Identifying Health Care Environment Contradictions in Terms of Infection Control during a Pandemic with a Focus on Health Workers’ Experience

Abstract

During the past year, health care environments have struggled to cope with the various impacts of COVID-19 around the world. Health care facilities need to help strengthen resistance to pathogen threats and provide care for patients and health workers in the safest possible way. Architectural design strategies can play a significant role in infection prevention and control. The current study aims to examine the experiences of health workers with hospital spaces during the COVID-19 pandemic. Identifying the difficulties they face, the present study attempts to shed light on the role of the health care layout configuration in combating pandemics. The authors conducted observations at four hospitals and a series of online semi-structured interviews with 162 health care staff from March to May 2020. The study indicated that space configuration and the hospitalization of patients, layout and circulation of the environment, operation services such as indoor environment conditions, maintenance of health care system, and organizational support for health care staff were the most critical factors affecting infection control in health care environments. The initial zoning and separation of patients were the most effective methods of controlling infection. Hospitals with clustered plan layouts were found to be the most effective buildings for the zoning of COVID-19 patients during the pandemic and for infection control.

Current approaches for preventing environment-associated contamination in healthcare facilities: a systematic literature review by open access database

“…Among the problems identified through these instruments are poor isolation of the infectious ward; improper or absence of spatial isolation of patients with COVID-19 from others; long-distance between essential parts; problems with the main entrance/shared entrance for the Computerized Tomography (CT) scan and lung screening, and the inadequacy of facilities [ 47 ]. Problems of the emergency department and waiting rooms; improper or absence of spatial isolation of communication spaces and transporting patient tested positive; lack of sufficient elevators; non-segregation of hospital admission; and lack of social distancing measures were also identified [ 47 ]. Furthermore, there are improper clothing isolation and disinfection of equipment for non-COVID-19 patients; lack of indoor environmental conditions/improper lighting; inadequate resting places for medical staff; inappropriate eating conditions of treatment staff; and improper separation of sanitation services [ 47 ].…”

“…Problems of the emergency department and waiting rooms; improper or absence of spatial isolation of communication spaces and transporting patient tested positive; lack of sufficient elevators; non-segregation of hospital admission; and lack of social distancing measures were also identified [ 47 ]. Furthermore, there are improper clothing isolation and disinfection of equipment for non-COVID-19 patients; lack of indoor environmental conditions/improper lighting; inadequate resting places for medical staff; inappropriate eating conditions of treatment staff; and improper separation of sanitation services [ 47 ].…”

“…Another system developed combines fans with germicidal filters that were installed in hospital lighting to improve the air quality of hospitals [ 39 ] Need to think about mitigation measures for COVID-19 beyond those depending on human behaviour (minimise time exposed to the virus, social distancing, and wear personal protection equipment). An example is the use of far-UVC lighting to disinfect in-room air that has proven effectiveness [ 42 , 45 ] Need to carry out assessments based on existing recommendations, guides, protocols, and tools to ensure hand hygiene, healthcare facilities hygiene, water quality, sanitation, organisation management, among others Layout and spatial organisation [ 47 ] Environmental design strategies can play a significant role in infection prevention and control. They can reduce problems related to poor isolation of the infectious ward; absence of spatial isolation of patients with COVID-19 from others; long-distance between essential parts; problems with the main entrance, waiting rooms, and emergency department; lack of vertical and horizontal circulations to transport patients with infectious diseases; lack of social distancing measures; improper clothing isolation and disinfection of equipment; inadequate resting places and eating conditions for treatment staff; among others [ 48 ] In general, safe measures adopted in COVID-19 pandemics decrease the perception of teamness and depending on how the changes are implemented, teamwork could be sacrificed [ 49 , 50 ] Need to balance face-to-face (physical visibility) and virtual service (telemedicine) and to study how isolation and reduced contact with family members or healthcare professionals impact the patients [ 50 ] Telemedicine allows for greater flexibility and resilience in the hospital environment [ 51 ] Possibility of using CFD simulations to properly organize the layout of environments, considering the effect of fans, air conditioners, and openings on aerosol contamination [ 46 ] Importance of coordinating the flow and the movements, the management of waiting, the materiality of the waiting room (layout, design, and furnishing), and questions related to the air, among other things, to prevent cross-infection and antimicrobial resistance Air curtain and air purification [ …”

“…For instance, while the safety precautions in response to COVID-19 are necessary, teamwork could be sacrificed depending on how the changes are implemented [48]. Similarly, Lesan et al (2021) [47] highlight the role of healthcare layout configuration in combating pandemics, considering and examining the experience of health professionals that work on the front lines of the pandemic, through observations and 162 semi-structured interviews in four hospitals in Iran [47].…”

Responsiveness and Adaptability of Healthcare Facilities in Emergency Scenarios: COVID-19 Experience

“…Among recent papers that deal with the COVID-19 pandemic experience, there is the one by Lesan et al [ 38 ] who described how improper space management can increase the risk of infectious disease transmissions. The authors highlight the role of environmental design on infection control focusing on the experience of health care workers.…”