Health Care & Senior Living Changes: Post-COVID-19

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Author: Jane M. Rohde, AIA, FIIDA, ASID, ACHA, CHID, LEED AP BD+C, GGA-EB

This article is dedicated to all frontline care givers and first responders for their heroic efforts in all they do for everyone, including those in hospitals and long-term care settings. Thank you for your service and your selfless dedication to the health, safety and wellness of others.

COVID-19 has impacted everyone’s life around the globe, specifically impacting health care and senior living settings, in all aspects related to life and death. Wearing masks and social distancing are part of our everyday routines and in many places within the U.S., reopening is taking place. Using science, evidence and authoritative sources as resources for decision-making are key to reducing fear and anxiety and protecting health and safety.

Maintenance Is the First Line of Defense

Coronavirus, or SARS CoV-2, is the virus responsible for the disease COVID-19. The virus is an envelope virus and is relatively easy to kill when outside of a human host. Therefore, maintenance as an overall system for cleaning and sanitizing or disinfecting surfaces, including textiles, can be a first line of defense in inactivating the pathogen. Materials and surfaces play a center-stage role in their ability to be cleaned, sanitized and disinfected. And there’s a difference between each one of these approaches:

Figure 1: Diagram and information is courtesy of CleanHealth Environmental, an organization specializing in training and educational programming for environmental services technicians and related staff on cleaning, sanitizing and disinfections. For additional information, contact Shari Solomon at solomon@cleanhealthenv.com.

The authoritative source on cleaning, sanitizing and disinfection is the Centers for Disease Control and Prevention (CDC) and for registered disinfectant chemicals and brand name products listed as effective in inactivating pathogens is the U.S. Environmental Protection Agency (EPA). Specific to SARS-CoV-2, EPA’s List “N”[1] is the recognized source and includes a searchable database by the following:

  • EPA Registration Number
  • Active Ingredient
  • Use Site
  • Contact Time
  • Browse All
  • Keyword Search

 

Maintaining Contract Upholstery – Paying Attention to the Details

Prior to applying any type of disinfecting chemical, all residue on a surface needs to be removed. Removal of all visible inorganic and organic matter can be as critical as the germicidal activity of the disinfecting agent.[2] As with all interior finish surfaces, it is best to follow manufacturer recommendations for cleaning surfaces and materials. Isopropyl alcohol-based, hydrogen peroxide-based, quaternary ammonium-based (quat) and sodium hypochlorite-based (bleach) disinfectants are all safe on Sunbrella Contract upholstery textiles, even those with added finishes such as Assure or Defiance (when used according to disinfectant manufacturer recommendations).

When selecting any type of high-performance woven textile, it is always important to refer to both the manufacturer’s cleaning recommendations and the cleaning and disinfecting chemical manufacturer recommendations to avoid unintended consequences of material degradation. The additional goal is to utilize the least-caustic cleaning or disinfecting solution effective on pathogens (efficacy) to increase safety for environmental services staff handling and utilizing chemicals.

Note that chemical with a pH level of 12 or more should not be used in conjunction with the Defiance finish.

Don’t Go It Alone – Use the Help of a Planning Guide!

The recommendations for cleaning and disinfecting of all surface types in all types of physical environments for the SARS-CoV-2 virus is included in a planning guide from the CDC.

Figure 2: Centers for Disease Control and Prevention “Making Your Plan to Clean and Disinfect

There are three levels of disinfection outlined by the CDC: high, intermediate and low.

  • High-level disinfectants are used as chemical sterilants and should never be used on environmental surfaces.
  • Intermediate-level disinfectants are registered with the Environmental Protection Agency (EPA) and have a tuberculocidal claim.
  • Low-level disinfectants are EPA-registered without a tuberculocidal claim.[3] Low-level disinfectants are utilized on environmental surfaces, typically within health care settings and include both noncritical patient care items such as bedpans, blood pressure cuffs, electronic equipment, etc., and noncritical environmental surfaces such as bed rails, bedside table, patient furniture and floors.

