Key considerations for a successful project

In the March 2024 HEJ, Consultant Medical Microbiologist, Michael Weinbren, head of Estates Risk and Environment at Belfast Health and Social Care Trust, George McCracken, Susanne Lee of independent public microbiology consultancy, Leegionella, and Consultant Medical Microbiologist at NHS Greater Glasgow and Clyde, Dr Teresa Inkster, argued that ensuring patient safety in new healthcare facilities requires a markedly different approach to design and construction. Here, in the second half of the article, they discuss some of the key issues requiring particular consideration against this backdrop to ensure a successful project outcome.

Preventing infections arising from the built environment in a new healthcare facility is a different entity to the traditional understanding of infection prevention and control (an Infection Control team patrolling the wards, and adherence to handwashing protocols etc). Any stakeholder can inadvertently take an action which results in a patient acquiring infection. This could, for example, be a manufacturer, an architect, a member of the design team, or one of the contractors on the site (this list is by no means exhaustive). The approach to mitigating these risks is quite different, and beyond the remit/skills of the Infection Prevention and Control team (see Figure 1).

Within working hospitals, it has taken time to establish that infection prevention was everyone's responsibility, and not not just that of the Infection Prevention team. Likewise, it should become the responsibility of all stakeholders in any project to minimise the risk of their actions on patient safety.

Every stakeholder needs to be empowered through training, risk assessment, and continuous feedback from issues arising in the built environment within their area of expertise. The goal is to achieve informed governance — a situation where everyone understands the consequences of their actions on patient safety. This aspect of infection prevention might be better referred to as occupant safety to distinguish it from traditional infection control. Introduction of an effective safety culture system utilising the whole of the Heinrich ratio — including 'near misses' feeding into a risk-based approach — will intuitively help deliver occupant safety.

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