Topic: Nanjing Public Medical Center – Lemanarc SA

A dialogue with the principle architect of the biggest infectious diseases hospital on China’s healthcare architecture under the background of the epidemic in Wuhan

Project Specs

Location:

gooood对一些机会和条件合适的项目推出深度报道,希望对项目进行更为立体的表达和展现。

本次专辑带来的是 瑞士瑞盟设计 Lemanarc SA 设计的南京市公共卫生中心(全球最大的传染病医院)。gooood与瑞盟设计创始人及主创建筑师张万桑进行深度对话,就疫情背景下中国医疗建筑现状进行了交流,期望了解现状并收获有益医疗建筑发展的见地。

更多关于瑞盟设计: Lemanarc SA on gooood.
瑞士瑞盟设计 LEMANARC SA正在招聘人才,详情请点击这里

gooood would dig into projects which are appropriate for deeper report, in order to present the project in a more comprehensive way.

Nanjing Public Medical Center is the biggest infectious diseases hospital in the world. In this episode, we interviewed Vincent Zhang, founder and chief architect of Lemanarc SA who designed Nanjing Public Medical Center, to discuss on healthcare architecture in current China during the outbreak of coronavirus in Wuhan. We hope it will provide some useful ideas for improving the present situation of healthcare architecture.

More about Lemanarc SA please refer to Lemanarc SA on gooood.
Lemanarc SA is hiring now. Click here to read more.

出品人:向玲  Producer: Xiang Ling
编辑团队:武晨曦 陈诺嘉 刘丹阳 周诗若 董甜婉雨  Editor:  Wu Chenxi, Chen Nuojia, Liu Danyang, Zhou Shiruo, Dong Tianwanyu

 

关注武汉,为武汉加油。
Keep fighting, Wuhan. We are with you.

 

 

Vincent Zhang

张万桑,瑞士联邦高等工学院建筑学本科学习(EPFL)后,于日内瓦大学建筑学及规划学专业硕士毕业(IAUG)。是最早毕业于瑞士联邦高工及大学,并取得瑞士联邦注册(SIA)的华人建筑师之一。

Mr.Vincent Zhang, after graduating from the École polytechnique fédérale de Lausanne (EPFL), got his master’s degree in architecture and urban planning from the University of Geneva (IAUG). He was one of the first Chinese architects to graduate from the École polytechnique fédérale de Lausanne and to obtain the Swiss Society of Engineers and Architects(SIA).

 

 

_________
关于设计规范

Design specifications

1. 我国的医院选址,特别是类似于小汤山及火神山这样的特殊医院在选址上有哪些硬性要求?
What are the rigid requirements of site selection for hospital in China, especially for the special hospitals like those in Xiaotangshan and Huoshenshan?

总体来说,我们要根据不同的医院种类和不同的城市条件来确定选址。但对于小汤山这一类临时性的传染病医疗建筑来说,它的选址一般有这么几个要求:

首先是对其周边环境的污染情况比如水源,一般来说这类医院是不会建在会对水源造成污染的区域内的。其次是考虑风向。因为这类医院多是针对呼吸道传染病的,这就要求它们位于城市风向的下风向,例如如果一个城市的主导风向是东北风的话,临时医院就应该建在城市的西南方,以减少其可能受到的空气传染。第三,这种专项的传染病医院应尽量远离人群,避免建在城市人口密集的区域。总体来说就是考虑风向、水源和排污。

然后是对场地的要求。对于临时性的传染病医疗建筑来说,它的场地应该尽可能地平整。因为这类医院都是预制的,对建造速度的要求很高,如果场地不平,那么就很难快速地在现场进行组装。再来是要有相对便利的交通条件。因为随着大规模传染病的出现,大量的交通运输工作也会相继展开。最后是防洪防灾方面的要求。比如这类医院最好不要建在有洪水的区域或是油库的附近,要尽可能地避免其他类型的风险。

Generally, we select the site of a hospital according to its functions and the situation of the chosen city. For the temporary infectious hospitals such as Xiaotangshan Hospital, there are several requirements as following.

First of all, we should investigate the contamination condition of the site to other districts. Such hospital should not be built in the area that could pollute the water source. Secondly, considering this kind of hospital is always for respiratory disease, the building should locate on the leeward side of the city. For instance, if the prevailing wind direction of a city is northeaster, the temporary hospital should be built on the southwest side to reduce air pollution to the city. Thirdly, we should avoid building this kind of special infectious disease hospital in densely populated areas and ensure it could stay away from the crowd. Wind direction, water source and pollution discharge are the main considerations in site selection.

The site for temporary infectious hospital should be as flat as possible because this kind of hospital is prefabricated, which requires for construction speed. If the ground is uneven, it will be difficult to quickly assemble the components onsite. Relatively convenient transportation condition is also important for temporary hospital. When large-scale epidemic occurs, large amount of transportation work would be required to send the patients to the hospital. Last, we should also consider disaster prevention. The hospital should better not be built in the flood zone or near the oil depot, avoiding any other possible risks.

 

2. 我国公立医院的发热门诊以及传染科室在建筑设计上有统一的标准吗?发热门诊是否必须建造在一个独立的体量中?
Is there any uniform standard of architectural design for fever clinic and infectious department in China? Should fever clinic be designed in a separated building?

