New Building Standard for Ebola 29

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Thursday, October 9th, 2014
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With a mortality rate which currently sits at around 70 per cent, Ebola has claimed more than 3,000 lives throughout West Africa in recent months and the situation regarding its spread has been recognised by the World Health Organisation (WHO) as an international emergency.

Highly contagious, the disease is spread through bodily fluids such as saliva, blood, perspiration, excrement and semen and causes massive internal haemorrhaging, with victims suffering immense pain as they die from loss of blood.

Its proliferation is happening in densely populated parts of Sierra Leone, Liberia and Guinea, where under-resourced health systems and medical infrastructure have been overwhelmed – a situation exacerbated by the loss of health care workers, many of whom themselves have died in the course of treating victims.

Fortunately, the world is not standing still. A number of nations including the United States, China, the WHO and the World Bank are providing financial and human resource support; even Cuba has dispatched more than 160 health care workers.

But action is required on many levels, one of which involves the design and construction of treatment and quarantine centres to standards which minimise the risk of contagion and maximise both health worker safety and the opportunity for patient recovery.

Toward this end, the Centre for Best Practice Building Control is currently working on a draft building standard aimed at providing guidelines for the construction and subsequent use of such facilities and serving as a reference for builders, facility managers and maintenance personnel.

The project faces a number of challenges, including the incorporation of appropriate security and quarantine measures to prevent infections of workers or third parties as well as procedures for the safe transport and incineration of contaminated material such as bedding, clothing and used medical equipment.

Also, with corpses remaining contagious for at least a month following the victim’s death, the need for safe body handling arrangements and procedures post-mortem must not be forgotten.

The team working on the guidelines is doing so in a pro bono, best endeavours capacity within tight time constraints, and as the guidelines cover virgin territory, they can be neither definitive nor exhaustive.

A first draft has been published on a number of international online forums and the Centre is seeking feedback for a second draft expected within a fortnight. Accordingly, readers are encouraged to offer their thoughts and ideas in the comments of this article.

Any feedback will assist the development of the protocols and will represent one more step in helping to stop this deadly disease which is causing so much sickness and misery. Once the standard is completed, it will be dispatched to the Centre for Disease Control and other non-governmental organisations for their consideration.

To review the report, please click here

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29
  1. Kim Lovegrove.

    3400 deaths, 2 recently in Spain and USA. World Bank states $35billion is current likely economic fallout. A nurse in protective gear contracted ebola (from a patient who is now dead) in a Spanish containment centre. Ebola is now in 7 countries & at any time is 24 hours away from another courtesy of a carrier being on a flight abroad. The CBPBC standard is a work in progress and comments are sought to fine tune it; currently Bruce Rogers NZIOB & myself are drafting it. Some useful inputs came from a retired US military medical corp commander and these have been incorporated. Please help by feeding into this sourceable commentary thread.

  2. Lynda

    Shouldn't there also be building standards for ASAP retrofitting US hospitals without isolation quarters to begin handling Ebola patients?

  3. Trevor Hillard

    "A first draft has been published on a number of international online forums and the Centre is seeking feedback for a second draft expected within a fortnight"

  4. Kim Lovegrove.

    Since this article was published the death count has risen to 4,000. 2 health care workers have contracted the disease in the US and Spain whilst attending to patients. Note both workers were "suited up" and were working in containment facilities, which one would assume were operating in accordance with advanced "ebola contagion containment " regimes…..yet the disease migrated. All the more reason for an international standard, that can be called up by regulators, by either regulation or gazette. This is "front and centre" in the realm of building control regimes and Acts of parliament. This bloody disease doesn`t just have to be contained it has to be defeated because the carnage in Africa is beyond the pale.

  5. Justin Cotton

    Interesting article. Perhaps existing regulations that deal with such contaminants as absestos could be used as a guideline for dealing with treatment and contaiment of this new threat.

