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‘Appropriate design is a critical component in preventing healthcare-associated infections’

Amr Metwally, Head of Architecture Division PMC at Hamad Medical Corporation (HMC), shares with Fatima de la Cerna of Climate Control Middle East his insights on Qatar’s healthcare industry as well as details of the communicable disease hospital, currently under construction in the Gulf country 

| | Jul 8, 2015 | 12:30 pm
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Amr Metwally_opt

How would you describe the current state of the healthcare sector in Qatar?

We’ve had great progress, as evidenced by the fact that HMC buildings have received several awards and are recognised regionally and internationally. However, the industry seems to be focusing on transforming the healing environment into spaces that resemble more like hotels. While it’s good to make hospitals more welcoming and appealing, efforts appear to have stopped there. We only speak about design quality, but what about the design process?

What we are trying to do in our projects in Qatar now is bring attention to the process of design and implement methods that will result in speed and efficiency. We want to move away from the traditional way of thinking and go for more intelligent designs, to move towards smart products. And we also have a lot of projects in the works that are unique.

What kind of projects? What methods have you implemented to promote better indoor environmental quality (IEQ), particularly in connection with air quality and HVAC solutions?

Better IEQ starts with selecting the right design process, which is why recently we’ve been utilising simulation models more and more in our building design. Simulation models allow us to have better understanding of how buildings will behave after construction. An example is CFD (Computational Fluid Dynamics) simulation modelling, which uses numerical methods to solve the fundamental nonlinear differential equations that describe fluid flow (the Navier-Stokes and allied equations) for predefined geometries and boundary conditions. The result is a wealth of predictions for flow velocity, temperature, density and chemical concentrations for any region where flow occurs. A key advantage of CFD is that it is a very compelling and non-intrusive virtual modelling technique with powerful visualisation capabilities. It allows engineers to evaluate the performance of a wide range of HVAC/IAQ system configurations on the computer without the time, expense and disruption required to make actual changes onsite, hence promoting the concept of efficiency and energy savings in the early phases of the project. That’s why it has become a standard part of our design.

For hospital HVAC system designs, they present unique challenges to facility managers due to the sensitivity of the hospital environment. The selection process is not straightforward, because in healthcare facilities, there is an increased level of demand, a variety of required thermal conditions and codes regarding reliability and hygiene. On top of that is the increasing pressure to reduce energy consumption while maintaining a safe environment, which is mainly why we have started employing more VAV (Variable Air Volume) systems, known for offering energy savings and giving better air quality to the patient environment.

In general, we’re very careful when it comes to HVAC systems as they have a strong impact on patients’ comfort level. This is especially true in the communicable disease hospital we are currently constructing in Qatar, which I believe is the first in the Middle East and one of the few that currently exist in the world. It’s a new sector that has developed as a result of communicable diseases like Ebola.

What guidelines are you using for the hospital you’re building? What are your priorities?

Appropriate design of the physical environment in hospitals always contributes to improvements in patient well-being and satisfaction, delivery of medical care, staff satisfaction and reduction in healthcare costs. Appropriate design is also a critical component in preventing healthcare-associated infections (HAIs), particularly through the provision of sufficient single-patient rooms, ample physical space in clinical areas and an environment that can be readily cleaned and decontaminated.

The in-patient accommodation in hospitals generally should be designed in a way that addresses a number of requirements, including:

• Maximising patient comfort and dignity

• Ensuring ease of delivery of medical care

• Making appropriate provision for family members and other visitors

• Minimising the risk of infection

• Sustainable design and energy efficiency

When it comes to communicable disease hospitals, however, infection control and prevention demand critical attention due to the highly infectious environment, and one of the most important considerations are the HVAC design and the ventilation strategies, such as having 100% fresh air circulation not only in the isolation rooms with negative pressure and ante room but in all rooms. Also, all the ducts must be equipped with ultraviolet purifiers. This is in addition to exceeding code requirements by having the air extraction above the building by more than four metres, by vertical chimneys.

The entire project was really quite challenging. There are no solid standards dedicated for communicable disease hospitals, since as a sector, it is new. Also, their design is not quite aligned with certain cultural concepts, like having families stay with the patients. It is not recommended in this kind of hospitals; however, we cannot disregard culture so we had to create zones for the public that are completely separated from the patients’ zone, both in terms of planning and ventilation.

How about the doctors, nurses and the rest of the staff? How are they going to be protected ?

We are addressing that challenge by working closely with an established operation committee, whose responsibilities is to create the hospital operation policy. Another role of theirs is to minimise the direct interaction between the clinical team and the patients, without compromising the delivery of medical services.

Outside every room is a computer that is fed with real-time data about the patient. Unless there’s something serious that requires the doctors to go in and check the patient, they are not allowed in the room at all, and neither are the nurses or the rest of the hospital staff.

The policy is that every two months, every doctor and medical staff has to go for a medical check-up to make sure that they have not been infected.

Also, operation policies don’t only consider normal situations but also extend to cover potential issues that may arise during epidemics or other public health emergencies. The policies comply with the national strategy that focuses on legal and operational preparedness, and include laws related to: isolation and quarantine; travel restrictions; duties to treat highly infectious patients; implications of the federal Emergency Medical Treatment and Active Labor Act (EMTALA); healthcare workers’ rights to a safe working environment as well as workers’ compensation and medical leave; confidentiality protections afforded by the HIPAA Privacy Rule; and disability protection for patients.

What were the factors behind the decision to build a communicable disease hospital in Qatar ?

Qatar is booming now, with the construction market massively increasing. This means that the expected number of labourers coming in to Qatar is dramatically increasing as well, making them more vulnerable to communicable diseases like tuberculosis (TB).

TB is a difficult disease, because not only is it contagious, it also requires patients to stay in the hospital for at least 60 days. They need to be under supervision of the doctor to ensure that they take their medication. But with them staying for such a prolonged period of time, the capacity of TB clinics and general hospitals is not enough. That is why Qatar, knowing that facilities specialising in treating communicable diseases represent a new sector in the world, decided to build one, which will also serve as quarantine hospital in case of an epidemic.

You said that the hospital will be the first of its kind in the Middle East. Do you see other countries in the region following suit and building their own communicable disease hospitals ?

Definitely. In fact, I think Saudi Arabia is now requesting for one, because of the size of its population and the fact that religious tourism brings millions of people from all over the world to Saudi — the risk of having patients with infectious diseases is very high. There has also been recent news about some Ebola cases appearing there. So, yes, I think you will soon hear about Saudi building one.

Also, communicable disease hospitals will support disease prevention through travel clinics that provide information and recommendations as well as pre-travel vaccines and check-ups once back in the country.

I think all these factors, together with globalisation, point to this new type of hospitals spreading.

Earlier you mentioned that when it comes to the design process, speed is a main concern. Why is it a main concern ?

The biggest challenge we are facing in Qatar is the tremendous increment in population. Every month, we have around 25,000 people coming to the country as part of the country’s economic boom and its massive number of mega projects, either in construction or infrastructure.

But hospitals are not built as fast as the population is growing. So, while a growing population is good for the country’s development, for some sectors, if no proper planning is done to accommodate this growth, it will mean potential deficiencies.

In order to accommodate this growth, the government is going in two directions: short-term and long-term. Long-term involves the development of the Qatar Healthcare Facilities Master Plan, which identifies new hospitals that are being planned. And for short-term, we are looking at building small-sized hospitals that can be finished in less than a year and at developing a renovation programme for existing facilities, to expand their capacity.

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