目前为止,中国对于传染病医院、或是综合医院传染科的设计有一个非常概括的原则性建设标准,所以相对来讲实际的执行能力会比较弱。

综合医院的传染科与发热门诊是两个不同的概念,因为传染科必须布置在一个独立的体量中,要与医院的其他科室保持一个最小的距离。但是发热门诊是完全可以布置在医院主楼内部的。

但是就这次的新型冠状病毒肺炎来说,疫情已经造成了大量的感染。我认为在传染病爆发后,我们不能仅仅仰仗市中心的大型三甲医院来进行控制,(仅仰仗市中心的大型三甲医院来进行控制是一件不现实且有些荒谬的事情。这种不现实不光是对于中国,对世界上任何国家都是这样的。)因为这样会产生一系列叠加效应。就是说我们不能因为传染病的出现而影响到甚至是停止其他基础疾病的诊疗,因为一旦这些科室停止运行,其造成的死亡案例可能比因为传染病而去世的人数更多。

就传染病医院来说,我们目前已有的标准和规范在原则和细节上还有不少有待改进的地方,这就需要我们对其进行一些更为细致和扎实的研究。

So far, there is only a very abstract principle design standard in China for infectious hospital or infectious department in general hospital. We lack strict, authentic and detailed requirements to control our design, resulting in lack of practice ability. It is also the situation of the construction specifications of infectious hospitals in China.

Infectious department in general hospital is different from fever clinic as the former must be arranged in a separated building, keeping a certain distance from the other departments of the hospital. In contrast, we could set fever clinic in the main building of the hospital. Consider the current epidemic of coronavirus pneumonia, it was out of control in the early stage, which brought about large-scale of infections. Facing the outbreak of infectious disease, it is impossible to rely on the Grade A first-class hospitals to control the situation, which is also impossible for any other country in the world. It would cause a series of superimposed effects. We cannot slow down or stop treating basic diseases because of the epidemic. If we bring these departments to rest, it might cause more death than that of the infectious disease.

The current construction standard of infectious hospital needs to be improved in many aspects. It calls for further and more detailed research in infectious hospitals.

 

3. 医疗建筑的污水处理系统有哪些特殊的要求?医疗废品如何解决?在建筑设计中如何体现?
What are the special requirements in sewage treatment system of hospitals? How to deal with the medical waste and how does it reflect in architectural design?

传染病医院的医疗废水和医疗废品是两个概念。在传染病医院的设计和建造中,对医疗废水是有着非常严格的控制的。所有的医疗废水都需要经过专门的集成和消毒,在达到普通城市用水的排放标准后才能够对外进行排放。而一般医院的生活废水则可以较快地对城市管网进行排放。

医疗废品在传染病医院中更为常见,因为相较于一般的综合医院和专科医院,传染病医院会产生更多有传染风险的污染性医疗垃圾。然而目前为止,除了要求专门的人力收集医疗废品、专门的部门处理医疗废品外,我们还没有其他更具参考性的标准。但是从整个垃圾处理的流程上讲,我们需要注意垃圾在运输过程中的密闭性。

以南京市公共卫生医疗中心为例。它是全球最大的传染病医院,设有1200张床位。我们在设计时对传染病区的污染物进行了非常明确且细致的分类,将其存储和货运与普通的医疗垃圾和生活垃圾严格地区分开来,并着重强调了密闭性。另一方面,传染病区的运输器械和储藏器械在消毒和清洗上也明显区别于处理普通垃圾的器械。

医疗垃圾的处理系统是包含在医院的整体设计中的。医院的设计反映了一个医疗工厂的完整流程,所以必须将传染病区的污染物、普通的医疗垃圾、生活垃圾、生物垃圾以及各个方面的垃圾等纳入考量范围之内,将它们很好地区分开来,并形成一个系统。后期的补加会造成大量的冲突并增加交叉感染的可能性。

Medical sewage and medical waste are different things in infectious hospitals. In the design and construction of infectious hospitals, there are strict controls of medical sewage. All the waste water should be specially collected and disinfected. It could be discharged until it reaches the standard for urban water usage. However, sanitary wastewater from ordinary hospitals could be discharged to the city water supply pipe network in a faster process.

Medical waste is more common in infectious hospitals. Compared to ordinary general hospitals, there would be more polluting waste with risk of infection in infectious hospitals. However, except for requirements of using trained people to collect the medical waste and send to special department to process, there is no other standard that we could refer to. We have to pay attention not to leak anything during the transportation process in waste disposal.

Take Nanjing Public Medical Center for example. It is the largest infectious hospital in the world with 1200 beds. We carefully categorized the waste from the infected area in the design phase, strictly distinguishing it from the ordinary medical and sanitary waste. We also underlined the leakproofness of the space. In addition, cleaning and disinfection of the equipments to transport and storage waste from the infected area are also different.

Medical waste disposal system is included in the entire design of the hospital. The design of a hospital reflects the whole process of medical treatment. Thus we should take contaminant from infected area, ordinary medical and sanitary waste, biological waste and all the other wastes into consideration, and create a system to separate them from each other. If we skip this process and try to add it after construction, it will cause a lot of conflict and increase the risk of cross infection.

