Each year in the United States, roughly 1.7 million cases of healthcare-associated infections (HAIs) cause an average of 99,000 deaths and cost hospitals around $20 billion, according to Centers for Disease Control and Prevention estimates. Research on this subject has often focused on how nursing and physician practices can reduce these rates. But building environment conditions also play a vital role too. From design to maintenance, engineering can help prevent HAIs and ultimately improve patient health and satisfaction.

Architectural teams must keep in mind that once constructed, hospitals and their mechanical systems have to function optimally for several decades to achieve this goal. Plus it is crucial for mechanical engineers and designers to understand the clinical environment and how patient care is provided.  To do so, it’s important to first understand how a building will be used, how doctors and nurses will actually use a space and how to meet stringent indoor air quality requirements, and then design all systems to be easily maintained and operated over time. Here are a few clinical needs to keep in mind while designing hospital space:

Air quality

During invasive procedures like surgery, air quality plays a crucial role in protecting the patient from airborne infectious agents, especially in spaces where dirty air can come into contact with an open incision. Good air quality depends on adequate filtration, the volume of new air, and pressurization.

The concept of indoor air quality is relative, depending on location. For example, a surgery unit is more critical than a basic care patient room, which is more critical than an ultrasound room. It’s important to serve each of these spaces with different air handling and distribution systems to minimize the risk of infection while maintaining efficiency.


Another important factor that contributes to the transmission of HAIs is humidity. In oxygen-enriched environments like surgery, low humidity creates the risk of static discharge and possible fire. Conversely, if humidity is too high, there’s a risk of growing harmful organisms like mold or bacteria that cause HAIs. Keeping humidity within the ideal range of 20 to 60 percent is extremely important for patient safety.

One solution is to place the humidistat in a location that’s both easily accessible and provides an accurate reading of the patient’s immediate environment. The sensor would also be connected to the HVAC building automation system and allow for continuous monitoring.

Designing for maintenance

Poor maintenance is also a leading cause of environmental conditions that lead to HAIs. Examples include loose filters allowing air to pass by without filtration, old filters not changed until they’re clogged and blocking needed airflow, and dangerous outgrowth of mold on filters that leads to dirty air reaching patients.

Designers have the opportunity to facilitate proper maintenance by understanding how systems will be operated both at the clinical and facilities levels. Specifically, particular attention should be paid to the space that’s being served, the patient population, the size and type of filters required for protection, and how filters and filter racks fit in ducts so there are no gaps.

In short, designing mechanical systems with a focus on patient outcomes has major benefits. Implementing these strategies are small decisions that can result in positive results that can be magnified over the lifetime of a hospital. (Image via Shutterstock)

Source:  Dan Swanson | Designing Healthcare Environments To Prevent HAIs | July 23, 2014 | HealthCareDesignMagazine.com

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