Medical Construction & Design

JAN-FEB 2015

Medical Construction & Design (MCD) is the industry's leading source for news and information and reaches all disciplines involved in the healthcare construction and design process.

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Proper hand hygiene — fi rst defense Good hand hygiene is one of most basic yet ef ective means of reducing the spread of infection. In "The Important Role of Sink Location in Handwashing Compliance and Microbial Sink Contamination," a 2014 study in the American Journal of Infection Control, the authors investigated how sink location and visibility infl uences hand- washing and microbial contamination de- tected on clinical sinks in three pediatric intensive care units. They concluded the visibility of sinks directly impacts hand- washing frequency and duration and also has an impact on levels of bacterial con- tamination on and around the sink area. In planning for biocontainment units there are not only spatial requirements but also the requirements for ef ectively com- partmentalizing the unit from other areas in the facility. Upfront planning entails locating demising partitions, in addition to segregating the unit ventilation from shared ventilation exchanges. The recent Ebola outbreak has present- ed another set of facility concerns with the need for separate spaces for donning and dof ng protective gear as detailed in the revised CDC guidelines, "Guidance on Personal Protective Equipment To Be Used by Healthcare Workers Dur- ing Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Dof ng)." Anterooms provide a practical solution but their number is most often limited to a certain percentage of patient rooms and if there is an anticipated need for more anterooms that has a major impact on square footage. Another prevention consideration involves the disposal of contaminated waste. Determining "follow the process fl ow" pathways for safely storing and exit- ing waste is a primary programming issue for planners working with environmental services. Having immediate access to all the personal protective equipment before staf members enter the patient room is critical. Personal protective equipment takes up space; the design challenge is to make it easily accessible. Moreover, there is a strong correlation between ef ciency and patient safety. For recent projects at Ocean Medical Center and Houston Methodist Hospital, surveys of "super users" regarding supplies they need most helped guide the design. This degree of coordination takes time but it can be part of an iterative process: listening to feedback, reporting the fi ndings and then getting back to the users with the fi ndings in order to further guide the design. One of the issues in accessibility is the need to accommodate staf — human beings of various sizes. Reach heights are key. In designing for ef ciency, commonly used equipment is located in a middle height area. The least used equipment could be stored high or low. There's a reason why the middle shelves in a grocery store have the highest premium; they are the most valuable real estate because of being the most accessible. Factoring in design solutions The next level of refi nement measures design solutions against the latest infection-prevention literature, and then pushes beyond the published fi ndings with new interventions. For example, improving hand hygiene behavior with the number and location (including sight lines) of sinks is one aspect. Another is specifying plumbing fi ttings and other high-touch surfaces that are easily cleaned. The surfaces get contaminated on such a frequent basis that they will remain contaminated most of the time unless it is easy to arrange additional cleanings with operations. Could daily surface cleaning be increased to twice a day, or twice a shift? Nurses know they need to wash their hands to protect the patients, but they inadvertently touch the sink or other surfaces, and those surfaces are full of germs. Antimicrobial surfaces such as antimicrobial metals are a move in the right direction but they have not been tied to a successful reduction in infections acquired in the hospital. To date, antimicrobial metals require a minimum two-hour contact time with an organism before disinfection can fully occur on the surface — because they don't kill on contact, there is inevitably some biofi lm that remains. Visitors who have touched a door knob and then touched their eye may think the surfaces are clean, but in fact have become contaminated. The recent study, "The role of facil- ity design in preventing the transmis- sion of healthcare-associated infections: Background and conceptual framework," INFECTION CONTROL ISSUE FOCUS Comanche County: Aker Imaging Sink locations for both clinicians and family members in key circulation points at Coman- che County Memorial Hospital, Leah M. Fitch Cancer Center in Lawton, Oklahoma can impact clinical effi ciency and patient safety. 28 Medical Construction & Design | JA N UA RY/ F EBRUA RY 2015 | MCDM AG.COM

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