Volume 25, Issue Number 5, Summer 2020
Environmental/Utilities Issues

Healthcare to High-Rise

Lessons to Help Fight Cross Contamination

By KATHRYN GAYSINSKY | Other articles by KATHRYN GAYSINSKY

It must be stated, that this article is of a thought provoking nature, we strongly encourage to keep referencing the WHO (World Health Organization), Ontario Public Health as well as IPAC (Infection Prevention and Control) for any immediate response to any current and future health emergencies.

The year 2020 has started with an unprecedented global event - which will surely change and shape our world in years to come.

Newly minted concepts such as: social distancing, PPE (Personal Protective Equipment), N95 Masks as well as detailed description of hand washing procedures, have been comprising the bulk of our conversations since the beginning of the year.

We are all newly minted experts in virology and infectious diseases, with a mix of conspiracy theory mongering and just a dash of cautious hope that we are making a difference, as we go about our daily lives in this new normal.

Although us in the design community are pretty good with visualizing measurements, I bet nowadays the new standardized unit of measure that anyone can ballpark is 6ft of distance (applied onto a horizontal surface beneath our feet) - these stickers on the floor are very helpful!

All of us who are not used to working remotely, had a major routine change and a crash course in online collaboration platforms. We have become acutely aware of internet connection speeds as well as how to properly position the lighting to make us look our best (waist up) in our webcams.

In short, our daily lives have been altered beyond recognition in the early months of 2020.

The big question looming over everyone living in, providing services to and interacting with the Condominium community is what lessons can we draw from this situation in order to help protect us moving forward?

During our 16 year tenure in designing healthcare facilities and refurbishing multilevel residential communities, the recent events and ongoing developments have really crystallized a few parallels that may be helpful to discuss with the readership here. One underlying principle of action that the leaders of the world rely heavily on nowadays as the surest way to combat any infectious diseases is clear: Modifying Social Behaviour.

The way we interact with our immediate environment, is a result of our current phase in life, daily routine and of course is the product of the way our physical environment is designed. Therefore, it is no secret that with a well orchestrated interior, we can make a difference in helping to slow down the spread of communicative diseases.

For instance - in healthcare environments, such as dental offices, there has been for a long time, a strict separation between the clinical area, and the general area. All human interaction with work surfaces, work flow and ergonomics are clearly defined, and there is a strict separation between "contaminated" and "clean" surfaces.

For these specific areas, there is a protocol of requirements such as installing touch free plumbing fixtures, surfaces that are resistant to harsher chemical 52 CV CONDOVOICE SUMMER 2020 cleaning agents, recommendations with respect to location of personal protective equipment and maintenance procedures.

How can we draw on the lessons learned from healthcare environments to the dynamic and high-density condominium space?

If we were to examine a typical condominium structure, it becomes apparent that there are a few areas that require special attention with respect to sterilization and upkeep policies developed by WHO and Ontario Health. These are - not surprisingly areas that facilitate the highest amounts of traffic throughout the day. To put this in perspective, at any given day the elevator cabs in a 20 storey high rise building will get used approximately 800 times (that is assuming 20 residents per floor, using the elevator twice a day).

That is a lot of people pressing elevator buttons, leaning on the handrail and against the wall panels! In this particular scenario, and until such time as they come out with self-sterilizing elevator cabs, nothing beats good old fashioned cleaning. Do keep in mind at all times that if we are referring to a specific disease or type of virus, have your cleaning service provider consult with EPA* (Environmental Protection Agency) for a list of approved disinfectants. Remember to use water based cleaning products, as not doing so may damage the elevator finishes. Consider installing a wall-mounted hand sanitzer dispenser (assuming stock of this invaluable product is ever replenished globally) outside the elevators on each floor. This will foster creating a new habit - subliminal cue the residents can follow, before getting into the elevator cab.

Think of the hand sanitizer containers - as replacement for the ashtrays in the 80's (which we are still taking out of elevator lobbies in some buildings today).

Another consideration which would be helpful not only in case of emergencies, but during daily business of operating a condominium is installing electronic screens throughout the building with a centralized control panel - for quick and efficient deployment of information. In any event whether it be community events or information regarding a pandemic - having one source of input which is distributed to key points throughout the building minimises the risk of human error, and promotes an easier dissemination of information to the building community. In addition to this, should your Management Company not have an Emergency Action Plan (EAP) in place, you should certainly request them to develop it, and request a copy of it for review.

Other high-traffic areas that are a potential source of cross contamination - are Lobbies and more specifically, concierge desks.

The concierge desk is a logistical hub, the beating heart of the building - where security activities, delivery and parcel pick up takes place and building residents and visitors converge. Our new mantra - the 6 ft. rule - may be helpful to consider in this area as well.

