Contract - Designing for Health: The Role of Designers in Helping with Infection Control in Hospital Environments

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Designing for Health: The Role of Designers in Helping with Infection Control in Hospital Environments

18 January, 2011

-By Allen Buie, AIA, LEED AP, BD+C; Jessica Stebbins, IIDA, LEED AP, BD+C ; Lynnette McCurdy Tedder, IIDA, CID, AAHID, LEED AP, EDAC; Rashid Ashraf, RA, NCARB, LEED AP, BD+C


"Designing for Health" is a monthly, Web-exclusive series from healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments.

One of the most pressing issues in healthcare today is the presence of nosocomial infectious disease, otherwise known as hospital acquired infections (HAI). Today, HAI are a significant cause of morbidity and mortality in the United States. Proper design of facilities can have a strong influence on human behavior, which can have a positive impact in reducing infectious disease. Planning and choice of materials also play a role in infection control. Infection control staff are valuable team members and can be instrumental in supporting the designer throughout the planning and design process, creating environments that reduce the opportunity for transmission of infectious disease.

Common Hospital Acquired Infectious Diseases
Understanding infectious diseases and how they are transmitted can aid the designer in his or her design decisions. The primary hospital acquired infections are pneumonia, blood stream infections, urinary tract infections, and surgical site infections. The bacteria Staphylococcus aureus (Staph)[1] and its antibiotic-resistant strain, methicillin-resistant Staphylococcus aureus (MRSA), are commonly carried on the skin and become dangerous when entering the body through a cut or wound. [2] Klebsiella pneumoniae, commonly carried on the mouth, skin, and in the intestines, can cause pneumonia and urinary tract infections. The bacterium Uropathogenic E. coli (UPEC) is responsible for approximately 90 percent of urinary tract infections. Blood stream infections typically caused by a bacteria contaminated catheter cause approximately 10 percent of nosocomial infection-related deaths and is the eighth leading cause of death in the United States (2001) [3]. While these bacteria can be deadly, they can be controlled through proper hygiene.

Transmission of HAI Disease
Infectious diseases are transmitted through three primary routes: 1) contact, both direct and indirect (inanimate objects that transport infectious organisms); 2) large droplets, where microorganisms are dispersed from a person with an infection over short ranges; and 3) airborne, where microbes via droplet nuclei can be spread via HVAC systems. The majority of noscomial diseases are transmitted in the first mode, that of contact. [5] Most hospital acquired infections and diseases are spread by contact from an infected patient to the care provider or equipment/surfaces and then to another patient who then becomes infected. It is this mode of transmission the designer that should consider when designing the clinical environments.

Direct Contact Transmission Prevention: Encouragement of Personal Hygiene through Design
Hand washing is considered the most effective means of eliminating bacteria and viruses from one’s hands. Proper hand washing before and after medical staff touch a patient or handle the patient’s medical equipment can prevent disease from being transmitted from one patient to another. Human nature and pressing schedules often contribute to the neglect of this basic principle (less than half of medical staff wash hands between patients[6]). If a hand-washing sink is located on the opposite side of a patient from where the care provider is administering care then extra effort is required, to walk around the bed, to access the sink increasing the chances that the care provider will not wash their hands either upon entering the room or upon leaving. While placing the sink next to the door does not insure that medical staff will wash their hands, it does, however, make it easier and will increase the chances of use. Careful consideration must be made in the placement of the sink to insure water cannot be splashed onto the patient. There have been examples in the past where the sink was located too close to the patient, and the patient became infected by the splashing of contaminated water.

The placement of Personal Protection Equipment, i.e. face masks, gloves, etc. follow the same principle in proper location as hand washing sinks. They must be placed where caregivers can easily access them and in clear view.

Indirect Contact Transmission Prevention: Planning, Design and Material Selection in the Reduction of Infectious Disease
While direct contact as a means of transmission mostly is controlled through changes in human behavior and supported by proper design, indirect contact (that of touching inanimate objects that have been contaminated) can be greatly controlled through proper design. The choice of materials, furnishings and the detailing of spaces can greatly reduce the potential of harboring infectious microbes. If a space is cluttered and materials difficult to clean, then chances of infectious disease multiplying in these areas is significantly greater.

