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Hospital design and innovative cleaning can protect patients from resistant bacteria

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Lund University

Hospitals should design premises and adapt their infection control routines to a society that no longer has effective antibiotics, and that is vulnerable to fast-spreading global pandemics. This is argued in a new dissertation from Lund University in Sweden.

"Many hospitals in Sweden and the world are becoming old and worn out. Therefore, we now have the chance to build properly from an infection control point of view", says Torsten Holmdahl, doctoral student at Lund University and medical consultant at the infection clinic at Skåne University Hospital.

Torsten Holmdahl's dissertation includes studies on the planning and construction process of the new infection clinic at Skåne University Hospital in Malmö. As the former director of the clinic, he was also involved in this process.

"In my opinion, infection control should be one of the highest priorities when building new hospital premises. I realised that the new construction in Malmö was an opportunity that should not be missed", says Torsten Holmdahl.

As a result, all occupational categories at the clinic were involved in the planning. In addition, a full-scale, fully-equipped model of a patient room was also built, where extensive tests of infection safety and working methods were conducted.

The hospital decided to combine knowledge about construction from the time before antibiotics were used in healthcare with the latest requirements for a modern and well-functioning hospital. The end result became a building with very high standards of infection safety, with external entrances to all rooms and separate lifts/walkways to the clinic. The ventilation requirements, single-room standards, work patterns of the staff and the interaction with the adjacent emergency room, have all had a major impact and affected the final design.

The thesis also shows that they managed to keep construction costs down through extensive standardisation. In his conclusion, the importance of prioritising infection control and the participation of experts in disease control in the planning and construction processes are emphasised as factors for success.

Another aspect of major significance for the spread of infection is cleaning. Traditional hospital cleaning is done manually and several previous studies have pointed to deficiencies:

"According to international studies, in a newly cleaned space there is twice the risk that the newly admitted patient becomes infected with the previous patient's disease. Or that they take over as carriers of resistant bacteria", says Torsten Holmdahl.

According to the thesis, one solution involves different automated cleaning methods. It means that the staff start by removing any visible dirt, after which a machine or cleaning robot performs a more efficient decontamination.

Torsten Holmdahl found that the best results were obtained using hydrogen peroxide which, after cleaning, is aired out and broken down into eco-friendly end products. The research studies on new cleaning methods now continue at the infection clinic.


Facts/Infection clinic at Skåne University Hospital in Malmö:

The infection clinic at Skåne University Hospital in Malmö became operational in 2010. The function of the building is echoed in the design; floors 2-4 is where the infection clinic's single rooms are located and, currently, also the infection ward of the paediatric clinic. To prevent the spread of infection, all rooms have their own visitor's entrance from the characteristic balconies with glass windows. These provide some protection from the elements while the air circulation is sufficiently good from a disease control point of view. The staff have access to the rooms from an inside corridor.

The strict hygiene requirements have been combined with high demands for an interesting design.

In 2010, the infection clinic was awarded the Malmö Urban Planning Prize, and, in 2012, the Building Better Healthcare Award. The architects are C. F. Møller Architects in cooperation with SAMARK Arkitektur & Design.

Facts/Increased risk of virulent diseases:

Antibiotic-resistant bacteria - The occurrence of antibiotic-resistant bacteria has increased gradually over time, and several of the most common antibiotics today have little or no effect. Building hospitals in a way that makes the spread of infection more difficult and facilitates efficient cleaning are two of the many different methods to limit contagion and the number of ill patients.

Climate change - As carbon dioxide in the atmosphere increases and climate zones move north, there is a risk that unwanted microorganisms will gain a foothold in northern latitudes as well.

SARS (Severe Acute Respiratory Syndrome) - A communicable virus that was completely unknown before 2003. SARS is a contagious pneumonia that started in China and spread rapidly to Hong Kong, Singapore, Vietnam and Canada. It caused extensive emergency preparedness efforts in Swedish healthcare. The disease is now uncommon.

Calici (winter vomiting bug) - The calici virus is extremely contagious even in small quantities and causes severe gastrointestinal illness in the affected person. Many Swedish hospitals and nursing homes have problems with calici infections during large parts of the year.

Clostridium difficile - Clostridium difficile is a bacterium often found in normal intestinal flora. In case of overgrowth, it can lead to severe diarrhoea. The bacterium forms spores that can be difficult to remove from contaminated premises.

Fast-spreading pandemics and epidemics - The swine flu (new flu) outbreak in 2009 and the ebola outbreak in West Africa 2014 are some recent examples of how a virus can spread widely and quickly, and require high levels of protection in the form of disease control. Our way of travel today, which includes intercontinental flights, increases the rate of contagion.

(Source: Lund University and Skåne University Hospital)


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