Before the COVID-19 pandemic unfolded, occupied hospital renovations were already a complicated task. From maintaining sterile areas and negative pressure spaces to avoiding disruption to patient services—managing these projects has always been a complex task that requires expert oversight. And these challenges have only been amplified by the current pandemic.

Below are several healthcare construction best practices to consider when navigating COVID-19’s challenges, what trends we can expect to arise as a result, and how these learnings can be applied to our post-pandemic world.

Building for COVID-19 While COVID-19 Was Building

The key to maintaining long-term relationships with premier healthcare institutions is trust and flexibility. COVID-19 necessitated quick action, requiring the reallocation of construction staff from other ongoing projects on campus to address the immediate and rapidly evolving needs the hospitals had for addressing the pandemic. Management needed to quickly assess best fit roles for staff to pivot into. Staff, in turn, had to rapidly switch their focus from one project to the next. Additionally, they had to be flexible in their roles and be prepared to do whatever it takes to keep the project moving: project managers became supers. Moreover, subcontractors needed to modify their plans on all projects, COVID-19 specific and other, to incorporate COVID-19 measures.

Social Distancing Complicates Construction Operations

Hospital renovation teams were already tasked with separating construction activities from the ongoing activities of the hospitals. Typically operating with limited space — COVID-19 has only made this more difficult due to social distancing mandates.

Take for instance the fact that very often teams share bathrooms with hospital staff and visitors. When feasible, it’s important to rotate staff and minimize the number of construction personnel on-site at any given time. This requires maintaining robust PPE protocols – proper gloves, masks, and eyewear at all times — in addition to a significant increase in the frequency of sanitizing common areas including offices, shanties, bathrooms, etc.

The Role of Technology

To perform in this environment, you have to be technically sound. New technology for temperature scanning and screening of workers is essential for all projects, not just healthcare construction. What’s more, the need for laser scanning and reality capture of existing conditions is necessary — now more than ever — as we limit the amount of time needed to survey in and around occupied buildings.

Design Changes

We are already beginning to see changes in the way facilities are designed. Design changes related to addressing the admittance of virus patients will now begin at the front door. There will likely be separate entrances for elective patients, adults, pediatrics, etc., with robust prescreening. The logic being that separation and isolation as soon as patients walk through the front door can mitigate any potential infection spread. Moving into the depths of the hospital, waiting areas will all become negatively pressurized. Rooms will be larger to accommodate surge beds.

The HVAC controls system will include greater flexibility in isolating a bed unit, an entire floor, and/or units on multiple floors. HEPA filtration and UV systems will be standard and commissioned as such to ensure that healthcare facility systems are operating properly to limit the spread of the virus and other airborne pathogens. Access to these floors will be restricted and may include separate elevators for further isolation. More treatment will be taking place just outside the patient rooms, allowing for less frequent caregiver visits to infected patients, without any sacrifice to patient care.

Looking Ahead

Prefabricated and modular construction continues to innovate year after year, and as we look to reduce the amounts of hours and workers on site, this type of construction allows the majority of work to take place off-site within a controlled and clean environment. We are also seeing modular solutions being implemented to offer COVID-19 screening at building entry points and hospital emergency rooms. Going forward, we anticipate that these screening measures will be designed into the lobbies and entry points to help tackle the challenges of future pandemics and increase security for healthcare facilities.

Worker welfare and wellness are also a top priority for the future of healthcare construction. We must ensure workers are safe and healthy above and beyond current best practices. Additional protocols are required for cleaning, on-site medics can assess the health of workers displaying symptoms and provide treatment, and designated areas for hand washing will be much more abundant in and around the construction sites of the future. Better and more available cleaning equipment like “foggers” will help projects be cleaned more efficiently as well as recover from a positive case faster, and the live, electronic tracking of PPE supplies will be mandatory. 

Without exception, the needs that our industry had resulting from the virus were immediate.  Being responsive, nimble, and flexible were mandatory skills that will transcend the pandemic. COVID-19 also highlighted the importance of being willing to work in a team environment, as every aspect of project delivery was expedited through clear and continuous communication.  Only the construction organizations that can adapt to COVID-19’s hurdles and uncertainty will survive. Because if this summer’s prolonged challenges have shown us anything, it’s that this virus isn’t going away anytime soon. 

