Researchers Report That Design of Hospital Materials Can Lead to Infections

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A November article from Healthcare Design Magazine addresses an important safety issue for hospitals and healthcare organizations: how the design of various materials can increase risks to a patient’s safety and how these designs need to be altered or eliminated altogether in order to reduce the frequency of those risks.

The findings presented in the article were based on an HHS-funded study that was presented at the Healthcare Design conference.

Charlene Marietti writes, “When evaluating the impact of healthcare-facility design on HAI [healthcare-associated infections], researchers have concluded that some widely used materials and design features can become contaminated even when recommended cleaning and maintenance are performed.”

The study’s researchers are convinced that design is at least one of the “links in the chain of infection.”

For example, patients have been known to acquire Legionnaires disease from water walls and decorative fountains, even when those structures were properly maintained. The researchers warn, “Water walls and decorative water fountains present unacceptable risk in hospitals serving immunocompromised patients (even with standard maintenance and sanitizing methods).”

As Marietti reports, the researchers acknowledge, “There is little direct causal evidence linking design to infection but research, evidence, and simulation helps researchers move from a focus on outbreak to an understanding of mechanism.”

The researchers also point out that behavior and context can manipulate infection control. Therefore, it’s possible to clean something, but “a combination of low-wage workers and ineffective managers consistently fail to meet such standards of cleanliness.”

Two other areas they addressed as sources of infection were a lack of handwashing and curtains. They found that making dispensers more visible, incorporating alert lights and notices, and installing video surveillance monitors all led to a profound increase in handwashing.

With curtains, it seems that there is no ideal way to handle the contamination brought on by their design. The researchers concluded that it might be best to do away with them altogether.

Other methods that can be incorporated for infection control include antimicrobial coatings on materials, improved ventilation, and UV light. The researchers were also enthusiastic about up-and-coming technological innovations like copper-impregnated surfaces and ultraviolet germicidal irradiation cleaning agents in plenums and terminals.

More research is needed, they emphasized, especially with decorative fountains, carpeting, displacement ventilation, and a multitude of other areas.

What are your thoughts on the matter of design being at least one of the links in the chain to patient infections? Has your organization taken any special steps to ensure that handwashing is more frequent, water walls and decorative fountains are free from contaminants, etc.? What would you recommend as effective ways to combat infections and other patient-safety concerns?

-by Pete Fernbaugh

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