A Hospital Architect and an Administrative Responsibility- The aim of a hospital planner is to achieve a good hospital architectural design for better infection control and an administrator to practice good infection control policies and monitor them to achieve better patient care.
Not only is technology and design important for a hospital to run effectively but processes like infection control that is ignored in the planning stages is as important. Ignorance towards these soft department leads to high morbidity and mortality rates in the hospital adversely affecting the patient care, revenues, reputation, etc. Hospital planners, owners, senior administrators and key decision makers pay attention to mainly hospital design and planning but forget that functional departmental planning is as important as physical structural planning and each need to be interlinked for a successful hospital.
A patient enters a hospital thinking of it as a place where his ailments will end and he will return home bouncing to life again! But did you know that patients can get infections in the hospital while they are being treated for something else. These infections can have devastating emotional, financial, and medical effects. Worst of all, they can be deadly.
Every year, many lives are lost because of the spread of infections in hospitals. These Nosocomial infections, also called hospital acquired infections are a result of treatment in a hospital or a healthcare service unit. International average of infection rate is 3%. However, it is higher in India. Hospitals and health care workers can take steps to prevent the spread of infectious diseases. These steps are part of infection control.
The physical design and structure of a hospital is an essential component of a hospital’s infection control strategy, incorporating infection control issues to minimize the risk of infection transmission. Facility planning therefore needs to reflect the separation of dirty and clean areas, appropriate lighting and storage facilities, adequate ventilation, correct design of patient care areas, including adequate number of wash hand basins and single bed facilities. At the planning stage itself infection control criteria and principles should be fulfilled:
a) Hospitals should be designed to functionally segregate OPD, inpatients, diagnostic services and supportive services so that mixing of patient flow is avoided.
b) Critical areas like OT, ICU should be isolated from general traffic and avoidance of air movement from areas like laboratories and infectious diseases wards towards critical areas.
c) Zoning concept should be practiced during designing and ventilation standards should be maintained acute care areas.
d) Clean and dirty corridors should not be adjacent and they should facilitate traffic flow of clean and dirty items separately.
e) Adequate number of wash hand basins should be provided within the patient care areas and nursing stations with a view to facilitate hand washing practice for infection control.
f) Separate arrangements for garbage and infectious waste removal from wards and departments in the form of separate staircases and lifts should be incorporated.
g) Isolation wards for infectious cases should be kept out of routine circulation and constructed in ICU and acute care areas.
h) There should be a provision of airlock and anteroom before entering into critical care areas.
Apt designing, equipment and ventilation of wards go a long way in infection control in the area. A general ward can be planned based on bed strength ranging from 24-32 beds on rigs pattern where 2 single bed rooms, 2 four bedded rooms and rest 6 bedded rooms can be usually accommodated. One wash hand basin in each for these rooms averaging one wash basin per six beds is recommended. One to two standard isolation rooms per ward unit are planned throughout the hospital with wash basin in room, shower, toilet and bathroom.
Planning of ICU
The importance of adequate isolation facilities is not emphasized enough for an ICU. At least one cubicle per eight beds, sufficient space around each bed i.e. atleast 20 sq.m., wash basin between every other bed, ventilation including positive and negative pressure for high risk patients and sufficient storage and utility space is a thumb rule internationally while designing an ICU. ICU is planned with 15 air changes per hour (5 fresh + 10 re-circulation) as per minimum standards.
Each isolation cubicle is planned with self closing door and airlock. Air lock provides a barrier against loss of pressurization and against entry / exit of contaminated air into / out of the isolation room prevention spread of infections. Airlock also provides a controlled environment in which protective garments can be donned without contamination before entry into the room and acts as a physical and psychological barrier to control behaviour of staff in adopting infection control practices. It is also fitted with its own hand wash basin.
Planning of OT
Infection Control in OT can be carried out by planning correctly the design, ventilation, temperature, staff discipline, use of protective clothing and cleaning programme. While designing the OT the following factors should be considered:
a) Seamless flooring i.e. no joints
b) Plan OT to be in a separate area from general traffic and air movement of hospital.
c) Zoning i.e. sequence of increasingly clean zones from the entrance to the operating area with the aim of reaching absolute asepsis at operating site.
d) Easy movement of staff from one clean area to another without passing through dirty areas.
e) Removal of dirty materials from the suite without passing through clean areas.
This department most often overlooked during the planning and commissioning of a hospital needs to be given a more serious look and guidelines involving structural and functional requirements need to be put at the very beginning to be able to deliver efficient treatment and patient care.