LA County's own Ranch Los Amigos hospital is in need of CLOTH Masks for Staff. They are looking for 400-500 cloth masks for workers at their facility like shown in the picture below. If you can make or locate masks to donate please contact Alvin Lee, with Dept of Health Services at 310.628.2533 (cell) to arrange for a donation. Also, a good project for sewers making masks for their community!
Latest CMS Waivers and Guidance on COVID19
Please see the latest waivers and guidance CMS is providing to Hospitals, LTC, SNFs, Critical Access Facilities and more.
AIA Alternative Care Sites Preparedness guideline
Building during Coronavirus
At AmeriConstruct, our team has been looking for avenues to lend our expertise to supporting building efforts related to Coronavirus. We are a staffing agency for the construction industry - www.americonstruct.work. As we have started to research how we may get involved, a few things have started to become clear. The Army Corp of Engineers (USACE) leads the way in building temporary facilities for emergency patient care. They are also taking the lead in repurposing existing buildings such as conference centers and hotels for medical use. USACE started work in NY a few weeks ago and are moving across the country to the hardest hit areas. As of yesterday, they had built out 85 locations. Someone to follow closely is General Todd Semonite: He's doing a lot of press. Click on the links below to view his recent interviews and presentations. We're learning that to be involved - at least regarding emergency and critical structures - we need to be aligned with the USACE process. That means that after State's Governors identify sites and FEMA sanctions them, USACE then moves in with its operation. It is then that we could get a foothold during the next phase when the General Contractor partnership begins, and civilians are engaged. Yet, it remains a process that does require some clarity. Where anyone can immediately help, though, is to nominate sites for local government consideration. Sites must meet certain criteria as Semonite talks about in the clips. So, do you know a building that might work? Bring it to the attention of your local officials. Ultimately, buildings can be constructed by USACE or the State. For other companies not in the staffing business, but likewise interested in making a construction contribution, it seems that the path forward will also be directed if not influenced by USACE and FEMA. However, Semonite has mentioned on several occasions that he holds the blueprint for the designs, and that architects and builders don't have to wait for him or USACE to proceed. He'll willingly give up the plans. We're interested to learn what that process entails. More broadly, healthcare construction is on the rise. Though there is some debate regarding what constitutes essential activity at this time, construction projects across the country are moving forward. Note, though, that this varies greatly from State to State and their own internal recommendations or orders. Nevertheless, those participating in healthcare construction - whether it be tenant improvements or ground ups - can absolutely thrive in this climate. The short-term activity is getting the headlines, but the long game is also at a premium as developers continue to plan for the expected need for permanent structures - hospitals, medical centers, and other related facilities. For example, we were just commissioned to assist a developer seeking to turn 6 acres in Houston into medical buildings. It's a long-term project, but the future begins now. https://www.https://www.youtube.com/watch?v=xCsidYDqWo0&feature=youtu.beyoutube.com/watch?v=csfCKuy5HH8&feature=youtu.be
COVID-19 Facts vs. Fiction
Thought i would share some insight on Fact vs Fiction about COVID-19 (also posted on our website) FICTION: The coronavirus is smaller than 0.3 micron, so HEPA filters won’t be very effective. FACT: HEPA filters are rated at 0.3 micron particles because that’s where they are efficient. They are actually more effective with particles both larger and smaller. For the purpose of stopping virus, HEPA filters rated 99.97% or better can be considered effectively absolute filters. If properly installed in a sealed frame system, HEPA-filtered air is safe to return to occupied space. For those who want a deep dive into air filtration, here’s a guidance paper from DHHS/CDC/NIOSH. FICTION: We probably don’t need HEPA filters, because the filters in my air unit are 90-95% efficient. FACT: The standard filters required in healthcare facilities are MERV-14. They are rated differently from HEPA filters, so the efficiency ratings should not be compared. Typical viral particles range from about 0.01 to 0.1 micron. While MERV-14 filters are not specifically rated for virus-size particles, the literature suggests that they are roughly 50-60% efficient on virus-size particles. That does provide some dilution, but is not nearly as effective as HEPA filtration. Here’s a figure from the DHHS/CDC/NIOSH paper: 📷 FICTION: Negative pressure protects healthcare personnel from the virus. FACT: Negative pressure does NOT protect anyone who is in the room with an infected patient. Negative pressure is a containment measure – it may help prevent spread of the virus from one room to another. PPE is the primary protection measure for persons in the room with an infected patient. FICTION: I need to use hot water when washing my hands in order to effectively remove any pathogens. FACT: Temperature is not important for effective hand washing – soap, time, and technique (friction helps remove germs) are what’s important. Washing your hands in cool water will help