The focus on infection control and prevention in healthcare design is intensifying.
Hand sanitisers mounted to walls throughout healthcare precincts aren't cutting it. Neither are the disposable gloves, as both of these rely on self-initiated human activity.
Designers are now exploring more automated ways to combat bacteria through isolation units, technology applications, infection-reducing materials and greening spaces.
Most recently, the design elements within healthcare facilities for Ebola have been heavily documented. The illness has sparked an urgent enquiry for safer, infection-controlled healthcare spaces.
In mid-February, the World Health Organisation (WHO) reported that there have been 23,218 cases of Ebola, leading to 9,364 deaths.
The fourth draft of the Ebola Building Standard for the Construction of Healthcare Facilities in Developing Countries, chaired by Professor Kim Lovegrove FAIB, outlines the proposed design and construction of treatment and quarantine centres to standards which minimise the risk of Ebola to both staff and opportunity for patient recovery.
The WHO notes that Ebola spreads by “direct contact with body fluids of an infected person (including dead bodies) – most infectious: blood, faeces, vomit.”
In the draft, one aligning design factor links to the importance of temperature control: “Temperature control to minimise human perspiration, mindful of the fact that healthcare workers wear protective suits that are conductive to a high level of perspiration particularly in circumstances where there are human resource shortages and intensive and long periods of deployment are required.”
In the US, Ebola has attracted political concern with the suggestion of creating biocontainment patient care units for people with highly infectious diseases.
According to Healthcare Design Magazine, the US currently has a total of 25 beds of this nature, across four healthcare centres.
The article's author, Shelia F. Cahnman AIA, LEED AP, a founding principal of JumpGarden Consulting, noted that the North Shore-LIJ Health System in New York in introducing a new space to deal with contagious illnesses, and the Methodist Health System is converting an ICU wing at its Campus for Continuing Care in Richardson, Texas. The Methodist Health System's space will "provide decontamination, laboratory equipment and other dedicated personnel for IT and biomedical support to meet biocontainment standards."
Fighting infection is a collaborative endeavour and when it comes to the healthcare industry, all of the following design considerations are worthy of consideration:
While many highly infectious diseases aren’t primarily airborne (Ebola isn’t, according to the WHO), there’s still risk in poorly ventilated environments.
The WHO’s Natural Ventilation Guidelines for Infection Control in Healthcare Settings (2009) recommends a combination of natural and mechanical ventilation dependent on needs, resource availability (also climate dependent) and cost of the system. Natural ventilation should also be maximised where possible.
“Natural and mechanical ventilation systems can, in practice, be equally effective for infection control,” the report reads. “However, natural ventilation only works when natural forces are available, for example, winds or breezes, and when inlet and exhaust apertures are kept open.”
“On the other hand, the difficulties involved in properly installing and maintaining a mechanical ventilation system may lead to a high concentration of infectious droplet nuclei and ultimately result in an increased risk of disease transmission."
The report also refers to the opportunity of considering antibacterial design for common areas (waiting rooms, hallways and so forth) where disease transmission can occur.
Along with being durable and easy to clean, surface materials should also be airtight and resistance to cracks and dents.
Antimicrobial copper is recognised as one of the most effective antimicrobial touch surfaces.
According to the Copper Alliance in the UK, copper alloys including brass and bronze are collectively called antimicrobial copper.
“Copper will rapidly kill bacteria and viruses deposited on its surface," the Copper Alliance website reads. "Clinical trials in hospitals have shown antimicrobial copper surfaces will continuously kill germs, in-between cleans, reducing the risk of them spreading between people."
In 2012, Medicare Hospital in Mumbai was the first hospital in India to install antimicrobial copper touch surfaces in their new ICU unit.
Antimicrobial copper (brass) door handles and push plates were installed in the ICU and operating theatres.
"I heard a lecture on using copper in hospitals, which made an impression on me," said Dr Kushal Mital, director of Medicare Hospital and its ICU at the time.
"Until we made our new wing, it hadn't dawned on me to use copper as self-cleansing surfaces. The obvious choice was door handles and pushplates, so we installed them, but it's only the beginning. I would also like tables, bed rails, IV stands and medical devices made from antimicrobial copper.'
