Case study: Hospital achieves resilient design

In 2008, Silver Cross Hospital embarked on the initial planning for a 760,000-square-foot replacement hospital in the Chicago suburb of New Lennox, Ill. The new facility’s planning included an all-private and family friendly 289-bed facility program with med/surge, pediatric, obstetrics, intensive care unit, behavioral health and rehabilitation beds. To best support the hospital’s mission of providing quality services and dependable health care for a growing community, resiliency was a priority in the planning process.

Leadership at SCH, architects from CallisonRTKL, engineers from IMEG Corp. and construction management from Mortenson collaborated to ensure the topic of resilient design was discussed throughout the entire planning and design process. Throughout the project, the design and construction team held dedicated user group meetings with SCH clinical and facility operations staff to discuss emergency preparedness in the event of natural disasters, infrastructure failure, epidemics and man-made hazards. Vulnerability assessment tools were used to assess each potential hazard and provide a systematic approach to evaluate the risks and prioritize the planning.

Several resiliency measures discussed in these meetings were implemented in the final project, including:

• Building hardening.
• Infrastructure redundancy.
• Emergency department expandability.

Providing SCH with the flexibility to address an infectious disease outbreak was among the major topics discussed during the resiliency and emergency preparedness user group meetings. SCH infection control team members were interested finding a solution that would provide a quarantine space capable of isolating a large number of infected patients from the rest of the hospital. At the time of planning in 2008, most hospitals did not support a permanent quarantine space because it can be a substantial investment to create an area that is used rarely, if ever.

SCH requested a space for the quarantine area that would not recirculate air from the infectious disease zone and that would have a negative pressure relationship to surrounding areas. The team discussed options such as 100% outside air ventilation systems and dedicated air handling systems, but SCH challenged the design team to provide an heating, ventilation and air conditioning system that balanced first cost, operating cost and ease to implement.

The team ultimately created a design using emergency exhaust fans placed strategically to allow two wings of the inpatient bed area on the sixth floor and half of the emergency department exam rooms to switch over to 100% outside air and negative pressure wards with the push of a button.

The emergency exhaust fans were tied into the return duct distribution system for these spaces. Under normal operation, the air in these spaces is recirculated to the HVAC system through the return ductwork. But in an emergency situation, the building automation system signals a motor-operated damper on the return ductwork serving the spaces to close and an emergency exhaust system damper to open the emergency fans. The spaces become negative and remove the risk of recirculating air from these infectious disease zones back to the HVAC system.

When SCH moved into its replacement hospital in 2012, both clinical and facility staff were aware of the resilient design measures put in place during design to address a potential infectious disease outbreak. As part of the ongoing disaster preparedness training, the emergency system is tested annually to ensure its operation and staff’s understanding on how to implement it should the need arise.

In early 2020, the SCH clinical and facility team was prepared to quickly and easily adapt the facility and quarantine space to address the anticipated patient surge due to the COVID-19 pandemic. This seamless transition would not have been possible without the extensive resiliency measures taken more than 10 years before the outbreak.

No one on the design team or SCH’s staff could have guessed when a pandemic might arise or what it would be, but significant planning and creativity equipped the hospital with the means necessary for treating COVID-19 patients while keeping staff and other patients safe from infection.

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