▲瑞盟设计的南京市公共卫生中心,Nanjing Public Medical Center by Lemanarc SA ©LEMANARC SA

 

 

___________
详谈医疗建筑设计

Design of health care buildings

1. 对于综合性的医院设计而言,各个科室和功能空间的楼层划分和平面布局有哪些讲究?
What are the requirements of space division and plan layout in the design of general hospitals?

系统性的设计规则是与时俱进的,它与整个医学科学和医疗工程的进展都是紧密相关的。可以说,只要医疗设备有进步,设计规则就有可能发展,所以并不存在一个标准的布局。即使是真的存在一个所谓的标准布局,它也会随着医疗各方面的进步而发生变化,因为医疗建筑的本质是要实现医疗行为。然而医疗行为本身就是处在一个不断变化的过程中的,所以并不存在“标准”。不同类型的医院有不同的特点,建筑师应该针对各个医疗建筑需要解决的问题来进行设计。所以并不存在一种简单的、标准化的、可复制的东西

从医疗发展上来看,科室的楼层设置和布局有几个大趋势。从大的方向上来讲,科室的布置方式(比如哪几个科室会布置在一起)可能会更倾向于通过器官系统来确定。比如心脏外科可能会与心脏内科临近布局,因为它们都是跟心脏相关的。传统的分科方式比较粗糙,一般通过内科、外科、妇科和儿科等来划分,这样内外科就会被分开。但如果一个患者只知道自己的心脏有问题,到了医院后也并不清楚是应该看心脏内科还是心脏外科,这种传统的分科方式就会给他带去困扰。所以现在的分科方式越来越注重患者导向,从器官和有问题的身体系统(如神经系统、血液系统等)出发,进行科室的布置

另一种可能的设置方式是以人群为导向的比如针对多发于老年人的疾病建立老年科或是老年病医院,或者是国外比较多的妇女中心(women’s center)等。以儿科为例,虽然有些疾病在儿童和成人身上都会发生,但相较于成人,儿科在诊断和治疗方法上都会有很多不同,这就是以儿童为导向的科室设置。

还有一种可能是向转化医学的方向发展即科研、教学和医疗这三者之间的联系会更加紧密。比如在这次新型冠状病毒肺炎的治疗中,药物的实验和临床衔接得更加紧密。所以这也是医疗上的一个大的发展方向。

其实还有很多,比如工作的方法:传统的医院都是一位医生一间办公室,但现在大家会更加倾向于集中式的办公方式,因为这样不仅可以增加交流的可能性,也满足了医学的多学科需求。其实对于医院来说,交流是不可或缺的,因为任何一种疾病的诊断和治疗都会涉及到很多专业,这也强调了各学科之间协作能力的重要性。比如在此次疫情中,其实很多患者的死因并不单单是肺炎,而这就需要很多专业学科集中在一起才能够处理。

The systemic design rules are advancing with the times. It is closely related to the progress of medical science and medical engineering. The rules could be developed when the medical equipment improves. Thus there is no standard layout. Even if it exists, it will change according to the development of medical techniques. The core function of medical architecture is to service for medical treatment. As medical treatment is in a constantly changing process, there is no standard form for medical architecture. Different types of hospitals has different features and architects should focus on solving problems in each specific project. There is no simple,  standardized and duplicable solution.

We could see the trends of floor layout according to the development of medical treatment. Generally, the arrangement of different departments is often decided by the organ system. For example, the department of cardiac surgery would be placed close to the cardiology department because they are both about heart disease. Traditional departments are divided in a relatively rough way as internal medicine department, surgery department, gynecology department and pediatrics department. In this way, the internal medicine and surgery departments are separated, which would cause inconvenience to the patients. Modern department devision is becoming more and more patient driven. The departments are arranged according to organs and body systems (like nervous system and blood system) so that patients could find their way based on their symptoms.

Another possible layout is to divide the departments by different types of people. We could establish geriatric department or geriatric hospital focusing on the diseases mostly strike senior people. In foreign countries, there are also many women’s centers. Although some diseases could strike both children and adults, the diagnostic method and therapies would be different. Thus we could set up children oriented departments.

Translational medicine is also a possible development direction, which means that the relationship between research, teaching and medical treatment would be closer. In the treatment for the coronavirus pneumonia, drug study and clinical trial are connected more tightly than before. This will also be an important development direction of medical treatment.

There are also changes in working method. In traditional hospital, every doctor has his/her own office. However, working together in a common office is more welcomed in modern facilities because it could enhance communication and meet requirements of multi departments. As diagnosis and therapy of disease would involve various disciplines, communication is indispensable in the hospital. It also shows the importance of cooperation between different departments. During the epidemic of coronavirus pneumonia, many patients are suffering from various problems apart from lung disease, which requires for multi-discipline knowledge.

 

2. 如何在保证传染病区与非传染病区隔离的同时保持高效的交通联系?
How to keep effective transportation and ensure the isolation between infected area and other areas?