Rich Steimel serves as principal in charge, Lendlease Healthcare. For nearly 30 years, Lendlease has worked with some of the nation’s leading healthcare organizations—including New York City’sMount Sinai Medical Center, New York University Langone Medical Center, Northwell Health andNew York-Presbyterian Hospital—on expanding, renovating and modernizing occupied facilities, as well as building new ones.

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DEL NORTE, Colo. — Representatives from the Rio Grande Hospital and its foundation board gathered for a groundbreaking ceremony in Del Norte on Nov. 14.

The extension and renovation of the Rio Grande hospital will include an additional building between the main hospital and the Rio Grande Hospital Clinic. The new building will house a new physical therapy department — an expansion on the emergency room that will include a secure location where local law enforcement can bring inmates from the Rio Grande County Jail.

Additionally, there will be a new wound care department with a hyperbaric chamber and the latest therapy for wound care. Also, the new hospital will have room for new specialty clinics such as orthopedic, cardiology, ENT and specialty providers who visit regularly. Finally, conference rooms will be added to support education and networking for the community. This will include significant upgrades and remodeling of the Del Norte rural health clinic to be more patient-centric and team-based.

The project was funded through the combined efforts of the hospital board, who held several fundraising events throughout the last five years while planning for the expansion was underway, in combination with a low interest loan through the USDA. The two financial sources combine for a total of close to $21 million that is required to start the project. The construction schedule is estimated to take approximately one year.

The project will bring innovative healthcare to the steadily growing community and is just one of many instances of renovations that Rio Grande Hospital has undertaken in the southwestern part of the valley over the past 20 years. Since 1996, the Rio Grande Hospital has built clinics in Creede, Del Norte and Monte Vista — all located in Colorado — and keeping the Rio Grande Hospital itself as up-to-date as possible along the way.

“I have never seen a community that has been more supportive and willing to help as the one here in Del Norte,” said Arlene Harms, chief executive officer of the Rio Grande Hospital, as reported by Alamosa News. “The boards have continuously been in favor of supporting what this community needs.”

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The health care industry is growing fast as America’s older population ages and younger generations reach record numbers. Hospitals are expanding at a rapid pace to meet the new demand for health care services; however, during this process, it is important to not lose site of important facility programs, including pest management.

While renovations bring great changes, the process can often disrupt normal services, pausing normal sanitation schedules, interrupting maintenance routings, and increasing traffic and visitors. One unhealthy side effect can be that pest control services get shelved. However, renovations tend to be when pests pose the largest threat to health care facilities. When outdoor habitats are disrupted for new construction or pest control routines are abandoned during upgrades, it can lead to problems. Mice, rats and other rodents can scurry inside if their outdoor homes are disturbed. So, if you do come across any rodents on your property, you should call a professional pest control service, or manage the situation yourself by using something like a pellet pistol (if you find them in your garden), to ensure that they don’t interfere with your lives. These aren’t the only pests that can disappear if you don’t catch them quick enough though. Cockroaches and other insects also can take root if moisture seeps into foundations. And termites can run the show if construction debris isn’t discarded properly. Termites are everywhere and any waste will certainly attract them. The only way to remove them is to have a professional come and perform Termite Control in Phoenix, LA, or wherever you may be.

Patients can leave negative reviews or complain to auditors if pests are found, and rightly so. Everyone expects a high level of sanitation and cleanliness at hospitals, doctors’ offices and clinics.

Because pests carry harmful pathogens and the potential to ruin a hospital’s reputation, it’s essential to take a proactive approach to pest control before, during and after renovations. By taking preventive measures and working directly with a pest management professional, with measures like reading through a guide to how to get rid of spiders at pestsmartcontrol or calling them directly before a renovation or expansion, facility owners and operators can ensure a patients’ stay is healthy, and also keep on top of a construction timeline and budget.

Phase I: Planning for Pests Before Renovation

Being proactive about a pest management strategy from the start has long-term benefits. Managing pest control issues during construction typically falls on the contractor, who should create an integrated pest management (IPM) program. Effective IPM practices aim to limit pests’ access to the resources they need to survive and reproduce, typically food, warmth, shelter and water.

IPM is most effective when a property is evaluated beforehand to determine which pests already are located around the property, how large their populations are and in which season they are most prevalent. For example, this information could affect a decision to start a construction project in the driest part of the year if mosquitoes and flies are a problem in a particular area. This may prevent entry from swarms of mosquitoes or flies that could occur if the construction started during wet or humid months.

