Improving Hospital Ecosystems With Bioinformed Design
Are healthcare-associated infections (HAIs) driven not only by existing harmful pathogens but by the absence of helpful species? In our zeal to create an ultra-clean patient environment, are we actually removing ecosystems that can help heal?
Researchers are beginning to create a new paradigm that may change how we design, operate, and maintain hospitals. This model looks at biodiversity of interior spaces at the microbial level to try to determine the healthiest conditions. Jessica Green, biodiversity scientist at the University of Oregon, named this “bioinformed design”—how we can design to promote beneficial microbes and inhibit harmful ones.
Genome sequencing technology has allowed scientists to establish that our bodies harbor a 100 trillion microbes as a community of bacteria called a microbiome. We each shed 37 million bacteria per hour (imagine Pigpen from the Peanuts comics) that leave a footprint as we move through buildings. In hospitals, more than 50 percent of patients take antibiotics, which decimate the bad bacteria but also normal bacteria that provide resistance, making patients more open to HAIs.
As featured in a recent Wall Street Journal article, “Designing a Hospital to Better Fight Infection”, the Hospital Microbiome Project reported the preliminary findings of a three-year study of the new University of Chicago Center for Care & Discovery, an inpatient bed tower. This study looked at how ventilation, humidity, and design features affect both good and bad bacteria.
They’re mapping where and what type of microbes occur to potentially target and eliminate pathogens. Early findings indicate patient rooms, visited 100 times a day when occupied, become alive with human bacteria and biodiversity that rivals an Amazonian rainforest.
Within hours, a new patient’s microbiome becomes the dominant biological feature in a patient room. Different locations, such as shower heads, bed rails, and furniture, can harbor very different types of bacteria. Rooms also have microbial characteristics influenced by a number of occupants, temperature/humidity, and type of treatment occurring, so a one-size-fits-all approach to sterilization may be futile.
In fact, less sterile rooms may reduce the prevalence of harmful microbes by making them compete with healthy ones.
The Microbiology of the Built Environment Network is an online tracking of two dozen research groups studying microbes in hospitals, other building types, and in transportation. Studies have shown that rooms in proximity and those with a lot of traffic share similar biological compositions. Also, the use of operable windows introduces more biodiversity that may be useful in overwhelming pathogens. Rooms served by the same air-handling ducts have more similar microbes.
Some scientists believe this emerging bioinformed knowledge will affect building design within as early as five years. The future may bring building features that can introduce “curative probiotics” that enhance recovery. For instance, materials may be infused with properties tailored to their location and use that to enhance good bacteria.
There may be more attention paid to the location and entry of toilet rooms to space them away from food service and other sensitive areas. Ventilation systems may rely more on outside air to infuse more biodiversity into the indoor environment. Cleaning and sterilization may become more customized, treating different spaces with different solutions and targeting specific areas that harbor the most disease.
This is an exciting new development that engages architects and engineers proactively to create healthier buildings based on growing scientific knowledge.