这一点在南京市公共卫生医疗中心中得到了非常明显的体现。首先,在隔离方面,国内的很多规范都没有明确的要求和指导。而已有规范中的污染区、半污染区等概念,其实是比较中国特色的。这些概念容易造成一些误解。同时也会造成一些误解。比如大家会认为在所谓的半污染区内是相对安全的,但实际上当处于半污染区的时候,人是完全暴露在传染病的威胁之下的。

在小汤山这种模式的医疗建筑中,建筑师会在住院病房和半污染区的走廊之间建立分隔空间。由此有些员工或是医生和护理人员会误认为服务走廊属于半污染区,降低自身对防护工作的重视程度,在不知不觉中让自己处于被感染的高风险中。而在实际诊疗的过程中,这个服务走廊中所发生的人流和物流非常复杂,是很容易造成交叉感染的。所以我认为,在目前现有的规范中,诸如此类的原则性概念还不够清晰和深入。

而在南京市公共卫生医疗中心项目中,我们对空间类型进行了进一步的、更加精确的划分,比如我们会有非常清晰的传染区和非传染区。这并不是简单的清洁区和污染区的划分,它首先明确了传染和非传染的概念,其次传染区又根据病种和传染途径的不同进行了进一步的区分,因为接触类型的传染(如血液传染)和呼吸道的传染是完全不同的。另外,不同种类的传染病所产生的污染垃圾也需要区别对待,而不是将它们归类成统一的医疗垃圾进行处理,这也是传染病医院跟普通医院的区别之处。但是非传染区的内部也设有洁区和污区,这个非传染区中的洁区(也就是我们常说的医护人员的工作区域)在空间设计上是完全可以互通的。

传染区和非传染区之间的区域内的消毒和隔离设施至关重要,因为正是这部分空间保证了传染区和非传染区能够按照其各自的特性运转下去。

总体来讲,非传染区的内部是可以互通的,而传染区则要根据不同的病种和不同的传染途径进行进一步的空间划分。同时各个传染分区的洁净物品和污染物品也要进行进一步的区分。而即使是在非传染区内,也需要进行普通洁区和污区的分区。因此,经过几个层级的洁污分区后,我们得到了4到8个更为细致的空间划分。只有把传染病之间的分区做好,才能减少不同类型传染病的叠加污染和交叉污染。

This characteristic obviously embodied in the design of Nanjing Public Medical Center. There are no clear national instructions for isolation. In the existing regulation, we have contaminated area and semi-contaminated area, which could mislead people to think that semi-contaminated would be relatively safer. In fact, when people are in the semi-contaminated area, they are completely exposed to the threat of disease. In medical buildings like Xiaotangshan hospital, architects designed partitions between the ward and the corridor to the semi-contaminated area, which could make some of the doctors, nurses and works to think that the corridor belongs to the semi-contaminated area and reduce their attention on protection work, exposing themselves to the disease unconsciously. When the hospital is in use, this corridor is a space with diverse people and materials, which are easy to cause cross infection. It reflects the fact that the principle concept in the current regulation is not clear and thorough enough.

In the project of Nanjing Public Medical Center, we made more accurate division between different types of spaces. We did not simply divide the space as polluted and unpolluted. Firstly, we cleared the concept of infected area and uninfected area. In infected area, we further divided the space according to disease categories and route of transmission as requirements of avoiding contact infection and respiratory infection are totally different. In addition, contaminated waste from different infectious diseases should also be disposed separately from other medical waste, which is different from ordinary hospitals. In uninfected areas we also set clean zone and soiled zone. The clean zone in uninfected area, which is so-called working space for medical staffs, could be interconnected.

Disinfection and separation of the space between the infected and uninfected areas are significant because it ensures the different areas to operate under their own characteristics.

Generally, uninfected area could be interconnected while in infected area the space should be further divided according to disease categories and route of infection. The uncontaminated materials should be separated from the contaminated materials in different infected areas. Even in uninfected space, there should be partition between clean zone and soiled zone. After several levels of division, we came up with four to eight space partitions. Only by accurate space division, could we reduce the risk of cross infection and superposition of infection in the hospital.

 

3. 对于传染病医院来说,避免交叉感染非常重要,那么病区如何在保证避免交叉感染的同时,满足消防的硬性要求?
It is important to avoid cross infection in infectious hospital. How to meet the requirements of fire protection and prevent cross infection?

消防的硬性要求不外乎是这么几个:第一是场地消防,从建筑物的外围来讲,发生火灾的时候要能从立面上破窗而入。第二是逃生距离和防火单元,这是要按照每个国家自己的消防法规来设计的。逃生时从洁区进入污区是完全有可能的,在这些位置我们会设计逃生门,尤其是在医技部门集中的区域,这些门在日常保持关闭,一旦火灾到来会自动打开。发生火灾时,交叉污染是无可避免的,肯定要以“能通过”为优先。第三是关于建筑材料的使用,例如燃烧时间的规定等等,这些是按照规范和要求比较容易实现的。

The rigid requirements for fire protections are clear. First, we should ensure the fire protection of the site. When there is a fire, firefighters could get into the building from outside. Second, we should ensure the escape distance and fire protection units, which differ from countries. It is possible to run from uninfected area to infected area as we would set escape doors on certain positions. The normally closed doors at the medical technology department would automatically open in emergency. We should take escape in the first place and cross infection is inevitable under such situation. Last, we should use building materials that could meet the requirement of burning time. It is easy to realize according to relevant regulations.

 

4. 在有限的医院面积中,护理床位单元间距是如何考虑的?
How to decide the distance between beds in the limited space of the hospital?