The word “noncritical” means that an item is not “critical” or “semi-critical” in that it is not used within a sterile field of the body and does not come in contact with mucous membranes or nonintact skin, respectively. This does not mean that noncritical surfaces are unimportant. It means that the item or surface may come in contact with intact skin which can be an indirect pathway for transmission of a pathogen. Therefore, high-touch surfaces such as upholstery and furniture would be considered noncritical surfaces and if possible, would require low-level disinfection. The capability of disinfection is based upon the porosity of the upholstery, manufacturer recommendations and chemical disinfectant manufacturer recommendations.

Because of COVID-19, the recommendations typically used for cleaning and disinfection of health care settings, only, is also being recommended for community facilities and homes. The CDC’s definition of community spaces includes schools, daycare centers and businesses comprising of non-health care settings (retail, hospitality, restaurants, etc.) that are typically visited by the general public outside of a household.[4] Therefore, in the past only health care settings and food service areas were held to disinfecting and sanitizing recommendations, respectively. From here forward, there will be a higher expectation for all settings to comply with CDC cleaning and disinfecting recommendations. The first priority remains hand-washing as the most effective means for reducing spread of infection.

Do Your Clients Need Guidance on Reopening? Here Are Helpful Resources

Material and surface selection coupled with the evaluation of filtration and HVAC systems will be part of the reopening process for all types of settings. The following resources are provided for guidance on reopening:

American Industrial Hygiene Association (AIHA)

Back to Work Safely

American Institute of Architects (AIA)

AIA Re-Occupancy Assessment Tool V2.1 (July 21, 2020)

American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE)

Building Readiness/Reopening Guidance

Technical Resources

Building Owners and Manager Association International (BOMA)

Getting Back to Work: Preparing Buildings for Re-Entry Amid COVID-19

Coronavirus (COVID-19): Preparedness Checklist

Centers for Disease Control and Prevention (CDC)

Reopening Guidance for Cleaning & Disinfecting Public Spaces, Workplaces, Businesses, Schools and Homes

World Health Organization (WHO)

WHO Coronavirus Disease (COVID-19) Technical Guidance: Guidance for Schools, Workplaces & Institutions

What Might the Future Hold?

For the future, there is a balance between durability and performance, as well as the desired aesthetic within a 24/7 health care setting. In all care settings, the priority of cleaning and disinfecting is essential to reduce the occurrence of health-care-acquired infections (HAIs) and the spread of community-acquired infections (CAIs). The novel coronavirus is both a HAI and a CAI. The balance is evaluating all aspects of performance and safety coupled with the appropriate aesthetic for patients, residents and staff. The goal is to provide environments that embrace wellness features and in the case of long-term care, support the concept of “home” for residents living and being cared for within a setting. By combining safety and health with the concept of comfort in the materials being specified, such as textiles that will not degrade because of cleaning and disinfection we can create these spaces now and in the future.

About the Author

Jane Rohde is the Founder and Principal of JSR Associates, Inc. located in Catonsville, Maryland. JSR Associates, Inc. celebrates 24 years of consulting services in 2020. She champions a global cultural shift toward deinstitutionalizing senior living and health care facilities through person-centered principles, research and advocacy, and design of the built environment. In 2015, she received the first Changemaker Award for Environments for Aging from the Center for Health Design and in 2018, she received the ASID Design for Humanity Award, has been recognized as an Honorary Alumni of Clemson University’s Architecture + Health program, and has been honored as one of the top 10 Women in Design demonstrating leadership in health care and senior living design and architecture. For more information or comments, please contact Jane Rohde at jane@jsrassociates.net.

 

[1] United States Environmental Protection Agency (EPA): List N: available on line at https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19 (Unless otherwise noted all links provided herein are current as of July 24, 2020)

[2] Centers for Disease Control and Prevention (CDC): available on line at https://www.cdc.gov/oralhealth/infectioncontrol/faqs/cleaning-disinfecting-environmental-surfaces.html

[3]CDC: available online at  https://www.cdc.gov/oralhealth/infectioncontrol/faqs/cleaning-disinfecting-environmental-surfaces.html

[4] Source: https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html