The design of infection prevention measures

Dr Neil Wigglesworth, president of the Infection Prevention Society, outlines the importance of safe infection prevention measures when implementing hospital and healthcare plans

The Infection Prevention Society’s vision is that no person is harmed by a preventable infection, and a key part of this is ensuring that any healthcare facility is designed and maintained in a way to support infection prevention.

Healthcare associated infections (including those caused by E. coli, C. difficile and MRSA) can present major risks to patient safety and also incur costs to the NHS of at least £1 billion each year. Providing the right environment in all healthcare settings - including hospitals, clinics, GPs and specialised care centres - is a vital part of minimising the risk of HCAIs and ensuring that healthcare professionals work in a setting that best supports them.

To ensure the best healthcare settings, infection prevention and control requirements need to be considered at the very outset of the planning and design stages, and infection prevention teams must be involved, from the start, as an integral part of the design team. Infection prevention measures are not only vital when building new facilities, but also when refurbishments are taking place.

Determining whether the building designs will support infection prevention and control will involve ensuring things such as: enough well placed hand hygiene facilities to meet demand; appropriate storage space; single-bed rooms with en-suite facilities, for patient isolation; the right ventilation and airflow systems, especially in specialised facilities such as operating theatres; and facilities for decontamination of reusable medical equipment.

Good practices
The importance of adequate space and air flow in combatting infection was famously articulated by Florence Nightingale, hailed as the founder of modern nursing. In her 1860 work Notes on Nursing she highlighted the need to keep patients' windows open to allow a breeze in. While hospital settings have of course become ever more sophisticated, these principles have stood the test of time, and remain relevant to 21st century healthcare.

When it comes to designing the building, there are several straightforward ways to encourage good practices and behaviour. For example: ensuring there are adequate, separate facilities for clean and dirty procedures; providing facilities for cleaning staff to store and dispose of cleaning equipment and supplies as well as adequate waste disposal facilities; ensuring that all the surfaces are cleanable and able to withstand disinfectants such as chlorine; and making sure patient rooms, whether single or multiple occupancy, have doors so that they can be isolated from other areas and can be decontaminated with modern technologies such as Vapourised Hydrogen Peroxide (VHP) or Ultra Violet (UV) technology.

Protecting existing patients, particularly the most susceptible to infection, from contamination during improvements and renovations is also crucial. Key measures include: using floor-to-ceiling sealed barriers that encompass the work area; sealing windows; moving debris in sealed containers or bags; increasing cleaning in adjacent areas; and, in some cases, temporary air filtration systems may be required.

Once the building is constructed, good standards of basic hygiene, cleaning and regular maintenance will all help prevent healthcare associated infections. It is however important to highlight that there is no one size fits all approach when implementing hospital and healthcare plans. The type of patients and setting you are catering for must be considered, as the needs and requirements will of course vary significantly from a small GP surgery to a vast suite of intensive care units. As is true with much infection prevention and control work, planning is critical to helping establish what the particular needs are in each situation.

Doctors and nurses need to feel confident that their surroundings support them in delivering high quality patient care. By involving infection prevention teams in all planning and design, and adhering to key infection guidance and measures, we can ensure our healthcare settings are best equipped to prevent infection.

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