‘Hospital within a hospital’ concept explored

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When Toronto’s SARS outbreak was finally brought under control in the late spring of 2003, hospital design was clearly one of the many things that needed to change in order to more effectively contain another outbreak of an emerging infectious disease. But since SARS was a new threat, there was no established body of knowledge about how hospital design could be altered to prevent its spread.

To generate new ideas about containing virulent infectious diseases through facility design, Murphy Hilgers Architects Inc. hosted SARS: Planning For What’s Next, a roundtable discussion held on October 2, 2003. Over 60 doctors, front-line staff, administrators, designers, engineers and consultants attended, and out of the discussions came some perceptive insights and pertinent questions.

Two key requirements emerged from the discussions: the need to prevent the spread of infection inside hospitals and the need for facilities to be able to function normally during an outbreak, avoiding the massive disruption of services that occurs if an entire hospital has to be shut down. The response to these needs was the concept of the ‘hospital within a hospital’ – parts of hospital departments that could be completely sealed off from the rest of the facility during an outbreak.

If such a concept were adopted, what would be the features of a hospital within a hospital? How would it function? The roundtable participants put forward some ideas:

The emergency, intensive care and OR/recovery departments would all ideally have containment zones.

  • Incoming patients would be screened upon their arrival at the hospital, and those suspected of carrying infectious disease could then be immediately directed into the containment zone. Isolating potentially infectious patients as soon as they step in the door helps to minimize the chances of the disease spreading to staff, visitors and other patients.
  • Patient rooms within the containment zones could be used normally under routine conditions, then quickly converted to isolation rooms when necessary. These isolation rooms would use negative air pressure to prevent infectious air from leaking into the corridor and would also have two anterooms, one for a clean entry and one with a washroom and shower for a dirty exit. Air within the room would be best changed 9 to 12 times per hour and immediately exhausted to the outside, well away from air intakes or open windows to prevent infectious agents from spreading through the hospital. Specialized holding tanks might also be required so potentially infectious wastes could be properly disposed of.
  • Housing more than one infectious patient in one isolation room (or having several rooms in a containment zone) may be feasible if all patients have been confirmed with the same illness. Unconfirmed patients would have to be housed in separate rooms to avoid becoming infected if they were not already.
  • Suggestions to prevent spreading infectious agents while transporting patients from one department to another included designating certain corridors and elevators for infectious patients only; if that is not possible, patients could perhaps be moved in sealed, self-contained environmental transportation devices. Otherwise, corridors and elevators would likely have to be temporarily closed after transferring an infectious patient in order to be thoroughly disinfected.

Creating hospitals within hospitals in Canadian facilities may in some cases require significant renovations, but the changes would provide health-care professionals with much more effective tools for containing another outbreak of an emerging infectious disease. With future outbreaks of this type likely, creating hospitals in hospitals may prove to be the prudent thing to do.