Improving infection control through better healthcare facility design

Since the pandemic, it would be impossible to deny the existence of a new approach to infection control. The NHS’ healthcare estates were challenged to the ultimate test, leaving the lessons learnt and newfound priorities to continue influencing decision makers today and into the future. Some of those decision makers include those you will find within a multi-disciplinary consultancy, including architects, health and safety designers, and mechanical and electrical engineering specialists for example.

Spatial planning and material specification have come to the fore, while ventilation is now unquestionably higher on the agenda to prevent airborne infection spread.

The physical design of a hospital continues to evolve in response to the demands of the medical world. This is being seen in both new hospitals that are exceeding current healthcare standards and older hospitals that are being retrofit, refurbished or renovated. While some of the design choices are clear to the naked eye and can be easily retrospectively added, there are others that are less obvious and require careful consideration if they are to be implemented.

However, they all play a role in minimising the risk of infection transmission and maintaining more efficient healthcare estates.

Patient flow

Understanding the way people interact with their environment is a critical design consideration in each and every project we undertake, which impacts spatial planning to a huge extent. In the healthcare sector, each building, its patients, its visitors and staff, have a tailored journey from entry to exit and spatial standards can be improved through creative modelling.

Our work with hospitals, home to some of the busiest emergency departments in the country, could not be complete without thorough consultation and engagement sessions, which help us understand exactly how different facilities are used and the architectural limitations to consider.

Ways to control patient flow, with infection control in mind, include limiting the number of entrances and providing adequate social distancing space in waiting areas, corridors, hallways, and stairs. The ultimate goal is to maintain a predictable flow, in order to make other design decisions such as the location of hand sanitisers and associated facilities more effective.

Ventilation

Enhanced ventilation, whether natural or mechanical, can effectively decrease cross infection risk of airborne infections. Variance in air pressure and distribution is critical and it is essential to consult the ventilation engineers early in the design process to determine the air flow pattern required, without causing discomfort to occupants or affecting the function of the department the system is serving.

Different hospital departments have different ventilation requirements and it is important that initial stakeholder engagement sessions identify what the application is. For example, an infectious disease isolation room requires an air pressure of minus five pascals, whereas a critical care area requires an air pressure of 10 pascals.
Ventilation designs must always be coordinated with the designs of other disciplines, notably architects and structural engineers. For positive air pressure regimes, advising the architect of maximum air leakage rates from an operating theatre will inform their design of wall linings, lobby locations, pressure stabilisers and air transfer passages.

Advising a structural engineer early of plant loadings and locations will also inform their design. This is especially important on refurbishments where the location of proposed plant may have constraints, due to the existing strength and structure of the building.

Ventilation designs are rigorously reviewed by teams of experts prior to issue and construction. Then at the construction stage, the installation and system performances are validated with numerous tests and exercises to demonstrate the design intent has been achieved.

Once in operation, the ventilation considerations do not stop. It’s important to monitor the resilience of systems so that any faults with equipment can be prevented.

Shapes and sizes

All spaces and rooms in a healthcare facility are carefully considered to minimise the chance of infection to staff and patients. Minimal inside corners, with rounded solid surfaces, ensure cleaning can be completed more thoroughly.

Horizontal surfaces, such as ledges and shelves, are also being reduced as part of new design practices, to help prevent the build-up of bacteria and the number of surfaces at different heights.

Materials

Materials used in healthcare facilities must comply with the appropriate hygiene performance rating and include easy to clean surfaces. This covers everything found inside a space, from handrails to furniture, and is reinforced by technical standards and guidance found in the NHS’ Health Building Notes.

Antimicrobial materials are ideal for healthcare environments as they prevent microorganisms from growing on surfaces. There is value in material flexibility too. Look at removable privacy curtains for example, these can be replaced more easily and cleaned off site if required. Though some materials are better than others, the key is to ensure that spaces are managed through a thorough long-term cleaning strategy.

Tactile features

Possibly the biggest change since the pandemic is the reduction in the need for physical touchpoints, a benefit for both patients and hospital staff. No-touch technology, like motion sensors, are delivering significant improvements in risk reduction, while building patient and staff confidence, through touchless doors, lights, taps and hand dryers.

Conversely, high touch surfaces like enclosed cabinetry are being dispensed in favour of no touch alternatives.
Staff handheld devices create concerns about cross contamination and are being increasingly kept away from patient surfaces, such as overbed tables. We’re also seeing designated ‘staff-only’ stations, provided in accessible locations to store equipment safely and make obvious for cleaners which surfaces run greater risk of containment accumulation.

Hand hygiene

Regular hand washing is recognised as a key practise to control infection and reduce contamination. Where possible, individual hand washing stations are being provided in patient rooms, general wards, and all clinical rooms. To make this effort common behaviour, extra attention is directed to distinct visual cues that enhance desired behaviours. The stations should then be designed to accommodate recommended hand washing procedures, including features such as long arm taps that enable elbows to be used to operate water flow.

Hand wash sinks are also being positioned away from staff working zones to prevent splash and cross-contamination, while examination gloves, alcohol-based sanitisers and bins are placed in easily accessible positions when entering and exiting patient rooms.

Mental wellbeing

Physical health problems are thought to increase the risk of developing mental health problems, and vice versa. One thing that modern healthcare facilities aim to ensure is a calm and dementia friendly user experience.

Hospitals were once sterile, white, blank spaces, but they now embrace colour and stimulating visual features to give them an identity through their design. Especially for inpatients, the value of biophilic design can be proven through better overall health. The feeling of being outside can be mimicked much more effectively now and this can help patients recover from different conditions more quickly or make the experience of treatment less daunting.

Challenging typical healthcare design

As humans, we continue to evolve, and our healthcare facilities must continue to meet our needs. While some modern innovations and ways of thinking are born out of unexpected events, like the pandemic, we must all continue to invest time and resource into healthcare betterment. We are committed to challenging ourselves to review and trial different healthcare designs that have the potential to improve the experience of patients and staff.