Paths of resistant pathogens in hospitals: architecture, design interventions, transmission risks

Paths of resistant pathogens' will map and visualise the paths that pathogens take through hospitals in order to model exposure and transmission risks. The project aims to minimise risks and prevent the spread of pathogens by making hand hygiene compliance easier through design interventions. The emergence and spread of antimicrobial-resistance (AMR) is a growing concern to global health. An estimated 700,000 people already die every year of resistant infections. Improving infection prevention and control is one important strategy to combat AMR. However, traditional approaches have shown limited benefit. For instance, educating healthcare workers to achieve higher rates of hand hygiene compliance has proven short-lived and ineffective. In this project we are building on existing design research, which has begun to shed light on the powerful role design can play in behaviour change, such as the location of sinks in increasing hand hygiene compliance. We will take this tradition of design research one step further by asking who complies and who contributes most to the potential spread of pathogens. We will achieve this by focusing on the different types of agents populating the spaces around patients: doctors, nurses and other healthcare workers, but also frequently overlooked groups such as porters, cleaners, food service workers, medical students, volunteers, etc. We will carry out a detailed analysis of architectural layouts based on space syntax techniques, which map the potential to encounter other people arising from the geometry of the building. Spaces that by the nature of their strategic location in the wider hospital system attract more flow of traffic will carry higher risks of spreading pathogens. Depending on where agents go, what or whom they touch, whether and where they wash their hands, and whether they bring along mobile items (potentially shared with and touched by others), different transmission risks may emerge. We will create visualisations of the paths that pathogens may take, as well as estimate exposure patterns and risks for each agent path. Agent behaviours accruing the highest risks will become targets for design interventions. To create appropriate design interventions, we will use a participatory approach. We will invite the different agents populating wards as well as hospital stakeholders (such as hospital management and directors of infection control) to co-creation workshops, where we will present our findings on transmission risks and spatial practices of agents. Listening to their experiences and reflections, we will create - together with them - a brief for design interventions in order to make compliance easier and improve infection control. Design responses will build on the collected data and depend on the co-creation process, but generally we can see opportunities arising from architectural modifications of layouts, adapting the locations of certain functional programmes and improving compliance by installations or a designed piece of interactive furniture. Leveraging the role of design to subtly nudge people to modify their behaviours, we envisage this project as a starting point of a wider conversation between design research and medical science.