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Marberry: Revisiting designing for infection control in hospitals and other healthcare buildings

by Sara Marberry

Let me state the obvious: Designing for infection control in hospitals and other healthcare buildings isn’t a new thing. Because infection control has long been an issue for healthcare providers.

Before there was a Covid-19 pandemic, the U.S. Centers for Disease Control (CDC) estimated that healthcare-acquired infections (HAIs) accounted for 1.7 million infections and 99,000 associated deaths in the U.S. each year. Most of them are urinary tract infections, surgical site infections, pneumonia and bloodstream infections — mostly caused by the spread of Methicillin-resistant Staphylococcus aureus (MRSA) bacteria.

And these infections don’t just happen in hospitals. They also happen in ambulatory surgical centers, dialysis facilities, physician’s offices, clinics, as well as assisted living, skilled nursing and rehabilitation facilities.

Covid put new emphasis on infection control

But Covid-19 has made us all aware of the danger of patients and residents getting respiratory infections from contact and airborne transmission of germs. And it’s caused many hospital, healthcare, and senior living facility managers and designers to revisit best practices for designing for infection control, particularly when it comes to surface materials, points of contact, and ventilation.

Take copper, for instance. When regularly cleaned, copper products, like CuVerro continuously kill 99.9% of harmful bacteria.

One study found that CuVerro copper keeps 88% of hospital rooms clean and 93% maintain the clean. It’s also tarnish-resistant and will not oxidize like pure copper.

Glass is also inherently germ-resistant because it has a smooth, non-porous surface. It can be easily and quickly disinfected with bleach or common cleaning products.

Some hospital facility managers and designers are looking at glass as an alternative to cubicle curtains, which, unless frequently changed or cleaned, harbor lots of bacteria.

What else?

As for points of contact, I expect to see more use of automation for touchless contact, like health screening kiosks, automatic doors, voice-activated elevators (“Siri, please call the elevator”), as well as hands-free light switches and temperature controls.

And can someone please invent universal symbols and/or signage for handwashing, social distancing, and mask requirements? This would be great for all building types.

As many of you know, ventilation systems in hospitals are pretty sophisticated. Probably not as much in physician’s offices and clinics. And certainly not in senior living communities and senior care facilities. As I wrote about in May, hospitals, healthcare, and senior care buildings should have operable windows.

Covid-19 also made us realize that most facilities where patients are cared for and communities where seniors live aren’t designed for physical distancing. I think this is a big opportunity for designers to be creative with layout and furniture and other design elements to cue behavior.

May not be necessary to kill all the microbes

Also, as I wrote about in February, it may not be necessary to use as many infection control strategies in hospitals, healthcare, and senior care facilities. Because there are trillions of microbes in our indoor environments that are essential to our health and can actually help with infection control.

Researchers have found that even after rigorous cleaning, when patients are admitted to rooms, the prior patient’s microbiome is still present. Which is okay. Really.

Do we need another ratings system?

Another idea I came across recently is a call to create a rating system similar to LEED, WELL, and Fitwel that certifies buildings that utilize best practices to reduce infectious diseases in their design, construction, operation, and maintenance. I’m not sure we need another rating system, but I think standards and guidelines for infection control could be added to WELL or Fitwel.

Infectious disease experts now believe that like the flu, Covid-19 may never totally be eradicated. Does this surprise any of us? Eliminating MRSA in hospitals, healthcare, and senior care facilities will also be an ongoing challenge because that little bugger is hard to kill.

And that’s why we need to keep revisiting best infection control design practices for hospitals, healthcare, and senior care facilities (as well as congregated living communities for seniors). There’s a whole lotta room for more product innovation as well.

The winds have shifted and it’s time to adjust our course.

This column originally ran on Sara Marberry’s blog on Aug. 27. Marberry is a healthcare design expert who has written/edited five books and is a regular contributor to Healthcare Design magazine. Marberry also is a former Executive Vice President of the nonprofit Center for Health Design.