1. Wendy Davis Dip Carbon Management, Swinburne University, Melbourne
MBA (executive), Harvard Business School, Boston
M Ad Ed (adult workplace education), UTS, Sydney
B App Sci (medical microbiologist), RMIT, Melbourne

2. Facilities – protecting your assets and minimising hospital/facility acquired infection

3. Learning outcomes – Health Facilities
At the end of this session you will be able to…
Systematically identify areas of
High infection control requirements
High and medium horizontal impact risk
& understand why this is critical

4. Learning outcomes – Health Facilities
At the end of this session you will be able to…
Design interiors to
Withstand the daily inundation of collisions
Minimise the opportunity for hospital/facility acquired infections
& understand why this is critical and how they are related

5. Learning outcomes – Health Facilities
At the end of this session you will be able to…
Apply a cost benefit approach to design materials
Discuss the impact financial and other of hospital acquired infection
Justify reduced operational costs vs capex
At the end of this session you will be able to…
Apply a cost benefit model to the selection of design materials
Including recurring maintenance/replacement costs
Be able to discuss the financial impact of hospital acquired infections
Justify the use of products that reduce yearly/ongoing maintenance (operational costs) when discussing capital expenditure budgets.
& understand why this is critical

6. Importance of high infection control requirements.
Hospital - acquired = nosocomial INFECTIONS
Pertaining to or originating in a hospital
The most common complication affecting patients in hospital
Unnecessary pain and suffering for patients and families
Prolong hospital stays
Costly to the health system
Accessed Dec 2015

7. Challenges Normal bacteria - ‘hospital’ strains of
bacteria that are resistant to antibiotics
“ensure consistent cleaning and
disinfection of surfaces in close proximity to the
patient and those likely to be touched by the patient, staff and visitors”
Accessed Dec 2015
Not only hospitals, clinics, but communal living situations, retirement villages, schools (often more aggressive viruses/bacteria)
Normal bacteria – become disease forming in some compromised patients
Staff (and visitors) – carry ‘hospital’ strains of bacteria that are resistant to antibiotics
Viral spread eg EBOLA
Infections can occur in ANY health care setting
On of the four or five things you can do is…
ensure consistent cleaning and disinfection of surfaces in close proximity to the patient and those likely to be touched by the patient, staff and visitors

9. You might have heard of these…
MRSA, Golden Staph, MRSE (MR = methicillin resistant)
VRE
Clostridium difficile
MRO (M = multi)
SARS,
Ebola
Aspergillus
Gastro. causing viruses – Norovirus
Evolving influenza virus
Ebola has been around since at least the 70’s in other parts of Africa
Norovirus – typically cruise ship type outbreaks.
Clostridium difficile – antibiotic treatments
Aspergillus – swimmers ear, or surfers ear (one type) and others in damp building environments.

10. Hospital acquired infections
200,000 reported in Australia in 2010 (very under reported)
People die

11. Source of infectious agent
Chain of infection
Susceptible person
Source of infectious agent
Mode of transmission

12. Risk of infection (http://www. nhmrc. gov
Risk of infection ( accessed 2 Mar 2016
Now give them the plans and use yellow for areas of high infection concern (international color for infectious material).
Suggest they go for the areas of High risk first and foremost.
Extra oral just means outside the mouth.
Source URL (modified on 05/10/ :26):
2010/b4-1-taking-risk-managem
After this one – do the activity !!!!!!!!!
Need to change the color ideally for high health requirement - change to high risk of infection. From pink to yellow.

13. areas of high infection risk – see handout
Highlight in yellow,
areas of high infection risk – see handout
Now give them the plans and use yellow for areas of high infection concern (international color for infectious material).
Suggest they go for the areas of High risk first and foremost.
Review answers.

14. Minimise the opportunity for hospital acquired infections
Best protection against infection
is intact skin
Similarly best way to protect against
bacteria/viruses in the environment
is to minimise the opportunity for reservoirs
Minimise cracks/damage/joins/pooling of water

15. Prince Henry Hospital Sydney,
Fairfield Hospital Melbourne E
High chance of impact of trolleys/beds/ with walls and corners. High traffic. –
plan 2.3 corridors surrounding theatre
Passage from recovery to theatre.
Private corridor in between single bed wards, including nurses station and service lift lobby
quivalent ….. Royal Hobart…others in other states.