The listed items below include strategies the designer should focus on during the design process to aid in the reduction of infectious diseases:
• Proper design of the patient headwall and placement of medical equipment to minimize clutter and efficiency can reduce cross contamination.
• Provide adequate and properly sized writing surfaces within the patient room to reduce or eliminate the possibility of placing or charting other paper work on known contaminated surfaces.
• Provision of adequate equipment storage minimizes clutter and optimizes cleaning effectiveness.
• Minimize reveals, pendants, suspended surfaces, corners, edges, etc., where ever possible to avoid potential infectious transmission. Med surge, ICUs, PACUs, etc., need to be thoroughly cleaned. Areas that are difficult to reach tend not be cleaned or not cleaned as frequently as other more easily reached surfaces.
• Selection of materials that are non-microbial are preferred. Monolithic surfaces minimize or eliminate joints that can harbor mold and bacteria.

Summary
Designers can play an important role in helping hospitals deal with the issue of infectious disease transmission through their own awareness of how their design impacts disease control. Collaboration with the hospital infection control team and appropriate consultants can play a positive role in making hospitals safer environments for both patients and staff.


For 10 years, Allen Buie, AIA LEED AP, BD+C, has specialized in healthcare design that focuses on the creation of holistic therapeutic settings for both patients and staff. Educated at Clemson University’s Architecture + Health graduate program, Buie fundamentally questions conventional healthcare design and integrates planning, design, and operations in integrated design solutions.

With 13 years of experience in healthcare architecture and interior design, Jessica Stebbins, associate principal IIDA, LEED AP BD+C, believes that healthcare design must respond to the diversity of its end-users across multiple generations. Her working philosophy of staying attuned to the client, the technology, and the patient has resulted in the successful management of projects ranging from 7,000 to 600,000 square feet.

Lynnette McCurdy Tedder, IIDA, CID, AAHID, LEED AP, EDAC, is a senior associate in the Los Angeles office of Perkins+Will. A specialist in healthcare design and education, has been involved in many large Hospital projects including UCLA Ronald Reagan Medical Center, Los Angeles; St Joseph Hospital and Medical Center, Phoenix; Johns Hopkins Hospital, Baltimore; and Princess Nora University in Riyadh.

Rashid Ashraf, RA, NCARB, LEED AP BD+C, has more than 30 years of experience as an architect and 16 years in healthcare architecture with an emphasis on master planning, programming, design, facilities assessment and project management. He has worked on several projects that involve facility assessments and programmatic solutions to decrease operating costs while improving operational efficiencies.

Sources:

Klevens RM, Edwards JR, Richards Jr. CL, Horan TC, Gaynes RP, Pollock, DA and Cardo, DM. “Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002.” Association of Schools of Public Health. Public Health Reports Mar-Apr. 2007.
Pittet, Didier. “Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach.” University of Geneva Hospitals, Geneva, Switzerland. Center for Disease Control and Prevention. Emerging Infectious Diseases Vol 7, No. 2 Mar-Apr 2001.
“CDC Statement: Public Reporting of Healthcare-Associated Infections.” Press Release Feb. 2, 2010. CDC Division of Media Relations. http://www.cdc.gov/media/pressrel/2010/s100202.htm.
Ross, Robert. “CDC Reports Drop in Healthcare-Related Blood Infections.” CIDRAP News, May 27, 2010. Center for Infectious Disease Research and Policy, University of Minnesota.

Footnotes:
1. Stoppler MC, Shiel Jr. WC. “Staph Infection.” http://www.medicinenet.com/staph_infection /article.htm.
2. Wenzel, RP and Edmond, MB. “The Impact of Hospital-Acquired Bloodstream Infections.” Medical College of Virgina, Richmond, Virginia. Center for Disease Control and Prevention. Emerging Infectious Diseases Vol 7, No. 2 Mar-Apr 2001.
3. Damani NN. “Manual of Infection Control Procedures, 2nd Edition.” Cambridge University Press.
4. Pittet
5. Pittet
6. “Some Alcohol Sanitizers No Better than Soap and Water against Norovirus.” Microbe Magazine, March 2010. American Society of Microbiology.

