Workplace indoor environmental quality and asthma-related outcomes in healthcare workers.

BACKGROUND: Asthma-related health outcomes are known to be associated with indoor moisture and renovations. The objective of this study was to estimate the frequency of these indoor environmental quality (IEQ) factors in healthcare facilities and their association with asthma-related outcomes among workers. METHODS: New York City healthcare workers (n = 2030) were surveyed regarding asthma-related symptoms, and moisture and renovation factors at work and at home during the last 12 months. Questions for workplace moisture addressed water damage (WD), mold growth (MG), and mold odor (MO), while for renovations they addressed painting (P), floor renovations (FR), and wall renovations (WR). Regression models were fit to examine associations between work and home IEQ factors and multiple asthma-related outcomes. RESULTS: Reports of any moisture (n = 728, 36%) and renovations (n = 1412, 70%) at work were common. Workplace risk factors for asthma-related outcomes included the moisture categories of WD by itself, WD with MO (without MG), and WD with MG and MO, and the renovation category with the three factors P, FR, and WR. Reports of home IEQ factors were less frequent and less likely to be associated with health outcomes. Data analyses suggested that MG and/or MO at work and at home had a synergistic effect on the additive scale with a symptom-based algorithm for bronchial hyperresponsiveness. CONCLUSIONS: The current study determined that moisture and renovation factors are common in healthcare facilities, potentially putting workers at risk for asthma-related outcomes. More research is needed to confirm these results, especially prospective studies.

A hermeneutic-phenomenological study of paediatric intensive care unit nurses' professional identity following hospital redesign: Lessons learned for managers.

AIM: To provide insights for health care managers by exploring paediatric intensive care unit nurses' lived experience of professional identity in the context of organisational change. BACKGROUND: While professional identity improves retention of nurses and provision of quality care, outcomes of importance for managers, organisational change perturbs this identity. METHOD: The study used a hermeneutic-phenomenological design. Data were collected via individual interviews, photographs, participant observation and document review. A purposive sampling strategy was used to recruit paediatric intensive care unit nurses (n = 15) in a large Canadian paediatric hospital. RESULTS: Nurses' critical care identity eroded in this organisation due to the interplay between hospital redesign and new eligibility criteria for patient admissions. CONCLUSION: Interactions between multiple projects and the unit context, as well as nursing professional identity, need to be considered early on during project planning. This study fills an important gap in research concerning the management challenges brought about by the intersection of multiple changes. IMPLICATIONS FOR NURSING MANAGEMENT: The results from this study bring to light three important lessons for nurse managers: 1) the specific unit context should be evaluated before a project is initiated; 2) the physical environment needs to be considered when determining staffing requirements; and 3) identity transitions need to be managed.

Effect of laminar air flow and building construction on aspergillosis in acute leukemia patients: a retrospective cohort study.

BACKGROUND: The preventive effect of laminar air flow (LAF) on aspergillosis has been observed in patients with hematological malignancies. However, the short follow-up period limits the interpretation of study results. METHODS: To assess the preventive effect of long-term LAF use on aspergillosis in its long-term use, we retrospectively analyzed 124 acute leukemia patients at our hospital between January 2005 and March 2016. We compared the incidence of aspergillosis before (May 2008) and during the construction of a new building (June 2008-January 2010) and in the early (February 2010-March 2014) and late (April 2014-March 2016) periods after moving to a new hematology ward with an LAF system. The 2008 European Organization for Research and Treatment of Cancer and Mycosis Study Group criteria were used for the diagnosis of aspergillosis. RESULTS: Fourteen patients were diagnosed with possible, probable, or definite aspergillosis. Cumulative incidence rates of aspergillosis at day 180 were 12.4, 24.9, 9.3, and 25.1% before construction, during construction, in the early period after moving to a new ward, and in the late period after moving to a new ward, respectively (p = 0.106). Multivariate analysis showed that the LAF system tended to reduce the risk of aspergillosis in the early period (before construction vs. early period; hazards ratio (HR) = 1.97, p = 0.463 and during construction vs. early period;HR = 3.42, p = 0.184), but the risk increased in the late period (late vs. early period, HR = 5.65, p = 0.035). CONCLUSIONS: Building construction might increase the risk of aspergillosis. Short-term LAF use might reduce aspergillosis risk, but its long-term use is inadequate, although we could not exclude the possibility of increased risks in the recent period due to continued improvements in the different areas of our hospital. Strict maintenance, more effective LAF system, and optimization of aspergillosis prophylaxis may be necessary.

