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Issue Paper #1: 

The Impact of Design on Infections in Healthcare Facilities

Anjali Joseph, Ph.D.
The Center for Health Design, July 2006
Funded by the Robert Wood Johnson Foundation

Summary

Hospital-acquired infections, or nosocomial infections, are one of the leading causes of death in the United States —- killing more Americans than AIDS, breast cancer, or automobile accidents. In 1995 alone, nosocomial infections contributed to more than 88,000 deaths -- one death every six minutes -- and cost $4.5 billion.

Nosocomial infections typically affect patients who are immunocompromised because of age, underlying diseases, or medical or surgical treatments. Nosocomial infections are transmitted in hospitals through three main environmental routes -- air, surface contact, and water.

Airborne infections are transmitted when pathogens, such as Aspergillus, that survive well in the air, or dust and moisture present in healthcare facilities are released into the air. This usually happens during hospital renovation and construction activities and due to contamination and malfunction of the hospital ventilation system.

The importance of good air quality in controlling and preventing airborne infections in healthcare facilities cannot be overemphasized. Providing clean filtered air and effectively controlling indoor air pollution through ventilation are two key aspects of maintaining good air quality. HEPA filters, in particular, are highly effective in filtering out harmful pathogens and are strongly recommended in areas housing immunocompromised patients.

Adequate ventilation rates and regular cleaning and maintenance of the ventilation system are critical for controlling the level of pathogens in the air. Some special precautions to prevent infection during periods of construction and renovation include using portable HEPA filters and installing barriers between patient care and construction areas.

Most infections are transmitted in hospitals through the contact pathway. While microbiologically contaminated surfaces are reservoirs of pathogens, few infections are transmitted by direct contact with surfaces. Most infections are transmitted through contact with the hands of nurses and physicians, and poor handwashing compliance poses a serious problem in this regard.

There is some evidence that environmental support for handwashing -- providing numerous, conveniently located alcohol-rub dispensers or washing sinks -- can increase compliance. In particular, the evidence suggests that installing alcohol-based hand cleaner dispensers at bedside usually improves adherence.

Single-bed rooms are strongly recommended from an infection-control perspective -- it is easier to isolate infectious pathogens and disinfect single-bed rooms than multi-occupancy rooms once a patient has been discharged. The threat of infections spread through contact transmission of pathogens is also reduced in single-bed rooms with conveniently located sinks.

Waterborne infections spread through direct contact (e.g., for hydrotherapy), ingestion of contaminated water, indirect contact, and inhalation of aerosols dispersed from water sources. Regular cleaning, maintenance, and testing of water systems and point-of-use fixtures is important for preventing the spread of waterborne infections, such as Legionnaires’ disease.

A complete listing of references is also included.

Download PDF of 16-page paper.