How St. Louis healthcare providers are working to “pandemic-proof” facilities

As the pandemic commenced its spread across America in early 2020, health care providers nationwide scrambled to ramp up an effective response.  Yet this wasn’t the first emerging virus that local hospitals had dealt with in recent years. Existing institutional, professional, and governmental pandemic guidelines assured health care providers weren’t caught flat-footed as they learned more about this latest threat.

“When the CDC opened their incident command for COVID-19 in January 2020, we in infection prevention took that as an alert for us to respond,” says Christine Zirges, director of infection prevention for SSM Health. “We captured everything we did and learned from Ebola. I was also in the command center during the H1N1 [swine flu] pandemic. That helped us on this journey, because there are many things we did correctly then that helped us respond appropriately to COVID-19. We had many of those systems in place that we were still able to utilize.”

Zirges sees appropriate pandemic response as a three-pronged attack: alerts, containment, and environment management. “Many of these emerging viruses, such as COVID, have vague symptoms: cough, shortness of breath, fever, or just not feeling well. A lot of it is associated with traveling and exposure to other confirmed cases,” Zirges says. “So early on, working with the CDC, we were able to adjust our travel alerts in our electronic health records and quickly inform frontline clinicians to ask the right questions to appropriately put that patient in the right type of room or isolation.”

For hospitals, containment of the disease is crucial, says Zirges. “We want to minimize the risk of spreading it to other patients and our health care workers. We have isolation rooms with normal airflow or negative-pressure rooms,” that is, spaces where air is not recirculated—which is vital for containing diseases such as COVID-19. Zirges says an inventory of these negative-pressure rooms is taken every year, and retrofitted negative-pressure rooms are constantly being added. Engineers assess the rooms to determine which can be retrofitted  and which might be reworked.

Zirges’ third aspect of pandemic response, managing the environment, involves having in place administrative directives, engineering controls, policies, and protocols to not only manage infected patients but also to protect others: health care workers, staff, and visitors. “We’ve developed pandemic policies that have been around for 20 years,” she says, and they are still evolving. 

While health care providers learned via firsthand experience treating Ebola, H1N1, and COVID-19, they’ve also benefitted from state guidelines and national recommendations. All of this information, says Zirges, will influence the construction of new SSM health care facilities in preparation for future infectious-disease threats.

Similarly, BJC HealthCare’s COVID-19 experience is guiding enhancements to its new 16-story patient tower on Kingshighway overlooking Forest Park, which is slated for completion in 2026.

As COVID-19 spread, BJC leaders and the design team worked with frontline staff and managers to plan how the new facility could better accommodate surges in patient volume, as well as the need for isolation in the event of future pandemics.

Donna Ware, executive director of planning and design at BJC, says the long list of challenges during the pandemic was consistent with what other health care providers were experiencing. “How do you manage a highly infectious population? How do you keep family members and staff safe? When you’re managing a large patient population like we experienced during the pandemic, you unfortunately end up creating a lot of isolation for those patients,” including barring family members’ access to loved ones. “So we had to get really creative about how to allow for those connections to occur,” Ware says.

To do that they formed an interdisciplinary team that drew on the knowledge and experience from across the BJC HealthCare system and beyond. “The team was led by the architects but involved frontline staff, nurses, nurse techs, people from food service and housekeeping,” says Ware. “Infection-prevention specialists were also involved in the conversations, and folks from the facilities side who understood the challenges they faced with the existing infrastructure. BJC has 15 hospitals, so we pulled from the region to help inform all the conversations.”

The design team also sought guidance from the CDC and monitored journals to see what other providers were doing in response to the pandemic. The architects also reached out to clients in other health care systems to gather more intelligence. Ultimately, all of that input would inform design adjustments for the new tower that would improve patient care and comfort. “We always try to focus on the patients’ and the families’ experience when we’re designing any of our projects,” says Ware. “Whether it’s providing access to rooftop gardens they can use for respite, access to beautiful views of nature, natural light, all the way down to the colors and artwork we selected specifically in reaction to the pandemic.”

While aesthetics are important to the patient experience, human interaction is vital. The new building will employ evolving technology to aid isolated-patient interaction with family members and caregivers. “There’s a monitor on the footwall [of isolation rooms] that aids in that, with software devices providing ways for our staff to monitor patients without going into the rooms,” says Ware. They’ve also added windows and negative-pressure options in all patient rooms, allowing staff members to work and chart patient progress from directly outside the room.

All 224 private inpatient rooms and 56 private intensive care unit rooms will have negative-pressure capability. Further, many of the inpatient rooms will be ICU adaptable, with needed clearances around the bed, outlets for medical gases and electrical monitors, and reconfigured glass for enhanced visibility.

“We could essentially use the entire building to safely house patients that have COVID” or other diseases, says Ware. “The lessons we learned from our COVID experience are absolutely applicable to other highly communicable diseases, such as measles—or something that we don’t even know about yet.”

No Questions Asked

BJC EXPANDS ITS GUNLOCK PROGRAM ACROSS THE REGION.

BJC HealthCare has expanded its “No Questions Asked” gunlock pilot program to more than 20 locations within the system, including the St. Louis Children’s Hospital Specialty Care Centers in West and South County, the St. Louis Children’s Hospital Center for Families Resource Library, and St. Louis Children’s Safety Stop. At the “No Questions Asked” kiosks, families can find a variety of free gunlocks and pamphlets on how to safely store firearms. Additionally, physicians will screen patients seen in the emergency department for access to firearms and offer a free gunlock to those who are interested. When the program first started, in 2021, the St. Louis Children’s Hospital’s trauma department placed a basket of gunlocks in the emergency waiting area; today, approximately 5,000 free gunlocks have been picked up by patients, families, and staff. “Once we saw the success of the program at St. Louis Children’s,” Dr. Lindsay Clukies said in a press release, “we met with the BJC’s Community Health Improvement team to discuss how best to further disseminate the ‘No Questions Asked’ gunlock baskets.”