Environmental contamination with highly resistant microorganisms after relocating to a new hospital building with 100% single-occupancy rooms: A prospective observational before-and-after study with a three-year follow-up.

INTRODUCTION: Inanimate surfaces within hospitals can be a source of transmission for highly resistant microorganisms (HRMO). While many hospitals are transitioning to single-occupancy rooms, the effect of single-occupancy rooms on environmental contamination is still unknown. We aimed to determine differences in environmental contamination with HRMO between an old hospital building with mainly multiple-occupancy rooms and a new hospital building with 100% single-occupancy rooms, and the environmental contamination in the new hospital building during three years after relocating. METHODS: Environmental samples were taken twice in the old hospital, and fifteen times over a three-year period in the new hospital. Replicate Organism Direct Agar Contact-plates (RODACs) were used to determine colony forming units (CFU). Cotton swabs premoistened with PBS were used to determine presence of methicillin-resistant Staphylococcus aureus, carbapenemase-producing Pseudomonas aeruginosa, highly resistant Enterobacterales, carbapenem-resistant Acinetobacter baumannii, and vancomycin-resistant Enterococcus faecium. All identified isolates were subjected to whole genome sequencing (WGS) using Illumina technology. RESULTS: In total, 4993 hospital sites were sampled, 724 in the old and 4269 in the new hospital. CFU counts fluctuated during the follow-up period in the new hospital building, with lower CFU counts observed two- and three years after relocating, which was during the COVID-19 pandemic. The CFU counts in the new building were equal to or surpassed the CFU counts in the old hospital building. In the old hospital building, 24 (3.3%) sample sites were positive for 49 HRMO isolates, compared to five (0.1%) sample sites for seven HRMO isolates in the new building (P < 0.001). In the old hospital, 89.8% of HRMO were identified from the sink plug. In the new hospital, 71.4% of HRMO were identified from the shower drain, and no HRMO were found in sinks. DISCUSSION: Our results indicate that relocating to a new hospital building with 100% single-occupancy rooms significantly decreases HRMO in the environment. Given that environmental contamination is an important source for healthcare associated infections, this finding should be taken into account when considering hospital designs for renovations or the construction of hospitals.

Maximizing hospital capacity to serve pandemic patient surge in hot spots via queueing theory and microsimulation

This paper presents a mixed-integer mathematical program with embedded equations developed from concepts of queueing theory and Jackson networks for estimating the steady-state maximum potential hospital capacity for COVID-19 patient care in extreme surge conditions, where a hospital must turn nearly all of its existing resources toward the care of pandemic patients. Estimating the potential maximum hospital capacity for pandemic patient care can aid in assessing regional healthcare capacity during surges in pandemic patient demand, predicting shortfalls, and designing preparedness and response actions. To obtain such estimates and inform action, the program determines a best assignment of a heterogeneous staff of nurses and doctors to key units appropriate for their skills to create the optimal allocation of staffed beds. An alternative trial-and-error approach is offered that decision-makers without optimization or software expertise can use to obtain similar estimates. Under a given assignment of resources, a variety of key performance indicators can be obtained through the direct use of the queueing equations. Results of comparisons to outcomes from a detailed discrete event simulation model of an identical hospital design show the accuracy of the equations to be high despite the added simplifications needed for the use of a closed-form equation-based methodology. KEYWORDS: Micro-simulation;hospital capacity planning;COVID-19;pandemic;queueing theory;surge planning;KPIs. Copyright © 2022 "IISE".

