Tuesday, April 28, 2020

Draft Minutes of Virtual Meeting held on 25th April 12-1.00 PM to discuss Future Pandemic Friendly Infrastructure

IJCP May Issue

Draft Minutes of Virtual Meeting held on 25th April 12-1.00 PM to discuss Future Pandemic Friendly Infrastructure

List of Participants

Dr KK Aggarwal, President CMAAO & President HCFI
Dr AK Agarwal, Ex Dean MAMC, Advisor Apollo Hospital, Delhi
Dr Mahesh Verma, VC IP University, Ex Director MAIDS Govt of Delhi
Dr Suneela Garg Dir Prof MAMC,  National President Elect IAPSM
Dr Atul M Kochar, CEO NABH
Dr T S Jain, Consultant Pediatrician, Max Smart City Hospital, Ex MS
Dr Bejon Misra, Founder Patient safety and Access, Consumer online Foundation
Mrs Upasana Arora, Director, Yashoda Hospital
Dr K K Kalra, Ex CEO NABH, Director HCFI
Dr Sanchita, Editor IJCP

Subject Experts

Mr Sarvagya  Srivastava, Engineer in Chief (Rtd), CPWD, Advisor IP University  
Dr R Chandrashekhar, Chairman IGBC Green Healthcare Rating,  Consultant World Bank, Consultant IUIH ( Indo UK Institute of Health ), Vice President RFHHA, Vice President IBIMA (India BIM Association), Visiting Prof. London South Bank University, UK;  Former Chief Architect, Ministry of Health &FW, Govt. of India
 Mrs Maninder Kaur, Architect Yashoda Hospital
 Mr Suresh DN, Project Manager, Max health care
 Mr Ashish Rakheja, Managing Partner AEON Integrated Building Design Consultant, Past President ISHRAE and Ashrae India Chapter, Chairman Technical Committee Indian Green Building Council Specialization Thermal Engineering


1.      Past pandemics and especially present Covid -19 infection around the globe and in our country, have given us opportunity to think about future protection from similar attacks and built systems which are safer, resilient and adaptable.

2.       A s Covid -19 infection is going to persist for some time may be 2 years or so, even after the lockdown is lifted in phased manner, we need to start afresh with new way of working in our workplace, hospitals or homes to maintain social distance and hygiene measures for personal protection as well of ours neighbors.

3.      Discussion points: How to maintain social distance in lifts, clinics, hospitals, factories, public transport systems, airports  etc.; Appropriate ventilation systems at homes, workplace and hospitals, high risk areas which are necessary to stop transmission of microorganisms including viruses and consumer friendly.; Impact of NO TOUCH technology and its utility in cost effective way; Use of infection resistant materials like wall paints, door knobs, handles etc. and Decontamination ease

Following infrastructure related concerns were highlighted by the experts after deliberations 

1.      Most importantly, after an episode is over, complacency sets in at all stakeholder’s levels and learnings are forgotten to safeguard future calamities.

2.      Ventliation is double edges sword, if not appropriate is rather counterproductive and is den for colonization and enhance transmission of disease agent. 

3.      Space management

4.      Non utilization of technology and poor design of the building like green building concepts, natural ventilation and lighting

5.      High cost of establishment and operative costs

Broad Solutions suggested are

1.      Building designs should be Evidence based designs (EBD) and meticulous planning to incorporate Green concepts, use of nature resources like lighting and ventilation, resilient and adoptable for expansion and contraction of services in time of crisis (need based) as makeshift arrangement.

To cut down cost, in place of single rooms, Nightingale wards having large windows for lighting and ventilation, maintaining distance between beds minimum 1 meter and curtains for privacy. Common hygienic toilets.

For this purpose, provision to be made in parking areas, lobbies and other space within or near premise to raise modular structures in minimum time.

Use of auditoriums, conventions halls, sports auditoriums etc.  to turn them into temporary isolation/quarantine/ triage facilities/primary care/monitoring areas like Wuhan erected 13 temporary hospitals in such places in hours to a weeks’ time creating 18000 beds with zoning and ventilation. Minimum standards for quality and safety were implemented in these makeshift arrangements also.

2.      To reduce over crowing in OPDs
Provision for large area in OPD to maintain physical distance
Appointment system
Teleconsultation/video consultation room

3.      Triage /screening area for prioritization of patients, less than 3 minutes for screening to minimize chances of contact transmission.

4.       Separate walkway for movement / transfer of infected patients from non -infected patients

5.      2-4 patients per lift and separate corridor and lift for Healthcare workers

6.       To reduced transmission by contact:  use of sensors for doors, washbasin taps, flush systems in toilets/urinals.

7.      Use of copper alloy (minimum 63%) cu as bacterial resistance material in doorknobs/handles/railings etc.

8.      Sufficient facilities for hand wash /sanitizers in clinical areas

9.      Sufficient AIIR rooms (isolation rooms) with negative pressure [CDC suggest 1.7 rooms per 10,000 population in mild epidemic; 6.56 rooms per 10,000 population in moderate epidemic severity and  61.5 rooms per 10,000 population in severe   epidemic        

Ventilation: involves 4 steps

1.      Pressurization

2.      Air changes per hours

3.      Filtration

4.      Purification of exhaust air

Ventilation systems should follow standards laid down by ASHRAE or other recognized national standards for installation and operations and maintenance. First 3 processes result in trapping and colonization with microorganisms, purification of these is most essential and generally this step is not taken care of adequately resulting in transmission of infection through HVAC system.

Proper Temperature and Relative Humidity as per need of clinical area is important for comfort of staff /patient and well as deterrent for infecting agents

Various methods for purification like HIPPA filtration, UVGI or ionization can be used in combination

Direction of air flow is also concern

Provision for switching of type of pressure from positive to negative in rooms or ICU on need base can be made

Preventive and regular maintenance as per guidelines

In any type of setting varying from a single room clinic to N Homes to tertiary hospitals, system of adequate ventilation and safe disposal of exhaust air is must and is feasible by using various technologies. The additional cost of installation is going to add cost to establishment but is vital for safety of staff and patients and communities.

Public Transport

Decongestion at airports, stations and bus stops is need of hour.

Sitting norms in airplanes, trains or buses shall change

Bicycle or two wheelers use to be encouraged

Minimum Quality standards should be made mandatory for all types of health facilities
Standards to include social distancing norms and infection prevention & control measures

Meeting ended with vote of thanks to chair and participants. It was decided to hold 2-3 more sessions to discuss technical details.

Copy of guidelines issued by CPWD for ventilation and by IDA for Dental facilities are attached

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