September 21-23, 2021
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The Leaflet Article

Featured Article:

Where the Personal Meets the Professional

Gina M. Semerad, HFDP

When I graduated college, I knew I wanted to be an engineer. While it was something I was interested in since childhood, realizing that dream was just the beginning of learning what it meant to actually be an engineer in the professional world.

Within the first few years at my company, I was able to design some of the coolest projects in the office. I was a young engineer, yet I was able to have hands-on design experience with two large hospital projects totaling over 1.5 million square feet. I loved all the challenging components and what seemed like an endless wealth of new information to learn. It was at this juncture that HVAC and healthcare engineering became my direction. It wasn’t planned, but I feel fortunate that it was where I was led.

What I learned from working on healthcare projects is that I am a natural-born engineer. It felt like there wasn’t a problem I couldn’t solve if I had the right information. I thought I could always find an analytical approach to get to a solution.

In 2014, I had just issued construction documents for a 700,000 square foot outpatient cancer center, and my daughter was born a few months later. She was healthy and beautiful and the easiest baby you could imagine. When she was 7 months old, we noticed a firm area on her abdomen, and within a few days, I quickly transitioned from healthcare designer to an end-user.

Over the course of the next few weeks, we learned that my daughter had liver cancer. It had already spread to her lungs before we caught it, so we were dealing with a complicated and aggressive diagnosis. Although I spent several years entrenched in the details of operating rooms, MRIs, and protective environment rooms, the large projects I worked on hadn’t reached the construction phase, so I had never actually stood in a project’s physical space. After looking at these spaces on paper for all that time, my first experience in one of them was holding my daughter’s hand while she received a CT scan or saying “I love you” to her as she drifted off on an operating table.

All of this challenged the engineering part of me that believed in analytical solutions. My stress during the 18 months of her treatment was managed by “doing something” and “learning something” to help control whatever parts of the situation I actually could control. I channeled my “doing” energy into fundraising for Alex’s Lemonade Stand Foundation for childhood cancer research. To date, almost $250,000 has been raised in honor of my daughter.

Along with learning, I was constantly asking questions of everyone I met, even when topics were completely out of scope for my daughter’s treatment. Sometimes it felt like I had more questions than answers, but I was constantly compiling observations about what I thought needed improvement.

My daughter was severely immunocompromised the majority of the time she was in treatment, so I received a real-world education about infection control. I was shocked when all they did was pull a curtain around us at the clinic to protect the other patients from my daughter’s runny nose. I was even more shocked by the impact of a chicken pox outbreak in that same clinic. I previously had no idea that chicken pox was considered airborne, and I witnessed the oncology floor struggling with patient placement when several children were infected and there weren’t enough airborne infection isolation (AII) rooms.

Having all this new information about infections and knowing how at-risk my daughter was, I began to question all hospital procedures. She was frequently carted around for specialized tests such as echocardiograms or scans. She would leave the bubble of her isolated patient room and cross paths with dozens of other patients and clinicians. If one of them was sick and didn’t know it at the time, how was that contact traced?

We had some extended stays in the pediatric ICU after several surgeries. On almost every wall there were signs reminding the staff of the dangers of central line infections. On one occasion, an otherwise very skilled nurse recommended that we actually skip the central line dressing change since we were being transferred to the oncology floor the next day. She felt it was an unnecessary risk because the oncology floor was a safer place to perform this sterile process. If this is a known problem, why isn’t more being done to fix it?

I also received first-hand experience with a by-the-book design of a protective environment room. I often slept in the patient bed beside my daughter while we were inpatient, and the cold air that falls directly from the ceiling above is a chill I will never forget. I knew the air was flowing like that for her protection during her stem cell transplant, but I could only imagine how much more uncomfortable it feels for a sick patient without that context. We would often be placed in those rooms, and many times I would enter and see that someone had placed a rolling dresser in front of the low return grille. I would immediately move it, but remembering that always reminds me to design a space as it will be used, not just as it works on paper. A non-engineer entering that room wouldn’t have known what to do.

After a lot of ups and downs, my daughter was briefly in remission before relapsing again. Her clinical team was not willing to give up, and they put together one of the most complicated surgical procedures ever attempted for a child. Even during the most stressful moment of my life, my engineering brain was fascinated by their plans. The strategy involved interventional radiology in one space, then moving to a standard operating room. During the surgery, they would utilize intraoperative radiation as an extra level of treatment. These are all terms that I have seen used during design projects, but had never really questioned before. I had another outlet for my anxiety because I was having a real-world lesson on what invasive really means in these spaces. I know it can sound odd to be so interested in such things at such a stressful time, but the knowledge and explanation from the doctors gave me a sense of control.

Despite the best efforts of a huge clinical team, my daughter passed away after a year and a half of creative treatments. Not one who’s comfortable standing still, I dove back into work. The work wasn’t the same though. It wasn’t just lines on paper with dots I was trying to connect. Even when I was walking through the construction sites for designs of mine that were being built, I would imagine my family in those spaces and quality control took on a much more personal meaning.

So when I approach a project now, the codes and recommendations don’t just feel like boxes to be checked. I need to understand why every guideline is in place so that I can provide evidence-based recommendations to make a design even better. Recommendations for healthcare design are constantly evolving, and I want to be one of the people who helps make hospitals a safer place for everyone.

Some of my favorite projects have been the computational fluid dynamics (CFD) studies that clients have requested. Modeling software is used to simulate the airflow within a space such as a procedure room, and you can see where air may be circulating in a way that could be dangerous to a patient. Thanks to those studies, I’m typically able to review the details of the space with architects, facilities managers, doctors, nurses and other users, and it gives me the opportunity to do a deep dive into the details of the space. The rooms are sometimes antiquated designs with a high-volume program, so the constraints can really create a tricky problem to tackle, but there’s nothing I love more than fixing something to make a space safer.

Some of the things I saw during my experience on the patient side really stuck with me, but there wasn’t necessarily a project-specific task to address it. When my company began a think tank program to promote innovative thinking, I created a team to study some of these items I’ve been curious about. My experience in the pediatric ICU made me question why infection rates were so high and why the HVAC design wasn’t significantly different than in an acute care patient room. Through research, we’re now developing CFD models to see how we can improve those spaces and hopefully make an impact on infection rates.

When I first started to hear about COVID-19 in the news, my personal experience was enough to get me worried. Dealing with the intensity of its impact in NYC, I felt real stress for the first time since I lost my daughter. I have never been so grateful to be a healthcare engineer. My company was involved in dozens of rapid-fire projects with multiple large hospitals throughout the area, and I was personally responsible for several of those locations. Nothing controls my stress more than taking action, and I was able to use my years of experience to make a measurable difference during one of the toughest months that NYC has ever dealt with.

Projects needed to be built in a matter of days, when normally we would  have months or years to figure out problems. We weren’t able to just check boxes and put a complete design together this time.  All that time I’d spent developing a true understanding of the “why” behind these designs paid off. I was able to make on-the-spot design decisions and judgment calls to make the spaces as safe as possible with the tools that were available. I was a healthcare engineer MacGyver.

I was even able to support the plumbing engineers using my personal experience with ventilators. When the doctors would do rounds in the ICU, I would join in as the attending physician quizzed the interns on the ventilator settings. At the time, it felt like an interesting distraction, but the knowledge I retained on that functionality helped support the studies and research that the team did during the rapidly expanding need to provide oxygen for newly converted ICU beds.  

I realize that there are definitely occasions when caring this much and taking every decision personally can feel like a hurdle to overcome, but it also brings a level of satisfaction to my career that I never imagined was possible when I started my first day as an engineer.

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