Past installments of "Designing for Health" include (click on title to access the full article):
The Unexpected Oasis—A medically, spiritually, and emotionally caring environment
Integrating Research into the Design Process
Altruism in the Profession—The Implementation of Social Responsibility
How Green is Your Furniture
Workspaces for Well-being
The Cultural Differences of Latin American Countries and Their Desire for American Influence
Light and Its Role in Patient Safety
Research-Based Client Communication
An Urban Clinic—Connecting with the Community
Patient and Staff Safety in Behavioral Health Facilities




Designing for Health: The Role of Designers in Helping with Infection Control in Hospital Environments

18 January, 2011


"Designing for Health" is a monthly, Web-exclusive series from healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments.

One of the most pressing issues in healthcare today is the presence of nosocomial infectious disease, otherwise known as hospital acquired infections (HAI). Today, HAI are a significant cause of morbidity and mortality in the United States. Proper design of facilities can have a strong influence on human behavior, which can have a positive impact in reducing infectious disease. Planning and choice of materials also play a role in infection control. Infection control staff are valuable team members and can be instrumental in supporting the designer throughout the planning and design process, creating environments that reduce the opportunity for transmission of infectious disease.

Common Hospital Acquired Infectious Diseases
Understanding infectious diseases and how they are transmitted can aid the designer in his or her design decisions. The primary hospital acquired infections are pneumonia, blood stream infections, urinary tract infections, and surgical site infections. The bacteria Staphylococcus aureus (Staph)[1] and its antibiotic-resistant strain, methicillin-resistant Staphylococcus aureus (MRSA), are commonly carried on the skin and become dangerous when entering the body through a cut or wound. [2] Klebsiella pneumoniae, commonly carried on the mouth, skin, and in the intestines, can cause pneumonia and urinary tract infections. The bacterium Uropathogenic E. coli (UPEC) is responsible for approximately 90 percent of urinary tract infections. Blood stream infections typically caused by a bacteria contaminated catheter cause approximately 10 percent of nosocomial infection-related deaths and is the eighth leading cause of death in the United States (2001) [3]. While these bacteria can be deadly, they can be controlled through proper hygiene.

Transmission of HAI Disease
Infectious diseases are transmitted through three primary routes: 1) contact, both direct and indirect (inanimate objects that transport infectious organisms); 2) large droplets, where microorganisms are dispersed from a person with an infection over short ranges; and 3) airborne, where microbes via droplet nuclei can be spread via HVAC systems. The majority of noscomial diseases are transmitted in the first mode, that of contact. [5] Most hospital acquired infections and diseases are spread by contact from an infected patient to the care provider or equipment/surfaces and then to another patient who then becomes infected. It is this mode of transmission the designer that should consider when designing the clinical environments.

Direct Contact Transmission Prevention: Encouragement of Personal Hygiene through Design
Hand washing is considered the most effective means of eliminating bacteria and viruses from one’s hands. Proper hand washing before and after medical staff touch a patient or handle the patient’s medical equipment can prevent disease from being transmitted from one patient to another. Human nature and pressing schedules often contribute to the neglect of this basic principle (less than half of medical staff wash hands between patients[6]). If a hand-washing sink is located on the opposite side of a patient from where the care provider is administering care then extra effort is required, to walk around the bed, to access the sink increasing the chances that the care provider will not wash their hands either upon entering the room or upon leaving. While placing the sink next to the door does not insure that medical staff will wash their hands, it does, however, make it easier and will increase the chances of use. Careful consideration must be made in the placement of the sink to insure water cannot be splashed onto the patient. There have been examples in the past where the sink was located too close to the patient, and the patient became infected by the splashing of contaminated water.

The placement of Personal Protection Equipment, i.e. face masks, gloves, etc. follow the same principle in proper location as hand washing sinks. They must be placed where caregivers can easily access them and in clear view.

Indirect Contact Transmission Prevention: Planning, Design and Material Selection in the Reduction of Infectious Disease
While direct contact as a means of transmission mostly is controlled through changes in human behavior and supported by proper design, indirect contact (that of touching inanimate objects that have been contaminated) can be greatly controlled through proper design. The choice of materials, furnishings and the detailing of spaces can greatly reduce the potential of harboring infectious microbes. If a space is cluttered and materials difficult to clean, then chances of infectious disease multiplying in these areas is significantly greater.