The hospital used the material to "bring down cross-infection rates, nosocomial infections will come down and fewer antibiotics will be used. Patients will have faster recoveries," according to a statement.
International Copper Association Australia recently announced that Greek company Karabinis Medical S.A. has launched an antimicrobial copper thermometer with touch surfaces that will continuously kill disease-causing microbes.
The statement said "multiple clinical trials have shown antimicrobial copper surfaces harbour >80% less contamination than non-copper equivalents, and a multi-site clinical trial in the US also demonstrated a corresponding 58% reduction in a patient’s risk of acquiring an infection.”
Paints such as easy-on+ antibacterial paint features an antibacterial coating incorporating Akacid (plus). According to the website, Akacid is a biocide proven to disrupt the cell surfaces of bacteria and reduce hospital acquired infections including MRSA, E. coli, salmonella and listeria.
The paint can be applied over existing, bare or painted surfaces including including brick, stone, plaster, metal, powder coatings, plastics and woods.
Benchtop in Melbourne stock Duropal Microplus, which offers an antibacterial surface.
According to Benchtop, Microplus permanently and effectively neutralises the ability of bacteria to grow and multiply.
Another study found 30 per cent lower infection rates after introducing a photocataltytic surface coating. That study found that photocatalytic materials exhibit antimicrobial activity when exposed to light and provide a safe, durable coating on a wide range of surfaces.
Cork, rubber, tile and vinyl are preferred in the healthcare precincts for their antibacterial attributes.
Cork is antimicrobial and hypoallergenic, though it can be difficult to clean and prone to infection.
Some companies offer a solid vinyl tile product which features a built-in antimicrobial barrier to control bacterial and fungi.
A 2013 article in Health Facilities Management Magazine - Thoughtful design can aid infection prevention in healthcare facilities - highlighted the importance of keeping water out where “cracks, crevices and seams can be problematic.”
The article highlighted resin floors by Silikal America, which are made of acrylic finish that contains no pinholes or pores to harbour bacteria.
It also mentions the Joe DiMaggio Children’s Hospital in Hollywood, which features rubber sheet flooring for the patients room and bathrooms.
“The deign met the hospital’s sustainability and patient safety requirements by using a renewable, slip-resistant material and removing a trip hazard, by eliminating the threshold, the design also removed a trap for spills, direct or pathogens," the article states.
Nature can also play an integral role in helping prevent the spread of infection. It's a combined effort that sees natural light and greenery (including healing gardens) aid patient recovery, while natural ventilation offers improved air quality.
According to the GBCA Green Star Healthcare v1 (2009), the Bronson Methodist Hospital in Michigan found that applying green design principles (a combination of ventilation, private rooms, music, light and nature) led to an 11 per cent reduction in secondary infections and a decrease in nursing turnover rates to below seven per cent. such as improved
UVC technology is also being utilised in healthcare precincts to help reduce infection transmission.
In 2009, Steril-Aire announced that UVC Emitters were being used at the new Muskogee Community Hospital (MCH) in Oklahoma.
According to a statement, the devices are installed in the air handling units and in custom-designed, ceiling-mounted devices in the surgical and procedural suites, marking the first time a hospital has used UVC technology in this way.
Steril-Aire devices use high output UVC energy to eradicate airborne viruses and bacteria as well as surface biofilm/mould and pathogens, to improve indoor air quality and reduce hospital acquired infections.
“We are hopeful that UVC technology will help us to record some of the lowest infection rates in the country by keeping bacteria and other microbes continuously in check,” MCH president Mark Roberts said at the time.
Lighting supplier Phillips also offer UV lamps to help reduce the risk of airborne infections.
"Hospital acquired infections affect around 10% of patients during their stay," Phillips' website reads. "There is increasing evidence that up to 20% of these infections are transmitted via the air. UV disinfection lamps deactivate microorganisms, contributing to a safer indoor working environment."
Design details that can assist with infection control and help hospitals meet nurse pioneer Florence Nightingale's first requirement: that they "should do the sick no harm."