Medical Real Estate in the Age of COVID-19

 Is your facility Covid ready and what can be done?

By FRANK RICCI

The COVID-19 Pandemic of 2020 has had a profound effect on hospitals, medical practices, staff and the business of medicine. From a practical point of view, we have witnessed just how vulnerable we are as a society to new viruses and how ill-equipped medical practices are to infectious agents. In this article, I will outline some practical steps to better prepare your medical facility to deal with this and future outbreaks which will ensure safer visit for you, your patients and staff.

Viruses like COVID are spread in three primary ways; 1) contact, where transmission is through touching a person or an object which another person then contacts, 2) large droplets such as through a cough or sneeze where droplets are dispersed over a relatively small area where they fall on surfaces or another person and 3} small droplets transmitted through speech and normal breathing and which can be carried by a/c ventilation.

Here are some practical methods to minimize the risk of exposure in your facilities:

Check-in, Check-out and Payments: Limit patient/staff interactions by providing online check in, checkout and payment processing. Eliminating the need to complete forms, sign in and out and process payments reduces contacts with papers, pens, clipboards, horizontal surfaces, money and credit/debit cards.

Social Distancing: Provide adequate space between patients by limiting the number in the waiting room, providing sub-waiting areas throughout the facility and move patients through as quickly and expeditiously as possible. Glass/plexiglass partitioning can also provide a form of social distancing in waiting rooms, between patients and the business office and between patients and staff. Additional precautions include evaluating patient forms prior to visit to ascertain potential infectious patients, taking their temperature upon arrival, providing separate waiting areas and directing potential Covid patients to the appropriate testing facility.

Waiting & Reception Areas: Eliminate toys, magazines and other reading materials that might spread viruses via contact. The use of hard surface flooring and hard surfaces for walls and ceilings greatly reduces the opportunity for viruses to linger. Horizontal surfaces should also be minimized and should be resistant to strong disinfectants. Additional bonuses include volume ceilings which reduce the level of contaminants in a given space and sunlight which is known to kill many viruses. Copper is a natural antibacterial, antifungal, antiviral material so door handles and other frequently touched objects made with copper content would be ideal. Motion and voice activated doors also decrease the chance of contact transmission.

Exam & Procedure Rooms: The proper design of these rooms is of the utmost importance in reducing exposure to pathogens. [see illustration]. Of notable importance are: the sink is near the door for frequent handwashing and should not be so shallow so water can splash out. The patient is shielded from ventilation from the corridor as well as being visually guarded from others passing by. Staff work is almost always confined to the area near the door and they can keep social distancing from any guests of the patient. All utensils and supplies are within easy reach and are designed such that there is no clutter and fewer horizontal surfaces. Exam and procedure rooms should be on a separate HVAC zone with ceiling mounted air supply, frequent air exchanges, HEPA filtration and frequent maintenance.

Additional Features: Personal protective equipment can be made available to patients upon entering. Hand sanitizing stations should be spread liberally throughout the facility. Toilets, faucets and paper towel dispensers should be hands free and paper towels are preferred over blowers. Single use toilet rooms are preferred with limited horizontal spaces and antimicrobial surfaces. The use of motion/voice activated lights, doors, faucets, toilets, blowers, dryers and equipment all reduce exposure to infectious agents and will become standard in future medical centers.

Telehealth: The rise in the use of Telehealth services greatly increased throughout this pandemic of 2020 and will continue to grow as new technologies are introduced. The space needs are not overwhelming, and in fact, three consults can occur simultaneously within the space of one procedure room. The use of modular partitions and workspaces means that physicians can extend their practices far from their original location and penetrate rural areas where there is a particular shortage of healthcare workers. This is an excellent revenue enhancement opportunity which also serves to greatly restrict visits from infectious patients.

As the need for medical services and providers continues to increase, we must remain vigilant in our quest to provide the safest atmosphere possible for both patients and staff. While there is certainly a cost to equipping facilities appropriately, there is an even greater cost in not being able to operate at all. For more information on options and strategies, contact your infection control specialist or feel free to call on us.