Guidelines for Limiting Contagion in COVID-19 Tent Clinics
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The Role of Architecture in Fighting COVID-19 Updated March 31, 2020
Guidelines for Limiting Contagion in COVID-19 Tent Clinics
Misha Friedman (Getty Images)
Tents are not ideal facilities for the treatment of patients with the highly infectious COVID-19. About this Document
Regardless of the tent’s design and construction, there is a strong possibility of contagion when
These guidelines are written in reference to a
sick patients, uninfected patients, and uninfected health care providers are co-located in tight
two-ward clinic 20 feet by 80 feet with 10 foot
quarters. However, when a community has no better alternative than the erection of a tent
square vestibules, but the principles apply to
facility, the risk of contagion might be lessened if the tent construction follows these basic
clinics of other configurations and other
infection control guidelines.
assemblies. Click here for a spreadsheet
COVID-19 is understood to be primarily spread by large droplets and perhaps secondarily by listing furniture and equipment for this tent
surface contamination. Some research indicates that it might become aerosolized in particular clinic.
circumstances, which is a tertiary concern. A tent clinic design must consider all 3 modes: 1)
This module may be aggregated to create
droplet spread - distances between people of ideally 6’ or more to prevent direct contact with
more wards serving more patients. Boston
respiratory droplets; 2) droplet contamination - touch surfaces simplified, obvious, and easy to
Health Care for the Homeless’ experience has
clean; and 3) airborne - dilution and removal, or UVGI or HEPA disinfection of contaminated air.
been that separate wards allow administrators
to flexibly meet the demands of rapidly
shifting patient populations such as triage
Limit droplet spread between people. cases, asymptomatic and untested close-
Created by Jasfart
contact observation patients, asymptomatic
from the Noun Project
tested patients awaiting results, low and high
risk symptomatic patients awaiting results,
Mitigate contagion via surfaces. and confirmed positive patients. Note that
infection control to limit cross-contagion
Created by Adrien Coquet
from the Noun Project
between asymptomatic and untested
Control for airborne infection. close-contact observation patients and
between all asymptomatic patients may be
Created by Fahmi Ramdani
more critical in limiting spread than it is for
from the Noun Project
symptomatic and confirmed cases.
MASSDESIGNGROUP.ORG/COVIDRESPONSE
Guidelines for Limiting Contagion in COVID-19 Tent Clinics Updated March 31, 2020
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Download the full plan. 6
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MINIMUM PATIENT BAY '�
1 Health care providers 2 Providers should enter 3 A simple MDO, plastic 4 Aisles within tents 5 Centralizing clinical 6 Separation of beds by
should have a seperate directly into a donning laminate, or draped work should allow for social staff spaces - donning, a partition or tensioned
entrance from patients. vestibule or room, where surface provides a buffer distancing, but tents come doffing, storage, and work vinyl screen of 8’ high will
This avoids close contact they can put on their between a provider and an in fixed dimensions. When areas - will make clinical limit cross-contamination
between patients and Personal Protective ambulatory patient. This possible, strive for larger work efficient and limit between patients.
providers, outside and Equipment (PPE) before link shows one example dimensions than the 6’ uncontrolled interaction 7 A stand-alone 10’x10’
inside the tent. interacting with patients. of a simple site-built between partitions and 5’ between providers and conditioned tent (not
(Re-donning supplies workstation. between beds shown here. patients. shown) can serve as a staff
within the tent allow PPE to break area.
be refreshed.)
Mitigate contagion Materials and surfaces should be deployed and installed to minimize
touching, to make touch points obvious, and with the understanding
via surfaces.
Created by Adrien Coquet
from the Noun Project
that they must be frequently cleaned and disinfected.
The CDC understands that contaminated • The CDC advises that cleaning of visibly dirty surfaces followed by
high-touch surfaces may be a transmission disinfection is best practice for prevention of COVID-19.
route for COVID-19. In a tent clinic, doors • Cleaning removes dirt and most germs, while disinfection - with a
(often supplied with the tents), doorknobs, bleach solution, an alcohol solution, or a proper disinfectant - kills
The COVID-19 virus has
bed linens, partitions between beds, outlets, germs. different life spans on
storage containers, counter tops, toilets, and • A storage area for cleaning supplies and other non-PPE items different materials, but in
tents material choices will
sinks are examples of high touch surfaces. should be provided. most likely be driven by
availability and cleanability.
Control for Source Control: Trap droplets before they spread
Beyond use of PPE for providers for droplet protection, the CDC recommends
airborne infection.