Emergency Nurses' Perceptions of Efficiency and Design: Examining ED Structure, Process, and Outcomes.

INTRODUCTION: Due to increasing demands, it is imperative for emergency departments to improve efficiency, while providing safe and effective care. Efficient and quality healthcare delivery are impacted by interactions among the emergency department's physical structure, processes, and outcomes. Examining the interrelationship between these three components is essential for assessing quality of care in the ED setting. Studies simultaneously investigating all three aspects of this model are rare. OBJECTIVES: To study examined emergency nurses' perceptions of efficiency and satisfaction with the design of a newly constructed academic emergency department through analysis of these three assessment factors. METHODS: Data were collected using observational techniques, physical measurements of walking, and staff questionnaires. Correlation analysis was employed to investigate the relationships among specific structure, process, and outcome factors. Hierarchical linear regression was conducted to understand which structure and process variables in particular were related to the dependent variable, perceptions of efficiency and staff satisfaction with design. RESULTS: Outcomes revealed that all of the structure and process factors examined in this emergency department including unit configuration, technology, lighting, visibility, patient room layout, storage, walkability, staff stress, data access, and teamwork were significantly associated with perceptions of efficiency and staff satisfaction with design. DISCUSSION: The findings suggest that the structure of the built environment can shape healthcare processes occurring within it and ultimately improve the delivery of efficient care, thus increasing both patient and staff satisfaction. As such, the designed environment has a critical impact on enhancing performance, productivity, and staff satisfaction.

[Analysis of contemporary hospital infrastructure pertaining to infection prevention in Germany]. / Ausstattung mit Händedesinfektionsmittelspendern und Einbettzimmern in Hinblick auf die Infektionsprävention - eine Bestandsaufnahme in Krankenhäusern in Deutschland.

BACKGROUND: A high percentage of single-bed rooms and antiseptic hand rub dispensers in hospitals are required for infection prevention OBJECTIVE: Data acquisition of the hospitals' current status of infrastructure pertaining to infection prevention MATERIALS AND METHODS: A electronic questionnaire was sent in March 2015 to all hospitals participating in the nosocomial infection surveillance system (KISS) to collect operational infrastructure data. RESULTS: Completed questionnaires were received from 621 hospitals (response rate 46 %) and provided data about the building infrastructure of 534 intensive care units and 621 representative medical wards. While most beds in the intensive care unit are equipped with an antiseptic hand rub dispenser at the bedside, only 31.5 % of the medical ward beds are so equipped. Moreover, only 27.1 % of intensive care beds and 6.4 % of medical ward beds are in single-bed rooms. The intensive care room size showed a median of 18 m² for single-bed rooms and 28 m² for two-bed rooms. In the medical wards, 28.2 % of the patient rooms are not equipped with an ensuite toilet. CONCLUSIONS: The paucity of bedside antiseptic hand rub dispensers in medical wards should be rectified at once to optimize hand hygiene compliance of health care workers. Likewise, the lack of single-bed rooms on medical wards and intensive care units should be considered when renovating old or planning new buildings in the near future.

ICU architectural design affects the delirium prevalence: a comparison between single-bed and multibed rooms*.

OBJECTIVES: Delirium risk factors are related to the patients' acute and chronic clinical condition, treatment, and environment. The environmental risk factors are essentially determined by the ICU architectural design. Although there are countless architectural variations among the ICUs, all can be classified as single- or multibed rooms. Our objectives were to compare the ICU delirium prevalence and characteristics (coma/delirium-free days, first day in delirium, and delirium motoric subtypes) of critically ill patients admitted in single- or multibed rooms. DESIGN: Retrospective. SETTING: ICU of a teaching oncologic hospital with 31 beds. Twenty-three beds distributed in one multibed room with 13 beds and other with 10 beds. Eight beds distributed in single-bed rooms. PATIENTS: All adult patients admitted from February to November 2011. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We evaluated 1,587 patients and included 1,253 patients. Patients' characteristics at ICU admission and their outcomes along the ICU stay were not different between patients admitted in single- or multibed rooms. One hundred sixty-three patients (13.0%) had delirium, and the prevalence was significantly lower in patients admitted in single-bed rooms (6.8% × 15.1%; p < 0.01). This lower prevalence occurred in patients admitted due to a medical (11.0% × 25.6%; p < 0.01) or postoperative (5.0% × 11.4%; p < 0.01) reason. However, the coma/delirium-free days, the first day in delirium, and the delirium motoric subtypes were not different between the single- and multibed rooms. The risk factors associated with delirium were admission in multibed rooms (odds ratio, 4.03; 95% CI, 2.13-7.62), older age, ICU-acquired infection, and higher Simplified Acute Physiology Score 3 and Sequential Organ Failure Assessment score. CONCLUSIONS: Critically ill patients admitted in single-bed rooms have a lower prevalence of delirium than those admitted in multibed rooms. However, coma/delirium-free days, first day in delirium, and motoric subtypes were not different.

