Architectural design strategies for infection prevention and control (IPC) in health-care facilities: towards curbing the spread of Covid-19

Society of Critical Care Medicine 2024 Guidelines on Adult ICU Design

RATIONALE

Advances in technology, infection control challenges-as with the COVID-19 pandemic-and evolutions in patient- and family-centered care highlight ideal aspects of ICU design and opportunities for enhancement.

OBJECTIVES

To provide evidence-based recommendations for clinicians, administrators, and healthcare architects to optimize design strategies in new or renovation projects.

PANEL DESIGN

A guidelines panel of 27 members with experience in ICU design met virtually from the panel's inception in 2019 to 2024. The panel represented clinical professionals, architects, engineers, and clinician methodologists with expertise in developing evidence-based clinical practice guidelines. A formal conflict of interest policy was followed throughout the guidelines-development process.

METHODS

Embase, Medline, CINAHL, Central, and Proquest were searched from database inception to September 2023. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine certainty in the evidence and to formulate recommendations, suggestions, and practice statements for each Population, Intervention, Control, and Outcomes (PICO) question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and practice statements when the benefits of the intervention appeared to outweigh the risks, but direct evidence to support the intervention did not exist.

RESULTS

The ICU Guidelines panel issued 17 recommendations based on 15 PICO questions relating to ICU architecture and design. The panel strongly recommends high-visibility ICU layouts, windows and natural lighting in all patient rooms to enhance sleep and recovery. The panel suggests integrated staff break/respite spaces, advanced infection prevention features, and flexible surge capacity. Because of insufficient evidence, the panel could not make a recommendation around in-room supplies, decentralized charting, and advanced heating, ventilation, and air conditioning systems.

CONCLUSIONS

This ICU design guidelines is intended to provide expert guidance for clinicians, administrators, and healthcare architects considering erecting a new ICU or revising an existing structure.

Investigation of airborne contaminant transmissions using network models: COVID-19 outbreak and potential risk in senior care facilities

Many COVID-19 outbreaks occurred in senior care facilities during the last three years. Senior care facilities are nursing places for the long-term treatment and care of senior citizens, who are prone to be exposed to an infectious disease that spreads into these buildings. Therefore, this study investigated airborne contaminant transmissions based on outbreak cases in senior care facilities in Korea and analyzed the potential impact of architectural features in a selected senior care facility using network simulations. The results showed that during COVID-19 outbreaks in 85 senior care facilities the staff accounted for the largest proportion of the index cases, indicating that the staff members would be the primary virus carriers in the initial process of the virus transmission in the senior care facilities. Network simulations indicated that the (reverse) stack effect could significantly influence airborne contaminant transmission in these facilities during the summer and winter months. The indoor airborne contaminant exposure may change according to seasonal indoor airflows, with the potential for long-distance airborne contaminant transfer through shafts (e.g., elevators and staircases) in the senior care facility. The findings of this study can serve as a reference for developing customized countermeasures against airborne contaminant transmissions in senior care facilities.

Evaluating the resilience of residential buildings during a pandemic with a sustainable construction approach

The COVID-19 pandemic has been a catastrophic event that has affected all aspects of human life worldwide. Due to the high genetic mutations of the virus, there has been a prolonged search for definitive therapeutic discovery, leading to extended periods of home quarantine. As a result, homes have become multipurpose spaces for work, education, sports, and other daily activities. Given the importance of residential buildings as the first line of defense against possible future pandemics, a model has been proposed to assess their readiness to handle pandemics using a sustainable development approach. This study investigates the most crucial criteria for evaluating residential buildings and applies them in a Multi-Criteria Decision Making (MCDM) process. The final evaluation model is presented using the SWARA and COCOSO methods, along with a set of criteria selected and weighted by experts. The study shows that the criteria related to health and safety are more critical than other sectors. Buildings that meet the standards of this group better are likely to have a higher score.

