Helping Medical Facilities Adjust to the COVID-19 Pandemic
Since the COVID-19 pandemic hit the U.S., medical facilities have been overwhelmed with the task of providing critical care for the rapidly spreading disease while at the same time protecting their uninfected patients and staff from the virus.
Several health care organizations wasted no time in upgrading their facilities to meet the anticipated surge and maintain safe, secure environments.
With the resources and experience to move quickly on medical facilities and high-containment laboratory projects, WSP USA has been part of several teams currently working with health care organizations, providing engineering services on tight deadlines to ensure facilities can serve patients as quickly and safely as possible. That work includes three patient care facilities, including one that is already up and running.
In just three weeks, Boston Medical Center’s unoccupied Newton Pavilion was upgraded into a facility now offering homeless Boston citizens with a place for COVID-19 care and quarantine.
In Hagerstown, Maryland, Meritus Regional Medical Center is building a new regional infectious containment (RIC) unit as part of its rapid response to the COVID-19 pandemic.
And at the University of Oklahoma (OU) Medical Center, WSP was part of a team that shifted gears on construction of a new medical tower to convert a portion of the unfinished space specifically for COVID-19 care.
Newton Pavilion: Care for the Homeless
Newton Pavilion, unused for nearly two years, was scheduled to remain closed during a $200 million renovation project. The pandemic diverted those plans, and the city of Boston and the state of Massachusetts, recognizing the potential of the unused medical building, requested its prompt reopening for COVID-19 treatment and isolation for the city’s homeless in 21 days.
Collaborating with the architect, SLAM, and general contractor, Gilbane, WSP provided the mechanical and electrical engineering support necessary to reactivate the building systems for emergency temporary occupancy.
Quickly, the team identified spaces capable of accommodating 302 beds suitable for quarantine and/or isolation. These were rooms that already had existing headwalls. WSP technicians evaluated what work was needed to fix the dormant mechanical-electrical-plumbing/fire protection (MEP/FP) infrastructure.
A critical consideration was determining which of the existing air-handling units were capable of being reused in order to service these critical areas in the facility. This ensured air was cleaned and secured for patients and medical staff when the facility opened.
WSP realigned the overall pressure differentials between occupied and unoccupied spaces by adjusting air-handling units and exhaust fans. New parts and filters were installed, tested, and balanced for air distribution, and exhaust fans provided 100% fresh air in all occupied spaces. Head-end hardware and software was installed to provide the necessary controls, and WSP provided a qualified operator to ensure the system functioned and was maintained properly.
WSP confirmed the steam heating distribution was fully operational, the valves at the converter units were checked, and the three chillers and pumps were checked, making repairs when necessary.
Before the building was declared operational, WSP and the team left no stone unturned … or unsanitized. Water pipes, sprinkler systems, emergency lights, fire alarms, plumbing systems, sump pumps, and IT networks were all among the systems that were installed, cleaned, inspected, tested, and approved for use before the facility was opened.
Today, Newton Pavilion provides quarantine for those awaiting test results, those who are symptomatic of COVID-19, and for anyone confirmed positive with COVID-19 but with mild symptoms that requires isolation but not necessarily hospitalization. The facility is also offering isolation for anyone recently treated for COVID-19 and discharged from a hospital but without a secure place to stay during recovery as well as an intensive care unit for sicker patients.
As of May 1, more than 700 patients have been discharged from the Pavilion.
Meritus Regional: Containing the Risk
The 12,800-square-foot, single-story RIC addition to the existing Meritus hospital will house an acute care, medical/surgical patient room program. It will create an infectious isolation suite with negative pressure and ventilator-capable areas, separated from the remainder of the hospital’s inpatient functions, with 20 patient rooms, entrance and exit ante rooms, a respiratory therapy space, and the support spaces required for a medical/surgical facility.
Leach Wallace, acquired by WSP in 2019, is part of the design and construction team, providing the MEP/FP design services, telecommunications, and construction administration services as well as testing, balancing, and commissioning of the HVAC systems.
Completing the $12.5 million facility within four months required swift action from the design and construction team, which included Matthei & Colin, architect of record; Gilbane, construction manager; and Frederick, Seibert & Associates Inc., civil engineering, land surveying, and landscape architecture. The design was approved on March 23. Construction is underway, and the facility is on schedule for a July 30 completion.
The HVAC system includes a dedicated outdoor air-handling unit served from the campus’s chilled water system. The unit contains dual-supply fans and HEPA filters in the final filter position. Its dedicated, fully redundant exhaust system will consist of two high-velocity, high-plume discharge exhaust fans equipped with a bag-in, bag-out HEPA filter assembly on the roof with bubble-tight isolation dampers.
