August 23, 2021

Case Study: Design Features Help Reduce Potential for HAIs in ICU

In a recently completed ICU project, Haskell designers included numerous measures to reduce the risk of contamination and post-discharge infections.


Post-discharge infections are one of the leading causes of hospital readmissions. Medicare payments typically make up 33-55% of annual hospital revenue, so even a relatively small hospital with $100M in revenue could have more than $10M at risk when you consider loss of payment and the cost of extended stays. And those  figures do not include the significant costs of litigation arising from infections or the fact that Medicaid and private payers are likely to follow suit, exacerbating the risk.

At a recently completed 12-bed ICU, we evaluated the inclusion of several design features intended to minimize the potential for Healthcare Associated Infections (HAIs). Following are the measures we implemented and our reasoning for those decisions.

Prominent Handwash Sink Placement

It is well established that hand hygiene is the most important single measure for preventing the spread of pathogens in healthcare settings.  Studies  show that offering a multifaceted approach that incorporates both traditional sinks and alcohol-based hand-rub stations near the patient significantly improves handwashing compliance.

In this project, we installed alcohol-based hand-rub stations outside the patient doorway and inside the patient room adjacent to the soiled room door. Also, medical staff and Infection Control officers wanted to promote the act of care provider hand washing in the patient engagement process. We prominently located the in-room sink on a peninsula to enable providers to make eye contact and initiate conversation with the patient or family care partner while washing their hands. This gives us the triple advantage of increasing handwashing compliance, letting the physician know that we are sensitive to their productivity, and displaying to the customer a commitment to high-quality care.

Integral Blinds in Lieu of Cubicle Curtains

In 2013, a study published in the American Journal of Infection Control found that 37% of hospital facilities launder privacy curtains only when they are visibly soiled, but 92% of hospital privacy curtains are contaminated one week after laundering. And the research becomes more alarming when you consider the types of contaminants: 42% of hospital privacy curtains in the study were contaminated with vancomycin-resistant enterococci (VRE) and 22% with MRSA4.

Given that one MRSA infection costs $47,000-$53,000 on average, and a typical 200-bed hospital incurs $1,779,283 in annual MRSA infection-related expenses per year, we recommended, and the hospital agreed, that the upfront building cost of incorporating integral blinds ($5,083 per room) was worth the expense. As clinical quality and safety move to the forefront of inpatient priorities under the Affordable Care Act, this feature is an excellent example of using evidence to guide investment.

Virtual Rounding

The new ICU utilizes a state-of-the-art team theatre for virtual team rounding. Physician leadership sought to lessen the impact of educational rounding in this teaching hospital environment and requested a central room where students virtually observe the immediate clinical team as they interact with the patient and family care providers. The medical team proposed that reducing the number of persons entering/exiting the patient care environment should reduce the introduction of potential contaminants.

At Haskell, we are committed to integrating data and research in our architectural solutions. This ICU will benefit from these enhancements both now and in the future at we deal with more complex germs in a ‘drug resistant’ era in which we live.

About the author: Haskell’s David Martin, AIA LEED AP BD+C, is an experienced healthcare planning and design leader with a professional history coordinating multi-disciplinary teams of hospital administrators, physicians, clinicians, design professionals and consultants in the healthcare architecture arena. He is a strong arts and design professional with a Master of Architecture (MArch) from Clemson University.

Haskell delivers $2± billion annually in Architecture, Engineering, Construction (AEC) and Consulting solutions to assure certainty of outcome for complex capital projects worldwide. Haskell is a global, fully integrated, single-source design-build and EPC firm with over 2,200 highly specialized, in-house design, construction and administrative professionals across industrial and commercial markets. With 20+ office locations around the globe, Haskell is a trusted partner for global and emerging clients.

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