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Facility Design to Reduce Hospital-Acquired Infection

No one who enters a hospital to address an acute or chronic health condition deserves to acquire a dangerous or life-threatening infection as a result of their temporary vulnerability. The Institute of Medicine report (2000), To Err Is Human, described the unnecessary deaths or harm attributable to preventable causes, one of which is infection acquired during a hospital stay. The problem of hospitalacquired infection is increasing around the world (Scott, 2004). It is exacerbated by the emergence of resistant strains among many bacterial and viral infection sources (Capriotti, 2003). Design of the hospital environment plays a role in the control or transmission of infection. Proper hand hygiene is the single most effective intervention in the prevention of infection in hospital settings (Albert & Condie, 1981; Boyce & Pittet, 2002; Larson, 1988). Prevention of infection may be facilitated or hampered by specific physical design features of the facilities for decontaminating hands. How can the design and research communities contribute to important improvements in the prevention of infections?BackgroundInfections that originate in the hospital, also called nosocomial infections or hospital-acquired infections (HAIs), are a serious problem (Capriotti, 2003; Struelens, 1998). Infections are caused by bacterial, viral, or fungal organisms, and strains of these organisms have developed resistance to the antibiotics used to treat them. Strains of methicillinresistant Staphylococccus aureus (MRSA) have been spreading rapidly in hospitals and in the community. Struelens (1998) reported that strains of vancomycin-resistant staphylococci and enterococci are emerging, and that Klebsiella pneumoniae, Enterobacter, Pseudomonas aeruginosa, and Acinetobacter baumannii are gradually developing resistance to "useful classes of antibiotics, including the penicillins, cephalosporins, aminoglycosides, and fluoroquinolones" (p. 652). Increased death rates associated with outbreaks of Clostridium difficile have been reported in North American hospitals (Wilcox, Cunniffe, Trundle, & Redpath, 1996). Other community-acquired infections, such as resistant strains of tuberculosis, also have appeared (Frieden et al., 1993).Fungal infections, such as Aspergillus (Stevens et al., 2000), can be found at construction sites, for example, in the case of hospital renovations.There are reports that physicians overprescribe antibiotics, and that patients don't always take their antibiotics to the end of the prescribed course. These factors tend to increase drug resistance in the organisms that threaten hospital patients (Capriotti, 2003).Scope and Consequences of the ProblemThere are strong reasons to reduce rates of HAIs. The cost of HAIs, in dollars and unnecessary suffering or death (Scott, 2009), is enormous. Infections are more serious than they have been in the recent past. After World War II it was assumed that penicillin was a "miracle drug" capable of defeating any infection. Penicillin, sulfa, and numerous other drugs provided excellent defenses against infection, but seven decades later, many infectious organisms have developed resistance to the range of drugs in the physicians' armamentarium. More virulent strains of infectious organisms with greater resistance to antibiotics threaten patients in healthcare settings with lowered immune responses (Capriotti, 2003). The number of infections, adverse events, and errors in critical care environments is especially significant (Rothschild et al., 2005) in ICUs, where the most vulnerable patients face increased risk for every day they stay. If configuration and features of the hospital and critical care environments can make a significant difference in reducing infections, then discovery of better designs must become a high priority.Contact Transmission and Hand HygieneThe transmission of infection from one patient to another is often through the contact of a caregiver with a patient, or with objects and surfaces either may touch. …