Hospital design plays a key role in improving hygiene practices and reducing the spread of HCAIs. John Little, business & soft FM services development manager for contractor BAM, explains how good design can improve health outcomes.
You can and should have clean hospitals. At BAM FM, we manage facilities for four hospitals in the UK, and many other facilities. Lessons are constantly emerging about how to design facilities that not only enhance the patient’s recovery but also help to manage down the risk of infection or the spread of infection in health facilities.
The lessons we learn are ones that contractors, such as our sister company BAM Construction, can import into the design of their new facilities.
Effective measures can be surprisingly simple. Traditional hospital design has resulted in inherent dust traps, loose equipment and materials that are difficult to clean. The traditional Nightingale ward design, which consists of a number of beds in a single room, exacerbates problems of cleaning and infection control. We’re now aware that the spread of infection is often better prevented with self-contained en-suite facilities, and there is a move towards single-room facilities in many new hospitals. BAM is building the first publicly funded 100% single-bed NHS Hospital at Ebbw Vale, Wales, closely followed by the new general hospital in Caerphilly.
Square edges are more difficult to clean, meaning smoother edges are increasingly being ‘designed-in’, even behind headboards, for example, and on surfaces with tiling or carpeting. Coved finishes to flooring have replaced traditional skirting boards, offering fewer places for dust and infections to develop. Room design has evolved to remove dust traps, especially common in exposed frames of bed supports, and walls are smoother, thereby providing less surface area for bacteria to cling to and develop.
Toilets and showers follow this design principle, aiming for a seamless finish and removing traditional tiling that involves grouting. Shower cubicles can be lined with single wrap-around floor vinyl and have more easily removed heads for cleaning, or even disposable showerheads. Toilets can be pre-formed. This all helps prevent the spread of legionnaires’ disease.
Cleaning technology and room design are linked. It is now possible for floor coverings to have antifungal properties such as a PUR (polyurethane) vinyl top-coat that works very efficiently with modern microfibre cleaning materials. These are better than traditional spray and wipe cleaning as the filaments in the cloths and mops utilise no chemicals and are therefore less harmful to the environment and less hazardous to health. The result is vastly improved hygiene, with up to 99% of surface bacteria being removed.
Contamination control is also improved by coating doors and wall panelling with BioCote antimicrobial protection. The gold or silver ion-coated handles clean on contact, reducing this very common method of spreading germs and infection. The same antibacterial coating approach can be extended to curtains and bedding materials, which are major contributors to the spread of infection.
Another technology, Easy-On, is especially good for creating surfaces that clean more efficiently. It protects the quality of a finish on a surface such as wood for as long as 25 years. Surfaces clean as though they were glass and the lifecycle of wooden or other surfaces is extended.
We use ozone in the cleaning processes. This converts O2 to O3, reducing energy usage by over 40% because no hot water is needed during the cleansing process. The environment is a beneficiary due to a 90% reduction in the use of chemicals.
One innovative approach to reduce MRSA that is not a widespread practice is the separation of tasks that can create a risk of cross-contamination. In the traditional healthcare environment, for example, the entire ward is cleaned by one person, who is also involved in food service. This creates a higher risk of contamination. BAM introduced a new approach involving strict delineation of tasks. Workers that are involved in food handling are not employed in deep cleaning. BAM believes this is a major factor in reducing the risk of MRSA being spread.
The net result is that at all the health facilities managed by BAM FM so far, while cases of MRSA have come into the facilities, not a single case has spread. There is constant evolution in how the experience of facilities management and the intrinsic design of our health facilities interact. For example, it is becoming widespread practice for nurses and hospital operatives not to wear uniforms outside their place of work – for example, in cars or on public transport. Uniforms attract and import infection. The corollary is clear – we need more locker space, better laundry management and more staff changing facilities.
An Australian idea that has been imported into modern design is aimed at speeding patients’ recovery by providing ‘positive wandering space’. This is a very simple idea – such as communal areas for eating which allow greater social interaction. These areas can be enhanced by using ‘domestic’ rather than ‘institutional’ colour schemes, making them more akin to a home environment. Many visitors to East Ayrshire Community Hospital remark that it feels more like a hotel. The use of colour schemes for those with sensory difficulties is increasingly used for navigating around facilities.
The principle of positive care extends to the landscape and providing rooms that have a relaxing view. At mental health facilities in East Ayrshire and Tayside for instance, we use the sort of plants that provide a pleasant fragrance that is enhanced by touch. At the same time, these must not be poisonous if consumed accidentally.
BAM won healthcare contractor of the year for its work at Essex Cardiothoracic Centre recently – the landscaping and design were significant aspects of that project. The benefits of better hospital design will be felt for generations of patients.
BAM FM manages services for three hospital health facilities in East Ayrshire, Doncaster, Leeds and mental health facilities at Tayside. BAM Construction is one of the UK’s largest healthcare contractors and is on all three major healthcare framework agreements. Both are part of BAM Construct UK.
Contact BAM FM Ltd (Scotland office) Kelvin House, Buchanan Gate Business Park Stepps, Glasgow G33 6FB UK T +44 141 779 8888 F + 44 141 779 8889 www.bam.co.uk