The new facility will feature two operating modes: “normal,” where the suite acts as a typical medical/surgical patient floor; and “infectious,” where all 20 patient rooms will operate under negative pressure and maintain a minimum of 12 air changes per hour.
Each patient room and the entrance/exit ante rooms will be equipped with room pressure monitors to maintain pressure requirements. The medical gas systems will allow 20 ventilators to operate simultaneously. All critical functions are served from the hospital’s emergency power generator plant.
Continuous communication has been critical to the project’s success. Daily design calls include the construction manager, design team, project owner, and Washington County code officials. Including the code officials has expedited the process, providing real-time input to facilitate smoother permit submissions and on-site inspections. As a result, the underground piping design drawings, which had been prepared prior to the structural footing design being completed, were reviewed and approved with no comments from the county.
Changes in supply chains and distribution threatened to further slow down progress. Fortunately, identifying this concern at the onset eliminated this as a potential problem. Equipment with long lead times — air-handling units, exhaust fans, variable air volume boxes, plumbing fixtures, medical grade lighting fixtures, electrical transformers, and panelboards — were selected, submitted, and approved in the first week, prior to final load calculations and before the final floor plan was established, keeping the project on schedule.
OU Medicine: Doubling the Intensity
The University of Oklahoma Medical Center is constructing a new 450,000-square-foot, Level 1 trauma center, surgery, and patient room tower on its Oklahoma City campus, set to open for patient care in November. But, in early March, when the severity of the pandemic became apparent, city and state officials inquired about fast-tracking some of those floors to care for COVID-19 patients.
WSP, who is providing MEP and technology network solutions, teamed with the Perkins + Will, architect, and Turner Construction, construction manager, to open up two bed floors within a 60-day window, expediting that section of the project by nearly six months.
For its part, WSP was tasked with figuring out how to get the systems prepared for 72 double-occupancy rooms and possibly an additional 30 beds in areas where double-occupancy would be possible and safe. This included the cooling system, medical gases, emergency power, and privacy requirements for the clinical areas. Headwalls and flooring were also installed to provide safety and privacy.
The team also looked ahead with plans for decommissioning the temporary space when it was no longer needed for COVID-19 in order to restore it to its original use. About 60% of what is being fitted for the temporary facility will be able to be integrated into the eventual plans for those floors. Since the permanent doors were not available in time to meet the timeline, they will need to be replaced before the project is completed. Some of the ductwork will also be replaced.
In addition, WSP also supplied services from an in-house industrial hygienist who provided strategies on cleaning the ductwork, suggested what materials could be reused safely, and certified the project’s forward movement. HEPA filters were installed to extract the virus from the airstream. The industrial hygienist also helped the medical center with its existing facilities, which would be in use in the meantime.
One of the biggest technological lessons learned on this project centered around the use of UV light in the air-handling units. While this has already been in use to remove mold and mildew for regular maintenance, WSP researched UV applications with the manufacturer and was able to determine the benefits of doubling the intensity, which would bring it up to a germicidal level and neutralize the virus in the airstream.
Interestingly, adding more lamps and ballasts did not require any additional electrical systems, as the equipment that was already installed for general maintenance was capable of handling the increased intensity. This has put double-intensity UV on WSP’s radar for medical facility projects moving forward. The firm is analyzing the potential of advising the installation of UV lamps with a baseline scenario and considering an option to increase the levels of intensity for seasonal outbreaks.
The conversion process was on schedule to be completed within the 60-day projection; however, due to the flattening of COVID-19 projections in Oklahoma, OU Medicine has paused the effort in early May to evaluate the future needs for the space.
WSP has been helping hospitals across the U.S. convert existing medical and nonmedical spaces into areas that have the HVAC and electrical systems that can support the demand these services will place upon a facility. While the requirements and needs may vary from facility to facility, they all bring very similar needs when it comes for safety — both for the workers at the site and the systems that they create to maintain safe environments for patients and health care staff.
Safety measures and minimizing potential exposure to the COVID-19 virus has been a top priority on all projects to ensure the expedited nature of the project did not expose workers to any additional site hazards.
All staff scheduled to work at the sites wear the necessary protective equipment and have been fully educated on WSP safety policies regarding the pandemic. Everyone knew what they needed to do and followed every safety protocol that was put in place.
Although these facilities are meeting an immediate need, the pandemic is shaping the visions these health care providers have for the future, as they are becoming aware of the infrastructure they need to have in place should another similar health crisis strike. These are not short-term problems, and engineers, planners, and construction professionals are adapting to this “new normal” by looking at priority shifts with all clients and preparing to adapt quickly to address their needs and changing financial situations.