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Wolfgang Sunder Structural Hygiene: Making Hospitals Safe

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The Safe and Antibiotic Resistent Hospital

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Wolfgang Sunder Structural Hygiene: Making Hospitals Safe

  1. 1. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER Structural Hygiene - Making Hospitals Safe BUILDING THE FUTURE OF HEALTH GRONINGEN 2016
  2. 2. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER Institute for Architecture For Health Faculty Planing, Building and Environment Univ.-Prof. Christine Nickl-Weller Institute of Hygiene and Environmental Medicine Charité Berlin Prof. Dr. med. Petra Gastmeier Institute for Industrial Building and Construction Design Faculty of Architecture, Civil Engineering and Environmental Sciences Uni.-Prof. Carsten Roth Research and Development: Wolfgang Sunder STRUCTURAL HYGIENE PARTNER - UNIVERSITY 2 Infect Control 2020 – Innovative Reseach Alliance Administration: Hans-Knöll-Institute (HKI), Jena Prof. Dr. Axel Brakhage
  3. 3. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 1. FACING THE PROBLEM 2. OBJECTIVE TARGET 3. METHOD 3 STRUCTURAL HYGIENE STRATEGY
  4. 4. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER Hygiene-Scandal in Bremen: Looking for the guilty! STRUCTURAL HYGIENE HYGIENE SCANDALS IN THE MEDIA 4
  5. 5. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER STRUCTURAL HYGIENE INCREASE IN THE OCCURENCE OF RESISTENT BACTERIA 5 0 2 4 6 8 10 12 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 MREpro1000Patiententage Vancomycin resistant E. faecium Imipenem resistant A. baumannii 3GC resistant K. pneumoniae 3GC resistant E. coli MRSA Surveillance of Antibiotic use and resistance in ICUs
  6. 6. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 500.000 Patients fall ill to hospital-specific infections annually 10.000 Patients annually die because of these infections 23.000 Euro direct cost per patient 60.000 Euro indirect cost per patient = 5 Mrd. Euro Total cost per year Economic and Image damage! Source: Federal Ministry of Health 2015 STRUCTURAL HYGIENE LIFE-THREATENING INFECTIONS 6
  7. 7. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER STRUCTURAL HYGIENE LESS PROTECTION WITH ANTIBIOTICS 7
  8. 8. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER IMPORTANT: Recommendations are only evidence-based to a small extent! Source: Robert Koch Institute: Guideline for Hospital Hygiene and Infection Prevention (2001) STRUCTURAL HYGIENE LOW SCIENTIFIC STUDIES 8
  9. 9. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 1. FACING THE PROBLEM 2. OBJECTIVE TARGET 3. METHOD 9 STRUCTURAL HYGIENE STRATEGY
  10. 10. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER HOW CAN MY WORK CONTRIBUTE TO SOLVE THE PROBLEM? 10 STRUCTURAL HYGIENE OBJECTIVE TARGET
  11. 11. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER HOW CAN MY WORK CONTRIBUTE TO SOLVE THE PROBLEM? Recommendations of - innovative space interrelations and - processes in hygiene-critical functional areas of a hospital Focus presentation: ICU 11 STRUCTURAL HYGIENE OBJECTIVE TARGET
  12. 12. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 1. FACING THE PROBLEM 2. OBJECTIVE TARGET 3. METHOD 12 STRUCTURAL HYGIENE STRATEGY
  13. 13. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER HYGIENE 13 STRUCTURAL HYGIENE METHODS
  14. 14. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER HYGIENE 14 STRUCTURAL HYGIENE METHODS
  15. 15. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER QUESTION: Does single rooms in ICUs reduce the transmission / infection rate of nosocomial or MRE infection agents? 15 STRUCTURAL HYGIENE METHOD: RESEARCH ON SCIENTIFIC STUDIES
  16. 16. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER Search Strategy: • Studies since 1990 • Studies in english, german, … • Pubmed • Meshterms: architecture, design, healthcare associated infection or bloodstream infection 16 STRUCTURAL HYGIENE METHOD: RESEARCH ON SCIENTIFIC STUDIES
  17. 17. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 17 STRUCTURAL HYGIENE METHOD: RESEARCH ON SCIENTIFIC STUDIES
  18. 18. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 18 STRUCTURAL HYGIENE METHOD: RESEARCH ON SCIENTIFIC STUDIES SINGLE ROOMS IN THE ICU REDUCE INFECTION RATES AND MRE COLONIZATION RATES!
  19. 19. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER QUESTION: What deficits and improvements can I get from people who deal in their daily work with the topic of Hospital hygiene? 19 STRUCTURAL HYGIENE METHOD: USER SURVEY
  20. 20. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER Hospital Hamburg Hospital Schleswig- Holstein Hospital Lower Saxony 1.460 beds 54.000 inpatients per year 121.000 outpatients per year 330 beds 11.900 inpatients per year 33.700 outpatients per year 1.330 beds 45.900 inpatients per year 116.700 outpatients per year 20 STRUCTURAL HYGIENE METHOD: USER SURVEY, HOSPITALS
  21. 21. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER Doctors Hygienists Nurses Chief physican, Clinic for Anesthesia Chief physican, Clinic for Internal Medicine Chief physican Clinic for Orthopedics Chief OP-Management Deputy Emergency Department Deputy Surgery Emergency Department Hygiene Specialist Head of Hygiene Hygiene Specialist Hygiene Specialist Hygiene Specialist Care Manager Surgery Care Manager ICU Care Manager Neurology Care Manager ICU Care Manager ICU 21 STRUCTURAL HYGIENE METHOD: USER SURVEY, EXPERTS
  22. 22. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 18,75 Corridor, Care Unit and ICU Too tight, too little shelf, too long distances 18,75 Storerooms, Care Unit and ICU, Emergeny room Too little and minimal storage space, clean and unclean area in one room 18,75 Operation room No inward and outward yet, little movement area, exchange not working, anaestetic recovery room has overlap with other functional areas, Operation field n=17 19 % 19 % 19 % Which hygiene critical areas do you see in your hospital or at your station? 23 STRUCTURAL HYGIENE METHOD: USER SURVEY, EVALUATION