Materials also have the potential to be problems or – when chosen wisely – solutions. When sourcing building materials, choose those that have the potential to deter pests, such as concrete, fiber-cement siding or non-cellulose insulation. Facility owners also need to inspect all incoming materials for signs of pests, as sometimes they hitch a ride onto the construction site with the new materials. Things to look for include droppings, chewed surfaces, or even dead rodents or insects.

A pest management provider can work with the contractor to treat for termites and other insects as walls and foundations are poured and installed. Owners (or hired contractors) will also want to carefully inspect walls and foundations for cracks that rodents and ants could use as an entry point into the structure, and may ven want to read through sites that ran a recent post about how to ensure the beds are kept clean and safe for use. Newly emptied rooms can be treated with a growth-regulating product to prevent insect pests from breeding before construction begins. New carpets also can be pre-treated for pests before installation.

Additionally, facility owners and maintenance personnel must be proactive about maintaining a clean and clutter-free construction site from the beginning of a renovation. After all, a single leftover lunch could cause a full-fledged infestation of roaches, ants or flies.

Phase II: Implementing Best Practices During Renovation

During renovations, it’s important to grade a property properly so that water drains away from the foundation. Standing water is particularly attractive to mosquitoes, and moist, disturbed soils can be the perfect hiding grounds for termites. While grading the property, place baits around the perimeter to prevent termites before they find a way inside the facility.

Any new landscaping installed during a renovation should be kept trimmed and placed at least 2 feet away from buildings to reduce rodents’ accessibility to upper levels and building roofs. Pests will be further deterred from entering the property by installing LED lights (as some studies have shown are less attractive to flying insects than traditional lighting).

During renovations, it’s important to revisit the most common methods that pests use to enter the property. For instance, entry doors (loading docks, front or back entrances, garage doors, etc.) should remain closed as much as possible to reduce entry of rodents or pests with wings, like birds and flying insects. Double sliding doors are recommended at major entrances to create an additional barrier. If windows must be left open, they should be properly screened. Any utility openings should also be closed off.

For frequently used entrances, air curtains (which are fans mounted against the doorway) and plastic strips help to prevent pests from getting in and conditioned air from getting out. These are often a good idea to install at loading docks or supply areas. Steel or copper mesh can be used to seal walls so that rodents can’t gnaw through to the building’s wires and electrical systems.

At the end of each workday, it’s important that construction crews cover all building materials to protect against the elements, especially rain. No one wants to find fungus, larvae or full-grown pests hiding in wet building materials.

Phase III: Maintaining Pest Management After Renovation

Even when a renovation is complete, pest management is not. Work with a pest management professional to update an IPM program based on new additions to the hospital or clinic. Certain areas of a health care facility need special attention and certainly any new food service areas will need to have a strong pest management plan in place.

Education is the key to long-term prevention of pests following renovation. Health care staff – particularly those who work with food, laundry or patients – should be trained on prevention and inspection techniques. After all, they are on the front lines of pest threats, and they should be encouraged to report and log any pest sightings.

As health care providers, it’s essential to be proactive about pests as renovations occur. By maintaining effective pest management practices before, during and after renovation, a health care facility can provide high-quality care to patients and continue to be a place where health and wellness can thrive.

Tim Husen, Ph.D., BCE is a technical services manager at national pest control company Orkin LLC. A board-certified entomologist specializing in urban entomology, he has more than a decade of experience in the industry. For more information, email thusen@rollins.com or visit www.orkincommercial.com.

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The construction industry as a whole is growing, and the health care sector continues to be a big part of that growth. There is tremendous pressure for hospitals and health systems to reduce costs and increase efficiencies while improving patient care as well as financial stability. While this may be daunting, streamlining processes and putting in place a few key best practices can save both time and money over the course of these construction projects, allowing for greater focus on patient welfare.

Health care construction spending in 2016 exceeded $40 billion and is expected to increase 5 percent annually through 2020, according to the U.S. Census Bureau. More than 50 percent of construction projects completed between 2012 and the first quarter of 2016 were construction renovations (including alterations and additions), according to information provided by the Healthcare Facilities Symposium. So, how can facilities keep up with these challenging demands and plan properly for the future?

During a recent webinar presented by Gordian, a construction data and software company, David Clark, associate vice president of facilities, construction and design at Jackson Health System in Miami, provided insight into how the health system plans for the future with facility master planning. While many projects are currently ongoing, the actual Jackson Health facility master plan was developed in 2012 around three critical questions:

1. How are we operating today?
2. Are we meeting the needs of the community?
3. How do we develop a strategy to improve and expand operations?