Preventing the spread of COVID-19 through environmental design in Thai community hospitals

The unprecedented outbreak of COVID-19 has had a tremendous negative impact on healthcare facilities, especially public hospitals. Thai community hospitals serve as primary care for COVID-19 patients. However, many hospital buildings were constructed in the 1990s and are now becoming outdated. Community hospitals faced many difficulties during the Thailand COVID-19 outbreak. To identify these difficulties this study focused on the physical settings of the community hospital’s outpatient departments (OPD) between 2020 and 2021. Furthermore, the study provided design suggestions for preventing the spread of respiratory infectious diseases. The study used a three-step process of data collection. The first was to observe the physical settings of the OPD buildings of the three hospitals. Secondly, interviews were conducted with thirty healthcare employees: 11 from the first hospital, 11 from the second hospital and 8 from the third hospital. Interviews were transcribed and analyzed using content analysis. Subsequently, the architectural design was produced based on observation and interview analysis. In the third step, the same thirty participants evaluated the architectural design through a focus group. Findings from the interviews led to four themes: 1) factors leading to the accumulation of pathogens, 2) measures for preventing the spread of respiratory diseases, 3) the effect of patient numbers on virus transmission, and 4) suggestions for improving the physical setting of OPDs. The analysis of the four themes led to the preliminary design recommendation, which was evaluated through a focus group, leading to suggestions for the improvement of thirteen areas. The analysis results showed that the participants were satisfied with the architectural design with additional minor recommendations. This study provided originality for the implementation and future development of hospital layout designs that can prevent the spread of COVID-19 throughout Thai community hospitals. Copyright © 2022 Waroonkun and Prugsiganont.

Prevention and Control of Airborne Infections;investigating the efficiency of hospital design using (AIC) evaluation tool

Our world is resisting the new pandemic “severe acute respiratory syndrome Coronavirus 2” (SARS-CoV-2) causing the disease known as COVID-19. To date, more than two hundred and three million cases were confirmed out of who more than four million died. Sharing data that will help the community to intervene with measures that will decrease the spread of the virus and protect the population is an obligation. This will help the world cope with this pandemic. This research aims to highlight the different criteria that will determine that the building of a health facility is ready to control the infection of this virus and similar airborne viruses. The research developed an evaluation tool that can be used by hospital administration to assess the hospital building readiness to prevent and control airborne infection from the viewpoint of architecture if it is an existing one or alternatively it can assess the design in case of a new hospital building, determining required roles and responsibilities.

STROKE CARE QUALITY BETWEEN 2017- 2020: OBSERVATIONAL DATA FROM THE AUSTRALIAN STROKE CLINICAL REGISTRY

Background and aims: National clinical quality registries facilitate reliable monitoring of stroke care by providing local hospital teams with data on their performance compared to national benchmarks. We aimed to assess changes in stroke care over time from public hospitals participating in the Australian Stroke Clinical Registry (AuSCR). Methods: AuSCR stroke quality care indicators were compared between 2017 and 2020, using a matched-hospital design. Analyses were limited to adults with stroke or transient ischaemic attack admitted to hospitals contributing ≥30 episodes each year during the study period. Descriptive statistics and linear tests for trend were used to assess changes in quality indicators across years. Results: Among 47 eligible hospitals, admissions increased from 13,508 (2017) to 18,139 (2020). Overall, half were aged ≥75 years, 45% were female, and 59% had a severe stroke (no differences by year). Between 2017 and 2020, improvements were observed for: endovascular retrieval (+8%;P<0.001), hyperacute antithrombotics (+6%;P<0.001), mobilisation during admission (+3%;P<0.001), swallow screen/assessment within 4 hours (+12%;P<0.001), discharge care planning (+11%;P<0.001), and discharge secondary prevention medications (+10%;P<0.001). However, delivery of thrombolysis remained unchanged (-1%;P=0.07), door-toneedle within 60 minutes decreased (-6%;P=0.008), and access to stroke unit care declined in 2020 (76% 2019 vs 72% 2020;P<0.001). Conclusion: Improvements in many indicators of quality stroke care have been observed within Australian hospitals participating in a national registry. Declines in timeliness to thrombolysis and access to stroke units in 2020 represent a likely consequence of the COVID-19 pandemic that requires national action.