床和床的间距和病区单元的间距是两个概念。首先,在传染病病房的设计里,可以看到中国目前的传染病病房往往还是一房多床的状态,在这种状态下几乎是无法避免患者之间的交叉感染的。在西方国家更多是以单病床为主,而且它的一些治疗设施可以被移动式地植入,就是根据需要移动到病床的旁边来进行治疗和处置。

如果从病区和病区之间的距离来讲,现在病房主要是靠机械通风,在这种情况下,病区之间的距离就并不是最重要的。国家现有的很多规范是基于很早以前的,比如说窗户都是可以打开的,全部是自然通风的环境。这种情况下,外面的窗户一旦打开,半污染区和污染区之间的窗口区会瞬间形成巨大的空气压,实际上就会立刻丧失掉原来设计的正负压的关系,也就是说所谓的正负压的设计是基于窗子不打开的情况进行的。

通过调节病房的温度和湿度有可能会使病毒大幅度减少,但是像新造的这些板房,如果连室内的温度都无法保障的话,那实际上在比较寒冷的情况下,这个传染病是很难对抗的。

Distance between beds and distance between inpatient units are two different concepts. In the design of inpatient ward for infectious diseases, we still use multiple bedded rooms in China. It is almost impossible to avoid cross infection between patients. In western countries, single bed room is more often used for patient with infectious disease. In addition, the treatment equipment is movable so that it could be moved to the bedside according to requirements.

As mechanical ventilation is mainly used in the inpatient wards, the distance between inpatient unites is not that important. Many regulations are established basing on early situations with natural ventilation, such as the rule that the windows should be operable. If the window is opened, there will be great air pressure at the opening and destroy the designed positive-negative pressure relationship. It is to say, positive-negative pressure design is based on the situation that the windows of the inpatient ward are rarely open.

The virus could be effectively controlled by adjusting the temperature and humidity of the ward. However, the newly built wards could hardly ensure the interior temperature. As the virus is weak to high temperature, it will be hard to defeat the disease in cold weather.

▲瑞盟设计的南京鼓楼医院的病房内部,a patient room of Nanjing Drum Tower Hospital designed by Lemanarc SA ©LEMANARC SA

 

 

___________

武汉疫情下的反思
A reflection about the epidemic in Wuhan

1. 针对武汉疫情修建的方舱医院,像这样的医院怎么去避免交叉感染呢?
How to avoid cross-infection in mobile cabin hospitals (方舱医院) built for the Wuhan epidemic?

方舱医院实际上回到了中世纪最早的医疗护理的模型。人类最早的医院和ICU实际上就是这种集中式的。它的优势是在人员比较少的情况下可以形成比较高的照顾效率,但它的劣势也是很显然的,那就是在同一个环境中,相互传染是不可避免的。但事实上每一个个体都是不同的,所以我们在讲医疗的未来的时候要讲精准医学,同一种传染病对每一个人带来的危害是不同的。就目前而言,方舱医院也好,小汤山医院也好,都是在已经爆发了大规模传染病之后,再进行补救的无奈之举。它没有办法避免同一个区域内的交叉感染,或者提供更细致更人性化的服务。

The form of mobile cabin hospital, actually, reproduces the earliest model of medical care in the Middle Ages. The earliest hospitals and ICUs were just centralized in similar way. The advantage is that more patients could get efficient care with relatively small number of medical staff. However, the defect is that, which is obvious, the cross-infection in this kind of closed environment is inevitable. But in fact, we are all different individuals, which means the influence on everyone impacted by the same infectious disease would be different, so we could not discuss future medical treatment without precision medicine. For now, both the mobile cabin hospitals and the Xiaotangshan Hospital were all remedies after the break of mass infection. There is no perfect method to avoid cross-infection in the same space or provide more careful and personalized services.

 

2. 您对于此次在短时间内建造的火神山和雷神山医院的评价是?
What do you think of the Huoshenshan Hospital and Leishenshan Hospital built in such short time?

它是17年前SARS时期小汤山医院的翻版,我们也没有看到明显的技术水平或者是设计方法的细化或者先进性。事实上,在这么短的时间内,要求在设计方面有变化是不现实的,我们应该考虑的是,在没有传染病的情况下,国家能够提前地、预见性地做好哪些储备。当事情已经发生的时候,现在只能是这样快速建造,暂时来用。建造低质量的临时建筑只能是应急之需。

The Huoshenshan Hospital and Leishenshan Hospital are the imitation of the Xiaotangshan Hospital built during the SARS period happened 17 years ago. Either the construction technique or the design strategies has not experienced visible development. Actually, it is unrealistic for the design to get obvious improvement in such a short period of time. More consideration should be put on what kind of preparation the states could conduct in advance of infectious disease. When disappointed accidents have already happened, building temporary hospital as quickly as possible seems to be the only solution. This kind of low-quality buildings could only be an emergency and would be abandoned after once.

 

3. 经过此次疫情后,医院传染科室的门诊和病房设计会发生怎样的改变趋势?
After the epidemic, what will be the development trend of the design for the infectious department?