Design Criteria of Shelter Hospitals in Response to Biological Accidents: A Systematic Review.

BACKGROUND: The appropriate response to mass causality biological events requires well-established preparedness and providing a surge capacity. In such a situation, a practical solution is to convert large public venues into shelter hospitals. Due to the lack of a guideline for the transformation of a large public center into a hospital, the present study collected the design criteria for the transformation of public buildings into shelter hospitals in response to biological events such as epidemics or mass causality biological accidents. METHODS: The keywords were searched in Scopus, Web of Science, and PubMed databases until November 2021. This systematic review was conducted using terms related to mass causality biological accidents, shelter hospitals, and design criteria. RESULTS: Of 1802 extracted articles, duplicates (n = 280) and unrelated publications (n = 1342) were left out in the initial evaluation. Among 180 remained papers, 29 records satisfied our criteria after reviewing abstracts and full texts. Most of the included studies were related to the transformation of public venues into hospitals in response to the coronavirus disease 2019 (COVID-19) pandemic. The investigated themes included site selection, layout and structure, waste and wastewater management, ventilation, communication, food and medicine delivery, humanitarians and social supports, post-treatment care, and Management measures. CONCLUSIONS: In summary, large public venues are highly recommended alternatives for surge capacity in response to mass causality biological accidents. However, the main challenges for using these centers are the provision of basic requirements such as water and electricity, ventilation, and available space.

Do windows or natural views affect outcomes or costs among patients in ICUs?

OBJECTIVE: To determine whether potential exposure to natural light via windows or to more pleasing views through windows affects outcomes or costs among critically ill patients. DESIGN: Retrospective cohort study. SETTING: An academic hospital in Philadelphia, PA. PATIENTS: Six thousand one hundred thirty-eight patients admitted to a 24-bed medical ICU and 6,631 patients admitted to a 24-bed surgical ICU from July 1, 2006, to June 30, 2010. INTERVENTIONS: Assignment to medical ICU rooms with vs. without windows and to surgical ICU rooms with natural vs. industrial views based on bed availability. MEASUREMENTS AND MAIN RESULTS: In primary analyses adjusting for patient characteristics, medical ICU patients admitted to rooms with (n = 4,093) versus without (n = 2,243) windows did not differ in rates of ICU (p = 0.25) or in-hospital (p = 0.94) mortality, ICU readmissions (p = 0.37), or delirium (p = 0.56). Surgical ICU patients admitted to rooms with natural (n = 3,072) versus industrial (n = 3,588) views experienced slightly shorter ICU lengths of stay and slightly lower variable costs. Instrumental variable analyses based on initial bed assignment and exposure time did not show any differences in any outcomes in either the medical ICU or surgical ICU cohorts, and none of the differences noted in primary analyses remained statistically significant when adjusting for multiple comparisons. In a prespecified subgroup analysis among patients with ICU length of stay greater than 72 hours, MICU windows were associated with reduced ICU (p = 0.02) and hospital mortality (p = 0.04); these results did not meet criteria for significance after adjustment for multiple comparisons. CONCLUSIONS: ICU rooms with windows or natural views do not improve outcomes or reduce costs of in-hospital care for general populations of medical and surgical ICU patients. Future work is needed to determine whether targeting light from windows directly toward patients influences outcomes and to explore these effects in patients at high risk for adverse outcomes.

Using Space Syntax Analysis to Measure Patient Aggression Risk.

