Healing Architecture: Infection prevention by design

Patients are hospitalised to get better, not worse. Contracting an infection during their stay, however, can significantly imperil their health and healing process. An increasing number of multi-resistant pathogens put patients at risk in a place, where hygiene should be at home. The fight against viruses and germs begins in the patient’s room. Now, the research project KARMIN (the acronym stands for hospital architecture, microbiome and infections in the hospital) is setting a new standard for the optimal patient room, designed to prevent infections.

M:IP should not be left to medical professionals alone. Disciplines such as architects, designers or biologists, must take on the challenge, too.

The precedent-setting research project unquestionably demonstrates that infection prevention in the hospital cannot solely rest on the shoul-ders of medical professionals: „Finding solutions for better controlling and fighting infections should not be left to one isolated group of ex-perts,“ agrees the KARMIN project’s principal investigator and architect, Wolfgang Sunder, PhD, from the Institute of Construction Design, Indus-trial and Health Care Building (IKE) at Technische Universität Braun-schweig (TU Braunschweig). „Rather, such undertaking requires the insight and expertise of an interdisciplinary team of experts from various professions and fields of study.“

Interdisciplinary team of experts designs prototype

Indeed, a team of architects, designers, medical professionals and mo-lecular biologists from TU Braunschweig and Charité Berlin was the first to identify risk factors of infection transmission in a hospital room across disciplines. Together, they designed the optimal floor plan and outfitted the room with the best-possible equipment to all but eliminate contamina-tion with dangerous pathogens.

In particular, hygiene hinges on people’s activities in the hospital room: patients’ behaviour, how workflows guide staff around the room, where and how visitors stay in the room and how the room is cleaned and disin-fected. Consequently, any object in the KARMIN prototype room that touches the ground is movable so it can easily be moved during clean-ing, to name one example.

The disinfectant dispensers specifically developed for the KARMIN project are strategically placed along staff’s routes around the room, at the counter of the nurse’s work station, at the foot of each bed and in the patient bathrooms. Thus, movement about the room is minimised and the dispensers are in nurses’ view at all times to encourage hand disinfection.

KARMIN researchers interviewed experts as well as the various types of users of a hospital room. The team took sample swabs of surfaces and objects, such as door knobs and sinks. Even swabs of the patients’ body were taken. At the same time, the interdisciplinary team analysed work-flows and routes of nurses, doctors and cleaning staff in the room. One conclusion, for instance, was that pathogens are most often transmitted between the cohabiting patients when doctors and nurses interact with one patient while treating the other, for instance, if that patient calls a nurse over to his or her bed for help.

Based on the new insights and analysis, the team developed require-ments for an infection-proof patient room, including the bathroom. „The KARMIN patient room represents the first prototype of a two-bed room with two bathrooms, designed, furnished and equipped to adequately prevent infections. It was also the first prototype an interdisciplinary team of researchers was able to plan, realise and analyse,“ project leader Sunder says.

Specifically, the solution includes a thoroughly considered, specially zoned room layout, innovative furnishings and features, such as BODE/HARTMANN’s disinfectant dispenser Eurospender 3 flex at the foot of the beds, the nightstand, the bedside terminal displaying innova-tive content with targeted informational campaigns for the patient, plus, last but not least, a well-thought-out lighting concept.

HARTMANN was part of the network of industry partners supporting the KARMIN project, which took several months to complete. In late 2020, a prototype was installed on the campus of Charité Berlin, giving experts and the public the opportunity to explore the KARMIN hospital room and provide constructive feedback. Moving forward with the project, the researchers are set on continually expanding and optimising the concept.

The current pandemic will provide researchers additional new insights, allowing them to approach healing architecture from yet another new perspective. At this point, the KARMIN project has revealed evidence and set a new standard for sensibly planning hospital rooms of the future — far from a scary place where the invisible risk of infection lures in every corner but rather a highly functional and comfortable place of wellbeing and coming together.