Infectious Disease Control and Architectural Design - MEP Engineering - Expertise - NIKKEN SEKKEI LTD

9/26/23, 9:16 AM Infectious Disease Control and Architectural Design | MEP Engineering | Expertise | NIKKEN SEKKEI LTD
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MEP Engineering Infectious Disease Control and Architectural Design
 CAREER NIKKEN BRAND 日本語中文 NIKKEN SEKKEI LTD
Infectious Disease Control and

Architectural Design
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Clinical healthcare professionals and researchers from a variety of CATEGORY
professions, including physicians, nurses and pharmacists in the field, as MEP Engineering
well as bacteriologists, continue the daily battle against the novel

RELATED EXPERTISE
coronavirus (COVID-19) that is currently running rampant around the
MEP Engineering
world. We spoke with Dr. Akira Ito, a member of the Building Services
Design Division, Engineering Department which is regularly involved
share   
research on infectious disease control in medical settings, together with
healthcare professionals.
Team approach to infectious disease control

Reportedly, more than 17,000 people die each year in hospitals in Japan due to infections acquired while
hospitalized. There have also been reports of hospitals with nosocomial infections occurring in about 10% of
hospitalized patients. As unknown infectious diseases spread, preventing hospital-acquired infections and
protecting the safety of patients and healthcare professionals has undeniably become an important and urgent
task.
In addition, research activities are being developed to protect
 againstNIKKEN
CAREER and prevent
BRAND 日本語spread
the 中文 of infectious
NIKKEN SEKKEI LTD
diseases not only in the clinical field, but by using a multi-faceted approach to control pathogenic bacteria and
viruses, as a reliance on antibiotics to protect against and prevent the spread of such bacteria and viruses is simply
not sufficient as antibiotic-resistant bacteria continue to emerge. Under these conditions, architects have joined
teams of medical professionals and researchers to carry out research and put infectious disease control measures
into practice in the field of architecture.
Architectural design that helps cut off infection routes

How can architectural design help control infectious diseases?
Infections take hold only when three factors converge: the existence of a pathogen (microbe causing an infectious
disease), host (human in which a pathogen grows), and an infection route (transmission pathway that carries the
pathogen). Hospitals are high-risk areas where all three factors are present.

Pathogen x host x infection route
Architectural design measures focus on preventing the spread of infectious diseases before they take hold in
hospitals by cutting off the infection route, one of the above three factors.
Types ofInfectious
NIKKEN
infection
MEP Engineering routes
PROJECTS
Disease Control and
EXPERTISE
and Architectural architectural design
Design
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日本語中文
measures
 CAREER NIKKEN BRAND NIKKEN SEKKEI LTD
There are three types of infection routes: contact, respiratory droplets, and airborne transmission.
“Contact transmission” is an infection route through direct or indirect contact with a patient. Measures to avoid
this include “hand hygiene” and “environmental surfaces (surfaces touched by hands)” through innovations in
architectural design.
Measures to avoid “respiratory droplet transmission” include the arrangement and layout of beds and furniture
that consider the distance that droplets can reach (2m).
Primary measures for “air-borne transmission” include the use of private rooms for patients and “negative
pressure ventilation” in which a steady flow of air is pumped into a hospital room based on the difference
between supplied and vented air.

Healthcare-related infectious diseases and important points on measures
Points on
NIKKEN
controlling
Infectious
MEP Engineering Disease Control and infections
PROJECTS
Architectural Design from planning to
EXPERTISE INSIGHTS ABOUT NEWS
日本語中文
implementation
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The “Guidelines for Designing and Managing Hospital HVAC Equipment (HEAS-02-2013)” (published by
Healthcare Engineering Association of Japan (HEAJ), 2013) is the most widely used guideline for planning,
designing, and managing hospitals. Classifications on “air cleanliness classes and zoning for hospitals” can be
found in these guidelines, which regulates air cleanliness by assigning hospitals rooms levels on a 5-level scale
ranging from “highly clean area” to “contamination controlled area” and “non-proliferation area (or dirty area)”.

