How hospital designers can help ES

Our knowledge of how to prevent health care-associated infections (HAIs) has come a long way since Ignaz Semmelweis identified that hand antisepsis between autopsy and obstetrical procedures reduced mortality. One such advancement has been in the area of disinfection.

The health care environment always will harbor microorganisms. This is largely because our bodies house 10 times more microbes than cells. We constantly shed these microbes, which contaminate the environment and enable transmission to others. Microbes capable of causing infections have an excellent opportunity to do so, as they can more easily invade the bodies of sick, hospitalized patients. However, this risk can be reduced through appropriate environmental hygiene.

Ensuring that the environment is clean and disinfected for patients can be difficult. Novel interventions such as targeted educational efforts, rapid feedback and touchless machines have shown varied success.

One reason that many of our environmental interventions have failed at reducing HAIs is that we are developing new products and technologies to disinfect objects in the hospital environment that were not manufactured to undergo disinfection (i.e., wood floors, carpet and upholstered furniture). Present technologies will not overcome this issue, but we need to begin thinking about how we can construct health care facilities to ensure that disinfection is possible and efficient.

Completing this task may seem daunting. However, if we look to other disciplines, it becomes apparent that the rationale, plans and proven effectiveness and efficiencies are already available. Take a biological safety Level 3 or 4 laboratory, for example. These laboratories are known to harbor highly pathogenic and virulent organisms (e.g., Ebola virus) used in basic science investigations. Clearly those organisms must be contained within the laboratory with 100 percent certainty. Buildings are constructed with cleaning and disinfection in mind. Floors, walls and ceilings are installed to be impervious to liquids and resistant to chemical deterioration. Floors either curve up the wall to ensure suitable disinfection of corners or there are seamless connections between floors and walls. Even furniture is designed for disinfection, using compatible materials and ensuring that all spaces are accessible. Furthermore, ports often are built into the walls of the laboratory to provide efficient delivery of touchless disinfection modalities.

There is little doubt that we have made significant improvements in our ability to prevent HAIs. It is time to take the next leap into the future, which includes reimagining the health care environment from the ground up.

By Timothy Wiemken, Ph.D., MPH, CIC, assistant professor of medicine for the division of infectious diseases at the University of Louisville (Ky.), and assistant director of epidemiology and biostatistics for the clinical and translational research support center.

AHE insight

Valuable resources available

AHE is the membership organization of choice for professionals caring for the health care environment. Here are a few of the many educational resources that AHE offers.

• EXCHANGE 2013. Attend the industry's premier conference and trade show at the Indiana Convention Center in Indianapolis on Sept. 1518. Registration information is available at www.ahe.org.

• Shiny Floors: The Real Deal. Attend this valuable floor care webinar, which is available for free to AHE members and for $139 to nonmembers. It's on March 20 at 1 p.m. CST. For more, go to www.ahe.org/education.

• Practice Guidance for Healthcare Environmental Cleaning, 2nd edition. Purchase this valuable resource today or download the e-book. To order by phone, call 800-242-2626 and ask for product code #057034 or log on to www.ahe.org.

• From Top To Bottom: The Environmental Services Series. This multi-part DVD series is an excellent training solution for environmental services managers and infection prevention and control professionals who may be challenged with high employee turnover, limited time to train workers, language barriers and infection rates. For more go to www.ahe.org.