One of the biggest risks in hospitals is infection. Therefore hospitals and healthcare facilities should be designed to provide clean environments that assist in preventing the spread of contagions and pollutants. But even when infection is not the major concern, the architectural and interior design can improve patients’ rate of healing and should help to reduce stress and injuries of medical staff.
Curbing infections
Research on evidence-based design (EBD) and healthcare by *Alfonsi et al. has identified three transmission routes of nosocomial infections: Air, water and contact. Airborne and waterborne pathogens are mainly transmitted by hydraulic and ventilation systems, while contact-transmitted infections can be controlled through environmental design that influence behaviour (direct contact) and reduce the rate of pathogens on surfaces (indirect contact).

This is why Dr Vivek Desai, managing director of Hosmac India Pvt Ltd, a leading hospital planning and management firm in Mumbai, encourages close collaboration between caregivers and the professionals who plan facilities for care. In particular, he stresses that considerable inputs from agencies for air-conditioning, electrical services, plumbing and more, are critical to finalise the working plan of the building.

When it comes to reducing direct contact with bacteria, Alfonsi et al. points out that hand hygiene is strictly linked with the accessibility of hand-washing sinks. Increasing the ratio of hand-washing sinks per bed and providing accessible, alcohol-based hand rub dispensers closer to staff work paths, significantly increases hand-washing compliance.

Another option is to introduce single rooms. In the Bronson Methodist Hospital in the USA, after the extension of single bedrooms in low acuity units, together with hand-washing facilities, the rate of infection decreased by 45% in those units and by 11% in the entire hospital.

However, if single rooms are not feasible, the space between patients’ heads can be maximised, for example, United Kingdom healthcare design firm, Nightingale Associates, recommends only having four beds per 58m², or making use of Bed Pods, which provides a more private space for each patient.

Innovative materials
To address the risk of healthcare-associated infections (HCAIs) transmitted through indirect contact, many companies have come up with ways to develop self-disinfecting surfaces or fabrics. These include using compounds that are activated by light, thereby altering the structure or surface to minimise the attachment of microbes or to delay the development of biofilm. Others incorporate a heavy metal such as silver or copper, which has intrinsic antimicrobial activity and results in reduced microbial surface counts in clinical areas.

A team from Kenall Manufacturing together with the University of Strathclyde in Scotland have even developed a light fixture that uses continuous environmental disinfection technology to continuously inactivate a wide range of micro-organisms in the air and on surfaces. It uses a narrow spectrum of visible indigo-coloured light which is absorbed by molecules within bacteria, producing a chemical reaction that kills the bacteria from the inside. Because the light is visible, it is safe for patients and staff.

Speeding up healing
In addition to products and materials designed specifically for environments with high requirements in terms of hygiene, architects can also use functional design to create healing environments that contribute to the welfare and recovery of patients.

The research by Alfonsi et al. confirmed that contact with nature, whether real or simulated, lowers stress levels and effects physiological changes in blood pressure, heart activity, muscle tension and brain electrical activity. While this is true for anyone, for patients it is significant because it helps to speed up healing, reduces the length of hospital stay and lowers the sensation of pain.

Natural light is also a crucial factor that can expedite healing, but not all beds can have window views of nature. Valid alternatives are green-integrated shading systems, pictures of nature on walls and ceilings, and Bed Pods, such as the design by Nightingale Associates + Tribal, which incorporates soothing effects to be used during medical treatments.

Tackling layout inefficiencies
Hospital and healthcare facility design should also consider the caregivers. If workers experience injuries due to work difficulties and an unsafe work environment, absenteeism and general discontent increase. The result is a decrease in quality care, which in turn increases the risks for patients.

A big inefficiency, highlighted by Alfonsi et al., is time wasted walking. This has been assessed as taking up to 28,9% of nursing staff time, while patient-care activities only accounted for 56,9% of their time.

Unit layout, the shape of wards and the distance between patient rooms and nursing stations and stores supplies, undeniably play a role, and efficient design will help to reduce nursing staff walking and translate into patient-care activities.

An ideal might be to add workspaces and supply stores outside each patient room, but since this might not always be feasible, an alternative is supply storage for each room, such as the solution invented by PieArq for the Galliera Hospital in Italy. It is a wall-drawer where sterile medical equipment is stored every evening for use the following day, avoiding continuous trips to fetch equipment from a unique disposal.

Evidence-based design
Evidence-based design is a field of research that is widely used in the healthcare industry and, although it is an ongoing process that produces different ad hoc solutions, the principal outcomes of these studies are essential for performance-based healthcare design.

Full thanks and acknowledgment are given to Atelier Martel, CAZA, http://academic.oup.com, Keppie Design, Menkès Shooner Dagenais LeTourneux Architectes, Provencher_Roy and v2com for the information given to write this article.

Project focus: Ronald McDonald House children’s facility, Glasgow
When designing this children’s facility adjacent to Royal Hospital for Sick Children, Keppie Design took a humanising perspective, conceiving a “home away from home”.

The vernacular white brick structure creates a silhouette that shields the house from the noise of traffic and ambulances, while its gabled roofs and two landscaped courtyards give the building a welcoming feel and provide space for staff, patients and families to relax and interact.

Inside, calming, light-filled spaces flow throughout the building, providing comfort and reassurance.

Ronald McDonald House
© David Cadzow
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Project focus: Facility for people with epilepsy
French architecture firm, Atelier Martel, collaborated with doctors, patients and artist Mayanna von Ledebur from the start of the project, and the input of all involved has strongly impacted the location, design and materials used to create a protective but open environment.

An innovative touch is the stippled concrete facade designed by Von Ledebur, which is a free interpretation of the inscriptions of Mesopotamian steles, the first mention of epilepsy in written history. These indents also offer new sensory experiences, visually enriching the concrete walls and making them tactile, round and soft.

The building has a functional layout that limits the distances to be covered by the nursing staff and falls are limited by the absence of stairs, enabling the patients to move around freely. Four large planted patios soften the rough concrete through a curved matrix and colourful wool tapestries are hung against the walls, bringing patients closer to nature and giving the facility a homey feel.

ATELIER MARTEL
© Mayanna von Ledebur  /  © André Cepeda
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Project focus:
For the expansion and modernisation of the Sainte-Justine University Hospital Centre in Canada, Menkès Shooner Dagenais LeTourneux Architectes and Provencher_Roy followed a “hyper-nature” concept to create a healing and welcoming environment.

The architects made use of colours and elements inspired by the animals and plants of the nearby forest, natural light and green paths linking the existing building to the new one. In addition, vivid colours and fun symbols brighten up the corridors while serving as functional navigation markers.


Sainte-Justine
© Stephane Brügger
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Performance-based healthcare design should:
1.    Prevent the spread of infections.
–    Design that influences behaviour.
–    Innovative disinfecting surfaces.
2.    Improve the rate of healing for patients.
–    Contact with nature.
–    Natural light.
3.    Make it easier for medical staff to do a good job.
–    Functional layouts.