The impact of COVID-19 on visitors' wayfinding within healthcare centers

The novel COVID-19 pandemic has caused substantial calamities in developing countries such as Iran, which initially suffered from inadequate infrastructure essential for the pandemic control. Due to the ongoing development of this malady, healthcare centers are recognized as one of the most significant hotspots within public settings so they are directly pertinent to the physical and mental health of visitors. The main objective for conducting the present study is to investigate the impact of the COVID-19 pandemic on the visitors' wayfinding procedure within Qa'em hospital, located in Rasht, northern Iran. The adopted methodology in the present study is based on a comparison between the collected data regarding the wayfinding behavior of visitors before and after the outbreak of the COVID-19 pandemic using mixed methods, namely Space Syntax, gate counting, people following, and semi-structured interviews. The obtained empirical results displayed that visitors were significantly confused and hesitant throughout their wayfinding process after the outbreak of the pandemic. Indeed, spatial accessibility and legibility were not found to be adequate for facilitating the wayfinding of the visitors. Moreover, the requirements for the reconfiguration of furniture layout in the waiting areas, according to the underlying notions of social distancing, became conspicuous as the pragmatic implications for the post-pandemic healthcare centers.

Evaluating Therapeutic Healthcare Environmental Criteria: Architectural Designers' Perspectives

This study presents architectural designers’ perception of the importance of healthcare environmental criteria in the implementation of user-centered, therapeutic hospital design. Architectural designers with over three years of professional experience (N = 182) in South Korea were surveyed using an empirical questionnaire. The extensive interviews of 15 hospital design experts followed to interpret the survey results and discuss the barriers and suggestions for the successful delivery of therapeutic healthcare design practice. Among the 27 variables selected from the preliminary literature review, factor analyses revealed seven important therapeutic environmental criteria (i.e., management, interior design, spatial quality, service, nature and rest, ambient indoor comfort, and social program and space; χ2 = 1783.088, df = 300, p < 0.001). Analyses of variance revealed the level of importance among these criteria related to respondents’ personal and professional characteristics. Significant differences were found for the variables from the management, interior design, and spatial quality factors in relation to the respondents sex and age. For the successful delivery of therapeutic healthcare design, the design experts highlighted the implementation of evidence-based design practice that integrates local and international knowledge from various hospital users and multi-disciplinary specialists participating in the healthcare design process.

Active Design: Architectural Interventions for Improving Occupational Health Through Reducing Sedentary Behavior - A Systematic Review

OBJECTIVES

To systematically review architects' literature concerning stair promoting design interventions for reducing sedentary behavior and improving occupational health.

DATA SOURCES

English language, manuscripts published between 2000 and 2022 in Google scholar, Science Direct, PubMed, CINAHL, and ERIC.

STUDY INCLUSION AND EXCLUSION CRITERIA

The criteria for inclusion in this review include; Presence of two words from the searching term in the title, a study conducted by an architect (or at least one architect author), English language, published after 2000, investigate built environment and design features that influence stair use in the building.

DATA EXTRACTION

The data extraction process included; Author (year), country, study design, type of buildings, the population of the study, duration of the study, measured variables (dependent and independent), measurement tool, analysis and outcomes.

DATA SYNTHESIS

Extracted data were synthesized in a tabular format and analytical figures with narratives summary.

RESULT

Nine features of the built environment that affect stair use determined from the literature; safety, motivations, appeal and comfort, and legibility were the most common features in the studies, followed by connectivity, building codes, and elevator programming. The good quality of mentioned features positively affects stair use level and vice versa. However, the review also reports a shortage of architects in both practice and research concerning active stair design.

CONCLUSION

Stair use is of great importance in increasing physical activity and improving occupational health in the workplace. Architects and designers should pay special attention to the design of staircases and encourage their everyday use by considering the largest number of features that encourage stair use.

Development of an infectious disease prevention behavior model for public health center workers in a rural area of Indonesia

The Infection Prevention Behavior (IPB) for health personnel at the Surade Public Health Center has not reached the target. The purpose of this study was to develop the IPB model for health personnel which is suitable to be applied in rural areas in Indonesia. The model was developed through a literature review from online journal database in the last 10 years. The model was tested using a cross-sectional design by the Structural Equation Model Partial Least Square (SEM-PLS). Six selected variables had direct and indirect influences on the IPB of health personnel. They were supervision (27.50%), facilities (9.87%), training (10.44%), compensation (16.97%), work climate (10.78%), and work motivation (8.15%). The model was valid and significant. The Q2 showed 95.7% which mean 95.7% of the components in the model could be applied to other Public Health Centers in the rural area. The development of IPB models for health personnel which wass measured from the direct and indirect effects of six variables proved valid and significant to help achievement Public Health Center reach the target of protecting health workers from infectious diseases.

