Infection control starts from the ground up

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When Maja McGuire sees hospital construction she experiences a different sense of anticipation and opportunity than most. She’s anticipating dust control and inspections of hoarding. She’s considering the opportunity for installation of superior, easily cleanable materials, surfaces and finishes. She’s pouring over plans for hand sink locations, waste disposal, storage, heating, ventilation, and the spacing of beds.

Maja McGuire is an Infection Prevention and Control Coordinator at Sunnybrook Health Sciences Centre and beneath the tell-tale construction cranes at Sunnybrook’s main campus, McGuire is busy collaborating with core groups to ensure continued patient, staff and public safety – through infection control design literally from the ground up.

Substantial construction is underway. The M-Wing or main wing of Sunnybrook’s main campus will be expanded four floors to house a new state-of-the art unit for high-risk birthing, the Neo-Natal Intensive Care unit and research facilities. Expansions are also underway in emergency and in the John & Liz Tory Trauma Centre.

“From the earliest construction discussions, our Infection Prevention and Control team has had a significant, ongoing and integrated role in planning and execution,” says McGuire. “We are part of a highly functional working group representing corporate development and project planning, risk management, occupational health and safety, facilities management, and affiliated architects and contractors.”

Proactive design in emergency and

neo-natal intensive care

Using guidelines from the Canadian Standards Association and American Institute of Architects, the group interprets these standards into practical design and execution with a focus on infection prevention and control. Says McGuire: “Active participation in the user groups facilitates the creation of well-designed patient units and rooms that improve patient outcomes by addressing variables such as staff satisfaction, layouts to reduce infection, and patient privacy. The goal is to make decisions based on the best information available from research, standards and project evaluations.”

The expanded emergency department will be double its original size at completion. The emergency room is often the point of entry for ill and potentially contagious individuals. The new emergency department will be structured in a strategic pod design to reduce risk and offer better containment in the event of an outbreak. Each pod will be self-sufficient with a centralized nursing station, racetrack design with patient rooms on the outside, areas for supplies and independent heating, ventilation, and air conditioning systems.

“This is about being forward-thinking,” says Dr. Mary Vearncombe, Medical Director, Infection Prevention and Control, Sunnybrook Health Sciences Centre. “Sunnybrook is investing in proactive, evidence-based design to increase safety for patients and staff.”

The new Neo-Natal Intensive Care unit – for which the Infection Prevention and Control team received North American recognition for best practice approaches on design – will exceed standards in spacing with more single rooms, independent heating, ventilation and air-conditioning.

Similar to the emergency expansion, there will be more hand hygiene stations installed, greater provisions for appropriate waste disposal and storage, and meticulous attention to materials, surfaces and finishes including walls, ceilings, light fixtures and equipment. All surfaces are reviewed by Infection Prevention and Control and determined to be non-porous, easily cleanable with minimal seams.

Leading the way in infection control in health-care facility design and

construction

“Hospitals are ever-expanding structures that must continue to provide quality patient care,” says Sandra Callery, Director, Infection Prevention and Control, Sunnybrook Health Sciences Centre. “A big part of continued quality patient care is to implement the latest infection prevention protocols in planning and day-to-day monitoring of construction, and also to execute in the new structure, standards and best design practices to more proactively prevent and control infection.”

On best design practices, Sunnybrook’s Infection Prevention and Control team is active in research and has also been recognized by their peers.

Both McGuire and Dr. Vearncombe were invited to join an eight-member Infection Prevention and Control Facility Design Advisory Group. The group, brought together by the Ministry of Health and Long-Term Care and Infrastructure Ontario, is developing generic output specifications which will provide the baseline design criteria and performance requirements for new design or redevelopment of health-care facilities in Ontario including acute care hospitals, complex continuing care, rehab facilities and mental health centres. The advisory group developed a set of recommendations on spacing requirements, single rooms, waste management, airborne precaution rooms, hand hygiene and HVAC (heating, ventilation, air conditioning) systems, in addition to participating in the area specific focus groups that looked at departments and programs.

Early 2008 will also mark the third annual Symposium on Infection Control in Healthcare Facility Design and Construction. Initiated by McGuire and hosted by Sunnybrook, this unique forum supports the exchange of ideas and best practices in facility design and construction among Ontario’s health-care facilities. The forum brings together the perspectives of infection prevention and control, corporate planning and development, facilities management, architects and contractors, and focuses on education and the practical application of infection control standards and their interpretation into construction design and execution.

To further support exchanges for infection prevention and control professionals across Canada, McGuire also created and currently chairs the national and local Healthcare Facility Design and Construction Interest Groups for CHICA (Community and Hospital Infection Control Association of Canada).

For Maja McGuire, that different sense of anticipation and opportunity to build from the ground up is about greater opportunity for infection control design in anticipation to safeguard the future.