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Just over two years ago, I was offered the opportunity to undertake a PhD focused on the relationship between the healthcare built environment and infection prevention and control (IPC). Having a rather unusual background as a town planner turned operating department practitioner, this seemed like an unexpectedly good fit with my experience and an excellent opportunity to take the next step in my academic development. Spurred on by a researcher’s curiosity and a growing interest in public health, I took up the opportunity.
My first impression of the relationship between the healthcare built environment and IPC was that it is a fascinating, but complex area. Early consideration of the evidence in the field certainly supported this view and gave me a taste of the depth and breadth of the issues involved. One issue of note, and the issue I chose to put at the heart of my research, centres on the role of IPC specialists in providing expert advice and guidance during the design and construction of new healthcare buildings.
In my review of the available literature, I noticed a consensus that the early and continuous involvement of IPC teams in the design and development of new healthcare buildings promotes good management of IPC design issues and is, therefore, a key element in managing IPC risk (Shajahan et al. 2019; Zimring et al. 2013; Stockley et al. 2006). Clear support for this position could be found in a number of areas, including within the relevant standards and guidance (Health Facilities Scotland, 2014; Department of Health, 2012), in key supplementary documents such as the Infection Prevention Society’s Competencies Framework for Infection Prevention & Control Practitioners (IPS, 2020) and in the recommendations from the independent reviews of events at the Queen Elizabeth University Hospital in Glasgow and the Royal Hospital for Children and Young People in Edinburgh (Scottish Government, 2020; NHS Lothian, 2020).
There were a number of important and interesting avenues to investigate in this area, each of which could have supported a thesis of its own! In seeking a manageable and useful research focus, however, I chose to explore the fact that whilst there is general agreement in the literature around what should be done, there is little analysis of how this should be done.
What, for example, are the best ways to stimulate and maintain IPC team involvement? Are the current mechanisms designed to achieve this engagement working as they should? If not, why not? Are IPC specialists confident in their ability to contribute effectively in matters of the built environment and do they have the resources to do so? Where are the models of best practice?
Without this baseline information, I found it difficult to understand how progress could be assessed and, thus, how interventions to improve any deficit in this important area could be designed and developed. As a result, I focused my research aims on addressing these gaps in knowledge and investigating how the current situation might be improved.
Several key pieces of information are needed in order to study and improve a process or practice, including gaining an understanding of current arrangements, identifying key areas of focus, highlighting what is working well and acknowledging gaps and deviations in the process (Silver et al. 2016).
Gathering this information required a qualitative, and specifically phenomenological, approach to the research. Speaking to IPC specialists about their own experiences and opinions of being involved in the development process and identifying where the challenges and opportunities lie seemed the obvious way to build a detailed picture of the status quo and to gather the data required to develop strategies for enhancing engagement. For this reason, data collection was designed around a series of semi-structured interviews.
I have recently started these interviews and this has turned out to be one of the most enjoyable parts of the research process. Using the COM-B model (a theory of behaviour, used to identify how to make a behaviour-change intervention effective) as a framework, I have structured my interview questions in a way which simultaneously explores the experiences of research participants and analyses engagement processes by looking at issues of capability, opportunity and motivation (West & Michie, 2020). Using behaviour change theory in this way provides more structure and focus to the interview protocol and opens up possibilities for using this theoretical framework as the basis of future interventions in the management of IPC issues within the healthcare built environment.
My initial impressions of the interesting and complex nature of this field of research have been confirmed and perhaps even amplified by my early interviews and I have already gained some fascinating insights. I am very much looking forward to my next interviews and to the challenges and discoveries which lie ahead in my research.
I am still recruiting participants to my research and I would welcome approaches from anyone who is interested in taking part. If you are currently involved with, or have previous experience of, providing specialist IPC advice and input during the specification, design or construction stages of a new healthcare building in the UK, I would be keen to hear from you.
If you would like to participate or if you are just interested in more information about the research, please contact me here.
Further reading:
Department of Health. Health Building Note 00-09: Infection control in the built environment. London: 2012
Health Facilities Scotland. SHFN 30 Part A: Manual Information for Design Teams, Construction Teams, Estates & Facilities and Infection Prevention & Control Teams. Edinburgh: 2014
Infection Prevention Society. Competencies Framework for Infection Prevention & Control Practitioners. Bathgate: 2020
NHS Lothian. Governance and Internal Controls: Royal Hospital for Children and Young People, and Department of Clinical Neurosciences Edinburgh. Edinburgh: 2020
Scottish Government. Queen Elizabeth University Hospital Review. Edinburgh: 2020
Shajahan A, Culp CH, Williamson B. Effects of indoor environmental parameters related to building heating, ventilation, and air conditioning systems on patients’ medical outcomes: A review of scientific research on hospital buildings. Indoor Air. 2019, 29(2), pp. 161 -176. https://doi.org/10.1111/ina.12531
Silver SA, Harel Z, McQuillan R, Weizman AV, Thomas A et al. How to begin a quality improvement project. Clinical Journal of the American Society of Nephrology. 2016, 11(5), pp.893-900. https://doi.org/10.2215%2FCJN.11491015
Stockley JM, Constantine CE, Orr KE. 2006. Building new hospitals: A UK infection control perspective. Journal of Hospital Infection. 2006, 62(3), pp. 285–299. https://doi.org/10.1016/j.jhin.2005.03.015
West R, Michie S. A Brief Introduction to the COM-B Model of Behaviour and the PRIME Theory of Motivation [v2]. Qeios. 2020. https://doi.org/10.32388/WW04E6
Zimring C, Denham ME, Jacob JT, Kamerow DB, Lenfestey N, Hall KK et al. The Role of Facility Design in Preventing Healthcare-Associated Infection: Interventions, Conclusions, and Research Needs. HERD: Health Environments Research & Design Journal. 2013, 7(1), pp. 127-139. https://doi.org/10.1177%2F193758671300701S09