Facilities Management and Operations

Facility LayoutCopy Link!

Literature Review (Hospital Operations): Gallery View, Grid View

Principles for Adapting Spaces for COVID-19Copy Link!

Updated Date: December 19, 2020

Designating COVID Care Areas: Where possible hospitals and clinics should establish designated areas for screening, triage, specimen collection, and COVID inpatient care. It is important to try to separate patients by how likely they are to have COVID to avoid putting patients who do not have COVID on wards or in waiting areas where they could contract it. Patients who have tested negative or who are not suspected to have COVID-19 should never be co-housed with COVID positive or patients under investigation (PUI) for COVID infection.

  • Distances between people should be at least 1 meter (WHO recommendation), and ideally 2 meters (CDC recommendation) in all contexts.
  • Using outdoor spaces and spaces with good filtration or air turnover can decrease risk. All indoor spaces should be sufficiently ventilated and COVID care areas should be negative pressure whenever possible.
  • Areas should be clearly marked with appropriate and standardized signage indicating the category of precaution and PPE that is required to enter.

Entrances, Screening and Testing AreasCopy Link!

Updated date: December 19, 2020

Entrances and Screening AreasCopy Link!

To ensure all persons entering a healthcare facility are screened for symptoms of COVID-19, most facilities have reduced the number of entrances and exits (see Screening and Triage). Infrastructure adaptations include:

  1. Designating separate entrances for healthcare workers and patients. This allows for all staff to pass through the same entrance and undergo active syndromic surveillance (WHO).
  2. Ensuring screening areas are open to air (e.g. vehicle pull ups or on walkway outside). If weather or infrastructure make this impossible, people should never need to cluster close together while waiting to be screened.

Waiting AreasCopy Link!

After screening positive, individuals should be directed to a waiting area for Acuity Triage. Within the waiting area for those who screen positive, patients must be able to remain 2 meters from any other patient, or have physical barriers in between. The waiting room should be clearly visible from the triage area.

Specimen Collection AreasCopy Link!

Updated Date:

  1. COVID respiratory sample testing and sputum collection should be done outside in an area designated for sample collection where possible. Some places use outdoor stands, tents, and drive-throughs.
  2. If respiratory sampling must be done indoors, ensure adequate PPE and air turnover/filtration where available.
  3. Blood finger pricks and blood draws can be done in the consultative space.

Open Shared WardsCopy Link!

Updated Date: December 19, 2020

Ward DesignCopy Link!

In settings where private rooms are not feasible, patients with confirmed and suspect COVID are admitted to open wards, ideally stratified by likelihood of disease (see Case Definitions and Isolation).

Finding space: To create these new wards, some healthcare settings combine or convert wards typically used for other reasons into COVID-19 treatment wards

Designs for open shared wards: for COVID care should ensure that there are donning and doffing areas at the entrance to the ward, separate staff work and break areas, supply areas within the ward, and separate bathrooms for patients and staff. There should be sufficient spacing between patient beds to maintain physical distancing (minimum 1 meter, or 2 meters if health care workers will move between beds). Screen walls/ partitions between beds in open wards should be used to reduce particle transfer between patients.

Grouping by risk level: Ideally, separate wards will be created by Likelihood of COVID Disease. If separate wards are impossible, patients may be cohorted within different areas of the same ward, grouped according to likelihood level. Use physical distance (>2m) or barriers (designs available in the BHI guidelines below) between groups to minimize risk to PUI patients under investigation who do not have COVID (for detailed information on barriers see BHI Infrastructure Tool below). Strict decontamination and other Facility-based IPC Practices must be performed between patients, and practitioners should see patients from the lowest to the highest likelihood areas.

Tool: COVID Ward Plans Developed by PIH and Build Health International (BHI)
Tool:
BHI Infrastructure Guidelines
Tool: Ward Design Troubleshooting

Critical Care Units: Care of