Architecture rather than antibiotics: patient room takes center stage

Hospitals take many precautions – including hygiene concepts - to prevent the spread of infection but are still unable to eliminate all pathogens. Since 2016, an interdisciplinary research team has been studying how architecture and design can help prevent the spread of highly infectious and multidrug-resistant pathogens as part of the KARMIN project (the acronym stands for hospital architecture, microbiome, and infections in the hospital). The pandemic has also put a different perspective and urgency on the project.

One objective was to develop a patient room prototype that facilitates infection prevention and to assess its effectiveness. In this MEDICA-tradefair.com interview, D.Eng. Wolfgang Sunder talks about the KARMIN project results and reveals what the hospital of the future might look like.

Dr. Sunder, the allotted project timeline for KARMIN officially ended in the middle of 2022. The KARMIN model patient room is now being set up in its own pavilion on the grounds of the Braunschweig Municipal Hospital as the “patient room of the future” and is intended as a study and research space in the future. What insights did you gain from the KARMIN project?

D.Eng. Wolfgang Sunder: The project has shown that infection prevention requires an interdisciplinary approach. It’s not enough if only medical professionals view the issue from their viewpoint or if we consider it solely from an architectural point of view. Embracing the "One Health" approach, it is important to address this subject from a wider perspective. It takes the interdisciplinary collaboration of all project stakeholders.

In the scientific analysis of our project, defining the traffic patterns of the various groups within the hospital room proved very important. Our partner from the Charité Berlin University Hospital provided us with information about the transmission routes of pathogens within the hospital. This knowledge allowed us to optimize the routing within the patient room. The KARMIN patient room is characterized by a clear zoning of an entrance area and a façade-side visitor area, as well as symmetrically arranged wet rooms on the left and right sides, the nursing work area, and the patient area. This makes it possible to clearly coordinate movement sequences in the room and maintain distances.

The second finding concluded that great cleaning options in the patient room promote infection prevention. This can be achieved by minimizing joints and by merging the edges of furnishings together (e.g., eliminating grips and handles, if possible), thus creating smooth surfaces that flow throughout the room. All materials have also been tested for their ease of cleaning.

However, the most important finding is that hand hygiene is the central pillar of infection prevention in the patient room. Hence, the KARMIN model patient room features a smart selection of various disinfectant dispensers. The continuous availability of the resource, knowledge of the right application method and visible, strategic placement are important to ensure safe and effective disinfectant use.

What are your concrete goals as it pertains to the research and study laboratory?

Sunder: In this laboratory, researchers from the TU Braunschweig and the Fraunhofer Society will collaborate with the experts of the Municipal Hospital to continuously develop innovative, practical model solutions for hospital architecture. This includes smart materials and surfaces, as well as the assessment of care, treatment, and cleaning scenarios. New developments in medicine, changes in societal demands as well as advances in architecture, construction and material sciences will be incorporated into the work.  Future research will also focus on hospital-acquired infections. The increase in antibiotic-resistance bacteria in hospitals and the challenges amid the global spread of the coronavirus since the end of 2019 show that hospital room hygiene is a highly relevant issue.

Eighteen partners from the healthcare industry support this collaboration. The knowledge gained from the cooperation should flow as directly as possible into the planning and construction processes of healthcare buildings, be transferred into the professional practice of clinics as well as into the development of corresponding products.

Looking beyond the patient room or individual components to the big picture: What aspects should architects consider in hospital design and construction?

Sunder: If you look at the history of healthcare design and construction, it’s apparent that no other facility has had to undergo this many social and medical changes. Many factors – ranging from medicine and hygiene to politics and society – have prompted major changes. By the time its construction has been completed, a brand-new hospital building may already be outdated.

In the future, the hospital planning, design, and construction process will require architects to address the central issue of creating optimal conditions for patients and medical staff, whilst allowing for operational flexibility. Looking back at my own practical, teaching and research work, I maintain that only an interdisciplinary collaboration between experts can find the answers to the important questions pertaining to the design of future healthcare facilities and spaces.

Let’s look into the future: What will healthcare design and construction of the future look like?

Sunder: From my perspective, these three trends will guide and have a major impact on healthcare construction in the future:

• Centering design on the needs of the patients and healthcare staff: The idea is to not merely provide healthcare, but to also ensure patients feel more comfortable and at ease in the setting – think hotel-like vibe. For healthcare staff, it is about making the workplace more attractive. This includes work in the intensive care unit, for example. Especially in light of healthcare staffing shortages, hospitals must stay competitive as employers.
• Establishing close collaborative relationships between the designers and future users: This ensures that the right information about treatment and work processes is integrated into the design. Digitization will also have a lasting effect on these processes.
• Embracing flexibility in healthcare design and construction as it relates to infection prevention: This includes redirecting the use of a healthcare facility to address both local infection and pandemic events. The current compact architectural style for healthcare buildings has reached its limits and will give way to building structures that are divided into smaller sections, are decentralized and more open in the future.