you retain your natural skin oils while washing often in hot water can cause dermatitis, which can result in your skin harboring more pathogens than normal. FICTION: If I don’t have COVID-19 symptoms, I am not contagious. FACT: It takes between 2-10 days (on average 5) for people who are infected to become sick and develop a fever. While people may be most contagious when they are symptomatic, spreading the virus may be possible prior to becoming symptomatic and there have been reports of this occurring with COVID-19. The current recommendation for communities affected by the virus is to practice social distancing. Putting distance between yourself and others is a way to protect the whole community and slow the spread of the virus. FICTION: There are no resources to evaluate and optimize the shortage of Personal Protective Equipment (PPE) in a facility. FACT: The “PPE Burn Rate Calculator” is a spread-sheet based interactive tool provided by the CDC that can provide valuable information to help healthcare facilities strategize and optimize the use of PPE during the COVID-19 pandemic. Inventory data is entered by the facility and the model calculates the “burn rate” or average consumption for each category of PPE, allowing the facility to estimate their remaining supply. The tool can be downloaded here. FICTION: The COVID-19 pandemic is unpredictable and therefore facilities can’t adequately prepare for community spread of the virus. FACT: This pandemic is unpredictable and unprecedented in modern history, however, healthcare facilities can and should be preparing for a surge in patients requiring care and closely following local and state public health recommendations. Actions to prepare for COVID-19 spread in the community include: educating staff on COVID-19, explore the use of telehealth and develop protocols for triaging/assessing patients remotely, determine algorithms to help identify the appropriate level of care for patients (isolate at home vs. emergency care), prepare a safe and efficient triage system to deploy at your facility for patients with respiratory illness, evaluate and optimize use of PPE, and procure additional PPE if needed. For additional information, review the Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States on the CDC website. FICTION: Placing a “negative pressure machine” in the patient room makes it an isolation room. FACT: What is commonly referred to as a “negative pressure machine” is a portable system that pulls room air through a HEPA filter and blows it back out. If the discharge of the machine is ducted to the outdoors, it may well make the room negative. But, if the machine discharges inside the room, it does not. HEPA filter units can be used to increase room air changes and dilute the number of viral particles that may be suspended in the air. Consulting with a ventilation engineer is a good safeguard.
Flooring for temporary Covid 19 patient spaces
Understanding the need for temporary spaces for Covid 19 patients, we at Patcraft are offering a sheet vinyl product to meet those needs. The product is called Medically Urgent sheet (MU sheet) vinyl and we have an abundant supply ready for immediate delivery. We are providing the flooring material at our cost which is $4.99/SY or $0.55/SF. Please contact me for details.
ASHRAE COVID19 Guidance for Patient Rm Conversion
Attached is the latest guidance on ways to convert Existing Non-airborne Infectious Isolation (AII) Patient Rooms for safer use for COVID Patients. Multiple pathways for conversion are outlined.
HVAC question about large open spaces for treatment
I understand large convention centers across the country, including Javits in NYC and LA Convention Center have already been converted for COVID-19 treatment rooms. - Does anybody know how HVAC systems have been adapted in such spaces? Economizers set to full exhaust, with supplemental exhaust as well? - Are there concerns about air movement locally at floor level? Does it help/not help to have additional barriers such as curtains or barriers? - Is bed spacing affected by airflow patterns? - Do nurses/doctors working in such space have greater PPE protection?
NBBJ Plan for Prefabricated Augmentation of US Army Corps of Engineers A2HC Concept
Our Healthcare+ team at NBBJ rapidly developed recommendations building off the Army Core of Engineers Alternate Care Site plans for converting arenas into temporary healthcare sites. Recommendations include: Rapid assembly strategies using prefabricated materials to maximize inpatient bed capacity. Bed layouts that maximize the capability of each caregiver allowing an understaffed team to support as many patients as possible. Equipment plans that enable multi-patient sharing of life support equipment and reduces consumption rates for PPE. For more information contact: Ryan Hullinger, AIA, NCARB Partner | NBBJ Columbus, OH
Boston/NE | Alternative Care Sites
Looking to identify and inventory: 1. Sites/facilities 2. Best practices 3. Professionals to help!
MASS COVID-19 Guides
MASS Design Group is working on a series of resource guides, available to all, homeowners, builders, and designers on how to retrofit spaces for airborne infection control, including strategies for emergency shelters. They have a history of working on health facilities tackling infectious diseases in low resource settings. The first couple of guides are out. Guidelines for Limiting Contagion in COVID-19 Tent Clinics:
3D Printing faceshields
Share your news on 3d printing equipment. If you want to contribute, perhaps send it to your colleagues at other companies so they can send a consolidated package, to easen administration on the hospitals.