疫情下对酒店改造的思考:酒店“转型”医院
阅读:2326 2020-09-25

“THOUGHT LEADERSHIP | CRTKL洞见” 

分享CallisonRTKL作为行业引领者,

对于城市、建筑、产业、生活方式等不同维度

进行的深度思考、趋势探索和前瞻性研究。


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酒店“转型”医院

HOTEL/HOSPITAL ADAPTATION



从历史角度来看,适应性改造是为了高效灵活的盘活存量建筑资产而一贯采取的发展策略。在新冠肺炎全球大流行的背景下,感染病例激增的情况随时可能会再次发生,社会的发展充满着不确定性,人类正在接受史无前例的巨大挑战。突发事件带来的直接挑战,一度体现在紧急情况下社区病床的短缺问题上。


CallisonRTKL 作为一家全球性建筑、规划和设计咨询公司,一直关注医疗健康行业和酒店行业的建筑设计,致力于和客户共同探讨如何更好地应对各种化学、生物、放射性、核生化爆(CBRNE)等突发性事件,并努力寻求更好的解决方案。


这些措施包括:对现有场所进行改造,或扩大现有医院病房的使用面积,或通过模块化方式建造新的空间,或在这二者中找寻其它更适用的办法。


Historically, adaptive reuse has been a strategy that follows a resilient and efficient re-use of our building assets. We are now faced with a pandemic that is challenging our resourcefulness to meet the surge of infected patients who we know are coming – but cannot predict when. This is most apparent in the anticipated hospital bed shortage that will soon descend upon all communities. As an architectural practice that specializes in healthcare and hospitality, we have been exploring various solutions for a host of chemical, biological, radiological, nuclear and explosive materials (CBRNE) events with our clients. These have ranged from the expanded use of rooms in an existing hospital to building new accommodation through a modular approach and all options in between.


今年人类社会面临的新冠肺炎事件,如同核生化爆事故一样,是对全球公共卫生安全发起的巨大挑战,因此急迫需要快速制定全面且具有战略高度的措施,以解决如何避免出现大范围感染病例激增的情况。


酒店行业可能因疫情而遭受重创。考虑到酒店内部布局与医院的住院部布局高度相似,CallisonRTKL 建议可以在特殊时期将酒店做适应性改造,将其改为备用住院部,以容纳数量激增的感染病患。以下正文中,我们概述了酒店改造时需要注意的四个关键点,希望用我们的经验为酒店改造提供一些建议,从而帮助客户实现最佳效果。同时,从未雨绸缪的角度,我们也希望这些建议或经验能够给未来的酒店行业以新的启示。


The pandemic that we are now facing is having a comparable impact on global communities as a CBRNE event. Similarly, the immediacy of a pandemic requires a multi-facetted, strategic approach that starts by anticipating the mitigating measures needed to hold any surge at bay. In the prevailing situation, one such measure would be the adaptation of hotels whose livelihood will be severely affected by the pandemic – but whose format is most akin to inpatient accommodation found in hospitals. With little adaptation, hotels can be turned into additional inpatient rooms to absorb the surge of patients requiring nursing care. Here, we outline the principles that should be considered in the plan of the hotel to will make the adaptation a viable and efficient process.


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作为医院的酒店

HOTEL AS HOSPITAL


毋庸置疑,酒店行业成为了首批受疫情影响的行业之一。在个别国家和地区,由于短期内看不到疫情的转折点,急速下降的入住率成为了最令人担忧的问题。幸运的是,酒店的布局与医院高度相似,也配有餐饮和保洁等服务。如果我们计划进行适应性改造工作,则首先需要检查酒店的内部动线构造,并将其与医院的场景设置进行比较。


Hotels are one of the first businesses to feel the effects of the pandemic. Rapidly falling occupancy rates are a concern and with no immediate end in sight. Fortuitously, the basic characteristics of a hotel mimics a healthcare facility quite well: bedrooms with support functions including food service, environmental services, etc. If we are to adapt this building asset type, the first test will be to examine the flow through the hotel as it compares to a healthcare setting:

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所需要素

Elements 

下一步,则需要检查实际的楼层平面布局及相关工程实施标准,以确定其是否可以达到容纳与支持护理患者所需的必要条件,比如:


Following this, the actual floor plan and engineering provisions will be examined to determine if it is possible to accommodate all elements necessary to support the needed patient care functions such as:


护士站&会议室

Nurse Base including a meeting room

清洁工具储物间/药房

Clean Utility/Medication

污物间

Dirty Utility

废弃物存放间(尤其是有害废弃物)

Waste Holding particularly hazardous waste

设备存放间

Equip Storage would be helpful

电梯是否可以容纳担架?