Investigating the role of spatial configuration on visitors' spatial cognition in health-care spaces: case studies in Gilan, Iran

Purpose This study aims to explore the impact of spatial configuration on behavioral patterns of visitors in the ground floor of health-care spaces. Design/methodology/approach In this study, the Space Syntax analysis was used to combine visibility graph analysis and axial line analysis with empirical observation of visitors' activities. Two types of observation methods on visitors were conducted to discover the behavioral patterns of individuals, respectively, named "gate counts" and "people following." Findings The outcomes of this research revealed that the spatial arrangements of pathways, public areas, vertical circulations, entrance space, lobby, emergency department, reception desk and pharmacy have a significant influence on the way that visitors perceive the health-care environment. Research limitations/implications The current research is limited to two aspects of effective wayfinding (configuration of health care and geometry). Future work can investigate the other potential factors coupled with the current factor as an integrated research for enhancing wayfinding and sustaining accessibility. Another limitation is that the observation results for this study had been conducted before the COVID-19 pandemic and future studies can compare these results with the current COVID-19 situation within health care environments. Originality/value A large amount of research has focused on the needs of populations in developed countries. This topic has not been investigated thoroughly by professionals in developing countries such as Iran. Accordingly, this study benefits environmental psychologists and architects by revealing the effective characteristics of legible spaces in health-care environments.

Assembling atmospheres, encountering care: risk, affect, and safety in the cystic fibrosis clinic

This paper explores the design of hospital environments, in order to investigate how issues of infection control, spatial layout, and embodied practices intersect in the accomplishment of ‘care-ful’ geographies. Specifically, we trace how the material environments of three UK cystic fibrosis (CF) clinics are assembled in order to orchestrate routines that minimise the risk of cross-infection between patients and safeguard their wellbeing. Our analysis of these clinics, derived from interviews with staff and patients and ethnographic observation, reveals the importance of environmental factors in brokering affective atmospheres that can alleviate patients’ anxieties. Theoretically, we draw on Ben Anderson's understanding of how affect works as, simultaneously, an object-target, bodily capacity, and collective condition, in order to draw out the architectural atmospherics of the CF clinic. That is, we first report how clinic staff anticipate cross-infection risks and configure the physical environment in order to minimise these risks. We then describe the embodied practices of patients as they move through hospital spaces in ways that protect themselves, and others, from cross-infection. Finally, we analyse how this choreography of material environments by staff and the movement of patients’ bodies combine to evoke a shared understanding of the clinic as a safe space, in contrast to perceptions of the hospital as a threatening environment. Our focus on the affective atmospheres of the CF clinic allows us to develop an in-depth analysis of the role of materialities, mobilities, and design in the social construction of risk, especially in a post-COVID pandemic age.

Responsiveness and Adaptability of Healthcare Facilities in Emergency Scenarios: COVID-19 Experience.

The COVID-19 pandemic revealed many vulnerabilities of the contemporary built environment along with limited preparedness and low efficiency in mitigating unexpected and unprecedented challenges. This article discusses the efficiency and responsiveness of basic hospital spatial layouts in three different scenarios: normal operation; the segregation of a large number of patients and still providing them with access to emergency healthcare, typical for a pandemic; and a sudden, extremely high number of admissions typical for compound disasters and terrorist attacks. A set of parameters and a method for general adaptability assessment (GAAT) that can be used as a tool in decision-making processes as well as evaluation of both existing facilities and the new models for resilient hospitals resulting from the experience of the pandemic are proposed. The paper emphasizes why factors among which adaptability, convertibility, and scalability should be at the very core of hospital development and management strategies. It also discusses new models of adaptable healthcare facilities that enable day-to-day operations to continue alongside a pandemic, and other emergency scenarios.

