ObjectiveTo determine whether microbial contamination of door handles in two busy intensive care units and one high dependency unit was related to their design, location, and usage.DesignObservational study of the number of viable bacteria on existing door handles of different design at defined entry/exit points with simultaneous data collection of who used these doors and how often.SettingTwo busy specialised intensive care units and one high dependency unit in a tertiary referral NHS neurological hospital.Main outcome measuresSurface bacterial density on door handles with reference to design, location, and intensity of use.ResultsWe found a significant correlation between the frequency of movements through a door and the degree to which it was contaminated (p = <0.01). We further found that the door's location, design and mode of use all influenced contamination. When compared to push plate designs, pull handles revealed on average a five fold higher level of contamination; lever handles, however, displayed the highest levels of bacterial contamination when adjusted for frequency of use. We also observed differences in contamination levels at doors between clinical areas, particularly between the operating theatres and one of the ICUs.ConclusionsDoor handles in busy, “real life” high acuity clinical environments were variably contaminated with bacteria, and the number of bacteria found related to design, location, mode and frequency of operation. Largely ignored issues of handle and environmental design can support or undermine strategies designed to limit avoidable pathogen transmission, especially in locations designed to define “thresholds” and impose physical barriers to pathogen transmission between clinical areas. Developing a multidisciplinary approach beyond traditional boundaries for purposes of infection control may release hitherto unappreciated options and beneficial outcomes for the control of at least some hospital acquired infections.

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Extra care housing is seen as a popular option for older people by families, some older people, policy‐makers and practitioners. Some new build is being provided but another option, for which grants are available, is to remodel existing outmoded buildings. This research reports on recent attempts from 10 case‐study areas in England to remodel sheltered housing and residential care homes to extra care housing. The results are mixed, with satisfaction reported by many new tenants, anger by some existing ones, challenges at every stage of the project for design and construction teams, and issues over the provision of assistive technology and care. Nearly all the schemes experienced unexpected problems during the course of construction. Remodelling is not necessarily faster or cheaper than commissioning a purpose‐designed new building. Nevertheless, remodelling may be the only viable option for some unpopular or outdated schemes. The research showed that remodelling is not a quick fix, but that it did have considerable advantages for many of the older people and support staff who were living and working in the remodelled buildings. The research concluded that remodelling should only be undertaken when other options have been carefully examined. Drawing on the research findings, advice to policy‐makers and practitioners who are considering this course of action is outlined in the discussion.

Across the United Kingdom, new build and remodelled ‘extra care’ schemes are being developed in many areas on the assumption that they offer older people with care needs an alternative to residential care. This paper reports an evaluation by a multi-disciplinary team of 10 extra-care schemes remodelled from sheltered housing or residential care units. The evaluation audited buildings and identified social and architectural problems. No two schemes in the sample were alike; some aimed for a dependency balance and others set a dependency threshold for admission. The three criteria used for assessing eligibility were the number of paid care hours the older person had at home, their property status and the type of disability. This article focuses on the wide variation in assessing eligibility for an extra-care place and on some social consequences of remodelling. A number of tenants remained in situ during the remodelling process in six of the schemes. Building professionals were unanimous that retaining some tenants on site caused significant development delays and increased the remodelling costs. There was also a social price to pay. ‘Old’ tenants resented their scheme changing into extra care and were hostile towards ‘new’ tenants who had obvious needs for support. In some extra-care schemes, ‘old’ tenants were refusing to participate in meals and all social activities.

Purpose. Extra care housing (ECH) is housing for older people that aims to provide flexible care while fostering independence. The aim of this paper is to examine the impact that some of the successes and failures in improving accessibility during remodelling had on care provision, in order to offer advice to social housing providers planning to remodel existing properties into ECH. Design and methods.The data consisted of an inventory of accessibility features and assistive technology (AT) items in flats and common areas. The data was drawn from 10 ECH schemes in different regions of England. Findings. Most of the assistive technology found was low-technology supporting independence, such as grabbers; some was specific to care provision, such as hoists. Even after remodelling, the design and layout of most buildings did not fully comply with accessibility standards, leading to increased provision of care for some tenants: a care-negative situation. Research and practical implications. This multidisciplinary, original research on remodelling into ECH presents successful examples of accessibility, assistive technology and care integration that required active tenant involvement and creative design input from care staff, architects and builders who were assistive technology and accessibility aware. It is argued that for new and remodelled ECH buildings to be care-neutral, designers need to work towards the most inclusive model of ECH.