Visibility Impacts Patient Safety
Patient falls are the largest single category of adverse events in hospitals, resulting in serious injuries (such as head trauma or hip and arm fractures) that may lead to delayed rehabilitation, co-morbidity or even death. Our research brings attention to physical design factors and their impact on certain everyday care activities (e.g., patient surveillance, awareness and timeliness) that are crucial in preventing patient falls.
We discovered that specific rooms in a case study hospital had statistically significant increased fall incidence. A subsequent case-control study design, comparing the environments of those who fell with those who did not, found that patients not visible to nursing stations and/or from corridors were at an increased risk of falling. This is potentially due to the lack of visibility and accessibility to patients by caregivers, who are less able to intervene in situations in which a fall appeared likely to occur.
By using a mixed-methods approach to collect, analyze and interpret the falls data, we were able to demonstrate the importance of facility design and layout on patient safety.
Design May Impact Infection Prevention
To understand the role of design in infection prevention, we reviewed several thousand articles and narrowed them down to the 200 most relevant. We also interviewed experts in the various fields to determine the understanding of technologies, strategies and design interventions for mitigating the risk of infections.
Our multidisciplinary team, including researchers and clinicians from the Research Triangle Institute International (RTI), Emory University School of Medicine, and the Georgia Institute of Technology, explored three key questions:
- What conceptual framework best guides research and practice for using interventions in the built environment to control pathogens?
- For existing and new hospitals, what are the key design strategies that should be considered or avoided in new construction and renovation?
- What are important research directions to consider for the future?
A “chain of transmission” model was developed to depict the temporal and physical paths of pathogens that can cause healthcare-associated infections. Contact, air and water are the three primary mechanisms for transmission.
There are ways to interrupt the chain of transmission, such as standard safety practices, such as terminal cleaning, air filtration and water treatments. We found that design interventions -- conspicuous location of hand hygiene stations, for example -- can influence human factors such as improving hand hygiene compliance.
There is mounting evidence linking design interventions like antimicrobial surfaces, UVGI, HEPA filtration and copper-silver ionization, to a reduction in pathogen counts. However, there is limited research linking design interventions to a reduction in infection rates. The published guidelines are reticent to endorse the strategies or technologies without those outcome measures.