Developing a conceptual framework for the health protection of United Nations peacekeepers against the COVID-19 pandemic from global health perspectives

The coronavirus disease 2019 (COVID-19) pandemic has posed particular health risks to United Nations peacekeepers, which require prompt responses and global attention. Since the health protection of United Nations peacekeepers against the COVID-19 pandemic is a typical global health problem, strategies from global health perspectives may help address it. From global health perspectives, and referring to the successful health protection of the Chinese Anti-Ebola medical team in Liberia, a conceptual framework was developed for the health protection of United Nations peacekeepers against the COVID-19 pandemic. Within this framework, the features include multiple cross-borders (cross-border risk factors, impact, and actions); multiple risk factors (Social Determinants of Health), multiple disciplines (public health, medicine, politics, diplomacy, and others), and extensive interdepartmental cooperation. These strategies include multiple phases (before-deployment, during-deployment, and post-deployment), multi-level cooperation networks (the United Nations, host countries, troop-contributing countries, the United Nations peacekeeping team, and United Nations peacekeepers), and concerted efforts from various dimensions (medical, psychological, and social).

Designing for COVID-2x: Reflecting on Future-Proofing Human Habitation for the Inevitable Next Pandemic

The COVID-19 pandemic of 2020–2022 has revealed the vulnerability of modern society to a highly contagious airborne virus. Many spaces in the urban and built environment designed during the late twentieth and early twenty-first century are ill-suited to maintain the level of social distancing required to reduce the probability of virus transmission. Enclosed spaces—in particular, communal circulation spaces such as corridors, elevators and lobbies—have proven loci of transmission, together with circulating reticulated air and lack of proper ventilation. While urban planning needs to incorporate the lessons learnt during COVID-19 in order to future-proof our communities through the provision of well-designed greenspaces, the main burden will fall on architects, who will play an instrumental role in designing buildings that are fit-for purpose. This conceptual paper reviews the status quo and discusses a number of strategies to future-proof human habitation for the inevitable next pandemic.

Associations between the COVID-19 Pandemic and Hospital Infrastructure Adaptation and Planning-A Scoping Review

The SARS-CoV-2 pandemic has put unprecedented pressure on the hospital sector around the world. It has shown the importance of preparing and planning in the future for an outbreak that overwhelms every aspect of a hospital on a rapidly expanding scale. We conducted a scoping review to identify, map, and systemize existing knowledge about the relationships between COVID-19 and hospital infrastructure adaptation and capacity planning worldwide. We searched the Web of Science, Scopus, and PubMed and hand-searched gray papers published in English between December 2019 and December 2021. A total of 106 papers were included: 102 empirical studies and four technical reports. Empirical studies entailed five reviews, 40 studies focusing on hospital infrastructure adaptation and planning during the pandemics, and 57 studies on modeling the hospital capacity needed, measured mostly by the number of beds. The majority of studies were conducted in high-income countries and published within the first year of the pandemic. The strategies adopted by hospitals can be classified into short-term (repurposing medical and non-medical buildings, remote adjustments, and establishment of de novo structures) and long-term (architectural and engineering modifications, hospital networks, and digital approaches). More research is needed, focusing on specific strategies and the quality assessment of the evidence.

The Need for Smart Architecture Caused by the Impact of COVID-19 upon Architecture and City: A Systematic Literature Review

The recent pandemic era of COVID-19 has shown social adjustment on a global scale in an attempt to reduce contamination. In response, academic studies relating to smart technologies have increased to assist with governmental restrictions such as social distancing. Despite the restrictions, architectural, engineering and construction industries have shown an increase in budget and activity. An investigation of the adjustments made in response to the pandemic through utilizing new technologies, such as the internet of things (IoT) and smart technologies, is necessary to understand the research trends of the new normal. This study should address various sectors, including business, healthcare, architecture, education, tourism and transportation. In this study, a literature review was performed on two web-based, peer-reviewed journal databases, SCOPUS and Web of Science, to identify a trend in research for the pandemic era in various sectors. The results from 123 papers revealed a focused word group of IoT, smart technologies, architecture, building, space and COVID-19. Overlapping knowledges of IoT systems, within the design of a building which was designed for a specific purpose, were discovered. The findings justify the need for a new sub-category within the field of architecture called “smart architecture”. This aims to categorize the knowledge which is required to embed IoT systems in three key architectural topics—planning, design, and construction—for building design with specific purposes, tailored to various sectors.