Air cleanliness classes and zoning in hospitals

(Created by the author based on “Guidelines for Design and Management of Hospital HVAC (HEAS-02-2013)” published by the Healthcare Engineering Association of
Japan (HEAJ), 2013)

Air cleanliness classes in hospitals
These classes are modeled along guidelines from the U.S. and other countries and are rational and economic
indicators based on the latest scientific evidence. A number of building layout plans have been adopted based on
these indicators, such as layouts that separate rooms with higher andNIKKEN
CAREER lowerBRAND 日本語
levels of 中文
cleanliness or NIKKEN
that SEKKEI
completely
LTD
separate them from one another. Proper HVAC zoning in the hospital (separated systems) and controlling airflow
while maintaining air cleanliness also helps in maintaining a sanitary environment.
A brief explanation follows on planning requirements and important points on infection control.
①Creating a safe flow of air: Airborne Infection Isolation Room (AIIR)

Conventional hospital plans often focus on temperature/humidity and air volume (ventilation frequency).
However, safe air flow is designed in infection control measures from the perspective of “air pressure”, “air
cleanliness”, “air flow method”, and “air flow distribution” in preparation for airborne infections.
For example, if a HVAC system can create a flow as shown in the following figure while also taking into
account the balance between supplied and vented air, it will be possible to isolate the source of an infection and
reduce the risk of infection for medical staff.

Air flow in hospital wing (example)
The following points are key in ensuring that air does not leak from Airborne Infection Isolation Rooms (AIIR)
where patients with airborne infectious diseases have been placed.
・Create a constant flow of air to hospital room and maintain
 a negative
CAREER NIKKENpressure
BRAND 日本語
of 中文
-2.5Pa NIKKEN SEKKEI LTD
・Ensure air is ventilated frequently

・Use airtight specifications for interior materials
・Release contaminated are directly outside
・Use ultra-high performance air filters (HEPA filters) when air is circulated indoors
・Continuously monitor status of negative pressure
・Also effective to use hospital rooms with an anterior space to manage negative pressure

AIIR (Airborne Infection Isolation Rooms)
②Creating a safe flow of air: Protective environment (PE)

Rooms for patients with immunodeficiencies should have an airflow that is the opposite of that in an AIIR. In
other words, contaminated air should never be allowed  to CAREER
enter the room.
NIKKEN 日本語 to
Therefore,
BRAND 中文create aNIKKEN
PE, measures
SEKKEI LTD
are taken to set the environment of the hospital room to a positive pressure of +2.5Pa.
③Installation of easy-to-use hand hygiene systems

In order to ensure thorough hand hygiene to reduce the risk of infection through contact, it is effective to
clearly separate equipment and facilities by application and user, such as hand washing basins for patients,
clean sinks for medical staff to use for hand washing, and sinks for washing contaminated equipment after use.
In addition, the installation of hand-washing equipment and facilities in several easy-to-use spaces will result
in meticulous hand washing. Therefore, it is important to determine the location of these spaces after
conducting a survey and analysis of the trajectory of behavior of medical staff.
Setting that consider the psychology of human behavior should also be considered, such as not installing
mirrors around wash stands to encourage people to avoid the tendency to touch their faces when looking in
mirrors.
④Creating an environment where microorganisms cannot multiply