OBJECTIVES: The present study investigates whether space syntax offers appropriate tools for identifying risks of aggression, interventional opportunities, and environmental design strategies to reduce the risk of Type II violence in emergency departments. BACKGROUND: Although healthcare workers are a relatively small percentage of the U.S. workforce, they sustain almost 75% of workplace assaults. Poor environmental design has been identified as an antecedent to aggression by patients and/or their companions. METHOD: Guided by Rational Choice Theory, Lifestyle Exposure Theory, Routine Activity Theory, and Crime Prevention through Environmental Design (CPTED), the study uses five visibility graph analysis (VGA) measures: visibility, control, controllability, mean visual depth, and occlusivity. Three U.S. hospital-based emergency departments were selected. First, a VGA was performed on all three layouts. A second VGA was performed after excluding unconnected spaces, and a third was performed on key patient and staff areas. Last, a fourth VGA was conducted after performing physical modifications to the three departments. RESULTS: Statistical analysis revealed significant differences in VGA measures not only between different layouts but also between the original and modified layouts. Specifically, small changes created by architectural features can affect visual access and exposure as measured by space syntax. Alcove-style spaces in key staff areas are also associated with limited visual control of the local environment. Typically, in smaller zones, central staff workstations afford better control of patient spaces. CONCLUSION: This study shows that space syntax analysis is a useful tool for identifying risks of aggression in hospital spaces and for identifying interventional opportunities.

Evidence-Based Design in the Hospital Environment: A Staff's Burnout Study in the COVID-19 Era.

OBJECTIVE: This study aimed to evaluate the evidence-based design of the hospital physical space effect on the burnout of nurses and physicians during COVID-19. The research question was to identify the connection between daylight, nature-view windows, and hospital staff burnout during Covid-19. BACKGROUND: The evidence-based design in the hospital environment affects the health of the medical staff. The promotion of the hospital environment has a significant effect on healthcare system improvement. METHODS: This cross-sectional study was performed on 406 nurses and physician's burnout in Guilan province in 2020. Three questionnaires were used: demographic, physical space of the hospital, daylight, nature-view windows, and Maslach Burnout Inventory. Logistic regression (LR) analysis was used to determine the association between burnout and the hospital environment. The significance level was considered with p < .05. RESULTS: The results showed statistically significant correlations between patient units and the environmental characteristics of the hospitals with staff's burnout (p < .001). Of note, 62.9% of physicians and 71.9% of nurses had moderate work-related burnout. The highest burnout score was seen among staffs of emergency departments adjusted multivariate LR model revealed that 27.1% of work-related burnout in nurses and physicians was predictable with age, light, marital status, and hospitals. Our results showed that accessing more daylight could reduce burnout (p = .018, odds ratio [OR] = 0.910). CONCLUSION: Based on the result, the daylight impact on burnout reduction is more significant than other factors. It is suggested that adequate lighting, proper environmental design, and nature-view windows could create appropriate space for enhancing medical staff satisfaction and reducing burnout.

Adding additional grab bars as a possible strategy for safer hospital stays.

Patient room design should fulfill the safety needs of most patients. This article addresses the safety concerns related to grab bars and handrails (a United States-based review) and describes our proposed innovative approaches to promote safer hospital stays. The fixed augmentation of high-low grab bars and handrails can economically prevent inpatient falls in the areas commonly used by patients (e.g., patient rooms, patients' bathrooms, and hallways). The optimum grab bar and handrail configurations require further research. Revisions to guidelines for health care facilities related to grab bars and handrails should allow a range that respond to age- and disability-specific needs.

Temporal variations in bacterial community diversity and composition throughout intensive care unit renovations.

BACKGROUND: Inanimate surfaces within a hospital serve as a reservoir of microbial life that may colonize patients and ultimately result in healthcare associated infections (HAIs). Critically ill patients in intensive care units (ICUs) are particularly vulnerable to HAIs. Little is known about how the microbiome of the ICU is established or what factors influence its evolution over time. A unique opportunity to bridge the knowledge gap into how the ICU microbiome evolves emerged in our health system, where we were able to characterize microbial communities in an established hospital ICU prior to closing for renovations, during renovations, and then after re-opening. RESULTS: We collected swab specimens from ICU bedrails, computer keyboards, and sinks longitudinally at each renovation stage, and analyzed the bacterial compositions on these surfaces by 16S rRNA gene sequencing. Specimens collected before ICU closure had the greatest alpha diversity, while specimens collected after the ICU had been closed for over 300 days had the least. We sampled the ICU during the 45 days after re-opening; however, within that time frame, the alpha diversity never reached pre-closure levels. There were clear and significant differences in microbiota compositions at each renovation stage, which was driven by environmental bacteria after closure and human-associated bacteria after re-opening and before closure. CONCLUSIONS: Overall, we identified significant differences in microbiota diversity and community composition at each renovation stage. These data help to decipher the evolution of the microbiome in the most critical part of the hospital and demonstrate the significant impacts that microbiota from patients and staff have on the evolution of ICU surfaces. Video Abstract.