A Review on Building Design as a Biomedical System for Preventing COVID-19 Pandemic

Sustainable design methods aim to obtain architectural solutions that assure the coexistence and welfare of human beings, inorganic structures, and living things that constitute ecosystems. The novel coronavirus emergence, inadequate vaccines against the present severe acute respiratory syndrome-coronavirus-(SARS-CoV-2), and increases in microbial resistance have made it essential to review the preventative approaches used during pre-antibiotic periods. Apart from low carbon emissions and energy, sustainable architecture for facilities, building designs, and digital modeling should incorporate design approaches to confront the impacts of communicable infections. This review aims to determine how architectural design can protect people and employees from harm; it models viewpoints to highlight the architects’ roles in combating coronavirus disease 2019 (COVID-19) and designing guidelines as a biomedical system for policymakers. The goals include exploring the hospital architecture evolution and the connection between architectural space and communicable infections and recommending design and digital modeling strategies to improve infection prevention and controls. Based on a wide-ranging literature review, it was found that design methods have often played important roles in the prevention and control of infectious diseases and could be a solution for combating the wide spread of the novel coronavirus or coronavirus variants or delta.

Identifying Health Care Environment Contradictions in Terms of Infection Control during a Pandemic with a Focus on Health Workers’ Experience

During the past year, health care environments have struggled to cope with the various impacts of COVID-19 around the world. Health care facilities need to help strengthen resistance to pathogen threats and provide care for patients and health workers in the safest possible way. Architectural design strategies can play a significant role in infection prevention and control. The current study aims to examine the experiences of health workers with hospital spaces during the COVID-19 pandemic. Identifying the difficulties they face, the present study attempts to shed light on the role of the health care layout configuration in combating pandemics. The authors conducted observations at four hospitals and a series of online semi-structured interviews with 162 health care staff from March to May 2020. The study indicated that space configuration and the hospitalization of patients, layout and circulation of the environment, operation services such as indoor environment conditions, maintenance of health care system, and organizational support for health care staff were the most critical factors affecting infection control in health care environments. The initial zoning and separation of patients were the most effective methods of controlling infection. Hospitals with clustered plan layouts were found to be the most effective buildings for the zoning of COVID-19 patients during the pandemic and for infection control.

Environmental hygiene, knowledge and cleaning practice: a phenomenological study of nurses and midwives during COVID-19

Background

Environmental cleanliness is a fundamental tenet in nursing and midwifery but often overshadowed in practice. This study explored nurses’ and midwives’ knowledge and experiences of infection prevention and control (IPC) processes and cleaning, and perceptions about workplace risk-management during COVID-19.

Methods

Six registered and enrolled nurses (one with dual midwife qualifications) were recruited. In-depth telephone interviews were analyzed using Colaizzi's phenomenological method.

Results

Four major themes were identified: Striving towards environmental cleanliness; Knowledge and learning feeds good practice; There's always doubt in the back of your mind; and COVID has cracked it wide open. These articulate the nurses’ and midwives’ experiences and knowledge of IPC, particularly during COVID-19.

Discussion

The findings emphasize the dynamic, interdependent nature of clinical (time, staff knowledge and compliance, work processes, hospital design) and organizational contexts and environmental cleanliness, which must be constantly maintained. COVID-19 opened up critical insights regarding poor past practices and lack of IPC compliance.

Conclusions

COVID-19 has highlighted the criticality of environmental cleanliness within clinical and community settings. Evidence-based, experiential learning is important for nurses and midwives at all career stages, but provides only one solution. Clinician-led hospital design may also reduce the spread of infection; thus, promoting better patient care.