Hospital design
Special delivery anywhere – the modular hospital
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Innovative modular architectural design has many advantages, among them cost efficiency, customisation and speedy construction. Callan Emery spoke to Keith Smith, the chairman of MGI SI Gulf, a new Dubai-based provider of fast-track healthcare facilities in the region, about their novel product.

A new wave in building design and construction has recently come ashore in the Middle East. It is a wave that property developers and renovators in the United Kingdom have been riding for a while with increasing popularity. And it is not difficult to see why the stature of this innovative design and construction style has grown so significantly in the past few years when you consider its many positive features.

Construction takes place off-site and is considerably quicker than traditional brick and mortar. The building block-like units are completely customisable and suitable for permanent or temporary facilities. The structure has superb durability with a lifespan in excess of 80 years. And to top it all it offers attractive cost efficiency. For some, such as Keith Smith, who now heads up the Dubai operations for PKL Healthcare, the British company that specialises in designing, building and installing these fast-track buildings, it is the way of the future.

Smith is the chairman of the newly established MGI SI Gulf, an offshoot of PKL Healthcare. The company specialises in designing and engineering modular-based operating theatres, diagnostic imaging facilities, sterilisation facilities, laboratories, wards and day surgery centres.

Smith emphasises that the “buildings we construct are not ‘pre-fab’ constructions. Although they are constructed off-site as separate units and then shipped to site where they are bolted together to make up the complete structure, that’s where the similarity ends. They are steel-framed and are much stronger than your common timber-fame pre-fab units. They are extremely durable.

And when fully constructed you would be hard pressed to tell the difference between our ‘modular’ buildings and regular brick and mortar buildings.” In essence ‘modular construction’ is the use of pre-engineered volumetric units which are transported to the site as fully fitted out, serviceable building blocks where they are installed to form a building complex available for immediate use.

The length of time from design to completion varies depending on the size of the project, but generally it is months rather than years. “Building for healthcare we have to build to the highest specifications,” Smith said, adding: “We build everything to British standards of approval, which are very high. We build to ISO9001 for design.” Smith explained the process from design to installation by way of the company’s recently completed project – a trauma hospital for the US Army Corps of Engineers in Bagram, Afghanistan.

PKL won the contract with a Turkish company to jointly develop the hospital for the US military. PKL’s part of the job was to develop the critical care section of the hospital – the ICU, the operating theatres and the triage and trauma section, which when constructed as modular units could be slotted into the larger hospital which would contain outpatient facilities and wards.

The entire facility was designed on one level, although, as Smith noted, with modular units you can build up to six or eight floors. To facilitate the fast-track construction of
the trauma units PKL set up a company in Dubai – MGI SI Gulf with Smith at the helm.

Design

Once the contract has been awarded, the company notes the client’s requirements then goes to the drawing board. “All our architectural design is done in-house by an experienced design team,” Smith said.

Asked why PKL was favoured for the contract, Smith said there were not many companies that have the capacity to build these type of structures. “Building a modular structure is not rocket science. But the science and the art comes in when you put in, for example, the medical gases and the air handling for a hospital.

It involves expertise in ensuring that the system can handle the required 36 air changes an hour in specific areas and designing so that one room has positive pressure and the room next door negative pressure. That’s where the real design capabilities come in,” Smith spelled out.

“A lot of companies don’t understand the use of different materials for infection control. Infection control is the be-all and end-all of hospitals,” Smith explained. “We pride ourselves in designing first and foremost around infection control. “We design around the best method of keeping infection to a minimum.”

To ensure this designs are drawn up according to clinical flow patterns. “You have ‘patient flows’ through the building. We look at these diagrams and correlate them with ‘clinical adjacencies’, in other words which units in a trauma centre should be next to each other in relation to the way a patient moves through the building from admission to discharge.