Clinical performance and resource utilization in the start of a totally new Intensive Care Unit. Same staff, new area.

BACKGROUND: There is little information of intensive care unit (ICU) performance when it's relocated to a totally new and equipped area. OBJECTIVE: To analyze the clinical performance and use of resources of a new respiratory-ICU (nRICU) in a large third-level care hospital. METHOD: Cross-sectional, comparative study using prospective data of patients admitted from July 17, 2017 to July 17, 2018. The Rapoport adjusted method was used to obtain the standardized clinical performance index (SCPI) and the standardized resource use index (SRUI). RESULTS: Out of 354 patients, those who were readmissions or remained hospitalized and those whose treatment was withheld or withdrawn where excluded from the analysis. In 301 patients, the observed survival at hospital discharge was 63% while the expected survival was 67.7%. Values of SCPI and SRUI were -1.03 and 0.05 respectively, placing results in coordinates within two standard deviations when plotted in the Rapoport chart. There was a statistically significant difference in survival when comparing the study period with outcomes obtained in the RICU before its relocation (63% vs. 55%, p = 0.01). CONCLUSIONS: In its 1st year of operation, the nRICU had better clinical performance compared to the former RICU, with no change in the use of resources.

ANTECEDENTES: Existe poca información acerca del desempeño de una unidad de cuidados intensivos (UCI) cuando es reubicada en un área totalmente nueva y equipada. OBJETIVO: Analizar el rendimiento clínico y el uso de recursos de la nueva UCI respiratoria (UCIR) de un hospital grande de tercer nivel. MÉTODO: Estudio transversal, comparativo, con datos prospectivos de pacientes ingresados del 17 de julio de 2017 al 17 de julio de 2018. Se usa el método ajustado de Rapoport para obtener el índice de rendimiento clínico estandarizado (IRCE) y el índice de uso de recursos estandarizado (IRURE). RESULTADOS: De 354 pacientes fueron excluidos los reingresos, los pacientes aún hospitalizados y aquellos a quienes se limitó o retiró el tratamiento. En 301 pacientes la sobrevida hospitalaria fue del 63%, mientras que la sobrevida esperada fue del 67.7%. El IRCE fue −1.03 y el IRURE fue 0.05, situando el resultado en coordenadas dentro de dos desviaciones estándar en el gráfico de Rapoport. Hubo una diferencia estadísticamente significativa en la sobrevida comparando el periodo de estudio con resultados de la UCIR obtenidos antes de su reubicación (63 vs. 55%, p = 0.01). CONCLUSIONES: En su primer año de funcionamiento, la nueva UCIR tuvo mejor rendimiento clínico que la antigua, sin modificación en el uso de recursos.

Hospital Building and Departmental Area Calculation: Comparison of 36 Recent North American Projects.

BACKGROUND: Hospital trustees, administrators, and their consultants must base important budget decisions upon a projection of the size of proposed construction projects. The anticipated functions and an estimate of the space required are generally provided in a project program or project brief. The programming consultant, often part of the architect's team, will calculate the physical area (square feet or square meters) required to perform the desired functions based on an understanding of demographics in the service area, services offered, the volumes of service required, and a historical understanding of space required to perform those services. Hospitals and hospital designs in North America have been changing. Plans must now address far higher percentages of outpatient care, accommodate new equipment modalities, and provide space to account for family presence in patient rooms. AIM: A study was undertaken to better understand whether the allocation of space in recently constructed hospital projects is different from the amounts of area devoted to various departments and functions in older projects. METHOD: In order to assure measurement consistency, a measurement methodology was developed and is reported elsewhere. Thirty-six recently constructed hospitals were measured. RESULTS: The results provide new information about the allocation of space for nondepartmental functions within the overall building gross calculation. Many of the departmental space allocations fell within an expected range. Ultimately, significant detailed information about hospital area calculations is made available to the public because of this study.