Should you be planning to refurbish or upgrade your concierge desk, it may be a good time to consider points of access, approach and distancing between the concierge and visitors, ease of maintenance and cleaning of the surfaces, as well as proper placement for such items as message boards, hand sanitizers and, yes - perhaps a set of PPE for the concierge who may interact with people who are visibly unwell.

Getting back to the aspect of modifying human behaviour - consider the most efficient, contact free way for your concierge to interact with building residents on such functions as:

Parcel pick-up - Consider one of the automated parcel locker solutions, if feasible, to be installed in your building.

Bookings - Consider encouraging the building residents to electronically book such facilities as elevators for deliveries and move-ins, or even party rooms and other amenities without having to interact with the Concierge.

Of course, we still want our lobbies and concierge desks to be open and inviting, but with subtle placement of elements, proportion and design of approach to the desk, we can help protect our personnel and community from harm's way. Consider as well, the amount of lounge seating you wish to have in your lobby area. Depending on the way your community functions, it may be prudent to minimize or spread out the seating groupings. In some cases - a well placed sculpture or a plant may still make the area inviting, without encouraging large congregations of people.

When thinking about material selections for surfaces which are most commonly touched (such as an upper transaction top on concierge desk), have your design team present options that have fused seams, easy to clean and smooth in texture (there is a plethora of such materials on the market today).

Based on a recent study published by Public Health Ontario**, it was found that COVID- 19 virus may stay for 2-3 days on such materials as stainless steel or plastic, while staying only up to 4 hours on copper.

This leads us to another important potential area of potential cross contamination - door hardware.

Although for buildings that have recently had their door hardware replaced, adjusting the cleaning procedures would be the more cost effective way to go, for buildings that are looking to upgrade their door hardware, it may be prudent to have their design team look at alternatives to the standard stainless steel handles, to replace these with copper alloys (such as brass, bronze etc). There are numerous product lines that are branded as antibacterial, which are presently used in hospitals and clean rooms. I would not suggest replacing all the hardware in the building with this type of product - as it is likely cost prohibitive. If one were to consider a more strategic replacement for hardware in a building, it would be more impactful to replace hardware on the ground level, access to amenities areas (gyms, change rooms, party room), as well as exit door hardware and refuse room on each typical floor. it goes without saying that the best preventative behaviour for cross contamination, would be to install as many hands free door operators as possible - specifically at main entrances to the building.

To further develop this notion of hands free controls (remembering lessons learned from healthcare design), in such areas as change rooms or washrooms it would be ideal to install hands free faucets, paper towel dispensers as well as vanity surfaces which are easy to clean, preferably with under-mounted sinks (ones that do not have their rim sticking out above the counter top).

Ensure your design team evaluates any new finishes proposed for a refurbishment project, from a stand point of durability; resistance to chemical cleaning agents which may need to be more aggressive as well as from a standpoint of looking at the way people would interact with their environment. Should you be looking at replacing furniture for a party room or a lobby area, review the proposed finishes from a cleaning perspective, fire resistance as well as longevity and maintenance. For instance, in most healthcare applications, fabric waiting area chairs have already been banned from use - and are replaced with either a vinyl or leather finishes which are smooth and easy to clean. There is a plethora of antimicrobial fabrics on the market as well - should you and the rest of the Board wish to take it to the next level.

It needs to be said, that whatever solutions your advisors, whether it be management, or your design team, may come up with, these need to be properly and periodically maintained with appropriate cleaning agents. When planning the cleaning and maintenance routine for your building - request the cleaning company to provide specific schedules for areas to be treated as well as the frequency of cleaning, and make sure this schedule ties in with the building components which have the most potential for cross contamination.

So how does the future look like in the wake of the recent global events? I can only venture a guess that we are going to expect many new developments in the field of material engineering as well as many new regulations that may be transferred to multi level residential communities from other sectors such as healthcare. Going back to modified human behaviour, most of us in the condominium communities will become acutely aware of our proximity to other people in a public space, will most likely opt to take the stairs at any available opportunity, as well as will never look at a door handle the same way again. Furthermore, I do believe that regardless of when this particular pandemic is going to end, we will surely see many more remote meetings - whether board meetings or perhaps even AGM's. Not having to host 60 people in a single room may not be such a prohibitive idea, especially once we are all heading towards the next flu season.

All in all, I am looking forward to see which innovations will spring from this world cataclysm and am excited to learn about all the new ways we can mobilize as a community, to become stronger and more aware of our potential for growth, when faced with a common adversary.

References:
* The referenced website to Environmental Protection Agency list N: Disinfectants for Use Against SARS -CoV-2 can be found here: https://www.epa.gov/pesticide-registration/ list-n-disinfectants-use-against-sars-cov-2

** Aerosol Surface Stability of SARS-CoV-2 as compared with SARS-CoV-1relating to longevity of the virus on different surfaces published March 20, 2020 can be found on: www.publichealthontario. ca