17. Design interiors to Minimise high and medium horizontal impact risk
Withstand collisions, scrapes, and scratches
Use same plans as before. Use different color to highlight areas of high and medium horizontal impact risk. Review results.
Using same plans – now identify areas requiring corner protection. Review results

18. Design interiors to Withstand collisions, scrapes and scratches.
Use same plans as before. Use different color to highlight areas of high and medium horizontal impact risk. Review results.
Using same plans – now identify areas requiring corner protection. Review results

19. High impact high traffic areas

20. Review results. Check for accuracy.

21. CORNER
Plan 2.3 Corner protection - remember we want to maintain the integrity of the “barrier”(just like skin).
So doors to operating theatre particularly those within the isolated theatre space
High visibility, and high use..patients in wheel chairs/wheeling drips etc..
This will be pretty easy to see when you walk around the existing facility – just look for the bumps and scratches. Find the high profile - high infection risk – high visibility to public. Obviously it would be easier to just do all…but cost effectiveness is important.

22. Nord Parisien Private Hospital - Sarcelles (95)
Need to include a couple of other pictures here – relevant to the state in which the training is taking place

23. flu-like human metapneumovirus (hMPV)
Families blame hospital for four deaths at Herberton, North Queensland
January 30, :00amPeter MichaelThe Courier-Mail
FAMILIES believe the botched handling of a sick patient is to blame for a deadly virus outbreak that “swept like wildfire” through an aged-care facility in far north Queensland.
Four patients died and eight more were infected as the flu-like illness took a lethal stranglehold at the public hospital in Herberton, 90 minutes southwest of Cairns.
Doctors, nurses, patients and family of victims spoken to by The Courier-Mail expect a top-level probe will reveal how “Patient Zero”, the index case, was not put into an ­isolation ward nearly three weeks ago.
In a fatal mistake, it is understood a sick patient was transferred from another hospital and placed into a general ward with “very elderly, frail, and vulnerable patients in poorly ventilated rooms”, sources said.

24. Gastric flu outbreak spreads in Britain
Friday, Mar 4th 2016
Gastric flu outbreak spreads in Britain
Britain is in the grip of a gastric flu outbreak which has spread from hospitals in Scotland to the south coast, health chiefs said today.
Levels of the virus, which has already affected 12 hospitals in Scotland, are higher than those recorded in the past, said the Public Health Laboratory Service.
The number of people struck down with the viral infection on hospital wards was today expected to rise amid reports of the bug in Manchester, Hertfordshire, Sussex, Dorset and Cornwall. There was also a similar case in Birmingham earlier this month.
So far, Glasgow's Victoria Infirmary has been worst hit with 283 patients and staff hit by the illness.
It has forced emergency admissions to the hospital to be diverted to the city's Southern General Hospital until further notice.
To be updated with the most recent and most relevant HAI of the time per state.

25. How long do bacteria/viruses/fungi live outside of humans?
MRSA can survive for days to weeks on hard surfaces C.difficile has survived for 5 months Norovirus can survive for weeks or months Aspergillus
Hand out from the National Health Services UK Ht
Sources of high numbers of Aspergillus spores include air conditioning units, composting and damp or flood damaged housing & hospital building projects.
tp://
do-bacteria-and-viruses-live-outside-the-body.aspx

26. Health care examples
Airborne fungal spores eg. Aspergillus sp– indoor and outdoor sources in high-risk patients.
Bird droppings, soil, contaminated fire proofing material, damp timber and plaster (particularly particle board)
Building and maintenance activities disturb these reservoirs and can send millions of spores throughout the health care facility
• Surfaces near infected patients quickly become contaminated, creating numerous reservoirs that
can transfer pathogens to patients and staff.
• Screening for MROs or specific pathogens is effective but results may not be available on
admission; placing MRO colonised/infected patients with non-colonised /infected patients in

27. Example
Construction related Nosocomial infections for Hospitalized patients: Decreasing the Risk of Aspergillus, Legionella and Other Infections cites 25 outbreaks of nosocomial Aspergillus sp infections over 20 year period, 106 deaths.
These deaths were either suspected or confirmed as being caused by construction activity
Canada Communicable Disease Report July
This is not a lot of deaths in the scheme of things. Reality is these are rarely looked at in a lot of detail. Not routinely screened for in patients, disease is slow onset. There is monitoring for fungal spores that take place but it is a lag indicator. The horse is bolted. As our health care becomes become more
Currently some studies underway in the USA regarding the fine particles and aerosols from buffing floors – particularly for cleaning staff and respiratory illnesses.
Building works are a recognised source of
Aspergillus sp related nosocomial infections.2
The Health Canada publication Constructionrelated
Nosocomial Infections for Hospitalized
Patients: Decreasing the Risk of Aspergillus,
Legionella and Other Infections cites 25
outbreaks of nosocomial Aspergillus sp
infections over a twenty year period resulting in
106 deaths. These deaths were either
suspected or confirmed as being caused by
construction activity.

