How you design, build and test new hospitals is currently being widely discussed. However, there is not much of a focus on the patient environment, hospital building and environmental monitoring until there’s an IPC issue. "We have some guidelines such as ‘Health Building Notes (HBN)’ to guide the design of hospitals and wards and the Health Technical Memorandums (HTMs) to support how we test (air, surfaces and water) to monitor the patient environment. However, I don’t think we’ve got it right for existing buildings. There is little consultation with IPC in the early design stages for new hospitals."

In clinical settings, when it comes to training and development, most of the clinical interest is in patient to patient transmission and the clinical side of microbiology, as opposed to the environmental microbiology aspect, i.e. the influence of air, water and surfaces.

"There is an assumption that you can swab a surface or extract some air and a result comes out and it’s as easy as that...”

There needs to be an understanding that the matrix being tested (air, surface, water) will determine what kind of test is used: for example, swabs shouldn’t be used for testing water samples. When sampling surfaces, the swab needs to be the correct one for the type of surface being tested and the target organism. A swab that works for E. coli may not work for MRSA or Clostridioides difficile.

Looking at other considerations, for example, in water sampling: 100 mL samples are usually taken for routine water monitoring for Pseudomonas aeruginosa, however, monitoring of Legionella is more difficult. These require 1 litre samples, with a mass of 1 kg per
bottle to be collected. Logistically these add up to a huge weight across the thousands of samples that might be generated from numerous outlets across many wards. While swabs are small, the size of Legionella samples makes for complex logistics around storage and transport — and this needs consideration in planning design.

In the meantime, as NHS England’s New Hospitals Programme1 is rolled out, a new standardised hospital design has been proposed, designated ’Hospital 2.0’: “we have to consider what can be built now that will [both] cover enough of the infrastructure [and allow us to] add new tech and new innovations and new ways of working with it.”

How do the latest design trends to improve patients’ experiences impact on IPC?

Rooftop gardens
Mental health and mental wellbeing are increasingly, quite rightly, under discussion, particularly for long term patients who may feel trapped between their four walls. The idea ‘to bring the outdoors in’ in the form of rooftop gardens and other greenery is therefore very welcome, especially in cancer hospitals where patients can walk on grass, breathe the air, see the trees and sit
amongst ‘nature’.

However, this vegetation brings infection control risks with it: soil, compost and the plants themselves may harbour pathogenic microorganisms that can be particularly dangerous for immuno-compromised patients. This can pose a number of challenges...

Continue reading Dr Ali's interview here. 

This interview was published by Looking deeper: the Journal of the Water Safety Forum

Dr Ali is a speaker at the HIS 'Water and wastewater safety in healthcare' course.