Tuesday, January 16, 2018
Image: surgeons scrubbing their hands

Every year, approximately 75,000 people die as result of health care-associated infections (HAIs) in the United States, according to estimates from the Centers for Disease Control and Prevention. In this blog post, Paula Wright, RN, BSN, CIC, sheds light on the impact health care design has on infection prevention, and how designers, architects and infection prevention specialists can work together to decrease risks in the built environment.

Wright has been a nurse for 43 years, and has been in infection prevention and control since 1994. She currently works as a project manager within the Infection Control Department at Massachusetts General Hospital. Wright acted as a member of the FGI Health Care Guidelines Revisions Committee for the 2014 and 2018 editions. Additionally, Wright is a part-time ASHE faculty member, teaching the Managing Infection Prevention During the Construction & Operation of Health Care Facilities program.

Q: You‘ve worked in infection prevention since 1994. What has compelled you to stay in this area of health care for so many years?
A: (Wright) Infection prevention is an incredibly interesting and diverse field. You need to have a working knowledge of many different things, which always keeps me learning. Oftentimes, there is a narrow view of the infection prevention field. People think you focus only on hand washing and blood-borne pathogens; however, the field encompasses a vast number of skills and topics. We monitor the environment of care, investigate outbreaks, develop educational programs, look at medical equipment and how it’s maintained, establish policies and procedures for clinical best practices for preventing infection, review cleaning and sterilization of devices and cleaning and disinfection of the environment, and much, much more. Every day is different and it’s never boring.

Q: How has infection prevention changed as the health care field has shifted?
A: (Wright) When I started in the infection prevention field over 20 years ago, there was far less medical equipment in each room. While the increase in technology has obvious benefits when it comes to patient care, it means many more touch surfaces that health care staff interact with on a daily basis. Facilities must establish proper cleaning procedures and clearly delineate who is responsible for maintaining the equipment.

Additionally, with the shift to ambulatory care, more and more procedures are done in outpatient spaces that weren’t originally resourced or built to meet the needs or demands of those procedures. When changes are made to accommodate different types of care, Infection Prevention should be involved in order to identify risks and adjust processes as necessary.

Q: What is the HAIO Patient Room Challenge?
A: (Wright) In 2010, a businessman gathered a handful of Boston architects, facilities staff, infection prevention specialists, and epidemiologists to look at the role of the built environment as it contributes to transmission of infection. The group, the Healthcare Associated Infections Organization (HAIO), began meeting to research and review literature to come up with the ideas for what might constitute the optimum patient care room in terms of infection prevention.

After meeting and learning about infection prevention for some time, the HAIO invited seven multidisciplinary architectural firms to participate in the “Patient Room Challenge,” and put together a storyboard for the hypothetical “ideal” infection prevention patient room. The submissions were reviewed by epidemiologists, infection preventionists, and environmental service professionals. Elements of each submission were categorized into positives and negatives and the positives were further broken down into categories based on how the feature contributed to infection prevention such as “facilitates cleaning” or “facilitates hand hygiene”. The HAIO group used this information and moved on to evaluating and vetting products and ideas that could be used in the room. This process involved many in-depth conversations, but ultimately, the template room was designed and is currently under construction at Brigham and Women’s Hospital. Once the room is complete, it will be tested in various ways to determine if it’s easier to clean, if it can be scaled and ultimately, if it reduces infection risks.

Q: What unique aspects can be found in the template room?
A: (Wright) From design development, pre-construction, construction and beyond, designers and architects should involve infection prevention professionals in projects early and often; they can identify risks along the way and provide direction for mitigating those risks, saving the organization money and preventing setbacks in the future, while making the health care environment a safer space.

Join us at the 2018 PDC Summit for more on this hot topic. In the session Putting Competition Aside: Architects Collaborate to Eliminate HAIs, you can learn more about the HAIO Patient Room Challenge and explore the importance of collaborative design in preventing the spread of infection.