我们要分两个尺度来看这件事。一是从区域乃至全国的公共卫生的角度来看,需要进行更大规模的储备。南京在非典之后2013年建造(2016年建成)的南京市公共卫生中心,它同时也作为一个地区的综合医院在使用,当有大规模公共卫生事件发生的时候,现在的南京就会很从容,它不需要去临时抱佛脚地去建那些板房,并且患者所受到的医疗对待也相对会好很多,这个就是能够预见性地做好抗灾储备工作的聪明之处。我觉得这也是值得今后在全国范围内实行和推广的。

第二点,我认为在传染病到来的时候,不应该仅仅依靠三甲医院来做这件事。从武汉的疫情中我们看得很清楚,社区的医技能做的事情非常非常少,它本来应该是帮助社区内部快速实现传染病的隔离,比如征用社区范围内的一些礼堂、学校、体育设施、酒店和展馆等等,将病人隔离起来。让病人去非常有限的几家三甲医院排队,即使是制造再大再有能力的发热门诊和传染科都是不够用的。所以这个问题的本质是,不应当让普通的综合医院去承担本来应该是公共防疫层级的工作。社区需要征用社会的资源来快速地进行诊断和隔离,不能把压力都给到综合医院去。

当然,综合医院本来应该承担的部分还是有很大的改善余地。现在很多三甲医院是没有做好洁污分离和医患分离的,一旦有传染病的时候它进行改造的难度是极大的。反之如果可以真正做到洁污分离和医患分离,那么它的转变就可以非常迅速。我举个例子,我们设计的南京鼓楼医院,本身是市中心的一家三甲医院,到现在为止,这里还没有出现感染的情况。它在流线设计、洁污分离和医患分离上完全做到了现代化,在组织管理的层面能够做出很好的应对,并且运营也是非常有序的,不会出现不能运转的情况。近些年国内医院建成的速度非常快,量也很大,但绝大多数设计是对旧模式的拷贝,并没有真正地面向医学发展的未来,也没有体现出人性化和预见性的思考,这也是很可惜的一件事。

This question should be discussed from two perspectives. In terms of the territorial or even national public health, larger amount of equipment and preparation is in demand. Nanjing Public Health Center, which was built after SARS happened in 2013(built in 2016), is also been used as a general hospital. When magnitude public health incident occurs, there would be less panic in Nanjing since there would be no need of building prefabricated house and the patients could be provided with better medical treatment. This is the benefit of sufficient preparation. I think this mode is worth implementing and promoting national wide.

And also, in my opinion, it should not be the 3 grade A level(三甲) hospitals that take the whole responsibility facing the infectious diseases. According to the situation after the break of Wuhan epidemic, it is not difficult to aware that the doctors in community medical unit have failed to take efficient actions while they were supposed to immediately help isolate patients within specific places in the community, such as the auditorium, schools, gyms, hotels, exhibition centers and so on. Even the largest fever clinics and epidemiology clinics could not hold crowds of people waiting in limited general hospital. Normal general hospital dose not have capability of treating Public-level epidemic incident. Community should help relieve the excessive stress by integrating social resources.

Of course, the general hospitals could also be improved. In many hospitals, areas of clean and contaminated are not completely divided while doctors and patients do not possess separated spaces either. So, once the incidents occur, they are too difficult to reconstruct. On the contrary, if the spatial division of the hospital was operated thoroughly on usual, transformation on urgent circumstance could be conducted rapidly. Take the Nanjing Drum Tower Hospital for example (there is no infectious patient in it till now), it completely takes modern standard of architectural flow design and spatial division, the arrangement of which help the hospital deal with the incidents better. It can also prevent the hospital from inoperable condition. Recently, a great number of domestic hospitals had been built very quickly, but many of them were the duplication of old mode. Neither do this kind of design deliberately concern the future of medical development, nor do they deliver humanistic care or farsighted thinking.

 

 

__________
医院的人文关怀
Humanistic care

由您主持设计的南京鼓楼医院有两个特点,一个是人文关怀层面的,即花园化,给人带来心灵上的抚慰;另一个是历史文化层面的,即文化化,回归其“教会医院”的历史文化身份。
在当下考虑到现实情况,医疗建筑的设计似乎更注重流线功能等基础的部分,请问您是如何理解人文关怀和历史文化身份这两点于医疗建筑设计的意义呢?

There are two characteristics of the Nanjing Drum Tower design by your team. On the one hand, you express the humanistic care by gardening that psychologically comfort the patients. On the other hand, you paid a lot of attention to historical and cultural meaning of the building, culturalization in other words, and helped the hospital resume its historical role, the “church hospital”.
Currently, the design of medical buildings seems to realistically focus more on the fundamental issues, such as the flow organization and the functional arrangement. For you, what is the meaning of the humanistic care as well as culture of medical architect design?