  6. Stephen

    Appropriate building standards are essential for the effective control of this dreaded disease. The effective isolation of those who have the disease from those who do not is the only way one can stop it spreading at an uncontrollable rate.
    This is a proactive step in the right direction.
    If the care-givers cannot first be protected then there can be no effective treatment of those who have the disease which in turn lends itself to a proliferation of the disease itself.

  7. Seán P. Fay, M.S.. CEM

    Possible Ebola case in Braintree, MA

    A gentleman who had recently been in Liberia presented at a Braintree, MA (about 12 miles from Boston) Medical Clinic. Since he had flu-like symptoms, they employed security and isolation precautions and transferred him to Beth Israel Deaconess Medical Center in Boston. Beth Israel has him in an isolation environment and they are consulting with the CDC.

    Now, if only we can control the hyperbole and supposition in as professional a manner…

  8. Seán P. Fay, M.S.. CEM

    Hi Trevor,

    Actually, they are on the revisions for the third draft. With the current situation everybody is moving rapidly on this.

    The link has been added to the article above

    I'm sure they'd appreciate any feedback you'd like to provide.

    All the best,

    Seán P. Fay, M.S., CEM

  9. Robert Hunt

    I acknowledge the great work by the Centre for Best Practice Building Control on this issue. This is another example of how important the building and construction industry is to every facet of life. The provision of appropriate disease control facilities is critical to the control and hopefully one day the eradication of the type of epidemics that we are witnessing at the moment. This is critical work and I congratulate those behind the Centre for identifying this an important issue.
    Robert Hunt
    CEO – Australian Institute of Building

  10. Kim Lovegrove.

    There is a desperate shortfall in moneys needed to fight ebola. 30 billion dollars is now required according to the World Bank fight the ebola. A couple of weeks ago the UN quoted 1 billion dollars. As the disease spreads exponentially the cost of fighting the epidemic will increase exponentially. The G20 could give consideration to holding an emergency meeting to develop an international task force to mobilise resources and experts and interact with global stakeholders. G20 could also encourage member nations to raise "ebola battle capital" levies to help fund vital operations.

  11. Bruce Brady

    My hat is off to all those who have and are dedicating their time and talents to this global concern, especially those on a pro bono basis.
    While I have only briefly looked through the initial draft I would first highly recommend contacting a Mike Knowles a brilliant engineer who's been working on a super insulation which could be ideal for this application. 2nd, as a former leader in worldwide deployment logistics/USAF myself, I highly recommend consulting with the Red Horse rapid response with in the Air Force engineering sector, with regards to how best deploy and construct the facilities, and how this affects the design. And finally please feel free to contact me if I can be of any help.

    • Bruce Rogers

      Hi Bruce,

      Many thanks for those valuable leads and making yourself available to helping out. Are you able to go through the draft and make some commentary? Even making references within the draft such as in your comment here is precious.
      Many thanks.
      Bruce Rogers. NC NZIOB President

  12. Gideon van der Westhuizen

    As an African and a businessman travelling to Africa frequently, this is devastating and the potential impact on the African psyche could be immense. Designers, planners, engineers and project managers urgently need to contribute to the debate on how we respond to setting up / agreeing to universal healthcare facilities'standard.

  13. Olufemi Kuti-George

    A step in the right direction.

  14. Peter Micevski

    Great work.

    The Building standard for Ebola could and should be adopted and modified for other epidemic diseases affecting the world for e.g. HIV/AIDs.

  15. Meredith Cayzer

    This is a good initiative especially to ensure that those caring for Ebola patients in healthcare facilities can continue to do so without risk of getting the disease. The international community must step up and recognise the seriousness of this epidemic and implement these guidelines.

  16. Harley Dale

    A draft building standard is a vital component to the preparedness, and what we need ultimately to be success in overcoming this insidious disease. I would encourage anyone who has the skill/s to contribute towards this draft process becoming actively engaged.

  17. Jim Korfiatis

    Great article. As a father of 4 and a businessman traveling frequently, I thank those who put time and effort to fight and control this deadly disease. Governments need to do more to protect against economic and humanitarian concerns relating to this disease and put in place effective building standards and isolation controls to protect the millions that would otherwise be at risk, including those protecting us.

