A New Military Hospital
Can choosing the most effective cleaning method for infection control influence design decisions?
To use evidence-based design to raise infection control standards at a New Military Hospital.
Developing Infection Control Standards
The quest to develop tough infection control standards for a new military hospital started, literally, at ground level. To understand how to improve standards, architects and designers at HDR began by looking at how well floors and other surfaces were currently being cleaned throughout the existing hospital. The answer, as it turns out: not well.
“The hospital had been using a cleaning product designed for ceramic tile or porcelain tile for all surfaces in their existing facilities,” recalled Jean Hansen, Global Sustainable Interiors Manager for HDR, the hospital’s architecture and design firm. “It was ruining a lot of finishes because it was not a general purpose cleaner, and very harsh.”
To improve standards, Hansen says, the client wanted to effect a culture change. They wanted to do things “smarter and better,” and to implement best practices. To help them on their way, HDR championed evidence-based design strategies that would positively impact safety, healing, and patient outcomes.
“You really have to understand what your client understands,” says Hansen, who is based in HDR’s San Francisco office. “You need to have frank discussions about where they are at this point in time—and how they can rethink things from the perspectives of safety, healing, and patient outcomes.”
To understand the client’s needs, HDR held multiple stakeholder workshops to review everything from furniture to finishes.
To understand the client’s needs, HDR held multiple stakeholder workshops to review everything from furniture to finishes. Multidisciplinary teams were formed to make recommendations based on their workflow needs. The teams discovered early on that the hospital’s cleaning standards needed improvement. In some cases, furniture or flooring was being cleaned improperly or inadequately.
HDR started their analysis by asking the environmental services staff to help evaluate possible interior finishes before any decisions were made. Was the product easy to clean and keep clean? As Hansen says: “It’s important to have their buy-off. Without that, there’s limited chance for success.”
HDR also looked at the types of cleaning products that were being used. Hansen discovered that the organization’s standards required them to include antimicrobials, which she knew—from her research with Kaiser Permanente—were not always appropriate or desirable. A majority of antimicrobial products have not been tested for real-life scenarios, she says, and very little evidence exists to prove that adding antimicrobial agents to fabrics, furniture, or finishes improves their efficacy. In fact, Hansen says it can actually have the opposite effect: People think that because the product has added antimicrobials, it doesn’t need to be cleaned.
“It’s not self-cleaning,” she adds. “It still needs to be cleaned just as well.” The hospital’s administration agreed to review its standards requiring the use of (added) antimicrobials in every case. This opened up a new discussion about the kinds of furnishings and finishes that are best suited to a healthcare environment, including a review of how easy each one was to clean and keep clean. That included a head-to-toe examination of the durability, aesthetics, comfort, and ease of cleaning 13 recliners designed for use by patients. Nothing was overlooked; the arm details, the space where the seat and back meet, the levers, and the backrests were analyzed. The client took part in the evaluations, examining each recliner to confirm they would operate as intended—safely and durably for the staff and patients—and would meet infection control goals.
“We wanted to make sure that the surfaces and furniture can be maintained in a consistent manner,” Hansen says, “and that the environmental services staff don’t have to use two very different cleaning methodologies for finishes adjacent to each other.”
Today, many new cleaning methodologies are available, and Hansen believes designers and architects need to be familiar with them—including more comprehensive methods such as hydrogen peroxide vapor and ultraviolet germicidal radiation. Each of the different methods, she believes, can influence design decisions.
“If you don’t have a team that’s going to operate and clean onboard with what you are suggesting,” Hansen says, “it could be a potential challenge for the project. You need an integrated team. The appropriate team members need to evaluate the design, design details, and products to ensure maintainability.”
Architecture/Design Firm: HDR Architects