This somewhat older (2008) case study about Piedmont Hospital (Atlanta) remains a great example of how to keep a hospital fully operational while expanding space – the middle of surgical suites. Careful planning was paramount; so was inventing a way to safeguard air flow (it required an airlock elevator). In the end, B&K added eight surgical suites and renovated eight others, all while ensuring that 18 ORs never ceased operation.
Before we start work, we’ve got to create negative pressure in the construction area. Here, air must flow in and out, but not escape to the treatment areas.
It’s a simple concept, but making it happen can be fraught with challenges. That was the case a few years back with a project at Piedmont Hospital’s Atlanta location.
The hospital had 18 operating rooms, all clustered together. They wanted to build eight more, then renovate eight of the older suites. The catch: At all times, 18 ORs had to be open and available for surgery.
Of course, that meant building the eight new suites first with our general contractor partner, Skanska. The new rooms would be located in an area adjacent to the cluster of 18 ORs. Job one was to create that negative pressure to safeguard air quality.
“Skanska told us, ‘We’ll do the building while you guys figure out how to create the negative air space,’” says Trent Strine, who served as B&K’s project manager.
Because the new surgery suites were surrounded by hospital space – and nowhere near outside walls – we needed an idea. Then it hit us: The smoke purge system. All of the eight new rooms needed the system in case of smoke in the OR. What if we built it first and used it to create negative air?
Our plan was to cut the holes needed in each of the rooms, then run the ducts through wall space, up to a rooftop fan for discharging the air. “And that’s what we did,” Strine says, “except it seemed like every time we opened a wall, we’d come up against a piece of pipe in the wall.”
That part of the hospital was built back in the 1960s, and plans weren’t available to spot what was behind the walls. Piedmont only had a few faded blueprints.
So, when the demo crews went to work, they had to take great care in opening up the walls. We traced each pipe, determined which ones were dead, then removed those to create space to accommodate the smoke purge ducts.
Once those eight ORs were built, Piedmont had the surgical capacity it needed to decommission eight of the older suites for renovation. These were located right in the middle of the now 26-room operating area.
Meaning: We would be surrounded with live surgery space.
Piedmont brought us back for other projects, including building mechanical and plumbing for the world-class Marcus Tower, which opened in 2020. Here, B&K team members work on Marcus Tower systems.
We sat down with our partners at Skanska. How would we create negative air in that space? How would we even get demo material out – and equipment and supplies in?
The only way, we decided, was to build an airlock elevator, from the first floor, up and through the roof.
Skanska cut a hole in the roof, constructed the elevator shaft and built a doghouse to sit on top, for entry and exit. Our job was to come up with the mechanical system necessary to keep the entire space negative, including the operating rooms slated for renovation.
“We hooked up a negative air fan with HEPA filtration to exhaust the shaft,” Strine recalls. “Then we created a two-room, dual-door system where only one door could be opened at a time. It’s like a clean room airlock, and it kept the shaft negative with one door open.”
With negative pressure established, we could get on with the HVAC, plumbing and process piping work – but never while people were in surgery.
“Any shields we had to drill into the concrete had to be done early,” Strine says. “So we’d come in at 4 a.m. and drill all of the shields for the day. It was important to plan carefully and have all of our shields and anchors ready, and have all the hangers in place.”
That planning saved the day. The project came in on time, on budget. And ever since, Piedmont has been able to provide surgical care for many more patients.
How would we create negative air in that space? How would we even get demo material out– and equipment and supplies in?