  18. Robert Whittaker AM FAIB

    Well considered piece, and a much needed if not excellent paper.

    Form follows function, and a building standard to reduce the spread of this insidious disease is just what is required – and whilst the retrofitting of Western facilities will be the next step we are all capable of doing more than one thing at the one time

    • Neil Evans

      Well said Robert, I couldn't agree more.

      While there are short term strategies to save the lives of people who have the disease and others who are yet to contract the disease, we still need to do more.

      In terms of what else can be done, an industry building standard must be at the forefront of what is needed next to wipe out ebola.

      Neil Evans. – Executive Director HIA ACT/SNSW

  19. Aisha Mohamed

    This is esseatial to communicate to health authoritites in African countries , through the UN international health Organization ( WHO).Other wise Ebola stays to wipe out of the face of Earth more thousands in Africa and eslewhere.

    • Peter Jolly

      This is an excellent and commendable initiative. Given that the Australian Federal government is reluctant to send an Australian contingent of Health professionals to assist on the ground, maybe there is an opportunity for the government to provide some much needed funding towards this project. This would be a terrific contribution to make towards the overall international effort.

  20. Wallace

    Thought it worth bringing this modular product/supplier to the committees attention. It is a modular design (similar to a shipping container so nothing new there) but it can be flat-packed such that 4 modules can be delivered as one container.

    It seems to have the potential to meet much of the other criteria – transportability; prefab; scalability; easy to construct; minimal foundations; insulation; pricing etc.

    Once the design standards are refined I expect there would be scope to adapt construction materials as required.

  21. Keith Banks

    History shows us that governments are reactive not proactive. This draft standard provides an opportunity to act now and not wait until the infected are filling our hospitals. Time is of the essence.

  22. Ian Marshall

    This is a vital issue should the unimaginable ever happen in our part of the world. This standard will be vital. It is important that we have something reliable to refer to

  23. Adam Childs

    It's not actually clear what the jurisdiction for this protocol is. Are these guidelines for emergency, possibly temporary, structures (e.g. in W. Africa) or permanent structures in developed countries?
    Any protocol should incorporate – or be incorporated into – existing protocols for infectious disease control. They also need to think about co-infections (e.g. ebola with malaria) and contemporaneous cases: ensuring that the focus on ebola doesn't increase maternal mortality or mortality from other infections.

  24. Adam Childs

    But the biggest issue we have – and this isn't directly relevant to this protocol – is training and compliance. In the developed world we are seeing patient-to-carer transmission rates of about 60% whereas in the Africa, it is closer to 4%. There is a technology-complacency in the developed world that results in an overemphasis on 'hard' solutions. When developing and distributing protocols such as these, it is essential that we also stress that no matter how well the building was designed and built, the safety of staff and patients ultimately rests on the actions of people.

    • Kim Lovegrove.

      Adam what you say is so true, hard solutions are not the only solutions. The problem is multifaceted & the solutions must be multidimensional. In so many developing countries a coagulation of poverty, overcrowding, poor sanitation, high concentration of people living in tiny abodes, poor education, traditional practices & skepticism of modern medicine creates the "perfect storm". Net effect & the perfect environment for the proliferation of ebola. There will need to be major cultural paradigm shifts to deal with the holistics of this epidemic. Further Africa can no longer be "siloed" from Western consciousness, globalisation means that we cross fertilise on so many fronts. Africa must be embraced, backed & no longer neglected.

  25. Bruce Rogers

    This issue is starting to hit home the need for all geographical locations to contribute to a model building standard. I recommend that we consider developing the standard further to now include more developed countries that find themselves in a different and sometimes dangerous context to ensure that the standard covers these needs as well. This has the potential to be one of the greatest threats to mankind today and it is urgent we address such matters.

    The New Zealand Institute of Building certainly supports these efforts. Bruce Rogers. NC NZIOB President.