Pathways, practices and architectures: Containing antimicrobial resistance in the cystic fibrosis clinic

Abstract

Antimicrobial resistance and the adaptation of microbial life to antibiotics are recognised as a major healthcare challenge. Whereas most social science engagement with antimicrobial resistance has focussed on aspects of ‘behaviour’ (prescribing, antibiotic usage, patient ‘compliance’, etc.), this article instead explores antimicrobial resistance in the context of building design and healthcare architecture, focussing on the layout, design and ritual practices of three cystic fibrosis outpatient clinics. Cystic fibrosis is a life-threatening multi-system genetic condition, often characterised by frequent respiratory infections and antibiotic treatment. Preventing antimicrobial resistance and cross-infection in cystic fibrosis increasingly depends on the spatiotemporal isolation of both people and pathogens. Our research aims to bring to the fore the role of the built environment exploring how containment and segregation are varyingly performed in interaction with material design, focussing on three core themes. These include, first, aspects of flow, movement and the spatiotemporal choreography of cystic fibrosis care. Second, the management of waiting and the materiality of the waiting room is a recurrent concern in our fieldwork. Finally, we take up the question of air, the intangibility of airborne risks and their material mitigation in the cystic fibrosis clinic.

Exploring engagement with digital screens for collecting patient feedback in clinical waiting rooms: The role of touch and place

“…The appropriation by lay people of biomedical knowledge has been recognised as a way of making sense of illness and its origins ( McClean and Shaw (2005) , and thus, the above reasoning is consistent with this broader tendency. It also resonates with recent sociological research where interaction and spatiotemporal organisation of care within clinical waiting areas reflects their designation as cross-infection ‘hot spots’ ( Brown et al, 2019 ).…”

“…This is because of key concerns about trust and privacy and threats to patient identity where recipients of care might be labelled as ‘difficult’ or ‘demanding’ if they give poor feedback. Such issues have potential to transform the waiting room space as an extension of the clinic space where power relations facilitate different experiences of waiting ( Bates, 2019 ) and where waiting is ‘performed’ ( Brown et al, 2019 ).…”

Drawing Atmosphere: A Case Study of Architectural Design for Care in Later Life

“…By not merely accommodating the everyday but taking it as its first principle in guiding design, architecture can form a basis for more socially just, imaginative and realistic spatial cultures (Till, 2009). Drawing is, of course, just a first step in much wider processes of place making which, as we have previously argued, relate to how places are used in practice, by those who inhabit them in everyday ways (Brown et al, 2019; Martin, 2016; Martin et al, 2019). So, we do not suggest that convivial places will result in a causal way because of an architect’s good intentions or how they are sketched.…”

Air care: an ‘aerography’ of breath, buildings and bugs in the cystic fibrosis clinic

“…Much of the policy engagement with AMR has focussed on aspects of human ‘behaviour’ especially prescribing and patient ‘compliance’ (Chandler 2019, Will 2018), while less attention has been directed at the socio‐material nature/s of healthcare architectures (Brown et al . 2019, Martin et al . 2015).…”