Voices from the most recent NIH Biocontainment Conference

I recently had the pleasure of attending a two day Lessons Learned Workshop at NIH related to Biomedical Research Facilities that have been built in the last several years. In today’s complex world we architects are trying, harder than ever it seems, to meet the needs of our client with each project, but today, our clients seem to have many voices. The beauty of this conference was that all of the competing voices were in one place and had a chance to express their perspective in an educational setting. In the project world it can be an extremely delicate balancing act to place the proper emphasis on the right voice.

We have the voice of the economic buyer who commissions a building to add value to the bottom line of their business. They may not actually work within its confines, but they are likely to see the building as one of many pieces they are using to solve a larger puzzle. We have the voice of the user buyer who will work daily in the building. They have the expectation that it will be a comfortable, safe place to work and that it will help them be more effective at building their piece of the puzzle. Then we have the technical buyer whose job is to get the building done on time and budget while still meeting an ever increasing and sometimes conflicting minimum standard of code requirements. Lastly we have the public. While they aren’t a buyer per se they have the expectations, especially with issues related to biological containment, that our profession will exercise due diligence and safeguard them from hazards that may be produced in the building. With all of this noise it’s refreshing to hear a voice speaking a simple, clear concept that seems to cut across the needs of all groups. This is what I heard when Debra L. Hunt the Director of Biological Safety for Duke University said the following words: “Work Practices make all the difference… Technology advances but people stay the same”.

It was clear from Dr. Hunt’s remarks that Duke University struggled mightily to get the most building they could possibly get 0n a limited budget when they built their new Regional Biocontainment Laboratory. This is not new in today’s economic times, but when push came to shove they opted for “state-of-the-art” fail safe engineering control solutions. Its hard to argue with the choice, but remember given the principal of scarce resources every choice you make has consequences. In their case I’m sure this choice affected the amount and quality of space they could build. Dr. Hunt had historical data that showed nearly all laboratory-acquired infections at Duke and elsewhere are caused by poor work practices.

This led me to a place I’ve been many times before. As architects and engineers, we are not cape wearing super heroes. (Frank Lloyd Wright may be an exception). We can’t design buildings that protect people from all of the hazards of their jobs. The question we should be asking is: What can we do with the design of our buildings to encourage behaviors that will inherently lead to safe work practices? The combination of Dr. Hunt’s examples and my past experience in highly unique containment spaces gave me a list of five places to start. I wonder what others think:

1. Plan to make the gowning and access to Personnel Protective Equipment (PPE) as effective as possible – The act of gowning and de-gowning is a constant reality for these kinds of spaces. Unfortunately it is too often the last item considered. Please understand that every time a worker must enter a containment space they are committing a minimum of 15 minutes to dawn protective clothing and another 15 minutes to doff the material properly. Make two trips per day into containment and you’ve lost an hour of your day. Having this protective clothing properly in place is essential and when you take it off you must take extreme care not to expose yourself to particulate that may be on the clothing. Why isn’t it obvious that we must commit adequate space for this activity? More importantly we must carefully consider making proper hand washing and toilet facilities readily accessible to reinforce how important actions such as hand washing are in the prevention of exposure.

2. Encourage situational awareness – By their nature containment spaces can be a confusing maze. They can have very utilitarian finishes and look so similar that staff can easily become disoriented. I was recently in a space where by stenciling the room number on the clock; the only orienting device present in each room, the research staff was greatly able to improve their situational awareness. I couldn’t help but think what we could do if we employed our full arsenal of creative ideas on this topic. The use of color and/or graphics on various rooms could make a huge difference. The use of glazing in barrier walls can simultaneously improve orientation, operational efficiency, because you may not have to open a door to find a colleague and safety because we all behave differently when we can be observed.

3. Provide access to natural light – I’m not naïve enough to think that we’ll ever have windows in containment spaces, but the idea of knowing if the sun is shining without having to entirely leave the containment space seems far from impossible.

4. Think about how people will accomplish non-laboratory related tasks – In spite of the need to focus on this highly dangerous work; researchers are people too. They get emergency calls from home that a child is sick, they have to respond to e-mails, they need to take notes to document things and they need to communicate with each other. Yes they can do all of this stuff in their office, but is it too much to ask to have a small space for data reduction in a location that doesn’t require them to commit a half hour to gowning and de-gowning just to find out that the child in the nurses office with a tummy ache is OK and going back to class?

5. Carefully plan material and people flow simultaneously – In addition to people animals, samples, cages, feed, bedding, chemicals, glassware, gowns and varied supplies must all move through the facility. Given that people of varied education, security clearances and containment experience must move these materials, there are countless stories of how just one well-placed equipment air-lock or material pass-through had a positive impact on operations and prevented a potential exposure.