The listed items below include strategies the designer should focus on during the design process to aid in the reduction of infectious diseases:
• Proper design of the patient headwall and placement of medical equipment to minimize clutter and efficiency can reduce cross contamination.
• Provide adequate and properly sized writing surfaces within the patient room to reduce or eliminate the possibility of placing or charting other paper work on known contaminated surfaces.
• Provision of adequate equipment storage minimizes clutter and optimizes cleaning effectiveness.
• Minimize reveals, pendants, suspended surfaces, corners, edges, etc., where ever possible to avoid potential infectious transmission. Med surge, ICUs, PACUs, etc., need to be thoroughly cleaned. Areas that are difficult to reach tend not be cleaned or not cleaned as frequently as other more easily reached surfaces.
• Selection of materials that are non-microbial are preferred. Monolithic surfaces minimize or eliminate joints that can harbor mold and bacteria.

Summary
Designers can play an important role in helping hospitals deal with the issue of infectious disease transmission through their own awareness of how their design impacts disease control. Collaboration with the hospital infection control team and appropriate consultants can play a positive role in making hospitals safer environments for both patients and staff.


For 10 years, Allen Buie, AIA LEED AP, BD+C, has specialized in healthcare design that focuses on the creation of holistic therapeutic settings for both patients and staff. Educated at Clemson University’s Architecture + Health graduate program, Buie fundamentally questions conventional healthcare design and integrates planning, design, and operations in integrated design solutions.

With 13 years of experience in healthcare architecture and interior design, Jessica Stebbins, associate principal IIDA, LEED AP BD+C, believes that healthcare design must respond to the diversity of its end-users across multiple generations. Her working philosophy of staying attuned to the client, the technology, and the patient has resulted in the successful management of projects ranging from 7,000 to 600,000 square feet.

Lynnette McCurdy Tedder, IIDA, CID, AAHID, LEED AP, EDAC, is a senior associate in the Los Angeles office of Perkins+Will. A specialist in healthcare design and education, has been involved in many large Hospital projects including UCLA Ronald Reagan Medical Center, Los Angeles; St Joseph Hospital and Medical Center, Phoenix; Johns Hopkins Hospital, Baltimore; and Princess Nora University in Riyadh.

Rashid Ashraf, RA, NCARB, LEED AP BD+C, has more than 30 years of experience as an architect and 16 years in healthcare architecture with an emphasis on master planning, programming, design, facilities assessment and project management. He has worked on several projects that involve facility assessments and programmatic solutions to decrease operating costs while improving operational efficiencies.

Sources:

Klevens RM, Edwards JR, Richards Jr. CL, Horan TC, Gaynes RP, Pollock, DA and Cardo, DM. “Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002.” Association of Schools of Public Health. Public Health Reports Mar-Apr. 2007.
Pittet, Didier. “Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach.” University of Geneva Hospitals, Geneva, Switzerland. Center for Disease Control and Prevention. Emerging Infectious Diseases Vol 7, No. 2 Mar-Apr 2001.
“CDC Statement: Public Reporting of Healthcare-Associated Infections.” Press Release Feb. 2, 2010. CDC Division of Media Relations. http://www.cdc.gov/media/pressrel/2010/s100202.htm.
Ross, Robert. “CDC Reports Drop in Healthcare-Related Blood Infections.” CIDRAP News, May 27, 2010. Center for Infectious Disease Research and Policy, University of Minnesota.

Footnotes:
1. Stoppler MC, Shiel Jr. WC. “Staph Infection.” http://www.medicinenet.com/staph_infection /article.htm.
2. Wenzel, RP and Edmond, MB. “The Impact of Hospital-Acquired Bloodstream Infections.” Medical College of Virgina, Richmond, Virginia. Center for Disease Control and Prevention. Emerging Infectious Diseases Vol 7, No. 2 Mar-Apr 2001.
3. Damani NN. “Manual of Infection Control Procedures, 2nd Edition.” Cambridge University Press.
4. Pittet
5. Pittet
6. “Some Alcohol Sanitizers No Better than Soap and Water against Norovirus.” Microbe Magazine, March 2010. American Society of Microbiology.

Past installments of "Designing for Health" include (click on title to access the full article):
The Unexpected Oasis—A medically, spiritually, and emotionally caring environment
Integrating Research into the Design Process
Altruism in the Profession—The Implementation of Social Responsibility
How Green is Your Furniture
Workspaces for Well-being
The Cultural Differences of Latin American Countries and Their Desire for American Influence
Light and Its Role in Patient Safety
Research-Based Client Communication
An Urban Clinic—Connecting with the Community
Patient and Staff Safety in Behavioral Health Facilities

 


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