Created by lastspark
from the Noun Project
Created by Fahmi Ramdani
standard face masks, such as surgical masks, for confirmed and suspected patients.
from the Noun Project
Aerosolizing procedures such as intubation should be source controlled with a
The COVID-19 virus may become aerosolized
portable HEPA filter/fan unit.
by certain procedures such as intubation and
mechanical ventilation. Additionally, some Dilution: Decrease the number of contaminants in the air
recent research suggests that COVID-19 Contaminated air is diluted when it is combined with clean air. Clean air is created
might be aerosolized via fecal matter. Tent by HEPA-filtration and ultra-violet germicidal irradiation (UVGI) equipment, which
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from the Noun Project
clinics that might eventually be treating soiled efficiently recirculates conditioned (heated/cooled/dehumidified) air. However, HEPA-
patients, or patients needing aerosolizing filtration and UVGI strategies require more specialized expertise and equipment.
procedures should plan for airborne infection Contaminated air can also be diluted by adding fresh outside air, which is technically
control. simpler, but is inefficient since this dilution strategy requires more energy, and
therefore cost, to keep the air properly conditioned. Tent clinics should strive to meet
Airborne infection control systems require
CDC guidelines of 12 air changes per hour (ACH), but 6 ACH or even 4 ACH are likely
specialized equipment best specified by a
beneficial. Limits on equipment, ductwork, and power may in turn limit the number of
mechanical engineer. A few hours of time
achievable ACH.
from an engineer in your community will help
incorporate the following principles into a Airflow Direction: Remove contaminated air before it spreads
tent clinic: Carefully sealing gaps in the tent construction, supplying clean air through ducts
above the center aisle of the tent, and then exhausting air through a vent (see possible
detail here) next to each patient’s head at the tent perimeter may lessen the risk of
contagion to providers and patients. Air venting strategies that stir air within the tent,
or move contaminated air towards healthy people may heighten the risk of contagion.
MASSDESIGNGROUP.ORG/COVIDRESPONSE
Guidelines for Limiting Contagion in COVID-19 Tent Clinics Updated March 31, 2020
Toilets, Showers, and Hand Washing Stations
Toilets and showers will likely be rented mobile units vulnerable to
Created by Ralf Schmitzer
from the Noun Project
the three modes of contagion outlined above. These rental units are
spatially tight and direct droplet contagion should be addressed by
patient management. Surface contamination must be addressed by
cleaning between patients, and ideally different patient populations
should not share the same facilities. Toilet and shower units should
have passive or active ventilation systems. Healthcare providers
must have separate facilities. Install within the tents, separate hand
washing stations for patients and providers, whether mobile units or
constructed on site.
Water, Power, and Ventilation
For water and power, tent clinics can most easily tie into an available adjacent building, utility
Created by Atif Arshad
from the Noun Project
pole, or fire hydrant. If necessary, for power, rent a mobile diesel generator that meets the
amperage and phasing requirements for HVAC and other equipment. If water is transported to
site and stored, anticipate a pump or gravity feed system.
Almost certainly a mobile HVAC unit will be required for three critical reasons: to provide
comfort, to dilute air to as many as 12 ACH, and to create directional air flow. The HVAC unit
must have the conditioning, ventilation , and control capacity to maintain consistent air flow and
temperature, which is beyond the capability of many construction-grade fans and heaters.
Dignity and Efficacy Tent clinics might offer the following to promote patient dignity, comfort and security:
Beyond frustrating pathogens, tent clinics A legible, obvious ventilation Partitions between beds for privacy
Created by Pham Thi Dieu Linh
must
from thesupport people. Voluntary
Noun Project patients strategy that clearly demonstrates and contagion control
might leave clinics and further spread environmental safety
Created by Gerardo Martín Martínez
from the Noun Project
contagion if the clinics seem unsafe to
Individual lockable storage Large storage, such as a plastic tub,
them, are uncomfortable or are undignified.
for valuables, electronics, and for clothing and personal items
This is especially true for asymptomatic
medications
Created by celine labaume
from the Noun Project
and untested close-contact observation
Created by ibrandify
from the Noun Project
populations who might perceive themselves WIFI, power, and USB charging ports Screens and access to Netflix or Hulu
as being at greater risk and discomfort within at patient beds for patients who lack these
a clinic than outside of it.
Created by i cons
from the Noun Project
Created by Creative Art
from the Noun Project
Contributors • Edward Nardell, MD, Professor of Medicine. Departments of Environmental Health and Immunology and Infectious
Diseases, Harvard School of Public Health. Harvard Medical School. Brigham and Women’s Hospital.
These guidelines are offered within rapidly evolving clinical • Jessie M. Gaeta, MD; Assistant Professor of Medicine, Boston University School of Medicine; CMO Boston Health Care for
and research contexts. MASS is grateful to those who have the Homeless Program
advised on them. They do not represent the opinions or full • Joshua Barocas, MD; Assistant Professor of Medicine, Boston University School of Medicine; Infectious Diseases
understanding of any one person. physician, Boston Medical Center
• Nahid Bhadelia, MD, MA: Medical Director of Special Pathogens Unit, Boston University School of Medicine; Infectious
Diseases physician, Boston Medical Center
• Jim Crabb, PE, LEED AP, Principal, Mazzetti
• James Petersen,PE, Petersen Engineering
MASSDESIGNGROUP.ORG/COVIDRESPONSE
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