首先我觉得这是一个误解。第一,南京鼓楼医院首先是一个医疗机构,它是在对功能和流线的非常细致的研究的基础上得出的。这么多年来,很多医院设计会标榜自身特别注重功能,但我所看到的都是对许多年前的所谓一种标准化功能的不断拷贝。如果这样的拷贝能被叫做注重功能的话,那么几十年过去了,我们仍旧生活在对功能的过去的理解中。正如这次的火神山和雷神山医院,实际上跟小汤山医院没有区别。在这种情况下,我不知道你讲的功能到底是什么。我刚才提到的分区、空气控制、联动能力等等,这些因素都是需要被很认真地对待和加以研究的。

中国的医院拷贝速度太快,几乎已经变成“千院一面”了,不是拷贝一种东西就能叫做功能。一个医院从设计到实施,到建成,到运营,再到反馈和改进,需要几年的时间。医疗水平,包括医疗设备、思维和技术的发展速度其实远快于医疗建筑的发展。所以在所谓的医疗功能层面,应当是静下心来认真地做研究,而不是简单地拷贝一些几十年前的所谓规范,然后把它称之为功能,我认为这是很可笑的。

First of all, I think there is some misunderstanding. Primarily, Nanjing Drum Tower Hospital is a medical institution, the function and flow arrangement of which were designed according to deep research. Over these years, many designs of hospitals claimed to focus on functional demands, but I just found constant imitation of what was called function standardization decades ago. If this kind of simulation could be regarded as positive response to functional demands, our understanding of functionalization seems to be outdated.  There is no actual difference, for instance, between the Huoshenshan Hospital with Xiaotanshan Hospital. So I feel a little confused about the meaning of function you mentioned before. Spatial division, control of air circulation, the ability of emergency response, and other issues I referred above, should all be analyzed and studied meticulously.

The design of Chinese hospital relies too much on one mode, the result of which is that hospitals are becoming more and more similar with each other.  It may take years for a hospital from design, construction, operation to improvement. The development of medical standards, including medical equipment, theory and technology is much faster than the development of medical buildings, so we really need to be more addicted to further research. It is ridiculous to just regard some standard mode as functionalization.

▲南京鼓楼医院中庭,the atrium of Nanjing Drum Tower Hospital ©LEMANARC SA
点击查看项目详情,Click to check more details

拿瑞士来说,瑞士并没有做大规模传染病医院的需求,但公共卫生专家和传染病专家会游走于各个医院和社区,当传染病发生的时候,它会利用整个社会的资源。传染病专家本身会移动,而不是坐在医院里让人民去移动。当人民不得不移动的时候,并且同时又被剥夺了交通能力的时候,我觉得次生灾害是难以估量的。

总结一下,我认为现状下很多做法是无奈之举,但我们确实在同一个地方摔倒了两次。从上层来讲,应当去思考如何做好政策、设施、人员培训、法律等各个方面的储备工作。不能说这次过去以后,下次还是一样。第二,我觉得更细致地思考和研究,不一定等同于速度上更慢。有一种速度叫提前。临时仓促地去建造,这种速度只能说明你能临时调集多少人员而已,但它是否能达到更好的质量,实现更好的回报,这是值得思考的。医疗建筑的质量不应该为速度牺牲。这种质量代表着深入的、认真的思考和研究。有预见性的、有质量的建筑设计才能挺得更长远,才能在公共卫生事件中屹立不倒。

Take Switzerland as example, large infectious disease hospital is not demanded in Switzerland. It is the public health and contagion experts would that travel around hospitals and communities rather than patient themselves. When contagion occurs, all the social resources would be utilized. When people are forced to go out for medicine while the transportation system is closed, secondary disaster would beyond imagination.

In conclusion, though there is no better treatment under the present situation, it is not the first time we facing similar situation. From general perspective, more comprehensive policy and laws may help establish better preparation strategies, such as facility construction and professional training of relative people, so that we could make some progress. And also, deep thinking and research do not mean slow down the progress. Building in haste could only prove the stock of manpower. Whether the quality of the buildings could be guaranteed is still suspicious. The quality of medical buildings should not be sacrificed for construction speed. Only the farsighted and high-quality architecture could stand up for public health in the long term.

 

 

 

更多关于南京市公共卫生医疗中心
More about Nanjing Public Medical Center

依山就势,聚散有致,分区清晰,洁污分明。高效独立,骨干支撑,常态安全,应急储备,生态环保,节能智能,方便开发,易于成长,关怀医患,怀抱山林。在本方案中,环抱的山景与平静的湖水为病患带来环抱的照顾感和安全感,如同一双臂膀,向市民张开关爱的怀抱。

一千二百张床位的南京市公共卫生中心位于南京东南方的青龙山,群山环抱。总建筑面积约十五万平米。作为南京地区最具传统的传染病救治隔离生活区,这里山地复杂的地形、水系和植被状况使得即使普通项目的营建也会是困难重重。而如此规模 的多种传染病医院和综合医院的共生体的设计,在全球更是极为罕见。

▼南京市公共卫生中心概览,Nanjing Public Medical Center ©LEMANARC SA

▼建筑外观,exterior view ©LEMANARC SA

Nanjing Public Medical Center, surrounded by hills, with one thousand and two hundreds’ beds, is located in the Qinglong Mountain, which lies to southeast of Nanjing. It has a total floor area of about 150,000 square meters.

As the most traditional isolated living quarters for infectious diseases treatment, it is even very difficult for constructions of ordinary project because of the complex mountain topography, water system, and vegetation conditions. What’s more, a conjoint design of various infectious diseases hospital and general hospital is very rare on a global scale.

