Healthcare interior designers are navigating uncharted waters in the midst of the COVID-19 pandemic, causing them to turn a more critical eye to current design measures for infection prevention. In this roundtable article, we asked several healthcare interior designers to share their perspectives on this question: What are your preferred design solutions for infection prevention in particular or for healthcare facilities trying to create healing spaces in a post-pandemic world in general?

Lisa Cini

Owner of Mosaic Design Studio | Read Q&A

Proactive testing and touchless solutions along with ones that maintain prevention versus a one-and-done cleaning are top on my list for design solutions for infection prevention. But one of the most important factors to consider in designing is that we can lose sight of who we are designing for. Ensuring that communication and connection are effortless is easier said than done. Products which make it easy to be safe but still see a smile and understand what someone has said are key to reducing loneliness and depression.

Our healthcare designs are now including a holistic approach which include everything from products to kill COVID for up to 30 days to rapid testing for COVID.

Proactive testing

• Rapid immediate COVID testing with a pin prick. 

Touchless

• Temperatures can be taken though robots that greet and scan for temperatures and facial recognition (Zorpro and Temi)
• Touchless hand sanitizer located prior to entry at critical doors and all restrooms and dining spaces
• Touchless faucets
• Touchless hand dryers (Dyson, Xlerator, and Bobrick)
• Foot operated door openers
• Touchless toilet flushing (Techo)

Communication tools to reduce isolation

Acoustics

• Reducing noise in a space is even more important with spaces increasingly moving towards hard surfaces. Having a surface that also absorbs sound and therefore reduces anxiety, falls, and depression goes a long way to create healing spaces.

Hearing

• Induction looping technology to help those with hearing loss hear better with TV’s, announcements, etc
• Technology tools such as tablets and telemedicine to allow greater visual and auditory interaction without breaching safe protocols

Clear Mask

• Smiles heal and facial features show empathy. Not being able to see responses adds additional stress on the body and reduces its ability to heal.
• Helps to improve communication especially for those who are hard of hearing
• Allows caregivers to provide better care by seeing reactions

Effective long-term kill technology

• Air cleaning technology for our HVAC systems such as iWave or a UV solution
• Mechanical kill vs chemical kill – Mechanical kills encapsulate and continue to kill. They provide an instant destroying action with lasting prevention of up to 30 days. 

We believe the solution for a safe healing environment should engage the best technology available to reduce the stress and worry of the healthcare workers, patients, and their families so that they can focus on healing.

Melinda Avila-Torio

Senior Associate and Project Manager at THW Design | Read Q&A

Prior to the pandemic, we had always maintained a priority of selecting finishes that would be durable, allow ease of maintenance, and provide a high level of safety for the users. The current COVID-19 pandemic reminds us how critical it is that our selection and proposal of interior finishes and furnishings withstand the effects of cleaning solutions recommended by the CDC and approved by the EPA. The current movement of qualifying finishes and fabrics for healthcare environments has taken an upswing; designers are busy analyzing product integrity and stability in existing occupied spaces.  

There are a variety of healthcare environments (administrative spaces, retail venues, common use spaces and resident/patient private rooms) that should have solutions that can stand up to a variety of demands in their built environments. Those demands would include but are not limited to life cycle costs, maintenance schedule, replacement value, physical/material stability, and color retention to name a few. For example, we research fabrics that have inherent finishes built-in like antimicrobial treatment, NSF (National Sanitation Foundation) approved quartz countertop surfaces that do not need to be sealed, or wall protection that will not release toxins. Other products being considered include lighting that can inhibit the growth of pathogens which would compromise a person’s health or recovery.

Integral to a design solution for infection control is space planning. For senior living projects, we are looking at the movement patterns of care team members, operations, residents, and visitors. We analyze where they need to interact and what type of interaction occurs. This does not start or end in resident common areas but continues to junctures like decontamination areas adjacent to the resident room entrances. These layout studies will help minimize cross interference between residents, food delivery and/or soiled/trash removal. Though we aim for quality socialization and care, we also want to ensure health safety for all inside the community buildings.

An occupant’s experience of wellness is very much tied into the visual aesthetic of the spaces we help create. Today’s healthcare environments and its future to deliver healing is dependent on how well these various interior finishes perform together at its highest level. The future of healthcare is being defined by how we respond to this pandemic.

Marleen Milligan

Associate at Cuningham Group | Read Q&A

There’s nothing easy about what’s going on in this world today, but healthcare seems to have lived in a preventative world long before this pandemic. With that, we are always creating healing spaces that are functional as well as aesthetically pleasing. Hands down, the best solution to aid in infection control is specifying responsible finishes that can be easily cleaned and hold up to anything tossed at them physically and chemically. Wall protection is just one of many to provide “insurance” for long lasting finishes. From paint to fabrics, any finish that you can wipe and scrub and that still maintains its original form—that’s a product we look at for infection prevention. Products that don’t harbor microbes. Smooth, not heavily textured. These are the basics behind preventative care.

