The last four years have continued the hospital building boom in inpatient towers, with thousands of new patient rooms coming on-line. Only the past year's economic slump has slowed the wave of construction. With Hill Burton-era hospitals continuing to age and healthcare systems consolidating and reconfiguring, the industry will eventually revive, with more replacement of inpatient towers. Since my original series of articles, “Key Considerations in Patient Room Design, Parts 1 and 2”, ( HEALTHCARE DESIGN, April and May 2006), I have been directly involved with the design of eight such projects, all 100% private room design. Some of these projects are now completed and HOK has begun postoccupancy evaluations. Based on this experience, here is an overview and update of trends related to patient room and unit design.
Nurse servers containing frequently used patient supplies are discreetly located outside of each patient room at Soin Medical Center in Beavercreek, Ohio
Infection control strategies shape patient room design
No issue has affected the design of inpatient rooms and units more over the past few years than the increased emphasis on control of nosocomial (hospital-acquired) infections and response to recent viral epidemics such as SARS and H1N1. Since we now understand that infection is spread by physical contact more frequently than airborne transmission, there is more emphasis on hand sanitation and contact isolation for patients. It is now evidence-based practice to provide lavatories or hand sanitizers at the entries to patient rooms and in prominent locations throughout the unit. A few years ago, patient units were considered adequately equipped if they had one contact isolation supply cart per floor. This cart was usually stored away in an equipment room and brought room side. In the past few years, infection control compliance personnel are taking a greater role in facility design. Most are insisting that personal protective gear or equipment (PPG or PPE) be located outside of each patient room or small grouping of patient rooms (figure 1). This includes storage of over-gowns, masks, and several sizes of gloves. More negative pressure rooms are requested-usually two to three per a typical 28-36 bed acute care unit, though anterooms are no longer required in most states.
Since supplies and linens are considered contaminated once a patient leaves a room and it is terminally cleaned for a new patient, hospitals are now greatly reducing the amount of supplies stored in the room. Even supplies sealed in plastic wrappers can be considered contaminated by touching the wrapper. Most recent patient room designs have minimal to zero storage in the room, substituted by either supply carts or built-in nurse servers directly outside the room. Minimal storage in the room may include pillows or blankets accessible to families, and the required patient wardrobe.
Hospitals are reevaluating what needs to remain in the patient room. Even the use of cubicle curtains for patient privacy is falling out of favor, since they are touched often by passing personnel. New designs of specially treated fabrics or disposable curtains may mitigate this problem. Also the use of integral blinds, Vista or e-glass reduces the amount of cleanable surfaces of corridor windows. We are reducing the amount of horizontal surfaces in patient rooms since they harbor infection (figure 2). Manufacturers are taking a fresh look at infection-resistant computer keyboards and monitor controls for the same reason.