By Harland C. Lindsay, Director, Parkin Architects Limited
Ever since Joseph Lister started using carbolic acid in 1867 as an antiseptic, hospitals have acknowledged that infection control is essential, yet serious efforts to really minimize nosocomial infection have not always developed quickly. Even today, some hospitals tend to subscribe to different infection control rules and practices. We have to be particularly on guard for nosocomial infections such as MRSA and C-difficile, which target weakened immune systems.
The March 2014 Ebola outbreak is ravaging parts of Guinea, Sierra Leone, Nigeria and Liberia, where over 3,000 have died, and lock-downs are being effected to enable health workers to find and isolate cases of Ebola, in a desperate effort to halt the spread of the disease. No one seems to be able to predict when this outbreak might be conquered: early estimates were in terms of a few months; later estimates predict several years. The significant risk of Ebola spreading to other countries and continents manifested itself on September 30, when the first Ebola case outside West Africa was diagnosed in Dallas, Texas.
The SARS scare of only a few years ago was a wake-up call for many, resulting in frantic efforts to bolster our defense mechanisms. At that time, we had to completely redesign a part of one of our hospitals in mid-construction to accommodate re-thought approaches to patient screening and isolation, and infection prevention mandates. The world is watching and, once again, the importance of effective infection control is being thrust into the limelight.
Partly driven by the SARS scare, some of the many improved design and operational infection avoidance measures now in place in our hospitals are:
1. Spaces to facilitate screening of patients and staff at key entrances, such as:
- increased vestibule sizes;
- storage/rooms for personal protection equipment; and
- increased security at all entrance points.
2. Significant decrease in the number of multi-patient rooms:
- greater number of single patient bed rooms and bathrooms;
- more frequent air changes;
- hand hygiene stations in the rooms and at room entrances;
- splash-reducing hand-wash sinks and faucets (designated for hand-washing only);
- hand sanitizers located at hygiene stations and at patient bed-sides;
- room lay-outs that enable patients to see staff use hand-wash sinks.
- cleanable surfaces;
- increased/ refined protocols for staff and visitors; and
- reduced need for curtains and the issues associated with their cleaning.
3. Increased number of Airborne Precaution rooms (a.k.a. Isolation rooms) with negative pressure and vestibules, with:
- increased air changes / negative pressure / low level exhaust;
- cleanable surfaces; and
- hand-hygiene stations including sinks in patient rooms and vestibules.
4. General measures include:
- creation of segregated Outbreak Zones which can be used to contain / manage significant disaster situations without interruption to the functioning of the hospital;
- increased sink locations;
- increased and dedicated Personal Protection Equipment cabinets adjacent to exam rooms / procedure rooms / recovery spaces etc.;
- increased hand-hygiene for patients / staff / visitors;
- increased air changes including many areas with 100% outside air;
- more HEPA filters and filter-change protocols;
- increased awareness of clean-versus-soiled elevators and circulation systems; and
- increased definition of “front-of-house and back-of-house” segregation of public, semi private, private and restricted.