28. National Health and Medical Research Council – 2010 accessed on line Feb 2015

30. How is this playing out in health - USA
Oct 2008 Medicare decline payments for 8 conditions that could be avoided if “the hospital followed preventative procedure or common sense precautions”.
3 of these are Hospital Acquired Infections

31. Infection prevention
This responsibility applies to everybody working and visiting a healthcare facility, including administrators, staff, patients and carers.
Successful approaches for preventing and reducing harms arising from HAIs involve applying
a risk-management framework to manage ‘human’ and ‘system’ factors associated with the transmission of infectious agents.

32. 2009 figures
2 million bed days lost to the health service in AUSTRALIA per year due to .
Need to reference – check with opening information

33. 2009
2 million bed days per year in Australia lost to Hospital Acquired Infection

34. So what?
Direct effects
during hospital stay
Increase length of stay
Diagnosis and treatment cost increase
After discharge from hospital
Health – care services used more intensively
Pharmaceuticals required to treat infection
Indirect effects Patient/carers miss out on normal productive activities Reputation of hospital damaged Risk of litigation

35. Apply a cost benefit model to the selection of design materials
Cost of poor aesthetics - priceless?/missed opp/’bad press’
Cost of wall repair? /Disruption of normal usage?/ how many hospital administrators does it take to repair a wall…involvement of engineer, tradesperson, nursing unit manager, operations manager, ward staff, environmental services staff, patients, visitors, clinicians…
How frequently do they paint? Should they paint? What’s the cost?
Cost to the community of increased chance of hospital acquired infection

36. Impact of overall infection rates of 1% on bed availability (days) ( ) Graves, Nicholas and Halton, Kate A. and Paterson, Davis and Whitby, Michael (2009) The economic rationale for infection control in Australian hospitals. Healthcare Infection, 14 (3). pp
Graves, Nicholas and Halton, Kate A. and Paterson, Davis and Whitby, Michael (2009) The economic rationale for infection control in Australian hospitals. Healthcare Infection, 14 (3). pp

37. What if we could decrease by 1%?
1% increase means loss of > 150,000 bed days nationally ( )
1% decrease means increase of 150,000 bed days nationally AT LEAST
Total Loss of approx. 2 million bed days
nationally (2009)
What is it in 2016?

38. LH PHOTO LESS THEN 12 MONTHS OLD

41. Chipping and caps see circle

42. LHS poor RHS correct

45. s

46. QUIZ Multiple choice. 7 Questions.
Quiz to follow. Multiple choice. 7 Questions.
The estimated number of bed days lost per year in Australia because of hospital acquired infection in 2009 is (choose one answer)
1500 days, days or 2 million days
What is the direct and indirect effect of hospital acquired infections? Please tick the most appropriate answer.
People die
People suffer
Increase use pharmaceuticals
Increase cost of health care
Increased financial cost of health
Risk to reputation of hospital/facility
Increased risk of litigation
All of the above
In the estimated impact of reducing the number of hospital acquired infections by 1% per year is an increase in bed days of
1,500, 15,000 or 150,000
What is the best way to protect against bacteria/viruses/fungi in the environment? Tick all that are correct.
Minimise damage
Minimise cracks
Minimise joins
Minimise areas that are difficult to clean
Minimise pooling of water
Minimise building activities
Minimise maintenance activities
How long can some infectious agents survive on hard surfaces?
Tick the most appropriate answer.
They can’t, they die rapidly after leaving the human body
Bacteria have been known to survive for 5 months
Architects designing health facilities need to be aware of the impact of hospital acquired infections because (tick those that are appropriate)
Design has nothing to do with hospital acquired infection.
Minimising opportunity for damage not only saves the facility money, it also assists patients to a healthy recovery.
Once we design and the facility is built and commissioned, it is no longer our problem.
Facilities that have constant repairs increase the risk to their patients, of hospital acquired infection
Design impacts the ease of cleaning, directly impacting the possibility of hospital acquired infection.
What has Gerflor developed that protects the facility from constant damage, and helps ensure hospital acquired infections are minimised? Tick all that are relevent
Thermoforming, corner protection
Full or partial wall protection
Heat welding,
Fully encapsulated door protection
Specialist installation methods
Packages to protect the entire facility from theatre to entrance