Q&A with Sara J. Eastman, AIA
Principal, Science + Technology
EwingCole Architecture & Planning
Medical Lab Management: Clearly, the onset of the COVID-19 pandemic will widely affect the way workspaces are designed and assembled in the future, but what early ideas might be applied to hospitals in general, and clinical laboratories, specifically?
Sara Eastman: The COVID-19 pandemic will most certainly affect workspace design in the future and the medical profession is likely to see substantial change. Although flexible and modular design elements have been appealing to laboratory practitioners for some time now, among the effects of the pandemic has been the exposure of how space constraints and design rigidity can blunt the response to unexpected changes in workload and type. Therefore, out of necessity, clinical laboratories will need to continue to be designed with flexibility at their core and with the assumption that a massive shift in technology use and testing procedure may arise again.
In order to accommodate an unexpected and sustained spike in testing volumes for the public, larger laboratory testing centers (particularly those that handle a substantial outreach business) need to place a design focus on enabling the rapid on-boarding of instruments and analyzers into the existing workflow; this latter point is just as important as the former. When planning for the acquisition and placement of a large chemistry analyzer, consider whether another piece of the same or similar instrumentation could be added to that space (this includes power, plumbing, IT networking, etc). What this may ultimately require is for many facilities to adopt large, open, and flexible floorplan layouts with multiple access points (eg, floor, walls, and ceiling), both for current and potential technology additions and the staff members they would require to manage.
MLM: Certain clinical laboratory disciplines, such as microbiology, already utilize primary and secondary engineering controls in their workflow. Will other areas of the lab require the same or similar controls?
Eastman: Certainly, ensuring the proper biosafety design for a specific laboratory’s operations is essential, and this thinking should extend beyond what the lab is currently doing. While many clinical laboratory testing processes are performed in a biosafety level (BSL)-2 facility (ie, the handling of agents associated with human pathogenic and infectious organisms), some testing requires BSL-3 level controls. A BSL-3 laboratory typically includes work on microbes that are either indigenous or exotic and can cause serious or potentially lethal disease through inhalation. Examples of microbes handled in a BSL-3 environment include yellow fever, West Nile virus, and TB-causing bacteria. BSL-3 environments do require elements such as biosafety cabinets (BSCs), hands-free sink and eyewash stations near exits, and sustained directional airflow from clean areas to potentially contaminated areas.1
Specific to COVID-19, all requirements need to be evaluated based on the specific test(s) being run in the lab and may need to be expanded to include testing for COVID-19 if required. Among the resources for information on a specific laboratory’s needs is the regularly updated Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Coronavirus Disease 2019 (COVID-19) from the CDC.2
MLM: Shy of rebuilding a laboratory, what design elements can be incorporated into existing labs to create safeguards?
Eastman: While a total facility or laboratory re-build is often not feasible, there are several ways the laboratory can increase its flexibility and response to rapid change. Maintaining BSCs or other engineering controls as operational, even if in storage, is good practice. Likewise, consider how the laboratory would respond if new testing required BSL-3 restrictions or a negative pressure workspace. When reviewing new testing technology, determine if the testing process takes place within a completely closed system allowing for more placement versatility in the laboratory. As always (but particularly relevant now with COVID-19), whenever new testing is added or considered for addition, review the impact on movement of personnel and equipment in the lab. Maintaining a laboratory space that enables the isolation of certain practices, if necessary, would obviously be a benefit during an unexpected influx of new testing.
MLM: How is automation expected to continue to proliferate in the clinical lab and alleviate human interaction with samples?
Eastman: The proper management of limited human resources in the clinical laboratory is an aspect that has informed design for some time, well preceding the onset of COVID-19. Flexible and modular design and engineering elements in the laboratory are generally intended to maximize the efficiency of staff members, and automation is a natural extension of human-resource capabilities. By automating as many steps in all three phases of the testing process, staff can place their focus on tasks that automation cannot cover, which are plentiful.
Given that in several areas of the laboratory, automation can both increase testing volumes and reduce turnaround times, all while minimizing human interaction with samples, its utilization with novel or particularly dangerous pathogens will be a focus for manufacturers moving forward.
MLM: Presuming a vaccine is established and this strain of coronavirus is reined under control, what lasting impacts do you foresee this pandemic having on how clinical laboratories are designed?
Eastman: With both the public and the medical community keeping a close eye on any positive news regarding COVID-19, the proper management of a future vaccine will be heavily emphasized. With clinical operations continuing under a sense of “new normal,” it will be important to remember the hard lessons learned in this pandemic so far. Part of this future state will be attempts to protect operations and the human and technical resources behind them from an unknown disease. So, when reviewing new testing under “normal” circumstances, consider how the attendant instruments could be expanded, isolated, or contracted in the event of a crisis. Obviously, all clinical disciplines have limits to their workable space, but with necessity being the mother of invention, the lab must find a way to move forward while ensuring safe practices, including the proper management of an eventual COVID-19 vaccine.
MLM: What resources does laboratory management have when it comes to educating themselves on design principles or best practices in the designing and building of laboratory spaces?
Eastman: Whether building a new, custom-designed laboratory facility or adding to or altering an existing facility, the design should be evaluated and defined architecturally, incorporating efficient laboratory workflow and engineering elements that allow the laboratory to be modified. We utilize FDA and CAP guidelines and regulations, among others, and apply them to laboratory planning specific to each individual client’s needs. Best practices and principles for each lab can be interpreted from the various regulations and applied with different options to the built space. As mentioned, keep an eye toward future laboratory needs when building a space for today.
MLM: What other tips or advice would you give a laboratory director in approaching a lab build or redesign?
Eastman: When working with a laboratory architect, designer, and/or engineer, be sure to begin by asking the right questions for your operations. Does the solution work for our specific processes and workflow? Does it accommodate our vendor requirements now and in the next few years? What is the best short-term solution and what is the best long-term solution based on our projections? With many laboratories housed within hospitals, the design must work with other clinical disciplines as well. All these questions help determine the best site-specific design solution.
Once your needs are clarified, vet your options through a benefit analysis, and work with your architect to come up with a concept plan that includes basic programming elements based on test volume projections and project goals. Once the concept has been reviewed by laboratory stakeholders for applicability to their operations, specific costs can be estimated, and the architect can move forward with a fully detailed design.
Collaboration among clients, planners, designers, vendors, and contractors is key to a successful laboratory build or redesign. Architects, designers, and engineers commonly work with both the laboratory and its technology vendors to help pare down the options and determine the best solutions. Oftentimes, construction contractors and internal facility engineers are included in these conversations. This collaboration allows for the discovery of potential constructability issues and the availability of workers and materials.
Certainly, the COVID-19 pandemic has caught the world off guard and its effects will be felt for some time, but the impact only serves to solidify the need for communication. When attempting a rapid implementation and validation of new testing equipment and methodologies, the ability of the laboratory to be limber and pliable will help determine success. With this level of flexibility and all hands on deck to develop a design solution quickly, changes can be made to laboratory spaces in short order, allowing the lab to maintain an excellent level of safety and quality.
Sara J. Eastman, AIA, is a Principal architect and laboratory planner in the Science + Technology practice at EwingCole, where she plans and manages complex projects for clinical and research labs and coordinates large design-build teams across multiple offices. Sara holds a Bachelor of Architecture from Jefferson University and has resided in both EwingCole’s Philadelphia office and Irvine offices. She is a registered architect in multiple states, an active member of the American Institute of Architects (AIA), and serves as a Board member for Professional Women in Construction mentoring others in the A/E/C industry.