Factors affecting compliance to COVID-19 infection prevention and control measures and its effects on the risk of COVID-19 infection among physicians in a tertiary government hospital

Background: The coronavirus disease-19 (COVID-19) pandemic has severely affected the medical healthcare system in the Philippines, and members of the healthcare team are in the position to institute appropriate infection control and preventive measures against the disease. Physicians, who are valuable members of the frontline force addressing the disease, are at high risk for contracting the virus. Nevertheless, an array of individual, environmental, and organizational factors may contribute to noncompliance to infection control and increase the risk of contracting the disease. Objective: To determine the factors affecting compliance to COVID-19 infection prevention and control (IPC) measures and risk of COVID-19 infection among residents and fellows in a tertiary government hospital Design: Cross-Sectional Design Methods: From April to June 2021, 112 purposively-selected residents and fellows from different departments of a tertiary, government hospital completed a six-part survey questionnaire about their demographic profile, knowledge, attitude, perception of organizational and environmental factors, and compliance to COVID-19 infection prevention and control measures. Data were analyzed using exploratory factor analysis, linear regression, and log-binomial regression. Results: Compliance to COVID-19 infection prevention and control measures had three factors: hand hygiene and sharps disposal, medical equipment disinfection and waste disposal, and personal protective equipment utilization. Among the different dimensions, compliance score was lowest on personal protective equipment utilization (x=3.62, SD=0.49) and highest on hand hygiene and sharps disposal (x=3.72, SD=0.40). Results also showed that the perception of the organizational (β=0.42, p=0.01) and environmental factors (β=0.43, p=0.01) on infection prevention and control significantly affected compliance. However, the risk of COVID-19 infection was not affected by the knowledge, attitude, perception of organizational and environmental factors, and compliance with infection prevention and control measures. Conclusion: The perception on the organizational and environmental factors of infection prevention and control are substantial factors affecting the compliance to COVID-19 IPC measures of residents and fellows. This understanding can be utilized by infection control committees in developing appropriate strategies and programs to promote positive perception on IPC measures.

Building back smarter—part three: placing modular facilities in a resource-limited healthcare system

Land should be one of the greatest assets of the UK healthcare system, as a result of its large estates portfolio. Howere, the current state of many of the NHS's buildings means that physical spaces are often more of a burden, with maintenance backlogs costing billions. However, as a resource-limited public institution, it is crucial that all investments into NHS infrastructure are as effective and future-proof as possible. The previous two articles in this series have focused on the potential benefits of modular facilities to healthcare staff, services and patients, drawing on case studies of NHS trusts that have implemented modular facilities on their sites. This article, the third and final instalment of this series, discusses the health economic impact of current NHS infrastructure, and explores the ways in which modular facilities could provide a flexible and cost-effective means of expanding capacity and improving services in a resource-limited environment.

A National Look at Hospital Bed Tower Design.

This study evaluates 171 hospital bed tower designs from the past decade. The Floor-building gross square feet (BGSF)/Bed, patient care area, ratio between them, and the bed count per unit were analyzed. The findings suggest that the average patient care area has decreased 5%-10% to a 305 departmental gross square feet (DGSF)/Bed average. The patient care area, support, circulation, and area grossing on floor were found to average 908 Floor-BGSF/Bed, and were impacted by the total beds/unit. It was determined that larger bed count per unit designs with 32-36 beds/unit average 21.9% less Floor-BGSF/Bed than designs with 24 beds/unit. The research evaluates design solutions impacted by a shifting environment of regulatory change and escalating costs. The hospital bed towers represent new facilities, horizontal/vertical expansions, and 25+ design teams. Design and/or construction took place during a 10-year period (2008-2018). The acute patient unit designs were reviewed and electronically quantified. The area measurement methodology aligns with the guidelines set forth in the "Area Calculation Method for Health Care" guidelines. Each project team was faced with a unique but similar set of circumstances. The balance between core values, guiding principles, budget, and quality of care was always present and included a diverse combination of owners, designers, construction delivery methods, profit models, and clinical approaches. In today's world, common solutions are grounded in providing the best value. Project teams face a number of challenges during design. The lack of information should never be one.

Environmental hygiene, knowledge and cleaning practice: a phenomenological study of nurses and midwives during COVID-19.

