1. Unit 6.5. Facility design, renovation, and use TB Infection Control Training for Managers at National and Subnational Level

2. Objectives After this unit, the participant will be able to: List basic design principles for maximizing natural ventilation Provide an example of facilitating patient flow to minimize exposure to infectious patients Provide an example of rethinking the use of space to decrease the risk of TB transmission 2

3. Outline A. The managerial activities of facility design, renovation and use B. How facility design, renovation, and use can the risk of TB transmission 1.Reduce crowding 2.Maximize natural ventilation 3.Organize patient flow C. Maintenance 3

4. A. Inadequate design and use of space contribute to TB spread Managerial activities at national and facility levels: Ensure that health facility design, construction, renovation and use are appropriate Rethink the use of available spaces to optimize implementation of controls 4

5. Facility upgrade and reorganization includes: More complex solutions that require engineer or architect type of expertise 5 Simple interventions that do not require any structural change

6. B. How facility design, renovation, and use can reduce the risk of TB transmission 1.Reduce crowding 2.Maximize natural ventilation 3.Organize patient flow to minimize exposure to infectious patients 6

7. 1. Reduce crowding 98 patients exposed vs. 9 + 9 = 18 7

8. 2. Maximize natural ventilation Orientation to prevailing winds Elevation from the ground Stack ventilation Building dimensions 8 Placement and size of window openings for cross ventilation

9. Cross ventilation and shape 9

10. Poor air mixing, little air exchange 10

11. Cross ventilation 11

12. Cross ventilation 12

13. Windows design Tilting windows < 50% open area~ 100% open area Sliding windows 13

14. Tilting windows Tilting windows (horizontal) 14

15. 15 3. Organize patient flow to minimize exposure to infectious patients

16. Mixing of patients and staff 16

17. Separation of patients and staff 17

18. Crowded, indoor corridor used as a waiting area 18

19. Outdoor waiting area 19

20. Use of existing space 20

21. Radiology MDR ward 21

22. Radiology MDR ward XXXXXXXXXXXX New external stairs 22

23. Sputum collection outside: a simple solution! 23 Sputum collection Don’t! Do!

24. 24

25. 25 C. Facility maintenance Clinic design needs to support the operation and maintenance of the facility throughout its life cycle

26. 26 Budget for maintenance If the building has a 60 year life span, and the initial construction cost was 100 million, you will need to: budget 4% per year (4 million) for maintenance spend 240 million over the next 60 years on maintenance, or nearly two and half times the cost of initial construction

27. Risk of inadequate building maintenance 27

28. Risk of inadequate engineering service maintenance 28

29. Summary Managers should rethink the use of available spaces and consider renovation to optimize infection control Buildings can be designed or upgraded to decrease crowding and maximize natural ventilation Patient flow in facilities should be organized to diminish exposure by infectious patients. 29