There is a growing impetus to tackle healthcare acquired infections, which as well as potentially being life threatening, they cost the NHS around £1 billion per year. What role does design play? What is the evidence? What potential areas for action are there to improve infection control?

Introduction

• Most HCAI can be prevented by following current best practice. However, infection control is a complex issue: it needs to be tackled on a number of levels and embedded within an organisation's culture. The government has recently announced a series of measures aimed at improving hospital cleanliness and provided funding for hospitals to carry out a 'deep clean'.

The Department of Health's Saving Lives programme gives practical examples of strategies to tackle HCAIs. It supports the thinking that building design can promote infection control by encouraging Trusts to:

• minimise the movement of patients within the hospital, some of whom could potentially be carrying multi-resistant pathogens.
• review both the built environment and facilities management arrangements to ensure a safe and clean environment for patient care.

Building design can support the control of infection in a number of ways, for example:

• specifications for clinical environments should include the requirement to be easily and effectively cleaned and decontaminated
• the design should support clinical activities and infection control guidelines, enabling, for example, patients to be isolated when required or by promoting hand hygiene through the provision of easily accessible clinical hand-washing facilities

Hand washing and anti-bacterial solutions

Hand washing is an area which highlights the complexity of the issue. Performing the correct technique and using effective antibacterial cleansing products is important, but it is a more complex series of events and decisions which enable staff to avoid transferring organisms from patient to patient.

Clinical hand-wash sinks should be visible and easily accessible. The appropriate soap/antibacterial agents, dispensers, disposable towels should be well positioned, with spaces for waste bins, in all single rooms, multi-bed bays and rooms where clinical procedures take place. Alcohol gels and rubs should be easily accessible to visitors and staff on entry to, and exit from, clinical areas and at the point of care.

The design must be fit for purpose intended e.g. utilising waterproof splash backs and non-touch taps to avoid contamination.

Space requirements

Adequate space in both ancillary and core areas should be considered as part of all healthcare design specifications. If the space is too small, curtains separating patients, for example, can contaminate clinical trolleys, other objects, staff and patients.

Designing in accessibility and space can contribute to the ease at which areas are cleaned and maintained, as well as offering increased levels of privacy for patients and good access to the patient and equipment for staff.

Secure facilities within the built environment for the storage of waste and contaminated laundry are also important.

Single Rooms

It is generally thought that nursing patients in single rooms can greatly assist in the prevention of the spread of micro-organisms.

Single rooms with en suite facilities can enable more effective infection control measures, such as enabling thorough decontamination, and have been shown to promote hand hygiene compliance.

Design quality

Easily maintained high quality easy clean/wipe clean durable surfaces and fittings and fixtures) with sealed joints are required to help minimise the risk of infection. Curtains which can be washed at disinfection temperatures, low dust retention fixtures and integral blinds (within double glazing systems) are just a two of the methods which can aid cleaning. Systems need to be easily and regularly maintained with minimal patient disruption and without subjecting them to additional risk.

Conclusion

There is now a real impetus to reduce HCAIs. Year on year MRSA reduction targets for Trusts, promoting better quality care and improved outcomes, along with the evidence of the financial burden caused by HCAIs should, together, ensure that their control remains a priority and one where design can influence.

Designing healthcare buildings, however, is a complex process which needs to take into account a number of constraints and economic considerations, in the new world of consumerism, choice and payment systems related to quality outcomes.

The hospital planning team can influence good infection control practice during the development of a scheme. Involvement from infection control teams is important at the early stages of planning and throughout the whole procurement process.

There is often a lack of high quality evidence to support the role of design in the control of HCAIs. However, utilising available guidance such as Infection Control in the Built Environment (NHS Estates 2002) and developing professional consensus within partnerships, innovative solutions can be provided in the absence of systematic research.

Affordability remains an issue. There is a common assumption that providing more single rooms and minimum clear spaces around a patient's bed will have a huge impact on the cost of healthcare building projects. However a recent study from NHS Estates, Ward layouts with single rooms and space for flexibility (2005), suggests that this may not be the case. We also need to better understand the long term cost benefits of investing in good design and higher quality finishes which could see improvements in productivity and reduce the costs of HCAI's.

Useful Information:

HCAI's: What else can the NHS do? is a Healthcare Commission study giving practical advice for trusts to consider in their attempts to reduce rates of infection (IX Issue 46)

Please see Issue 50 of Information Exchange for the DH report on Factors leading to variation in MRSA rates between hospitals. The Clean, safe care: reducing infections and saving lives publication draws together recent initiatives to tackle healthcare associated infections and improve cleanliness and details new areas where the NHS should consider investing to ensure that patients receive clean and safe treatment whenever and wherever they are treated by the NHS.

The 'Catch it, bin it, kill it' campaign introduced by the Department of Health looks at encouraging the public to practice correct respiratory and hand hygiene to prevent the spread of viruses.

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