Renovating an operational hospital is never an easy task. There are a number of challenges to tackle and elements to consider, including successfully maintaining daily operations, continuing to meet patient volume, minimizing downtime and interruptions to utilities, and managing an active infection control program.

And the process of taking patient rooms, in particular, offline for renovations can be even more difficult. The hospital must determine spare bed capacity as well as the duration of time rooms will be unavailable, and how to minimize effects on operations.

Hospitals often opt to take an entire unit or department offline to complete patient room renovations, because the alternative of renovating one room at a time comes with plenty of deterrents, including a high price tag.

The increase in construction cost is due in part to the multiple phases required, which calls for contractors to bring the rooms to completion individually, including final inspection and cleaning, before move-in. Costs are also incurred by providing temporary medical gases to the occupied rooms and creating an infection control access point for each room as it’s renovated in lieu of isolating an entire unit throughout construction.

However, in some cases, renovating one room at a time, while expensive, can be the preferable route to take. And that’s the decision that one 1,000-bed hospital in downtown Baltimore came to.

The decision
The project goal was to transform 14 beds (10 single rooms and two semiprivate rooms) from general care to acute care, which, at a minimum, required installing new headwalls with increased utility connections and a dialysis cabinet in each room—tricky renovations to handle while still maintaining operations.

Hospital staff and the design team, including RMF Engineering, Waldon Studio Architects, and HITT Contracting, worked together to determine how best to bring the project to completion, assessing a number of issues: how to keep medical gases to occupied rooms within the unit, whether to replace or renovate the headwalls, how many rooms to take offline at one time, and ways to maximize the renovation by addressing as many needs as possible in the rooms while they were offline.

The hospital’s location and demand for services also had to be strongly considered. Because the hospital is in an urban setting and serves a large local and regional population, there’s seldom any spare bed capacity to allow relocation of patients from one unit to another.

With all of those factors in mind, the hospital evaluated the revenue that would be lost from beds being down and weighed the intangible costs to both patients and staff if an entire unit was offline. These factors were compared to the increased construction costs that would be incurred by going one room at a time.

Ultimately, the room-by-room approach, while more financially costly, was more operationally sound and worth the additional monetary investment. Once the room-by-room approach was solidified, the teams looked at how to address each critical component.

The plan
The first challenge was the medical gas system. An outage was scheduled to connect new gas piping to the existing service. All this gas piping, along with any additional electrical circuits and IT wiring, was installed on the corridor side of the patient units and up to the entrance to each patient room during normal working hours. The staff remained fully active during this time with only minor inconveniences.

When construction started in one room, the hospital then provided bottle gases to all the other rooms served by that same gas branch until the headwall was removed and gas lines were capped and certified. Once a room was renovated, that room would be served from the new gas piping, while the remaining rooms would be reconnected to the existing gas lines. This process was repeated for each room and required multiple certifications.

The design of the new headwalls had some obstacles to overcome, as well. First, a decision had to be made on whether to upgrade the existing headwalls or provide new ones. Given the lengthy amount of time it would take to add outlets and additional piping in the field and the fact that the existing headwalls were rather outdated, new headwalls were installed, effectively decreasing the amount of time a patient room had to be offline.

However, while the rooms were down, other deficiencies were addressed that weren’t directly related to the change of use. For example, HVAC controls were upgraded and new patient lift systems were installed.

Infection control is always of paramount importance in a healthcare facility, and during room-by-room renovations, it’s of even more concern because of patients in nearby rooms and nursing staff in the corridors. To answer those challenges, renovations began in each room with a plastic barrier constructed between the corridor and the room, complete with sticky mats at the entrance. A temporary floor-mounted fan was put in the patient room with a HEPA filter that helped maintain negative pressure in the room to keep contaminates from migrating to adjacent spaces.

Once the renovation and cleaning of the room were complete, the infection control components were removed and the process began all over again in the next room.

The results
In general, the decision to renovate an individual patient room in an occupied building isn’t done to save construction costs. The deciding factor for the hospital is whether or not it can afford to be down a number of rooms for an extended period of time. This effect on operations must be compared to the increase in construction costs, which can be as much as 30 percent.

To make a room-by-room renovation successful, it takes a coordinated effort by everyone involved— including the hospital staff, the contractor, and the design team—from the very beginning of the project. Otherwise, there’s risk of complications during construction that may require longer downtime. Every detail needs to be thought out, a thorough site investigation must be performed (including above the ceiling), and the construction documents need to reflect the entire procedure, any special features required, and the plan for infection control.

In this project, each room was renovated in less than a week’s time with the entire project completed in about four months. Had the entire unit been taken offline at once, it would have taken two months to complete. However, the extra weeks allowed the hospital to maintain the daily operations it required.

This method can be an attractive option to healthcare facilities, under the right conditions. With plenty of coordination and communication within the project team, hospitals can find a way to keep units operational while still undergoing renovations they require.


Stephen Devon, PE, LEED AP, CxA, is an electrical engineer and principal at RMF Engineering. He can be reached at