Designs to stop the spread of pathogens in hospital settings, part of an ongoing Boston study, could have implications for future designs of any building where people gather in numbers.

Teams of architects took up the challenge of designing the perfect hospital room for the Healthcare-Associated Infections Organization, a Boston-based group that seeks to reduce infections acquired during hospital stays that kill an estimated 98,000 patients in the U.S. annually. 

Amidst the COVID-19 outbreak, their recommendations for halting the spread of pathogens could become a model for the redesign of high-traffic buildings including hotels, office buildings and apartments to withstand its spread and that of potential future epidemics. They included self-opening doors, replacing curtains with tinted e-glass and replacement of pathogen-collecting carpets and tiles with solid floors. 

“If a room is hard to clean, it’s just not going to get clean,” said Cathleen Lange, a principal at Boston-based architects Shepley Bulfinch. “There’re a lot of these features that could cross over [to other property types].” 

Approximately 1.7 million U.S. patients acquire infections during hospitalization and 98,000 die annually as a result, according to the Centers for Disease Control. A recent analysis of hospital inspection reports by ProPublica, a nonprofit investigative journalism site, found recurring infection control problems at 55 hospitals designated as first-tier treatment centers for epidemics such as the 2014-2016 Ebola outbreak. 

One in 5 of the hospitals had four or more violations over a five-year period, ProPublica reported, including improper staff use of masks, overcrowding in emergency rooms and contaminated supplies. 

Local hospitals already are redesigning their real estate to prevent the spread of infections. Massachusetts General Hospital is planning a new 1 million-square-foot clinical center on its West End campus. All 456 rooms would be single-patient, which would help reduce hospital-acquired infections, MGH stated in a 2019 document submitted to the Boston Planning & Development Agency. 

An Urgent Call to Architects 

The HAIO group was founded in 2010 by MGH President Peter Slavin to engage architects and the building industry in hospital designs that discourage inpatient infections. In 2015, HAIO invited eight teams of architects to a competition to design the “perfect patient room,” one that maximized patient comfort while minimizing risk of infections. They presented about 50 ideas to hospitals’ infection preventionists, who evaluated them for effectiveness and cost. 

Amid widespread marketing claims about anti-microbial and anti-bacterial products, many ideas were rejected as unproven, such as the use of copper in “high-touch” areas such as handrails and bedrails, Lange said. 

Instead, the focus shifted toward simplifying room designs to eliminate places where pathogens can grow, creating new traffic patterns to minimize exposure to patients, and substituting materials that make it harder for pathogens to survive. Blinds and shades, for instance, are hard to clean, and can be replaced by e-glass that turns opaque for privacy. Floor surfaces that extend six inches up walls make cleaning easier, and no-touch systems open doors with the wave of a hand. 

Steve Adams

The competition took a collaborative turn as elements of all of the teams’ ideas were incorporated into the final design in 2018. 

The group’s research is continuing, expanding to 10 members including representatives from the construction and project management fields. It’s working with Newton-Wellesley Hospital on the design phase of a new study that focuses more directly on minimizing contact between patients and staff, Lange said. Ideas include adding a separate bathroom entrance from the corridor so cleaning staff can enter directly, redesigning bathroom fixtures with fewer joints that collect germs, and swapping out hard-to-clean tiles for solid surfaces. Handwashing stations and antibacterial dispensers should be located for maximum convenience.  

Natasha Espada, a principal at Needham-based Studio Enee and president of the Boston Society of Architects, said the study could be a guide for designing any type of building where people congregate in numbers. 

“A lot of it is intuitive,” Espada said. “The ability to segment a facility to control access is really helpful. It’s just the basic precautions that could be in all schools, nursing homes and dorms.” 

Redesigning Buildings to Halt Sickness’ Spread

by Steve Adams time to read: 3 min