According to the American Centers for Disease Control and Prevention, 99,000 deaths per year in the United States are caused or impacted on by multiple hospital-acquired infections (HAIs), which are roughly estimated to be around 1.7 million cases. In Europe, there are 25,000 deaths per year from the same cause, 17.000 of which are linked to nosocomial infections. Patient safety is a core issue in today’s health care settings. There is a growing consensus, supported by scientific investigation, that the role of the built environment is central towards minimizing and controlling the level of such infections. The contribution of architectural solutions and planning choices becomes crucial at this stage. This paper outlines the most common measures to adopt at the architectural and planning level, to combat HAI, focusing on the most critical areas of the hospital: wards, intensive care units and operating theatres. Conclusions
The role of the physical environment in contributing to the minimization and control of nosocomial infections is still too often considered a minor factor among others that impact the hospitalacquiredinfections rates. This happens regardless of the availability of a strong and growing scientific evidence which supports the importance of environmental factors in the transmission of MRSOs. Other factors, such as the adherence of medical staff to hygiene protocols and the vulnerability of the patients treated are thought to have a higher impact. The differences of emphasis given to one factor rather thananother is normally linked to the health care culture and the policy adopted. This might be due to the way operating procedures and teams are set up in different countries. The differences in planningsurgical departments in the Netherlands and the Nordic countries are a clear proof of that. This article has exposed some of the most common architectural measures used to contribute to hospital infection control in hospital wards, operating theatres and intensive care units. More space for hospital beds, the choice of single bedrooms, the availability and position of hand washing facilities, HVACsystems and air lock solutions, and proper materials seem to be the most common, but not exhaustive, solutions implemented to impact on the control of nosocomial infections. However, relevant layout arrangements are also considered to be highly important in preventing the spread of MRSOs. Differences between countries, beliefs and lack of scientific evidence in linking the built environment to the control of nosocomial infections, offer the possibility of exploring new frontiers in hospital design and management. There is a need and a challenge to set-up further and systematicinvestigations aimed at strengthening the role of the physical environment in the minimization and prevention of hospitalacquired infections. About the author
Giuseppe Lacanna is a health care architect. He is a PhD researcher at TU Delft in the Netherlands in the Department of Architecture and Chair of Complex Projects where he is involved in a unique research programme which runs over several countries in Europe. He is also a member of the UIA-PHG young leaders group and he leads the R&I department of EGM architecten b v, the biggest architectural practice specializing in health care in The Netherlands. Bron:
World Hospitals and Health Services, 2013 Vol. 50, nr. 2
The Official Journal of the International Hospital Federation (IHF)