The commitment of time and resources to design and construction of healthcare facilities can provide value in creating larger and more aesthetically-pleasing facilities, which may help attract patients, retain employees and accommodate new equipment. One value that may be under-recognized is the ability of design and construction choices to influence infection control. Approximately five percent of all healthcare-acquired infections are due to construction within the healthcare facility, according to Dan Lee, architect, interior designer and president of Lee Design Group. Mr. Lee, who was the first president of the American Academy of Healthcare Interior Designers, offers the following five tips for improving infection control through construction and design.
1. Create an integrated team. Managing construction plans of a healthcare facility with a multidisciplinary team can help assess how construction will affect different parts of the organization and how to minimize safety and health hazards. "It's extremely important to have an integrated delivery team approach rather than a design, bid and build approach," Mr. Lee says. "Bring in an epidemiologist and other gatekeepers, from internal stakeholders as well as the contractor/architect delivery team from the very start. When you have an integrated team of folks at the front end, you're more likely to develop a strategy that allows you to maintain business activities and equip the architect and designer with information they need to create a more process-oriented solution."
2. Confirm infection control guidelines. Healthcare organizations should discuss infection control regulations with the architect and designer in the beginning of the planning process to ensure everyone is aware of the limits and requirements of construction. "Understand the protocols and procedures you have to follow," Mr. Lee says.
While the policies may interrupt or complicate workflows, the procedures need to be followed to mitigate the risk of infection, Mr. Lee says. "[Under] no circumstance let your guard down on infection control guidelines and processes."
3. Conduct a risk assessment. A key step in reducing infection control in construction is to develop a risk assessment matrix that identifies the level of risk associated with each type of construction. A Joint Commission's policy states, "For all construction projects in a healthcare facility, the risk of construction-induced infection shall be assessed and potential patient impact identified and controlled," Mr. Lee says.
The assessment should include fire safety, air quality, utility impacts, noise, vibration and other hazards. "[This] is a critical part of the process. It's not just a process for the architect or the contactor or users of the facility, but the whole team," Mr. Lee says.
4. Choose materials wisely. The materials healthcare organizations choose for renovations, expansions or new buildings can significantly impact the organizations' ability to prevent and control infections. For example, copper is safer than stainless steel because superbugs cannot live in any scratches, as they do with stainless steel, according to Mr. Lee. One recent study found antimicrobial copper surfaces in intensive care unit rooms reduced the amount of bacteria in the rooms by 97 percent and resulted in a 41 percent reduction in hospital-acquired infection rates. Although copper is not appropriate for an operating room, it can be used as countertops, sink areas and other areas outside the OR.
In addition, carpets can be cleaned as easily and thoroughly and contain as little bacteria as hard surfaces, Mr. Lee says. Choosing carpets instead of hard surfaces may thus create a more comfortable environment for patients without increasing the risk of infection, he says.
As health IT systems such as electronic medical records and computerized physician order entry become more prevalent in healthcare facilities, healthcare leaders should consider materials designed to facilitate cleaning of electronics. For example, Mr. Lee says there are keyboards that can completely detach from equipment and computers and that these keyboards can be laundered at high temperatures or put in an autoclave for sterilization. "So many germs and bacteria are transmitted by hands, so for this reason, hospitals should be looking at these keyboards" he says.
5. Consider infection control-friendly designs. Design of healthcare facilities can also aid infection control efforts by making infection control resources easily accessible. "[It's] important that the architect and designer work together to plan medical space that supports and encourages frequent handwashing," Mr. Lee says.
Besides strategic placement of hand sanitizers, the location and number of sinks may affect infection control. "Too often sinks are put back in corners and not where physicians want to go to wash their hands," Mr. Lee says. "They want to be talking to the patient and within eyesight and [hearing] of the patient, so the location of sinks within patient rooms is extremely important."
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1. Create an integrated team. Managing construction plans of a healthcare facility with a multidisciplinary team can help assess how construction will affect different parts of the organization and how to minimize safety and health hazards. "It's extremely important to have an integrated delivery team approach rather than a design, bid and build approach," Mr. Lee says. "Bring in an epidemiologist and other gatekeepers, from internal stakeholders as well as the contractor/architect delivery team from the very start. When you have an integrated team of folks at the front end, you're more likely to develop a strategy that allows you to maintain business activities and equip the architect and designer with information they need to create a more process-oriented solution."
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2. Confirm infection control guidelines. Healthcare organizations should discuss infection control regulations with the architect and designer in the beginning of the planning process to ensure everyone is aware of the limits and requirements of construction. "Understand the protocols and procedures you have to follow," Mr. Lee says.
While the policies may interrupt or complicate workflows, the procedures need to be followed to mitigate the risk of infection, Mr. Lee says. "[Under] no circumstance let your guard down on infection control guidelines and processes."
3. Conduct a risk assessment. A key step in reducing infection control in construction is to develop a risk assessment matrix that identifies the level of risk associated with each type of construction. A Joint Commission's policy states, "For all construction projects in a healthcare facility, the risk of construction-induced infection shall be assessed and potential patient impact identified and controlled," Mr. Lee says.
The assessment should include fire safety, air quality, utility impacts, noise, vibration and other hazards. "[This] is a critical part of the process. It's not just a process for the architect or the contactor or users of the facility, but the whole team," Mr. Lee says.
4. Choose materials wisely. The materials healthcare organizations choose for renovations, expansions or new buildings can significantly impact the organizations' ability to prevent and control infections. For example, copper is safer than stainless steel because superbugs cannot live in any scratches, as they do with stainless steel, according to Mr. Lee. One recent study found antimicrobial copper surfaces in intensive care unit rooms reduced the amount of bacteria in the rooms by 97 percent and resulted in a 41 percent reduction in hospital-acquired infection rates. Although copper is not appropriate for an operating room, it can be used as countertops, sink areas and other areas outside the OR.
In addition, carpets can be cleaned as easily and thoroughly and contain as little bacteria as hard surfaces, Mr. Lee says. Choosing carpets instead of hard surfaces may thus create a more comfortable environment for patients without increasing the risk of infection, he says.
As health IT systems such as electronic medical records and computerized physician order entry become more prevalent in healthcare facilities, healthcare leaders should consider materials designed to facilitate cleaning of electronics. For example, Mr. Lee says there are keyboards that can completely detach from equipment and computers and that these keyboards can be laundered at high temperatures or put in an autoclave for sterilization. "So many germs and bacteria are transmitted by hands, so for this reason, hospitals should be looking at these keyboards" he says.
5. Consider infection control-friendly designs. Design of healthcare facilities can also aid infection control efforts by making infection control resources easily accessible. "[It's] important that the architect and designer work together to plan medical space that supports and encourages frequent handwashing," Mr. Lee says.
Besides strategic placement of hand sanitizers, the location and number of sinks may affect infection control. "Too often sinks are put back in corners and not where physicians want to go to wash their hands," Mr. Lee says. "They want to be talking to the patient and within eyesight and [hearing] of the patient, so the location of sinks within patient rooms is extremely important."
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