Jackson Health has six hospitals and 12 satellite facilities that together span more than 7.6 million square feet of occupied building space managed by the health system’s respective construction and facilities departments. These departments manage an average of 40 to 50 active projects a year.

With the development of an initial facility master plan, Jackson Health cultivated a new capital program, from which it defined signature projects. These signature projects included expansions and renovations of both the Jackson North Community Hospital and the Jackson South Community Hospital, building a new rehabilitation hospital, patient tower for transplant services and 100-bed hospital in West Miami Dade County.

Interestingly enough, project priorities have been evenly split between renovation projects and replacement projects. Perhaps one of the most difficult decisions included deciding whether a building was worth renovating or if it would it be better to demolish and build from the ground up. This is not an easy decision to make and requires careful consideration.

During the webinar, Clark was asked what matrix Jackson Health uses in determining whether to renovate by adding structures versus building new from the ground up. The organization uses a Phase I, Phase II, Phase III, due diligence process when reviewing renovation project requests.

• Phase I: Look at the project initiative request, look at historical data and estimate cost per square foot to determine ROI on proposed project
• Phase II: Bring on professionals, including architects and engineers, to look more in depth at aging facilities to see if infrastructure can support new project initiative and revisit ROI
• Phase III: Bring the engineering department and architects together with non-clinical departments such as IT to ensure departments can perform non-clinical services to match project initiatives in the structure; continue with cost benefit analysis, and if it is determined that it will work, proceed to renovate; if not, look at other options such as a new build or minor expansion

In making such a crucial decision, accurate construction cost data is key. Often project estimates are compiled from individual pieces of data pulled from different sources. This can lead to less than satisfactory estimates, which will inevitably lead to losses of time and money. They may even lead to erroneous conclusions on whether to move forward with a renovation or a rebuild. Therefore, compiling current, accurate and localized construction cost data is a key best practice during the planning stage of a project.

Square foot models further offer a solution to this crucial element. Instead of piecing individual pieces of data, this tool offers customizable estimations based on factors such as building type and location. During the planning process, comparing the numbers for a renovation square foot model versus a new construction square foot model provides a clear vantage over which option best suits the project at hand.

While the above methods on their own can lead to notable improvements within health care facilities, it is when they are strategically put into action together that major time and cost savings become a reality. This will lead to both better bottom lines and better patient care.

Scott Creekmore is the director of account management, healthcare for Gordian. Creekmore has managed job order contracting programs for Harris County, Harris County Hospital District, University of North Texas, University of Texas Health Science Center at San Antonio, USPS and City of New Orleans.  

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The $32.4 million project is broken down in to two parts: $30 million will build on three unfinished floors in the Turner Tower, where the Firefighters Regional Burn Center is located, and $2.4 million will expand the Elvis Presley Memorial Trauma Center.

The two large-scale projects include renovations to the Critical Care Assessment area in the Elvis Presley Memorial Trauma Center, and the development and renovation of unused space in Turner Tower, including expansion of the burn center. The expansion of the burn center will benefit those who have, or will in the future, experience injuries as a result of being scalded in some way. In situations where this occurs due to another’s negligence, the victim may want to consider a burn injury lawsuit to get justice for what has happened to them.

The design of the Critical Care Assessment area is outdated and includes limited assessment space, according to a statement on the medical center’s website. Square footage will be added in the trauma center, including modernizations and increased assessment space. Renovation work is projected to be complete in December 2012.

Turner Tower was constructed in 1992 and has three floors that have never been built out. As one of the newest buildings on campus, it is better suited to accommodate modern and more patient-centered care facilities.

The Turner Tower project includes relocating services from other areas of the hospital, increasing capacity and improving patient and guest experiences. The $30 million capital project will build out three vacant floors in the tower, install required infrastructure upgrades, and renovate other areas in the building.

The project includes:
• Relocation, expansion and modernization of the inpatient rehabilitation unit
• Creation of a new outpatient ambulatory surgery unit
• Opening a 24 private room unit for adult acute care patients
• Expansion of the dedicated burn inpatient surgery suite to accommodate a second burn operating room
• Relocation of the critical care waiting room

Reginald W. Coopwood, M.D., president and CEO, of the hospital hopes to have the project’s state approvals finished by December. The entire project is slated for completion in December 2013.

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