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Does proper design of an intensive care unit affect compliance with isolation practices?

Originally Published:
2011
Key Point Summary
Key Point Summary Author(s):
Zborowsky, Terri
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Key Concepts/Context

Local codes and current guidelines inform the design of airborne isolation rooms (negative pressure rooms), however, in general, little to no consideration is given to the regular patient rooms, which often serve as an isolation room for people with a multidrug-resistant organism (MDRO) or Clostridium difficile. This raises some questions: Is unit design a factor in infection transmission? How are these infections related to construction and renovation? Could design, function, or flow of an intensive care unit (ICU) affect patient outcomes?

This article tackles these questions, as well as looks at the importance of end-user input to renovation and construction healthcare projects.
 

Objectives

In this article, the authors explore the potential patient and staff impact of an improperly designed ICU. In addition, they hoped to, “create a communication bridge between infection prevention, the construction/renovation design team and clinical staff.”

Methods

Using a case study approach, the authors examined the functionality of two ICUs in the Baptist Health System’s five-hospitals. Their purpose was to capture a one-time snapshot of the flow in an ICU isolation
room to see if design could impact low and isolation compliance. In doing so, they created a spaghetti diagram of each medical intensive care unit (MICU).

The case study team performed observations and mapping on two 12 bed MICU’s between 8:30 a.m.  and 9:30 p.m. because contact isolation nurses identified that time frame  as a busy patient care time.
 

Design Implications
For designers, this article speaks to the integrative nature that design does and should take place. It offers much to consider as design tries to impact patient and staff outcomes. It also offers an algorithm for planning a design project. It was also noted that in the future, better design and placement of the supplies, medications, and the soiled utility room could enhance the work flow.
Findings

According the findings, patient and unit design, surface types, and supplies or medications accessibility effect staff’s ability to provide care to patients quickly and efficiently.

The authors conclude that design is one of several variables that impacts patient and staff outcomes. Further, say the authors, active end-user involvement and awareness of infection prevention during the early planning sessions, as well as through the end of the project, could prevent unfortunate design decisions. Finally, while acknowledging that it is time-consuming, the authors state that it is critical that all stakeholders give input early in the process.
 

Limitations

The observations were limited; additional in-depth observations over a longer period of time would help to
get more meaningful data that could inform future formalized improvements.

Design Category
Unit configuration and layout|Building location/site optimization
Setting
Hospitals
Outcome Category
HAI related outcomes|Patient health outcomes
Key Point Summary Author(s):
Zborowsky, Terri
Primary Author
Rodriguez, M.