For example, you don’t want to put a waste utility next to a triage area which will result in cross-contamination. “Our designs are clinical lead rather than construction lead,” Smith added. “This determines the layout of the building. Once the layout is done in principle on a piece of paper, we then modularise that. In effect we divide the building up into a series of rectangular boxes averaging about 12 metres in length, by 3 metres in width and just over 4 metres in height.”

Smith explained that there are various other constraints that need to be taken into consideration in the design phase. For example, the US military requested that the trauma hospital have all services – the air-conditioning, wiring, and so on – incorporated in the building, rather than on the roof where it would be fitted in a regular hospital.

He said the routes that the vehicles took to deliver the completed units to site also dictated design. Overhead bridges dictate height restrictions, for example.


And winding mountain passes may dictate the length of the units that can carried on a truck which has to negotiate the sharp bends in the road. “We carried out an entire route assessment for delivery of the units to Bagram,” Smith said.

The route would take the units by ship from Dubai to Karachi in Pakistan and then by road some 2,000 kilometres over the Khyber Pass to Kabul and north to the US military base at Bagram. Once design is complete, construction begins at a factory. In this instance it was in Jebel Ali Free Zone in Dubai. When the units have been constructed they are bolted together at ‘bay joints’ to form the entire building complex.

“It is then fitted out with all the gas, mechanical and electrical elements. “Everything is tested at the factory. We run water through the plumbing pipes, gas through the gas pipes and so on. All the fittings are installed in such a way that they can be conveniently separated at the unit joints and reattached when the units are locked together on site following shipping.

Sanitation Construction within the factory setting helps to ensure that the entire construction process remains sanitised, an essential element when constructing healthcare facilities.

This is an important advantage of the modular construction process as opposed to brick and mortar construction which is exposed to dust and dirt. Construction materials are also kept clean by being stored in the factory. Once the modular units have been built and fitted, the entire facility is cleaned and scrubbed.

Air ducts are blown clean and gas lines are purged. Each modular unit is then separately packaged in special shrink wrap material before being shipped to site. Shipping The units have standardised container corners to enable container cranes to hoist the units for shipping.

The Bagram hospital units were larger than the standard container and had to be shipped on a break-bulk carrier to Karachi. Shipping the units on such a long and tortuous route was not without its problems.

“Customs inspectors at Karachi port damaged some of the units when they broke into them for inspection. This despite the clearly marked inspection panels that could be removed for inspecting the interior,” Smith said. Some units were also slightly damaged while being trucked overland to Bagram.

“The Turkish company had insisted on organising the overland shipping. Against our better judgment they chose the cheapest company they could find. Of course, by the time the units arrived in Bagram, some were buckled as they hadn’t been correctly supported on the trucks.

Fortunately we were able to fix the problem on site,” Smith said. It was the dead of winter when the units arrived on site.

“We had to bolt the units together with about two to three feet of snow on the ground and temperatures were well below zero.” All the fittings were retested. Ceilings, walls and flooring materials were welded and sealed to provide a seamless fit in the interior.

The military trauma hospital in Bagram now has in place a 44-bed ICU with isolation rooms; a theatre block with four lamina flow theatres; and a triage unit with decontamination rooms and special treatment rooms. The triage unit links directly to the helipad for the medivac helicopters.

The laminar flow theatre is designed to ensure that through positive pressure in the theatre air is forced to flow from vents in the ceiling down over the patient and out via ducts at the side of the theatre.

The laminar flow system and built-in HEPA filters ensure infection control is of the highest standard. “We are one of the only companies in the world that can do this with modular structures,” Smith pointed out.

“Our modular buildings are designed to the highest specifications you can imagine. They have been designed so that they can be virtually submerged in water and would still pop up working perfectly.”

Earthquake resistant

Smith added that the modular structure has been shown to be the “most resistant” to seismic activity compared to any other type of building. “Our buildings are constructed in such a way that nothing can collapse on you. We use expansion joints on the pipes and on the duct work,” he said.

“We design for seismic activity, which is an important feature for places such as Afghanistan. “Our buildings don’t collapse. “In fact, the safest place during an earthquake would be for you to run into our building!” .