How to Plan for Infection Control
Posted on 29 January 2018
Patient Safety has always been a priority for Mediclinic and complying with Infection Prevention and control (IPC) principles was always a key consideration when new buildings have been designed.
With the emergence of multi-drug, extreme-drug and pan resistant organisms, so-called ‘Superbugs’ the healthcare industry has become even more conscious of the need to continuously monitor and improve IPC processes. “While IPC protocols are based on science, the effective implementation of these protocols is determined by human behaviour, such as practicing good hand hygiene. Mediclinic believes that design can support and assist to channel human behaviour to support adherence to IPC practices. Clever planning when designing units will result in improved human behaviour, assisting to improve compliance to protocols when the unit is operational,” explains Briette du Toit, Infection Prevention and Control Officer for Mediclinic Southern Africa.
Infection control: Process flows define safe layout
Let us consider an isolation unit or high care ward where patients are either exceptionally vulnerable or the patient poses a high-risk for transmission of pathogens.
In order to ensure compliance to hand hygiene, alcohol handrub dispensers have to be placed at the point of care and at the entrance and exit of a unit. For isolation units, placement of personal protection equipment (PPE) for nursing staff and a dedicated area to dispose of used PPE items can be as important as the actual equipment itself. Ensuring that documentation relating to the patient is stored outside the unit to ensure that the documents themselves are not contaminated and spread the infection/pathogen across the facility could be just as critical. In addition, decisions have to be made on where medication is stored – anything that has entered the isolation unit poses a risk of future contamination and should not be taken back to the pharmacy or store where it can contaminate the surrounding area. Each of these aspects has an impact on the design and flow of the patients’ room.
The ventilation system can also contribute to the transmission of infections and impact on patient safety. Certain diseases such as pulmonary tuberculosis and measles require special negative pressure rooms to prevent the transmission of these infectious diseases that spread through very small particles via air currents. Special negative pressure ventilation rooms are part of the isolation, medical or critical care units. Negative pressure refers to a ventilation system that generates negative pressure to allow air to flow into the isolation room, and then pushed to the outside, not back into the passage. Air will naturally flow from areas with higher pressure to areas with lower pressure, thereby preventing contaminated air from escaping the room. In a unit such as the hematology unit at Wits Donald Gordon Medical Centre, the opposite flow is required. Positive pressure from the ventilation ensures that air is pushed out of the room to avoid infection entering the treatment area of vulnerable patients.
Architects and engineers have to consider the flow of patients, equipment and staff when planning a room. “When it comes to design, we consider how the nurse will perform her actions and, through placement of wash basins and hand sanitising units, positive infection control habits can be reinforced. Hand sanitising units are placed alongside the bed, at the point of care or positioned outside the room, making it a challenge for nurses to move between patients without disinfecting their hands. It is important that the flow of the room encourage nurses to complete good hand hygiene between patients. Touch points of nurses when they moving between patients must be considered. The space between beds is also an important aspect to take into consideration to prevent infections. Adequate space between beds prevents contamination of equipment, bedlinen and the transmission of infections that are spread via heavy droplets, when patients cough,” explains Rinette van Wyk, a Mediclinic Architectural Design Team Manager.
By observation and experience clinical experts within the organisation have identified that creating physical barriers between patients may force nurses to pass these sanitising points, reinforcing the message and encouraging adherence to compliance to processes and aseptic techniques before moving on to the next patient. By recording, planning and testing these designs a best practice layout has been approved and is set as the model or ‘room data sheet’ for the hospital design team moving forward.
“Mediclinic has created room data sheets that give a detailed description of all the finishes, fixtures and fittings, mechanical and electrical requirements that will be required for each room or space in a project or building. The sheets are constantly updated as an indication of best practice across the 52 hospitals in the group, allowing the team to automatically incorporate approved and tested designs into each new project. We then use the room data sheets to communicate the client’s requirements for each room on a project or as a standard,” explains Amy Blaine, also an Architectural Design Team Manager with Mediclinic’s Infrastructure team.
A unique asset to Mediclinic’s business is the in-house team of engineers and architects that design and actively manage the whole project. Key to their understanding of infection prevention and control and other relevant aspects is the insight provided by clinical experts within Mediclinic, all having years of experience within the hospital environment. By working alongside each other technical knowledge from engineers is molded together with process insight from clinicians to create a safe environment for staff and patients alike.
Constant Learning Process
Materials used within the wards also need to be considered. While new treatments are available for certain equipment offering anti-bacterial benefits, it is often better to revert to simple treatments that can be continuously decontaminated rather than those that may contribute to greater resistance by the pathogens. Each element introduced into the hospital environment is considered, evaluated by a team of specialists, and decisions are made moving forward.
“Support services such as the dirty utilities are key areas for cross-contamination and the transmission of infection. Learning what has worked and what needs to be redesigned within such structures can have a significant impact on adherence to infection prevention and control principles in the hospital. Processes are continuously re-evaluated and new interventions tested to improving processes to ensure better outcomes and improve patient safety and the experience of the patient, emphasises du Toit.
“While Mediclinic has placed patient safety firmly as a core priority within their business, this does not signify the process is finished. As with any other design element, the changing healthcare landscape continues to influence processes and Mediclinic remains committed to improving the safety and overall experience of all patients within its care,” Briette du Toit affirms.