Contagious: The Role of Infection Control in Design

At first glance, this seems like a REALLY dry topic. The overly-technical kind you gloss over when reading a magazine or skip out on attending at a conference. But, before you give up on reading this post, consider: who wants to see their hard work in design ruined by the unsightly application of hand sanitizer dispensers, or the failure to really think about the visual clutter that hand washing sinks bring? 

Compliance with their infection control policies are no laughing matter. The Centers for Medicare and Medicaid will no longer pay for charges to treat patients for hospital acquired infections (HAI). Additionally, The Joint Commission, who accredits many hospitals and ambulatory care facilities, looks for compliance with infection control standards during their facility inspections. Can good infection control practice be supported through design decisions?
It can if you work with staff, including the infection control director and materials management folks instead of leaving decisions up to the facility to figure out post-construction. Employ evidence-based design strategies and don’t forget to follow-up post-occupancy to see how they are working:


1. Out of sight is out of mind- sinks that are not conveniently located in the main path of travel into and out of patient rooms, exam and procedure rooms or treatment/recovery bays are not likely to be utilized. Study the flow of staff in their existing space and talk about the steps they take before entering and leaving the patient zone. 

2. Create visual cues to help remind staff to use the sink- use floor patterns, ceiling treatments, lighting or contrasts in finishes to call attention to the sink area. Positioning the sink in the patient’s line of sight can also keep the patient aware that the proper measures are being followed by their caregiver.

3. Don’t forget about the accessories. At every sink, is a dispenser for paper towels, and soap, trash disposal and possible space for a sharps container or glove boxes. Place these to avoid creating visual clutter- but don’t get too clever. Over-designed custom casework that doesn’t consider the process of caregiving often goes unused. For example, cabinets for glove boxes are abandoned in favor of boxes placed right on the counter the first time someone needs gloves and can’t find them instantly. Also, materials management often negotiates contracts with paper towel or soap companies and the ugly plastic dispensers are often part of the deal. Work closely with the hospital to develop a policy for these items or you may find a soap dispenser on the wall right above the countertop mounted one you designed. Give it a couple of years, and there will be a different plastic dispenser made all the more resplendent by the holes in the wall left by the previous one’s removal. 

4. And then there’s waste disposal. Staff usually loves a big open container for regular and/or red bag trash because it doesn’t need to be emptied too frequently and is easy to access without contaminating a countertop or cabinet surface. As these do not contribute to providing a patient-centered design environment, work with department staff and housekeeping to explore alternatives for containing and stowing waste. Options can include using smaller containers, or ones purchased based upon their ability to blend in aesthetically with the design. In some cases, where large volumes of trash are not likely to be generated, it may be possible to use containers that can slide under a counter or pull out from a cabinet like a drawer.

The patient experience and outcomes are affected by things we often fail to truly design. Far from being boring, thinking about infection control issues may be the most important decisions we make.