Words by Neil Cadenhead
The warnings are out there …
We’ve had SARS, Ebola, MERS, Zika, A(H7N9), yet few places have really engaged with how such diseases should affect hospital design. The Singaporean government is one of the more advanced. In one competition bid, they asked designers to demonstrate that they could isolate a section of the hospital from the rest, in the case of an outbreak of something like SARS. The departments would act normally as part of the general hospital, but you could isolate some diagnostics, wards and outpatient areas to create a completely separate hospital within a hospital.
Different times, different attitudes
Victorian fever hospitals were designed before penicillin and the other pharmaceutical treatments we rely on today. Look at the measures they had for controlling infection — before you went onto the ward, you were stripped of all your clothes. You waved goodbye to your relatives and might not see them again until you came out. The idea was to protect the general population from infection, and to protect the patient from the infection in the general population. You couldn’t do that now — there’d be a riot if people weren’t allowed to visit their relatives. But it shows you the different attitudes to controlling infection.
Are we as understanding of infection today?
I would love to see the scientific paper that actually demonstrates whether moving to six air changes an hour in a hospital bedroom has made any different to patient outcomes, and what science it was based on. What is “fresh air” anyway? I love asking engineers that question. They’ll say things like “It’s air free of pollutants”, or “It’s air with a certain amount of oxygen in it”. Then I ask, “Is that the same sort of air that I feel walking down a beach in winter after a storm?” This matters because we are increasingly moving from natural ventilation to sealed buildings in the quest for energy savings.
Do we even make spaces that are comfortable?
Pictures of Victorian wards at night will show the nurse wearing her cape — because they turned down the heat so that patients could sleep, and no doubt to save money. There’s some pretty good research into sleep patterns that shows that humans like sleeping at an air temperature of 16°C, with colder head and feet. But today hospital engineering decides that all bedrooms will be 18-28°C, typically interpreted as a fixed 22°C, all day and all night. I’d like to read some proper science into the comfort conditions associated with waking and sleeping, and patients’ circadian rhythms.
There is a lot of mythology in healthcare design in different countries.
I have a German client who is keen to reduce the clinical hand wash basins, and scrub troughs, and increase alcohol points in his project. The view is that washing your hands increases the cohort of potentially infectious material on the unit! Is this where the science is? Do we learn from others, or is each country siloed in its own healthcare traditions? As a start, perhaps all guidance on national hospital standards should include references to the original science they’re based on.
Neil Cadenhead is an architect director in BDP’s healthcare team
“Fresh air”! Yes certainly not oxygen levels. What is 6 ACH doing, removing air-born pathogens or just blowing them around? A follow up question might be is any recirculation of air within any HCF a good strategy moving forward? When did someone breathe that breath the last time? Are we moving to future where every patient care room has a pressure monitor?
The sanitoriums of old had success with bundled patients moved outside for ‘cold fresh air’ and good doses of sunlight, inside and out. Are there places for the ‘old dumb’ ideas of simplicity and resilience alongside the wired ‘smart’ solutions of today?