Elevators – can they accommodate stretchers

楼层负荷是否可以容纳移动式x光机(非必要但很便捷)

Mobile X-ray – can the floor loading accommodate them (not essential but convenient)

CT设备

CT could be useful


目前,大多数类型的酒店都能满足这些必要条件,而且能够在短时间内完成医疗用途的改造工程。


Most hotel models can meet these requirements and more easily adapt for healthcare use in the short term.


在大流行病时期,有效维持公共出入口的秩序是确保患者、员工及访客健康安全的重要因素。因此,在入口处设置实名制注册与健康条件筛选成为了重要措施。如果改造后的酒店主要用于接收周围医院的非传染性患者,以便医院能够容纳更多传染性患者,防护措施则可以设置的相对简单些,可以达到人们对非传染性内/外科住院部的期望标准。但为了谨慎起见,在进入任何患者护理区域之前,设立个人防护设备(PPE)站是非常必要的。


In times of pandemics, the entry sequence needs to consider the safety for patients, staff and visitors. Thus triaging, as well as registering, all before they enter the facility will be paramount to protect everyone. If the hotel/hospital is to receive non-infectious patients from surrounding hospitals to create more space in their facility to accommodate infectious patients, then the provision will be relatively simple protective measures– as one would expect for non-infectious medical/surgical inpatient accommodation. It would be a prudent measure to position a Personal Protective Equipment (PPE) station before entering any patient care area as part of the entry protocol.


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另一种情境下,类似于此次的新冠疫情,如果改造后的酒店需要容纳单一病例的患者群,那么则需要酒店采用严格的感染控制措施。所有进入酒店的人都需要遵循感染控制指南条例,以达到保护自身健康及潜在未知接触人群的健康。因此,在所有大楼和住院部的进入点设立个人防护设备和更衣设施就显的尤为重要,更重要的是还要保证大楼内所有的工作人员及患者都能严格遵守规则。如果临近医院的ICU因患者数量激增而超出负荷,则可以通过利用移动病床、呼吸机以及其他合适的临床手段,为那些急需治疗的患者提供挽救生命的机会。最重要的一点是,经过适应性改造的酒店需要在专业人员的指导下才能达到与现有医疗设施配合使用的最终目的。


In the alternative where the hotel/hospital were to accommodate a single disease group such as the case in a pandemic, the hotel/hospital would need to have stringent and incorruptible protocols for infection control. All persons entering the hotel/hospital would need to follow very rigid infection control guidelines to protect themselves as well as those they come in contact with thereafter. Having PPE stations, including clothes changing facilities, at all building entry points and entry points to the inpatient units (that is at each floor) will add to the protective measures. Likewise, all support staff would need to be required to follow the same protocols even in back-of-house support areas. Importantly, this facility will be intended for the infected patients requiring intermediate care. However, should the ICUs in the neighboring hospital become overrun by a patient surge, then the use of mobile bedhead units and ventilators along with the appropriate clinical protocols could provide life saving measures for those more dependent patients. It is important that this adapted facility work in concert with the existing healthcare facilities and draw from the skills and experience of the dedicated healthcare professionals.


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适应性

ADAPTATION



和医院环境相比,酒店的家具配件更像居家设施,所以需要进行如下调整:


The hotel’s furniture and fittings will be more akin to a home setting than a hospital environment– which will require the following adjustments: 


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表面处理

Finishes


检查现有条件是否适于医疗体系的感染控制标准。

Check suitability of the existing conditions for infection control.

拆除织物窗帘,更换为医用材料的窗饰。

Fabric curtains removed and replaced with types of window dressings that are of hospital grade materials.

拆除床垫和床框,更换为医用病床,同时是否再利用现有的设施应该根据医用设备的获取难易度而做决定。

Mattresses and frame removed and replaced with a hospital grade patient bed – any reuse of existing could be left as a local decision based on access to hospital grade equipment.

墙面通常可以达到要求,但若墙纸或墙面出现破损,则需要进行修补。

Walls and their finishes will generally suffice, but any wallpaper must be intact throughout and repaired where not intact.

天花板通常不做改造,但需要打扫干净其周边的死角或相对隐蔽的空间。

Ceilings can be largely left with special attention paid to any hidden ledges, coves, etc. for cleaning.

墙体保护是一个有效的辅助措施,但并非必要条件。

Wall protection would be a good addition but not essential.

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工程系统

Engineering System


在现有的时间框架下,彻底地检修机电系统有些不切实际;但我们可以尽量在可控范围内做相对全面的检修,以掌握现有系统的局限情况。

Overhauling the Mechanical and Electrical systems will not be practical in the timeframes encountered; a conditioned survey will be necessary to understand the constraints imposed by the existing systems.

走廊需要尽量保持通风,让室内达到正压病房的标准。

Most corridors will be fed fresh air– creating positive pressure relative to the bedrooms.

