Healthcare-associated infections (HCAIs) pose a significant challenge to patient safety and healthcare delivery. According to a 2022 report from the World Health Organization (WHO), out of every 100 patients in acute-care hospitals, seven patients in high-income countries and 15 patients in low- and middle-income countries will acquire at least one HCAI during their hospital stay. On average, 1 in every 10 affected patients will die from their HCAI. People in intensive care and newborns are particularly at risk.1
In 2018, a report by Public Health England found that HCAIs in England resulted in an estimated 2.9 million extra bed days, 1 million antibiotic prescriptions and an estimated cost of £1 bn annually to the NHS. The report also highlighted the impact of HCAIs on patient outcomes, finding that patients with HCAIs had a 2-20 times higher risk of mortality compared to those without an infection.2 In addition, HCAIs can lead to prolonged hospital stays, with affected patients remaining in hospital 2.5 times longer than uninfected patients. The total annual cost of HCAIs in the UK is estimated to be £774 m.3 These staggering statistics highlight the critical need for robust infection prevention and control measures. The potential speed of infection transmission is alarmingly fast, and this is why infection control remains such a challenge for healthcare providers.
Two primary factors contribute to HCAIs: patient-related factors and healthcare-related factors. Patient-related factors include a weakened immune system, age and underlying medical conditions, while healthcare-related factors include poor hand hygiene, contaminated equipment and environments, invasive procedures and antimicrobial resistance. For the purposes of this feature, we will focus on healthcare-related factors.
High-risk infection hotspots
First, let’s look at typical high-risk infection hotspots in hospitals. These tend to be areas where there is a high concentration of patients, staff and equipment and include:
- Patient rooms: These are the primary source of infection, especially for patients with weakened immune systems. Bed rails, bedside tables and other surfaces in patient rooms can become contaminated with bacteria and viruses.
- Bathrooms: Bathrooms are high-risk areas due to the presence of moisture and potential for faecal contamination. Toilets, sinks and taps can harbour bacteria if not cleaned properly.
- Shared spaces: Common areas like waiting rooms, cafeterias and staff rooms can contribute to the spread of infection, especially if surfaces are not cleaned regularly.
- Medical equipment: Medical devices, such as catheters, ventilators and intravenous lines, can become contaminated with bacteria if not handled and cleaned properly. These devices can serve as a direct pathway for infection to enter the patient’s bloodstream.
- Mobile furniture: Mobile bedside tables, chairs and IV poles can become infection hotspots in hospitals. These items are frequently moved around, potentially spreading bacteria and viruses from contaminated surfaces to clean ones. The wheels and joints of this furniture can be difficult to clean, creating harbourages for microorganisms.
- Surfaces: High-touch surfaces, such as doorknobs, light switches and countertops, can become contaminated with bacteria and viruses. Regular cleaning and disinfection of these surfaces is essential to prevent the spread of infection.
Designing for infection prevention
Physical methods to reduce the risk of infection transmission include rigorous hand-hygiene, correct PPE, proper cleaning and disinfection of equipment and environments, ventilation and adherence to standard precautions and isolation protocols. While these measures are crucial, they are not always sufficient in preventing HCAIs. Today, there is increasing recognition of the role that healthcare environment design plays in preventing the spread of infection.
Traditional healthcare space designs and furniture can inadvertently contribute to infection transmission. Porous materials like fabric and wood, often found in traditional furniture, can harbour bacteria and are difficult to clean thoroughly. Intricate designs with numerous crevices and joints create ideal breeding grounds for microorganisms. Additionally, hard-to-clean surfaces, inadequate ventilation, inconsistent design layouts and inefficient workflows can further exacerbate the risk of infection.