▼总平面图,site plan ©LEMANARC SA

▼清洁区和污染区分布示意,layout of the volumes for clean area and soiled area ©LEMANARC SA

作为全球最大的传染病医院,南京市公共卫生医疗中心的建筑群包括一个处于下风向的结核病楼、一个多种接触类和杂病传染病楼,一个可独立运行的普通非传染病医院,这三栋楼组成了核心医疗区,三个病区的下部的由一个统一的医技服务块联结起来,其内部污染和非污染区严格分区、消毒分离。既分隔了各类不同传染病区,又实现了医疗资源的最大化集约利用。地下一层的洁净储存、消毒区和物流带对污染物实现了分区处理和统一管理。

▼南京市公共卫生医疗中心 – 入口广场,Nanjing Public Medical Center – entrance square ©LEMANARC SA

As the biggest infectious diseases hospital, the building group include a downwind building of tuberculosis, a building of infection of various touch diseases and miscellaneous diseases, and a common non-infectious disease hospital running independently. These three buildings constitute the core medical zone.

The lower part of these three medical zones is joined by a united medical and technique service zone, where polluted area and unpolluted area are separated and disinfected strictly. On the one hand, this way divides the different infection areas; on the other hand, it realizes the intensive utilization of medical resources to maximize. The clean underground storage, disinfection area, and logistic zone can dispose pollutants according to zones and control pollutants uniformly.

▼剖面图:三个病区的下部的由一个统一的医技服务块联结起来。Building sections: the lower part of these three medical zones is joined by a united medical and technique service zone ©LEMANARC SA

利用小山谷隔离设计的突发性传染病应急中心,保障了应对突发传染病时的自主封闭和安全扩张。北侧高处自成体系的员工休息区进一步保障了员工的安全。

The emergency center using the quarantine of valley realize that the center can close automatically, and the infection can expand in a safe area, when it happens sudden infections. The self-contained resting area for employees in the north high area protects the staff from infection further.

▼多种传染病综合楼,the building of infection of various touch diseases and miscellaneous diseases ©LEMANARC SA

根据传染病医院的特点,从医院整体到每个科室和病房都做到了医患分离,洁污分离。污染区与非污染区分离。并且实现了不同种类传染病间污染区的各自分离和控制。

According to the features of the hospital, from the whole hospital to each office and each ward, it realizes the separation of doctor and patient, clean and dirty, polluted area and unpolluted area. And it realizes respective separation and control of pollution area among different infections.

▼1层平面图,1F plan

▼平面局部 1:detailed plan 1 ©LEMANARC SA

利用山地高差, 建筑群怀抱中心区作为污染区,为医护人员及综合医院的普通病患提供了安全舒适的集散广场,并为综合医院清洁的独立运营提供了保障。而传染病患的出入流线则设计在外环道上以使得传染病患流线从入口开始的就相对隔离,从而为内部流线的深度分离提供了良好的外部条件。

▼内部庭院,the inner courtyard ©LEMANARC SA

While taking advantage of the vertical space, taking the centre area of building group as pollution area, it offers safe and comfortable evacuation square for medical workers and common patients of general hospital. And it protects the clean and independent management for general hospital. The flow line of access for infection patient is designed in the bypass road to avoid the entering of infection. And it offers good external conditions for deep separation of internal flow.

▼室内日光井,view to the indoor patio ©LEMANARC SA

最终, 方案充分利用山地提供的屏障、高差、山形和水体,结合南京当地的风向、日照等自然条件,通过对多类型传染病救治管理特点的深入研究,成功地设计了既资源共享又安全独立的大型传染病医院。

And last , the project design take full advantage of natural conditions ,such as the protective screen (mountains), vertical space, the shape of mountain and river system ,as well as the local wind direction , sunlight and so on , and it design successfully a resources sharing , safe, independent and large-scale infectious disease hospital , by a in-depth study of management features of different infections treatments.

▼整体鸟瞰,project overview ©LEMANARC SA

波浪形轻盈的外遮阳系统既是节能手段,又为室内提供了柔和的光线和私密的氛围;环抱的山景及利用场地泄洪水系形成的平静的湖面交相辉映,带给患者安全感和对生命的向往,如同创世者关爱的怀抱。

A light wave shape system with sunshade is a way of energy-saving; it also offers soft lighting and privacy atmosphere for indoors. The scenery surrounded by mountains and quiet lake formed by using the area to release the floodwater bring the patient the sense of safety and yearn for life. It seems like creator’s caring embrace.

▼立面效果图,Nanjing Public Medical Center – facade rendering ©LEMANARC SA

▼南立面图和北立面图,south elevation and north elevation ©LEMANARC SA

▼1层和2层平面图,1F and 2F plan ©LEMANARC SA

项目名称 : 南京市公共卫生中心
设计单位 : 瑞士瑞盟设计 LEMANARC SA
项目地点:中国南京市江宁区
设计师:Vincent Zhengmao Zhang 张万桑, Daniel Pauli
用地面积:127,380㎡
建筑面积:149,800㎡
设计时间:2012 年
开工时间:2014 年
投入使用:2016 年

More:Lemanarc SA(瑞盟设计)。更多关于: Lemanarc SA on gooood.

瑞士瑞盟设计 LEMANARC SA正在招聘人才,详情请点击这里

版权️©谷德设计网gooood.cn,禁止以gooood编辑版本进行任何形式转载Copyright©gooood
Click to contact with the designer/author

Post a Comment