Libby Laguta

‍Principal of L2D.design | Read Q&A

My preferred design solutions for infection control in a post-pandemic world go beyond healthcare spaces. I think as we have learned to cope in our present situation, all areas of design will continue to adopt design protocols to keep people safe. It will become less likely to specify textiles for privacy curtains, upholstery, and other applications. We will see more technological innovations for coated fabrics/vinyls. These will be the go-to upholstery in areas where cleaning, disinfection, and sanitation is standard procedure. So this now includes healthcare, hospitality, education and other project types.

Melissa Perry

Senior Associate at Inventure | Read Q&A

Infection prevention has always been a top priority in healthcare design but is even more paramount in our post-pandemic world. Starting at the floor of a space, seamless flooring products like poured epoxy and terrazzo are great options. With no seams, this allows for full disinfection and little to no areas for bacterial growth. Another tried and true product is Solid Surface. It is very versatile and can be used in a variety of applications from work surfaces to wall protection. Solid Surface comes in large sheet sizes, so seams are minimal. I have found that working alongside the Infection Control department of a health system is vital for designing healthy spaces. They are the litmus test for new products and design solutions, and these products have always fared well with them.

Haley Driscoll

Principal of the Philadelphia Health Sciences Studio at NORR

As we are facing the design challenges of the pandemic, it’s hard not to look ahead and try to understand what the future will look like for the design of healthcare facilities. While talking to clients, they don’t really know either. A vaccine is their first hope, rather than making big financial changes to facilities and processes.

For the most part, the areas that are facing the biggest challenges are waiting areas and public areas in both outpatient and inpatient settings. Clinical care areas, such as exam rooms and patient rooms are already designed to meet most of the criteria for infection control as it relates to design and finishes and are very comprehensively addressed in the FGI and by infection control officers within healthcare facilities. It’s the common visitor spaces that often get left open to interpretation. In the common waiting areas, the greatest single area that can be addressed is the furniture. We know proximity and touchable surfaces are the most common ways infection is spread. I believe adaptability in planning layouts and cleanability are the most important aspects of addressing infection prevention. We are looking at creating flexible furniture plans that can be easily adapted to create social distancing when necessary as well as furniture designs that can be easily modified simply by removing or adding back in the seats as conditions require. We no longer recommend ganged seating options for this reason.

Patients for the most part are coming to facilities alone without the assistance of any companion so ensuring universal accessibility is important. The selections for finishes must withstand a wider array of disinfectants, understanding that supply chain disruptions are likely and out of our control. All of these interventions can be done while still creating an environment that encourages a sense of healing and wellness for the patients and hopefully their companions again someday.

Kimberly Bernheimer

Principal at PF&A Design | Read Q&A

I would say the key to designing in this time during COVID is flexibility because we don’t know how long this pandemic will last and how the needs might change as we progress. We have worked on designs for reception windows and worked on dividers in classrooms and auditoriums. The key to this was coming up with a solution that did not need to be permanently attached if this needed to be removed in the future if things go back to being more open again. In healthcare we have always designed around ease of cleaning and best patient flow, but now we have been called to add another level of separation and one way flow to reduce cross contamination. We are working on ways to help answer that call!

Keith Stanton

Director of Design Development at Thoma-Holec Design | Read Q&A

Ownership groups of senior living communities are still focusing on the hospitality look for new communities. Our goal is to specify cleanable materials, which also give the community the perception of cleanliness upon first impression. We have always been specifying quartz countertops, but now they are a company standard for their cleanability and impermeable qualities. In our memory care communities, bleach cleanable fabrics are our standard, but now we purchase smoother, but still soft to the touch, bleach cleanable fabrics to give the visual perception of an easily cleanable product. We have always used vinyl seating in our food service areas and are strategically using more, while still preventing an institutional feel for our public spaces. The products to prevent infection control currently exist. We need to continue making the best design decisions for our residents and the health of employees.

Crystal Hill

Interior Designer at Odell | Read Q&A

Even in a post-pandemic world people are going to be more aware of infection control and prevention than they ever were before. Creating waiting areas that incorporate social distancing and a comfortable space between patients will be important. This includes the seating layout as well as the check-in procedure. Moving patients through with less congregating in waiting areas will become the norm. 

Surfaces will be sanitized more often with harsh cleaners. This will be important for designers to keep in mind. All surfaces that we specify must hold up to the antibacterial chemicals that are being used. In particular, waiting areas should move away from having wood arms on furniture and fabric seating. Also, countertops should be a solid surface or similar to hold up to harsh chemicals. All surfaces being used in a healthcare setting should go through testing to ensure they will stand the test of time and support the cleaning procedures of the facilities. 

