Health care design and infection prevention

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Infection poses a threat to everyone who walks through the doors of a health care facility, but especially to the people who are already immunocompromised. Despite increasingly strict protocols to reduce the risk of infection in health care facilities (e.g., hand hygiene and surface cleaning), health care-associated infections remain a major threat to patient safety.

There is a reasonable body of literature on the role of operational strategies in addressing infection prevention and control, but research often ignores or barely touches on the role of the built environment. Everything that surrounds us in health care facilities — from surfaces, to air, staff clothing and our own bodies — can carry pathogens.

So, how can design help to combat the problem? Several new studies added to The Center for Health Design’s Knowledge Repository help us gain insight in this important area. Three 2019 publications are highlighted here.

A study by Campbell, et al., focuses on infection prevention strategies in the radiologist reading room. Offstage areas like this have not been a primary focus in infection prevention and control research, but the increasing use of portable, high-touch technologies provide the perfect places for pathogens to survive.

Using photoluminescent markings on workstations, Campbell’s research team compared cleaning behavior before and after hand-sanitizing stations were installed in the room. They found a small but positive improvement of the sanitation stations alone and a significant improvement when paired with hand hygiene education for the radiologists.

In a pre/post and side-by-side comparison study by Murrell, et al., researchers also looked at the effect of combining design and cleaning strategies.

They found that a visible-light continuous environmental disinfection (CED) system augmented the effect of manual cleaning alone and significantly reduced microbial surface contamination and surgical site infections (SSIs) in the operating room. The authors attribute a potential $900,000 cost savings for the health care organization because of this reduction in SSIs.

Another study by Xiao, et al., used a simulation model to examine how MRSA is transmitted across various surfaces in a medical ward in a Hong Kong hospital. The paper includes graphics that clearly illustrate the network in which MRSA travels from the index patient (patient zero) to nearby surfaces and other patients. 

Like the other two studies, the authors found positive effects of a combined design-plus-cleaning strategy (especially in the area immediately around the index patient): Frequent surface cleaning paired with antimicrobial surface materials helped reduce the spread of MRSA.

Design can influence multiple outcomes and lead to the creation of safer and healthier buildings. 

Health care facility professionals can find the articles mentioned here, and many others on the topic of design and infection control, in The Center for Health Design’s Knowledge Repository.

The following citations from The Center for Health Design’s Knowledge Repository of health care design resources were used by the author when writing this column:

• J. Campbell, et al., “Keeping Clean in the Reading Room: An Initiative to Improve Workstation Hygiene,” Journal of the American College of Radiology, 2019, in press.
• L.J. Murrell, et al., “Influence of a Visible-Light Continuous Environmental Disinfection System on Microbial Contamination and Surgical Site Infections in an Orthopedic Operating Room,” American Journal of Infection Control, vol. 47, no. 7 (2019): 804–10.
• S. Xiao, et al., “The Dynamic Fomite Transmission of Methicillin-Resistant Staphylococcus Aureus in Hospitals and the Possible Improved Intervention Methods,” Building and Environment, vol. 161 (2019), in press.

Melissa Piatkowski, Research Associate, The Center for Health Design