Microorganisms multiply in humid spaces where water is abundant. For example, research is advancing on
designs for hand washing in which water does not splash or pool around edges. External insulation is also
effective in preventing water droplets from forming due to condensation, as well as the use of antimicrobial air
conditioners.
Toilet drainage pipes were identified as likely routes of transmission during the SARS outbreak. It is also
necessary to adopt designs that use traps for drained water with low levels of air leakage for drainage routes
where microorganisms can grow easily.
⑤Environmental surfaces where it is difficult for dust to accumulate and is easy to sterilize and clean
It is important that environmental surfaces (room elements, furniture, fixtures, etc.) are easy to disinfect and
clean and difficult for dust to accumulate. This may  include, for example,
CAREER 日本語areas
designing
NIKKEN BRAND 中文 whereNIKKEN
the walls
SEKKEI LTDand
floors intersect as curved structures, installing air conditioners and trash cans on the walls so that dust does
not accumulate on the floor surface, tilting the top surfaces of furniture, and adding casters to furniture so that
they can be moved around when cleaning. Pathogens are mostly transmitted from environmental surfaces to
patients when hands come into contact with these surfaces, so it may not be necessary to compulsively
disinfect/sterilize areas that will not come into contact with hands.
The use of non-contact systems, such as automatic faucets and cleaners that use sensors, is effective since there
is no direct contact with water around where pathogenic bacteria can easily grow.
⑥Avoid excessive infection control that is not based on evidence (scientific based)
For example, in the past, medical professional changed their shoes before entering an operating room.
However, as mentioned above, infections transmitted through contact are known to occur mostly through the
hands, so the risk of infection from feet is believed to be extremely low. Planning based on scientific evidence,
regardless of past hygienic practices and cultures, will allow the necessary space and flow lines to be secured
and result in a higher quality of medical care.

Habits, cultures and lack of common sense in the surgery department?
⑦Precautions during construction

Aspergillus fungal spores are a type of mold found in dust, such as in the ceilings of buildings.
When a person who is immunodeficient becomes infected with this mold, it can cause a severe respiratory
infection. When renovation work is being carried out at an existing hospital with patients that have
compromised immune systems, care must be taken to ensure that curing, negative pressure ventilation, and
proper ventilation areas are in place to thoroughly contain dust from construction work.
In addition, it is also necessary to consider infection control risk management, such as separating the flow of
workers from patients and sampling microorganisms, as well as keeping patients away from the construction
site.  CAREER NIKKEN BRAND 日本語中文 NIKKEN SEKKEI LTD
Development of technology and “visualization” of

infectious disease control
Today, the development of computational fluid simulation technology has made it possible to “visualize” the
concentration of pathogens, as well as the distribution of temperature and humidity and airflow in hospital
rooms.
Evidence can be obtained from the early stages of hospital planning to create safer airflows, achieving the design
and operation of hospital rooms that take patient safety and reducing the risk of airborne infections for
healthcare professionals into account more than ever.
I would like to continue researching how the architectural field can contribute to addressing the fear of infectious
diseases in the future.
Simulation of airflow in AIIR (negative pressure room) (computational model, distribution of droplet nuclei)

Simulation ofInfectious
MEP Engineering
airflowDisease
in AIIRControl and Architectural
(negative Design (computational model, distribution of
pressure room)
droplet nuclei)  CAREER NIKKEN BRAND 日本語中文 NIKKEN SEKKEI LTD
Akira Ito
Akira Ito
Senior Expert
Building Services Design Division,
Engineering Department
Doctor of Medicine
After completing his Master’s at Waseda University, Dr. Ito joined Nikken Sekkei in 1988. Since becoming a part of the team at
Nikken Sekkei, he has carried out research on optimal infection control at the planning, design, construction and operational
stages for hospital buildings, structures and facilities, and provided consulting services on the planning and design of medical
facilities based on infection control science, sustainable environmental facility planning and energy management.
Dr. Ito has a wealth of design experience in multi-purpose facilities, such as medical facilities, museums, hotels, high-rise
buildings, research facilities, universities, multi-complexes, and renovation projects, and is also engaged in advisory and
consulting services on management related to energy conservation and the reduction of CO2 emissions in large-scale, high-rise,
multi-complex facilities.
In 2008, he completed the doctoral program at Juntendo University's Graduate School of Medicine in Infection Control
Science.
He is a Facility Design First-class Architect, energy manager, CASBEE evaluator, consulting engineer for architectural
NIKKEN PROJECTS equipment,
EXPERTISEand medical doctor.
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9/26/23, 9:16 AM Infectious Disease Control and Architectural Design | MEP Engineering | Expertise | NIKKEN SEKKEI LTD

NIKKEN PROJECTS EXPERTISE INSIGHTS ABOUT NEWS

 CAREER NIKKEN BRAND 日本語 中文 NIKKEN SEKKEI LTD