BACKGROUND: Environmental cleanliness is a fundamental tenet in nursing and midwifery but often overshadowed in practice. This study explored nurses' and midwives' knowledge and experiences of infection prevention and control (IPC) processes and cleaning, and perceptions about workplace risk-management during COVID-19. METHODS: Six registered and enrolled nurses (one with dual midwife qualifications) were recruited. In-depth telephone interviews were analyzed using Colaizzi's phenomenological method. RESULTS: Four major themes were identified: Striving towards environmental cleanliness; Knowledge and learning feeds good practice; There's always doubt in the back of your mind; and COVID has cracked it wide open. These articulate the nurses' and midwives' experiences and knowledge of IPC, particularly during COVID-19. DISCUSSION: The findings emphasize the dynamic, interdependent nature of clinical (time, staff knowledge and compliance, work processes, hospital design) and organizational contexts and environmental cleanliness, which must be constantly maintained. COVID-19 opened up critical insights regarding poor past practices and lack of IPC compliance. CONCLUSIONS: COVID-19 has highlighted the criticality of environmental cleanliness within clinical and community settings. Evidence-based, experiential learning is important for nurses and midwives at all career stages, but provides only one solution. Clinician-led hospital design may also reduce the spread of infection; thus, promoting better patient care.

Temporary hospitals in times of the COVID pandemic. An example and a practical view.

We describe the most widely used temporary hospital in Europe during the first pandemic wave, its structure, function, and achievements. Other models of care developed during the pandemic around the world were reviewed including their capacity, total bed/ICU bed ratio and time of use. We particularly analyzed the common and differential characteristics of this type of facilities. IFEMA Exhibition Center was transformed into a temporary 1,300-bed hospital, which was in continuous operation for 42 days. A total of 3,817 people were treated, generally patients with mild to moderate COVID-19, 91% of whom had pneumonia. The average length of stay was 5 to 36 days. The most frequent comorbidities were hypertension (16.5%), diabetes mellitus (9.1%), COPD (6%), asthma (4.6%), obesity (2.9%) and dementia (1.6%). A total of 113 patients (3%) were transferred to another centers for aggravation, 19 (0.5%) were admitted to ICU and 16 patients (0.4%) died. An element of great help to reducing the overload of care in large hospitals during peaks of health emergencies could be these flexible structures capable of absorbing the excess of patients. These must be safe, breaking domestic transmission and guarantee social and emotional needs of patients. The success of these structures depends on delimitation in admission criteria taking into account the proportion of patients who may require, during admission, assistance in the critical care area.

An Italian Neurorehabilitation Hospital Facing the SARS-CoV-2 Pandemic: Data From 1207 Patients and Workers.

Objective: The aim of the present observational study is to report on the data from a large sample of inpatients, clinical staff and other workers at an Italian neurorehabilitation hospital dealing with SARS-CoV-2 infections, in order to analyze how it might have affected the management and the effectiveness of neurorehabilitation. Methods: The data on infection monitoring, obtained by 2,192 swabs, were reported and compared among 253 patients, 722 clinical professionals and 232 other hospital workers. The number of admissions and neurorehabilitation sessions performed in the period from March-May 2020 was compared with those of the same period in 2019. Results: Four patients and three clinical professionals were positive for COVID-19 infection. Six out of these seven people were from the same ward. Several measures were taken to handle the infection, putting in place many restrictions, with a significant reduction in new admissions to the hospital (p < 0.001). However, neither the amount of neurorehabilitation for inpatients (p = 0.681) nor the effectiveness of treatments (p = 0.464) were reduced when compared to the data from 2019. Conclusions: Our data show that the number of infections was contained in our hospital, probably thanks to the protocols adopted for reducing contagion and the environmental features of our wards. This allowed inpatients to continue to safely spend more than 3 hours per day in neurorehabilitation, effectively improving their independence in the activities of daily living.