  23. 23. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER Which hygiene critical areas do you see in your hospital or at your station? 18,75 Emergency room Isolation rooms with no lock, too tight, Triage area with excessive mixing, WC visitors 12,5% Patient rooms including bathroom Too smal, Shared rooms (ICU), frequent contamination of the baths n=17 19 % 13 % 24 STRUCTURAL HYGIENE METHOD: USER SURVEY, EVALUATION
  24. 24. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 25 STRUCTURAL HYGIENE METHOD: USER SURVEY, EVALUATION
  25. 25. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER Which hygiene critical details do you see in hygiene- relevant areas? 25% Doors Lock doors without automatic (ICU), open doors (Oeration), Patient room without doors (ICU), Damage caused by transport 18,75 Use of wrong materials In the patient room and bath, countertops 18,75 Poor ventilation In the patient bath, inaccessible other Lack of storage and work surfaces, Use of incorrect furnishings, missing splash guard n=17 25 % 19 % 19 % 26 STRUCTURAL HYGIENE METHOD: USER SURVEY, EVALUATION
  26. 26. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 27 STRUCTURAL HYGIENE METHOD: USER SURVEY, EVALUATION
  27. 27. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER QUESTION: What is the current situation of the building structure of German hospitals? Which conclusions can be made in relations to the other research results? 28 STRUCTURAL HYGIENE METHOD: EMPERAIL DATA COLLECTION
  28. 28. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER Database: National Reference-Center for the registration of von nosocomial infections (KISS - Charité Berlin) Request to 1.357 German Hospitals ICU n= 534/368 Period: 24.3.2015 – 2.6.2015 29 STRUCTURAL HYGIENE METHOD: EMPERAIL DATA COLLECTION
  29. 29. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 30 STRUCTURAL HYGIENE PHYSICAL STRUCTURE OF THE ICUs Centric duplex Corridor Annex duplex Corridor Grid Corridor Circle Corridor Annex Corridor Centric „corner“ Corridor Annex „corner“ Corridor Centric Corridor Annex circle Corridor
  30. 30. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 31 STRUCTURAL HYGIENE PHYSICAL STRUCTURE OF THE ICUs Centric duplex Corridor (46/534) Annex duplex Corridor (18/534) Grid Corridor (4/534) Circle Corridor (24/534) Annex Corridor (91/534) Centric „corner“ Corridor (34/534) Annex „corner“ Corridor (55/534) Centric Corridor (158/534) Annex circle Corridor (158/534) 19,5%29,6%
  31. 31. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 32 STRUCTURAL HYGIENE SIZE OF THE ICUs Number of beds Room size Percentage of Single rooms Room size Percentage of Twin rooms Room size Percentage of Triple rooms
  32. 32. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 33 STRUCTURAL HYGIENE SIZE OF THE ICUs Number of beds Room size Percentage of Single rooms Room size Percentage of Twin rooms Room size Percentage of Triple rooms
  33. 33. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 34 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING PLANING
  34. 34. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 35 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING GENERAL ASPECTS
  35. 35. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 36 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING GENERAL ASPECTS COMPACT
  36. 36. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 37 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING GENERAL ASPECTS SHORT DISTANCE INTERNALLY
  37. 37. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 38 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING GENERAL ASPECTS SHORT DISTANCE TO OTHER AREAS
  38. 38. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 39 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING GENERAL ASPECTS SEPERATION / ISOLATION
  39. 39. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 40 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING GENERAL ASPECTS ENOUGH MOVEMENT AREA
  40. 40. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 41 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING GENERAL ASPECTS NO PROJECTIONS
  41. 41. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 42 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING GENERAL ASPECTS STORAGE AREAS
  42. 42. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 43 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING GENERAL ASPECTS OVERVIEW
  43. 43. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 44 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING DETAIL ASPECTS
  44. 44. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 45 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING DETAIL ASPECTS
  45. 45. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 46 STRUCTURAL HYGIENE RECOMMENDATIONS FOR PLANING DETAIL ASPECTS
  46. 46. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER 47 Target group • Hospital operators • Architects • All professionals who are involved in the planning and construction of hospitals Content • Planing systematic • Recommendations of innovative space and hygienic processes STRUCTURAL HYGIENE PUBLICATION 2017
  47. 47. INSTITUTE FOR INDUSTRIAL BUILDING AND CONSTRUCTION DESIGN RESEARCH HEALTH CARE WOLFGANG SUNDER Wolfgang Sunder Dipl.-Ing. Architect Institute for Industrial Building and Construction Design (IIKE) TU Braunschweig Pockelsstr.3 38106 Braunschweig Germany Phone: 0049-531 391 2544 Email: w.sunder@tu-bs.de Web.: www.tu-braunschweig.de/iike THANK YOU! 48

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