© 2014 HDR Architecture, Inc., all rights reserved. © 2014 HDR Architecture, Inc., all rights reserved. © 2014 HDR Architecture, Inc., all rights reserved. © 2014 HDR, Inc., all rights reserved. © 2014 HDR, Inc., all rights reserved. © 2014 HDR, Inc., all rights reserved. © 2015 HDR, Inc., all rights reserved.

HDR Facility Guidelines

for Patient Biocontainment

with Highly Pathogenic Infectious Diseases

2015 Eagleson Colloquium

PRESENTORS

Jon Crane, FAIA from HDR Mark Fitzgerald, Director of Biocontainment Planning from HDR Jeff Owens, from HDR

General Thoughts on Guidance

Lessons from the biocontainment world

One size does not fit all. (State & local issues, union / non-union, age & condition of infrastructure,

location of facility in hospital, etc., etc., etc.).

An incident will occur. (Infection, lack of compliance to SOP, unplanned outage, pipe leakage,

lightning strike, etc., etc., etc.)

When an incident happens, every decision you have made will be challenged.

General Thoughts on Guidance

Lessons from the biocontainment world

General Thoughts on Guidance

In some cases we don’t know the risk.

General Thoughts on Guidance

Performance based versus prescriptive.

Guidance should be based on risk

assessment.

Guidance should be performance based

versus prescriptive where possible, for

example: Floors should be slip resistant,

seamless and capable of withstanding

decontamination chemicals.

Architectural Guidance

The Containment Barrier

Consider an anteroom with two doors in

series from any space that may be

potentially contaminated.

Consider primary containment devices

(biological safety cabinets) for small scale

work, laboratory testing that requires sample

manipulation and for other procedures

where practicable.

Consider sealed interior windows and

cameras to allow viewing of staff and

patients while minimizing entering

containment space.

Architectural Guidance

The Containment Barrier

Consider sealing windows and penetrations

on the containment boundary based on risk

assessment. This does not mean a

hermetically sealed room. .

Consider finishes (floors, walls, ceilings,

doors frames, etc.) that are easily cleanable

and can withstand routine chemical

disinfection.

Consider a pass-through decontamination

autoclave with both solid and liquid waste

cycles. Place the autoclave service space

outside of containment.

Consider redundant autoclaves.

Architectural Guidance

The Containment Barrier

Consider laboratory testing space within the PBU.

Consider a VHP pass thru, dunktank or other method for

laboratory samples to be removed from the contained

patient area after surface decontamination.

HVAC System Guidance

Control Areas with Potentially Contaminated Air

Consider inward directional airflow from

areas of lower risk to areas of higher risk.

Consider a separate air supply and exhaust

system for the Patient Biocontainment Unit.

Consider a decontamination-in-place HEPA

filter system on the exhaust system with

zero leakage ductwork from room to HEPA

filter. Base on risk assessment of discharge

point of exhaust air.

HVAC System Guidance

Control Areas with Potentially Contaminated Air

Consider capability for continuous operation

of air supply and exhaust.

Consider a decontaminate-in-place

HEPA filter system on the air supply

system with zero leakage ductwork from

room to HEPA filter.

Plumbing System Guidance

Minimize Staff Handling of Infectious Waste and Control

Areas with Potential Infectious Waste

Consider a liquid effluent decontamination system.

Consider backflow prevention or filtration on liquid or gas

services when entering potentially contaminated space entering

the room.

THIS IS BAD

Plumbing System Guidance

Minimize Staff Handling of Infectious Waste and Control

Areas with Potential Infectious Waste

Consider HEPA filtration (or equivalent) on plumbing vents based

on risk assessment of discharge location.

If vacuum is provided, use a local dedicated system.

Consider a system for space decontamination.

Electrical System Guidance

The Risk is Significantly Higher in Patient Care Facilities

than in Laboratory and Animal Facilities.

Consider back-up power.

Consider UPS for power continuity

for system controls.

Consider sealing conduits passing through

the containment barrier.

Consider a means of communication

between the patient care spaces and the

support staff outside.

© 2014 HDR Architecture, Inc., all rights reserved. © 2014 HDR Architecture, Inc., all rights reserved. © 2014 HDR Architecture, Inc., all rights reserved. © 2014 HDR, Inc., all rights reserved. © 2014 HDR, Inc., all rights reserved. © 2014 HDR, Inc., all rights reserved. © 2015 HDR, Inc., all rights reserved.