. It’s just… you need to make sure everything fits, because you’re putting new technology into an old building.

Based on your observation, what are the current trends in the healthcare sector, in terms of technology and HVAC solutions?

We’re doing a lot of ambulatory facilities, at least in North America. We’re seeing this big movement towards managing the population of patients through ambulatory services, because you can do ambulatory surgery and cancer centre work and clinics in these facilities. Patients go there for the day and then go home at night, and they get better. The air systems we’re using produce enough air changes to protect them, but I think they are the same systems as before. Of course, in-patient and operating rooms and ICUs require much more air changes and much more humidity control, because they’re more controlled environments.

For burn rooms, the focus is on protecting the patient from infection. The air has to have certain humidity content and must be bacteria-free, which means a lot of HEPA filters to make sure the air is really, really clean.

With regard to technology, we do a lot of 3D modelling. Bone marrow transplant patients, for example, are at most risk for infection, because their immune systems are basically rebuilding. What this means is that the air in the room must blow from the patient to the family member or whoever is in there with the patient. A lot of it is how you position the ductwork and the supply and return, and because of 3D modelling, we can now understand where the air is going to move in the room. We are very particular about where we place the registers. It’s actually more about that than the type of system we provide.

The same thing when talking about operating tables – we want the air to blow from the patient, who’s been cut open somewhere, to the staff and not the other way around. Protecting the patient is paramount.

During your presentation, you mentioned the need to keep noise levels down while doing renovation work. How do you do that?

If it’s an exam room, we often bring the partitions up to the deck above and not just to the ceiling but all the way up. That way the sound can’t travel from over the ceiling. Also, we make sure the doors have heavy insulation value, because we believe privacy is very important. We are actually at the forefront of proposing that recovery spaces should be individual spaces and that in emergency department settings, walls and glass doors should separate patients. They’re more dignified than mere curtains, and they also reduce infection, allow families to be together and provide better acoustical control.

The other advantage to individual spaces is that patients can control the lighting and the temperature. The customisation of the patient experience is very important at this point in time.

Speaking of controlling lighting and temperature, what is your view on the topic of energy efficiency in healthcare? Do you think it’s possible to achieve energy savings while maintaining the quality of medical care given to patients?

A lot of our clients are trying to cut down on operational costs, so what we advise them is if they’re not using their rooms at night, turn the lights off. And we also tell them that they can be more efficient with air handling. While they certainly should be careful in surgical settings, there are certain places where, when they’re not using the rooms, they can shut down a little bit. Energy cost is really high; that’s why older buildings can be a challenge. They have inefficient layout, and their energy-efficiency schemes are not set up from the get-go, which is why we’re very interested in using 3D modelling to show clients where they can control how much energy they’re using. And, of course, using controls and sensors can also help in achieving energy savings. Investing in controls in one of the best things building owners, in general, can do.