The way the exam room functions will change as well. In an effort to minimize patients traveling to different parts of the building or clinic for various services and procedures, providers will try to handle as much care as they can inside of the exam room. These practices have been adopted during this pandemic, and I believe they will stay around for a while.

Jennifer Fink

Senior Healthcare Designer/Planner at BDA Architects | Read Q&A

Infection control and prevention has been a focus point in healthcare design for years; this is nothing new for designers working in this field. The pandemic has only brought this issue to the forefront. As a designer working with a hospital, it is our responsibility to specify products that
suit the needs of the space we are designing. For most acute settings that includes surfaces that are not only durable, but easily cleanable and aesthetically pleasing. In recent years there have been vast improvements in products and finishes that are not only durable and cleanable, but ones that also have bacteria reducing properties.

Products such as EOScu, which is a cupron enhanced synthetic hard surface, replace materials such as standard solid surface and will kill 99.9% of bacteria within two hours. Lighting fixtures such as Indigo Clean by Pinnacle Architectural Lighting combine ambient light with 405nm Indigo light to safely provide visible light disinfection whenever the light is turned on. These lights help remove the bacteria that causes such infections as Staph and MRSA everywhere the light reaches. More recently UV products have been developed to further the disinfection capacities of light. Robots such as the Tru-D Smart UVC system can be brought into patient rooms and disinfect the entire space in one cycle between patients. Innovative shoe sanitizing stations have been developed by PathO3 Gen Solutions that successfully remove contaminants from shoes before they spread through a facility.

These products may present a higher up-front cost versus conventional products; however, the results should outweigh the costs. My hope moving forward is that more organizations see the value of incorporating some of these products into their designs for the infection control properties they present.

Diana Louden

Interior Designer at Array Architects

At Array we have been researching the nuances of the COVID-19 virus, its impacts on how our clients deliver healthcare, and how mitigation efforts affect the patient and staff journey as they move through a healthcare facility. One of the best ways to prevent the spread of viral matter in a post-pandemic world is to utilize Telehealth as much as possible and when deemed appropriate for the patient. Telehealth, which was once considered a novelty, is now an essential aspect of healthcare delivery.  From a design standpoint, not much is required for a successful telehealth consultation other than a desk, video-conferencing equipment, web access, and secure email capabilities. The space should be uncluttered with neutral finishes to focus attention on the provider. Camera placement should promote eye contact and lighting should be designed to minimize shadowing on the speaker. Visual and acoustic privacy are important and the space should ideally be an enclosed room with a door. If a traditional room isn’t available, pre-fabricated pods or full-height acoustic partitions are good options to ensure privacy. The bullet points below dive a little deeper into each of the components of a successful Telehealth space:

Camera Placement: In the article “Perception of Eye Contact in Video Teleconsultation” in Journal of Telemedicine and Telecare, found that a camera angle of 7 degrees yielded better results in videoconferencing than a 15 degree angle. Patients found the speaker to be happier, warmer, more approachable, and more confident which led to patients being more engaged and interested in their appointment.

Background and Color: Nothing in the background should take away the focus from the provider, so uncluttered spaces are a must. Designers should consider offering lockable storage with one-time use keypads so personal items and portable equipment can be tucked away. Wall finishes should be neutral and matte to eliminate glare and light reflectivity.

Other Considerations:

• Additional equipment like a translator phone may be needed.
• Allow users to control the environment with the use of dimmable lighting and adjustable task lighting.
• Prefabricated pods like Vpods, Jabbrrbox, or Steelcase's SnapCab Pods are interesting alternatives to traditionally built Telehealth rooms.

For more tips and resources to reduce infection risk in healthcare facilities, please see Array’s COVID-19 Outpatient Toolkit. The Toolkit outlines mitigation opportunities at every patient and staff touch point starting with Arrival and ending with Exam/Intake.

Lilliana Alvarado

Founder and Design Principal at UPHEALING | Read Q&A

As healthcare designers, we are always looking for ways to create spaces that can be comforting while addressing infection-control issues. More so than ever during this pandemic, we are looking at numerous finishes and upholstery options that can be cleaned and disinfected quickly and thoroughly without damaging the products. We are exploring options for enhanced ventilation systems and new sterilization procedures; however, all of these strategies are not necessarily perceived at first glance when you arrive at a healthcare facility.

Aside from these common approaches, we also understand the importance of hand hygiene as an essential way to prevent the spread of pathogens. My preferred design approach for infection prevention is to design towards our intuition to provide some level of comfort and have people regain some degree of control. Some examples are placing hand-washing stations, alcohol-based hand rub stations, and providing touch-free surfaces such as plumbing fixtures and door hardware throughout the space that are obvious. These simple measures can be incorporated into the overall design and not just as an afterthought, which can reassure those with a fear of infection.

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