Pathways, Practices and Architectures: Containing Antimicrobial Resistance in the Cystic Fibrosis Clinic (PARC)

Antibiotics may suppress infections without eliminating them, giving rise to antimicrobial-resistant (AMR) bacteria and cross-infection between people. This project is both timely and important because of the increasing numbers of bacteria acquiring resistance to existing antibiotics. Our research compares the way three outpatient lung infection clinics attempt to control AMR and cross-infection through the design, practices and architectural layout of their built environments. It further seeks to learn lessons from this to limit AMR in wider healthcare settings. The PARC project has been co-designed in close collaboration with our three partner cystic fibrosis (CF) clinics. CF is just one of many life-threatening conditions characterised by long-term antibiotic treatment giving rise to cross-infection. In turn, cross-infection leads to clusters of highly resistant bacteria which significantly reduce life expectancy and now threaten to reverse recent improvements in survival. Dialogue with our clinical partners highlights the very different material and design approaches taken to prevent cross-infection through physical isolation, segregation and containment. Despite these variations, detailed research into questions of design and practice within the built environment of respiratory clinics is sparse. This research will be significant because CF clinics have much to learn by reflecting on their own practices. They also have much to learn from each other, and much to offer the wider clinical community in limiting AMR. Our focus on CF as an exemplar has far broader relevance in design approaches to AMR mitigation in more common respiratory disorders and in infection control more generally. This research will make visible the different and sometimes competing AMR design priorities of key stakeholders (including people with CF, clinicians, designers, hygiene personnel, etc.). It will map the differing 'real world' pathways and journeys through each clinic. It will explore how physical interaction, contact and exchanges are managed through the layout of the clinics. It will also enable our partner clinics and their users to explore scope for redesigning practice and repurposing clinical space to limit AMR and cross-infection. Our project involves an innovative combination of visual and qualitative research methods. We will be using the architectural layout plans of each clinic as a focus for interviews with patients, clinicians, hospital estates personnel, hygiene staff and designers. Our interviews will also draw on the skills of the project's graphic artist who specialises in fieldwork illustration to visually record real world experiences and journeys. We will also be undertaking 'walking interviews' placing our respondents within the flow of their routines, and using photography to chronicle risky spaces and objects. The project has an observational component to document key sites of high risk within the clinics including waiting areas, reception desks, corridors, wash basins and hand sanitisers, etc. These visual, graphic and textual findings will subsequently be used in co-design workshops at each of the clinics to improve present and future AMR mitigation. The project brings together the expertise of a highly multidisciplinary team involving an academic architect, sociologists of medicine and science, micro-biologists and a graphic artist. PARC will have a positive impact upon: our three partner clinics who have been involved in the design of the project; people with CF and the CF Trust; the wider respiratory healthcare community, the NHS and Department of Health; healthcare designers and architects; policy making on AMR.