Frequent cleaning can actually accelerate the deterioration of certain cabinet types, leading to the formation of bacterial hotspots. Similarly, cabinets that are based on simple kitchen-type cabinets have rough and inaccessible inner surfaces and often have fittings that harbour dirt. Other design issues include the use of sharp and shallow corners, poorly sealed joints in worktops, and crevices and gaps between surfaces. When investing in new FF&E either for new build healthcare facilities or as part of a refurb project, it is vital to find a supplier who can demonstrate a high level of infection prevention risk awareness and reduction. Anticipation and prevention are paramount in healthcare interior design. Furniture should be designed with minimal crevices to prevent bacterial growth, and materials should be easy to clean and disinfect — ensuring that equipment is easy to maintain and sterilise.
Some of the key design features that can minimise the spread of infection include:
- Smooth, seamless panels and surfaces are more resistant to damage and easier to clean and disinfect, reducing the potential for bacteria to accumulate in crevices and joints.
- Rounded corners on furniture and equipment can prevent the accumulation of dirt and bacteria.
- Antimicrobial coatings can inhibit the growth of microorganisms, while easy-to-clean materials like stainless steel and laminate can reduce the risk of infection.
- Limiting the use of porous materials like fabric and wood is crucial. If fabric is necessary, it should be easy to clean and disinfect.
- Well-designed, ergonomic furniture can reduce the need for frequent adjustments, minimising the spread of germs.
- Robust furniture is less likely to chip or split when a trolley hits it.
- Smooth and simple shapes for hinges and handles minimise crevices and gaps, making them easier to clean and disinfect.
Engage frontline staff
Engaging frontline staff in all aspects of infection control is crucial for several reasons. Frontline staff have firsthand experience and can provide valuable insights, leading to improved compliance and a sense of ownership. Involving staff in decision-making can boost morale and drive innovation in infection control practices, creating a culture of safety and significantly reducing the risk of HCAIs.
We believe that frontline healthcare professionals should be key influencers in healthcare design innovation and actively seek input from NHS staff across diverse teams when designing our furniture. For example, when we spoke to a team of consultant microbiologists, they told us that their investigations had found that human fingers — whether gloved or not — are among the most significant modes of infection transmission. They observed that every hospital nurse and doctor touches something 10 times a minute. That equates to about 33,000 times a week. Each touch can lead to the exchange of millions of bacteria, including those found on door handles, worktops, bed rails, keyboards, call buttons, desks, oxygen taps, phones and countless other objects.
This ’10 touches per minute’ figure applies to hospital wards, nurse stations and other general healthcare spaces, but alarmingly in other hospital areas — an anaesthetic room, for example — it can be up to four times higher. In such environments, 30-40 touches per minute have been recorded by microbiologists, which is about 100,000 touch points a week.
Consider the exponential impact when this figure is multiplied by the countless interactions between doctors, nurses, orderlies, trainees and patients. This intricate web of human contact highlights the systemic challenge of infection control. It’s clear that a comprehensive approach, extending far beyond PPE, is essential to mitigate the risk of HCAIs.
By adopting a proactive approach to infection control, Trusts and other healthcare providers can significantly reduce the risk of HCAIs. This involves a multi-faceted strategy that includes rigorous cleaning regimes, involving frontline staff in decision-making processes, consulting with infection control experts and partnering with FF&E suppliers who prioritise infection prevention. By focusing on these key areas, healthcare providers can create safer and more hygienic environments for patients, staff and visitors alike.
References
1 World Health Organization Global Report on Infection Prevention and Control. https://www.who.int/news/item/06-05-2022-who-launches-first-ever-global-report-on-infection-prevention-and-control.
2 Public Health England (now UK Health Security Agency): The Hidden Costs of HCAIs report.
3 Manoukian S, et al. Bed-days and costs associated with the inpatient burden of healthcare-associated infection in the UK. Journal of Hospital Infection. www.journalofhospitalinfection.com/article/S0195-6701(21)00190-0/fulltext.
Acknowledgement
This article was originally prepared for HEJ’s sister publication, Clinical Services Journal. We are grateful to CSJ’s Editor Louise Frampton for kindly permitting its inclusion in this month’s issue.