AIA, NCARB, CSI, ICC
Constructive Criticism columnist Paul Gladysz, AIA, NCARB, CSI, ICC, is the principal architect at BDA Architecture. The Albuquerque, New Mexico, firm specializes in the planning, design and construction of animal care facilities. Gladysz has over 35 years experience in design and managing animal care facility projects. He has been involved in more than 300 veterinary designs, including 20 award-winning projects. His areas of special interest include project delivery methods, including design/build and construction management; lighting; acoustical control and new construction materials and methods.Read Articles Written by Paul Gladysz
Modern veterinary hospital design has long focused on pathogen control and biosecurity, but to be extra safe amid the COVID-19 pandemic, let’s review recommended strategies and features. The ideas laid out below are most applicable to clinics scheduled to be built or renovated, but a surprising number can be incorporated into existing facilities at minimal disruption. All of them support best practices and evolving protocols.
Double sets of doors are usually installed in extreme climates to conserve energy, as an after-hours security measure or as animal containment to prevent an off-leash dog’s dash to freedom. Today, they also can be used as a protected no-contact handoff point between clients and the veterinary team.
For example, a scheduled client can call upon arrival. After initial intake information is exchanged, the client is instructed to leave the pet in the vestibule, either in a carrier or on a leash hook. The staff can then bring the dog or cat into the hospital and disinfect the carrier. Check out and discharge can be done in reverse.
Direct-Access Exam Rooms
Many of the hospitals I design have a comfort room for euthanasia or client consultation. The room can have either a direct or near-direct exit door so that a grieving owner can leave in private. These rooms also function to limit person-to-person contact and minimize anxiety for fearful or aggressive dogs and cats.
As social-distancing restrictions are eased, the room can serve as a middle ground between today’s reality and the traditional waiting room setup. My firm is now advocating for more than one direct-access exam room.
I foresee the embracing of app-supported mobile check-ins, a natural extension to app-based mobile pay and medical tracking. The days of clipboards and paper forms will soon be in the past.
Reception areas need to serve modified functions in a post-COVID-19 world. When social distancing is in effect, few people will be seated close by for any length of time. As restrictions are eased, the waiting area will be more for staging than sitting. Fewer seats spread farther apart will be the norm.
At a recent project meeting, a client told me how the clinic’s hospitality station is no longer used to supply free water or coffee. It became a handwash station that each client is required to use before moving to an exam room. Outfitted with touchless soap, faucet, paper towel and hand-sanitizer devices, the features permit pre- and post-visit hand cleaning, which I think veterinary teams and clients will appreciate.
Pathogens are mostly spread by airborne droplets or by touching a contaminated object. We can address each of these through enhanced design features.
We all share the same air, of course, so the best strategies involve either separating, removing or neutralizing pathogens. In the case of new or substantially renovated hospitals, these strategies can take the form of a heating/cooling system that separates the building into zones so that air from one zone is not shared with the rest.
I typically design three zones:
- A front client-facing area like an entryway, waiting room and exam rooms.
- A central clinical area.
- An animal ward or housing area.
The number of zones will depend on the practice type and building size. Each has a separate heating and air conditioning unit and a separate thermostat. From high-risk rooms, such as an isolation unit, I go a step further and exhaust all the air to the outside.
Unless your climate is extremely mild, exhausting all air to the outside is neither practical nor affordable. Instead, most commercial systems recycle about 80% of the air and introduce outside fresh air for the balance.
Recycled air can be treated to kill pathogens and remove odors. When properly sized and positioned, add-on UV-C (ultraviolet C) modules will keep air conditioning coils clean — a common source of bio growth — and clean the airstream. One company I like, PetAirapy, makes veterinary-specific units that can often be retrofitted into existing equipment, depending on the type.
Hand in hand with active sanitizing is filtration. All air conditioning systems have disposable filters, but what is important is to use high-efficiency filter media and change them often, no less than once a quarter. This rule of thumb is true for all businesses but especially for veterinary hospitals because no matter how good your cleaning protocols, hair and dander will quickly overload a filter. Once a filter is clogged, you will not get the flow needed need for good ventilation or comfort.
For clinics that cannot add central features, the next best is room-by-room treatment. High-quality, wall-mounted air filters like Rabbit Air’s MinusA2 will go a long way toward improving indoor air quality. Some portable units from PetAirapy include internal UV-C lamps, which kill pathogens that manage to pass through the filter.
Take Care With UV-C
Filters are great at treating air that passes through, but filtering all the air in a room might take hours. In the meantime, pathogens can land on surfaces. A few things can be done besides continuous wiping.
Wall- and ceiling-mounted UV-C fixtures will sanitize all air passing through the units. Other UV-C fixtures sanitize through direct surface contact. You might have seen fixtures like these in health care settings. A growing strategy is the use of portable UV-C sanitizers, which are placed in unoccupied rooms between cases and run for a predetermined time based on the room size.
Be aware that some residential UV units lack the wattage necessary to effectively kill viruses in the airstream. Professional units are much more effective. I suggest hiring a technician to select the units and the mounting locations. Ultraviolet C exposure is dangerous. An improperly used fixture can damage a person’s eyes and skin.
Manufacturers of high-touch surfaces have added antimicrobial finishes. Those embedded in the material are better than surface treatments, which can wear off over time. Metal surfaces such as door hardware and faucet handles use copper alloy and silver ion technology to keep surfaces clean. Tests of these units show that viruses can be up to 99% eliminated after a few hours.
An excellent strategy is to minimize touch surfaces in general. For example, many doors in a veterinary hospital do not require locking or latching. Instead, they can be changed to a push-pull design so that in at least one direction, someone can open the door using an elbow or shoulder.
Even more effective are touchless sink fixtures. Infrared-activated faucets — today’s technology is unmatched — can be used at virtually any sink. Add in touchless toilet flushing and touchless soap and paper towel dispensers and you have gone a long way in eliminating the most common bio transfer points.
Do It by Hand
The most common sanitary efforts are labor-intensive. Once post-COVID-19 supply chains recover, sprays and wipes will be more heavily used than ever.
I want to offer a word of caution. “Some is good, more is better” is a dangerous mindset. Even the best products improperly used will cause problems. Some common and very effective sanitizers can be caustic and corrode even stainless steel if not properly diluted. Over time, the improper use of chemical sanitizers can destroy expensive equipment and fixtures without any gain in cleanliness.
Also, note that chlorine often is used as a sanitizer. While Clorox wipes are perfectly safe on most surfaces, they must be used with gloves. Liquid bleach is not advised as a surface cleaner, especially on floors. Chlorine ions break the chemical bonds that hold many materials together. Vinyl floors, tile grout and even concrete will break down over time when exposed to bleach. Anyone who’s seen ice-melting rock salt destroy a concrete sidewalk has witnessed this in action.
When building a hospital or giving one a facelift, be sure to select materials that make cleaning easier. While no surfaces are dirt-proof, some need less maintenance. I’ve discussed many of those options in previous articles, so I won’t go over them again here.
Along with material selection, cleaning systems deserve a lot of thought. Several very good central systems are available, but you need to compare the cost against the effort. A mop and bucket are perfectly reasonable for a majority of practices, but I would encourage at least a metered dispensing system for cleaning products to ensure that they are not overused.
Working with a designer who understands the specific needs of veterinary clinics in the new reality has never been more important.