Unit 6.5. Facility design, renovation, and use TB Infection Control Training for Managers at National and Subnational Level

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Unit 6.5. Facility design, renovation, and use
TB Infection Control Training for
Managers at National and Subnational Level
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Objectives

• After this unit, the participant will be able to
• List basic design principles for maximizing
  natural ventilation
• Provide an example of facilitating patient flow
  to minimize exposure to infectious patients
• Provide an example of rethinking the use of space
  to decrease the risk of TB transmission

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Outline

• A. The managerial activities of facility design,
  renovation and use
• B. How facility design, renovation, and use can
  the risk of TB transmission
• Reduce crowding
• Maximize natural ventilation
• Organize patient flow
• C. Maintenance

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A. Inadequate design and use of space contribute
to TB spread

• Managerial activities at national and facility
  levels
• Ensure that health facility design, construction,
  renovation and use are appropriate
• Rethink the use of available spaces to optimize
  implementation of controls

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Facility upgrade and reorganization includes

• Simple interventions that do not require any
  structural change

• More complex solutions that require engineer or
  architect type of expertise

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B. How facility design, renovation, and use can
reduce the risk of TB transmission

1. Reduce crowding
2. Maximize natural ventilation
3. Organize patient flow to minimize exposure to
   infectious patients

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1. Reduce crowding
98 patients exposed vs. 9 9 18
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2. Maximize natural ventilation

• Orientation to prevailing winds
• Elevation from the ground
• Stack ventilation
• Building dimensions

• Placement and size of window openings for cross
  ventilation

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Cross ventilation and shape
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Poor air mixing, little air exchange
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Cross ventilation
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Cross ventilation
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Windows design
Tilting windows
Sliding windows
lt 50 open area
100 open area
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Tilting windows
Tilting windows (horizontal)
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3. Organize patient flow to minimize exposure to
infectious patients
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Mixing of patients and staff
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Separation of patients and staff
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Crowded, indoor corridor used as a waiting area
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Outdoor waiting area
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Use of existing space
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Radiology
MDR ward
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Radiology
X X X X X X
MDR ward
New external stairs
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Sputum collection
Dont! Do!
Sputum collection outside a simple solution!
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(No Transcript)
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C. Facility maintenance
Clinic design needs to support the operation and
maintenance of the facility throughout its life
cycle
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Budget for maintenance

• If the building has a 60 year life span, and the
  initial construction cost was 100 million, you
  will need to
• budget 4 per year (4 million) for maintenance
• spend 240 million over the next 60 years on
  maintenance, or nearly two and half times the
  cost of initial construction

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Risk of inadequate building maintenance
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Risk of inadequate engineering service
maintenance
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Summary

• Managers should rethink the use of available
  spaces and consider renovation to optimize
  infection control
• Buildings can be designed or upgraded to decrease
  crowding and maximize natural ventilation
• Patient flow in facilities should be organized to
  diminish exposure by infectious patients.