Despite facing a rapidly declining and aging population, Japan's medical system is understaffed. First of all, the number of doctors per 1000 people in Japan is very low. According to a data compiled by OECD in 2019, there were 6 doctors per 1000 people in Greece, 4.3 in Germany, 2.8 in the UK, and 2.6 in the US, while there were 2.4 in Japan. In addition, despite the fact that there are more beds and that the length of hospitalization is longer than in other countries, the number of medical personnel per bed in Japan is extremely low. Furthermore, the number of beds for infectious diseases has been decreasing significantly in recent years. According to a data from the Ministry of Health, Labor and Welfare, the number of beds for infectious diseases decreased from 9,716 in 1996 to 1,809 in 2019. In fact, the utilization rate of beds for infectious diseases was extremely low, which means that medical personnel had little experience in dealing with infectious diseases. It was under such circumstances that the new coronavirus broke out in 2020, with medical personnel dealing with COVID-19 experiencing confusion, exhaustion, and a sharp decline in medical fees.
Given these circumstances, we were reminded of the importance of giving thorough consideration to the way medical facilities are built. What we felt was particularly important was that architects should understand how infections are transmitted and how to prevent such transmission. In dealing with the issue of infectious diseases by renovating and redesigning medical facilities, we developed countermeasures based on this basis. Okayama City Hospital, designed by Kume Sekkei and completed in 2015, was renovated in 2020 when the coronavirus pandemic was in full swing, so that 23 of its beds for general patients can be used for hospitalization and treatment of patients infected with COVID-19. (*) The area adjacent to the area containing infectious diseases in the fifth floor west ward was renovated. This area had been originally designed to accommodate infectious diseases in the future and is equipped with necessary building equipment to allow infected patients to be hospitalized. While regular patient rooms are either equally or positively pressurized, rooms for COVID-19 patients are negatively pressurized to prevent leakage of air from the room. Taking advantage of the original future plans, some of the HVAC systems were upgraded, patient rooms throughout the floor were converted to a negative-pressurized environment, and the HEPA exhaust system and monitoring cameras were added. In addition, we installed windows in the walls between the patient rooms and the corridor so that any sudden changes in patients' conditions can be easily detected and visually monitored. In order to protect the staff in the staff station from infection, glass screen and a door were added to the counter that had been open before the renovation to shut off any airflow.
*Renovation Design: Miyazaki Architects & Engineers Inc. / Post-renovation Photo Credit: Toda Corporation
The next example introduces a design change of a hospital during construction. The original plan was to have 4 beds for infectious diseases in addition to beds for general patients, and each area was to be divided by fittings installed along the corridors. However, in order to respond more effectively to infectious diseases, we changed the design so that the number of beds for infectious diseases can be increased in three stages as needed. This change makes it possible to provide a maximum of around 30 beds for infectious diseases, if various conditions including the availability of sufficient receiving staff are met. In the wake of the coronavirus disaster, the staff station has undergone a major change. While openness and accessibility have been preferred until recently, a closed space will be necessary to some extent to protect medical staff from infection in the future.
As mentioned earlier, the key is to prevent transmission of infectious diseases within the facilities. The types of transmission that can be prevented by architectural means are contact, droplet, and airborne transmissions, as well as aerosol transmission as demonstrated by the transmission of COVID-19. The best way to prevent contact infection is to avoid touching, and one of the effective ways is to create a touchless environment by installing automatic doors and automatic payment machines. To prevent droplet, airborne, and aerosol transmissions, it is effective to separate circulation routes of patients who may be infected from other patients and staff, and to provide individual rooms or negatively pressurized patient rooms. It is important for architects to thoroughly understand these measures and plan accordingly. In addition, it is crucial that architects and operators work together to not only bring changes to the facilities, but also its operation. There are still many things that we don't know about COVID-19, and we expect that the basic principles will be clarified gradually. We believe that architects involved with medical facilities design should pay close attention to the latest information and incorporate them into their designs.