Create a safety-first culture to minimize hospital-acquired infections

May 31, 2008
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Moderator: Carlos Marcet, HKS Architects

Panelists: Mark Schaefer, Dr. P. Phillips Hospital/Orlando Health;

Cynthia Ware, Florida Hospital;

Bob Danner, TLC Engineering for Architecture;

Grant Ramsay, The Robins & Morton Group

Ask any doctor “What matters most in a hospital?” and you'll get the same answer: “The patients.”

So when a 1999 Institute of Medicinereport revealed that preventable medical errors cause 44,000 to 98,000 deaths each year, the response was swift. In the nine years since the report was published, the government has implemented new regulations geared toward preventing medical errors and health professionals have increasingly focused on creating safety-first cultures within their institutions. Having a safety-focused facility is a big part of that equation, said Carlos Marcet, senior healthcare designer/planner for HKS Architects and moderator for this session.

Everything from noise to where the handwashing sinks are placed could affect the treatment a patient receives, said Marcet, who advises hospital leaders and building designers to “to establish patient-safety-centered principles that will guide the design process.”

“You think about improving safety in any way possible and that can happen in design also,” said Cynthia Ware, a registered nurse who now works as a patient safety officer at Florida Hospital.


Seemingly innocuous changes like keeping handwashing sinks in the same, accessible spot in every room, minimizing the distance patients must move from their rooms to hospital service areas and reserving space for staff members to relieve stress can play a big role in improving patient safety, Marcet said.

Ware said designers should also think about building halls wide enough for workers to get by and equipping rooms to deal with hospital-acquired infections such as methicillin-resistant Staphylococcus aureus, or MRSA.

Proper lighting is crucial for improving safety, too, said Bob Danner, associate director of the healthcare division for TLC Engineering for Architecture, who advocates a quality over quantity approach to choosing lighting.

Danner also advises facilities to install back-up power, cooling systems, dual-source water and medical gas systems. These redundancies help ensure that facilities will stay up and running should one system fail.

Virtual changes can affect patient safety too, said Grant Ramsay, a principal and director of special building systems for X-nth. Electronic medical records are becoming increasingly common in hospitals and can eliminate the confusion that occurs with handwritten charts. Also, Ramsay says new technology allows hospitals the ability to monitor patient areas more closely.

But Ware cautions health centers from employing technology that's too confusing or time consuming, noting that when the first electronic medical records came out, they were too long to complete.

“When you're designing you need to think simple so staff can go in and do the job they need to do and decrease the amount of errors,” she said.

- April Frawley Birdwell

Healthcare Building Ideas 2008 June-July;4(5):60