每个房间都需要安装方便个人操作的控制装置,可应对每台装置进行清洁、检查和安装所需的过滤网。需要注意的是,过滤网最好可以选择HEPA类型,如果无法实现,也可以在供应安装寄存器上安装临时的HEPA过滤网。

Each room is likely to have units for individual control and individual comfort; each unit should be cleaned, checked and have the required filters changed preferably with a HEPA type. If not possible, then a temporary HEPA might be fixed over the supply register.

医院标准的负压房间可能无法实现,但可通过增加洗手间/淋浴间等简单的通风系统,提供一定程度的负压环境。

Negative pressurized rooms to a standard expected in a hospital may not be possible but could the toilet/shower room’s extract ventilation be easily increased to provide some level of negative pressure.

根据酒店2014规范要求,酒店至少有一台电梯能够容纳移动担架床。如果酒店在2014年之前建成,则需要考虑是否能在酒店内部或外部增加一台更大的电梯。

Elevators: the 2014 codes for hotels require at least one elevator to be sized for gurney movement. If built before 2014, then will need to be determined if a larger elevator can be added either internally or externally.

无线网络需要全面覆盖酒店,以便保证远程监控效果及其他设备通讯的即时通讯和数据收集。

WiFi will be needed throughout for communication and data collection from telemonitoring and other equipment.

灯光照明设施进行更新;医疗场所需要更明亮的照明及真色效果。考虑到LED灯泡低电压、高输出的特性,可做首选替代品使用。

Lighting will need to be upgraded; healthcare settings will require brighter lighting and true color rendering. LED bulbs may be used as a substitute considering its low voltage high output characteristics.

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医疗设备

Medical Equipment


每个房间都需要配有可移动气瓶和真空装置。

Each room should have mobile gasses and vacuum.

为满足隔离病房的高供电需求,配备高电压通风机可能不易实现,但可以通过安装单独的发电机来满足隔离病房的要求。

Ventilators may need a higher voltage and provision of such electric supply in a specific room may be challenging; a separate generator may be considered to accommodate an isolated need.

可支持无线网络的设备是照看病人的必要设施,也是扩大医护人员照料病人数量的有效工具。

WiFi-enabled equipment would be necessary for remote (tele-) monitoring which will be an essential tool for the staff to extend care for more patients.

如果需要类似数字X光机、CT机等影像设备,则需要考虑楼层是否能承受这些设备的重量?

If imaging equipment were desirable, then can the ground floor accommodate the weight of the equipment? Digital X-ray, Computed Tomography (CT) in particular.

对于不能断电的设备房间,需要提供UPS电池系统。

Provide battery UPS systems for rooms with equipment that cannot tolerate power outages.

Stat实验室可迅速适应就地检测,当天即可出结果。

A Stat Lab accommodates rapid-in-place testing requiring same day results.

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其他需考虑事项

Other Items for Consideration


有害废弃物协议——除预期中的医疗废弃物外,所有的亚麻制品必须视作有害废弃物,并进行相应的处理。

Hazardous waste protocols – in addition to the clinical waste expected, all linen must be considered hazardous and processed accordingly.

如何将适应性改造后的酒店纳入现有的供应链中?

How can the hotel/hospital be included within existing supply chains?

现有的服务提供商如何纳入适应性改造后的酒店?

How can existing service providers include the hotel/hospital?


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◤适应性改造前后对比

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结论

CONCLUSION



利用酒店与医院相似的特性及特点,对酒店进行适应性改造,在对控制病患数量激增事件发生产生积极地影响的同时,其经验也同样适用于对其它相似场所,比如:


☞会议中心

☞体育场

☞闲置的购物中心

☞飞机机库

☞其他较大面积的封闭空间


恰当的改造能够进一步加强医疗资源的供应能力与全面部署。通过对资源的有效整合,可以解决医疗条件不足的当务之急。对酒店的适应性改造是应对大流行病的有效支持方案,酒店在其履行其企业社会责任(CSR)后仍可以恢复正常营业,继续服务社会。这也是增强医疗体系的韧性与应对突发事件的能力的有效途径。


The adaptation makes use of the hotel’s inherent characteristics that are similar to a hospital and its relatively immediate availability– thus having a positive effect on stemming the start of a sick patient surge. This will give time for other alternative resources such as convention centers, gymnasiums, disused shopping malls, airline hangars and other such large space enclosures to be adapted and come online. This will further reinforce the provisions needed as part of a multi-facetted strategic approach. In total, all of these resources can be used in varying degrees to solve local problems encountered within that given context. The hotel/hospital will provide a useful addition to the arsenal needed for pandemic planning. After it has performed its civic duty, the hotel/hospital can return to be a hotel once again– continuing its benefit to the community. This approach will give resiliency to the system and effectiveness to the response.


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William P. Clements Jr. University Hospital at UT Southwestern Medical Center Dallas, TX


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