Assess infection risks when designing new facilities

Posted: 24 September 2010 by Phil Astley

We’ve just completed research showing a major problem about healthcare associated infection (HCAI). The work gathered evidence demonstrating links between design and cross-infection. So, for example, the location and height of wash hand basins makes a big difference to patient and staff use. Likewise, good staff changing facilities are vital – it’s not helpful if there are no dedicated places for staff to change in the ward and for them then to treat patients. Likewise, it is a problem if they do not change, go home on the bus and potentially put the community at risk.

Yet, the references to physical design in official ‘Control of Infection’ (CoI) guidance refer simply to clinical practice and maintenance of equipment. We were surprised to find, for example, that the design guidance does not advise that sluice rooms have wash hand basins.

All this means that, at a time when the NHS has undertaken its largest infrastructural investment since 1948, we don’t understand the impact of these builds on one of the NHS’s biggest priorities – reducing HCAIs. Did the investment make rates better or worse? We don’t know. And we certainly didn’t choose the optimal designs for reducing HCAI – because we did not know what they were.

There are lessons here for the future, for an era when refurbishment is now a key infrastructural issue. At the moment, the NHS is legally required to do Equality Impact Assessments on service developments, ensure that issues of gender, ethnicity and other equality issues are taken into consideration. Should we likewise require that there is a design assessment with respect of HCAIs – to better understand the contribution of design to reducing HCAIs in refurbishment and new build?

This will require us to address how to optimise stakeholder engagement. Consultation needs improvement – for example, we found that housekeeping staff are often not invited to design meetings. So the insights they can offer into operational and infection control issues are often heard too late, when design is set in stone. That must change. Likewise, patients should be involved in the design process. It’s not good enough to hand change over to a designer and then blame them when things go wrong. The process must include everyone - and everyone has to share responsibility.

More detail: go to HaCIRIC International Conference Proceedings pp 153-168.

Phil Astley is Principal Investigator for the MARU research team, Senior Research Fellow, the Bartlett, University College London