Hospital construction: infection prevention through architecture?

Interview with M. Eng. /M. Arch. Wolfgang Sunder, Institute for Industrial Building and Construction Design (IIKE), Technical University (TU) Braunschweig, Germany


Hospitals apply many infection prevention and control measures. They all have one thing in common: they are individual parts of an overall concept that is aimed at preventing the spread of highly infectious and resistant pathogens in hospitals. Nevertheless, previous hygiene concepts ignore one aspect of hospitals: the architecture of the actual hospital facility itself.

Image: Smiling man with greyblack hair and suite - Wolfgang Sunder; Copyright: private

Wolfgang Sunder; © private

In this interview with, Wolfgang Sunder talks about the impact architecture exerts in the spread of pathogens. He is in charge of the KARMIN project, which has studied new approaches to this issue since October 2016.

Mr. Sunder, what is the objective of the KARMIN research project?

M. Eng./ M. Arch. Wolfgang Sunder: KARMIN is a part of the "InfectControl 2020" research association, which investigates options of breaking the chain of infection. KARMIN specifically examines this issue as it pertains to hospitals. We have defined two objectives for this project: the first objective is to develop a two-bed hospital room prototype with a bathroom, all specifically designed to prevent infection. The second objective is to examine a hospital microbiome with the help of the newly renovated patient care high-rise building of the Charité Berlin. We analyze the resettlement of pathogens at a hospital with a focus on architectural aspects. For example, we are comparing single-bed patient rooms with shared rooms.

What do we know already about the impact of architecture on the spread of pathogens in hospitals?

Sunder: Basically, we know too little. Over the past years and decades, there has been a very strong and justified emphasis on hygiene management. However, in light of an increase in multidrug-resistant organisms, for which new prevention measures need to be created, architecture and construction are also becoming more and more important. General trends across Europe increasingly call for single-bed rooms, even in general hospital wards. For example, some studies already examine whether it makes more sense to have single patient or shared rooms in hospital wards. Having said that, there is still a lack of evidence when it comes to hospitals as a whole but also as it pertains to individual departments.

Image: Hospital room with three beds; Copyright:

Rooms with two or more beds are common practice in hospitals. The reason for this often is the available space. But they have one disadvantage: patients get in contact with each other here and possibly infect each other; © logoboom

What specific unanswered questions are you seeking answers to in this case?

Sunder: When it comes to the structural level, one specific issue is what a room needs to look like to counteract the spread of pathogens: what size should it be? Does it require specific building equipment and ventilation technology? What materials do we need to use? How can surfaces be cleaned and disinfected? These are some of the questions we need to ask, which is also why we see an urgent need for research in this area.

Which structural infection-control measures are already being implemented today?

Sunder: Several measures are already being taken today - for instance, isolation rooms for patients with highly contagious diseases or the use of air locks or specific surface materials. However, those are always just individual aspects. There is a lack of overall, comprehensive perspective on this subject matter. To gain this type of perspective, all stakeholders such as architects, hygienists, medical professionals, and microbiologists must come together, take a look at the problem and work together to come up with solutions.

How are hospital patients currently being isolated if they have contracted or are colonized by multidrug-resistant organisms?

Sunder: This primarily depends on the size of the hospital and the hospital ward. Usually, these patients are placed in isolation rooms or designated single-bed rooms. Emergency rooms also have preassigned rooms where patients can be isolated.

Image: Single room with a window in a hospital; Copyright:

Contagious patients can be isolated well in single rooms. But is this also possible in rooms with other patients?; © epstock

By building the model hospital room, you intend to study how this type of isolation can also be achieved in a double-bed patient room. Are there already specific approaches?

Sunder: We are currently just at the beginning. Obviously, we will look into the positioning of beds, where the disinfectant dispenser should be mounted and how the bathrooms should be constructed for example. The project has to reveal what ultimately works and what doesn’t in controlling infectious hot spots in patient rooms.

We will actually build this room as a demonstration model, independent from any specific hospital operator. The goal is to carefully examine and evaluate the room in collaboration with nurses and hygienists for example. We are subsequently also able to consider implementing and testing this type of room in an actual hospital. Of course, one solution would also be to try and implement this concept in an existing patient room. However, this would limit us a lot more in terms of structural design.

What comes next for the project?

Sunder: The project is scheduled for three years, starting October 2016. During the first phase, we are analyzing and assessing a patient room’s critical areas that require infection control. After that, we plan to design the demonstration model and to develop solutions for infection prophylaxis. The third phase is dedicated to implementation. We will implement the solutions in the demonstration model, evaluate and optimize them so the concept can, in fact, be some day implemented in hospital facilities.

Image: Man with glasses and beard - Timo Roth; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Timo Roth and translated from German by Elena O'Meara.