Designing bugs out: from bedside to ward

John Cooper, chief operating officer at NHS Purchasing and Supply Agency (PASA), admitted that when he sat down with Health Minister Lord Philip Hunt in 2007 to discuss how much work had been put into reducing HCAIs through procurement of “bacteria-beating” hospital furniture and other equipment, he had no option but to tell the assembled gathering the answer was “virtually none.”1 Efforts are now underway to address this issue (supported by PASA and other key organisations), and it is widely recognised that the risk of infection transmission from bedside furnishings, surfaces and medical devices is one that requires urgent attention. A number of studies have documented that healthcare workers may contaminate their hands or gloves by touching environmental surfaces near to the patient, posing a risk of crosscontamination. In particular, bed rails, bedside cabinets, mattresses, pressure cuffs and textiles – such as ward curtains, bedding and uniforms – have all been identified as important reservoirs for “super bugs”. Early last year, for example, the Stokes VA Medical Center, Cleveland Veterans Administration hospital, in the US, decided to test privacy curtains for the presence of Clostridium difficile. The study concluded that 42% were in fact contaminated.2 Various approaches are being taken to eliminate infection through improved design by creating disposable, single-use, or easy to clean products – as well as integrating anti-microbial materials, such as silver and copper.

Design Bugs Out

Prototypes of new designs of hospital furniture and equipment were recently showcased by the Design Council – ranging from “intelligent mattresses” that change colour when “compromised by body fluids”, to a simplified pulse oximeter, which eliminates difficulties associated with cleaning hard to access, internal surfaces. Developed in collaboration with industry and the Helen Hamlyn Centre, the Royal College of Art (RCA), the prototypes are the result of the Department of Health and NHS Purchasing and Supply Agency’s “Design Bugs Out” initiative.3 Led by the Design Council, a team of designers, ergonomists, and researchers talked with healthcare staff to identify items perceived to be the biggest potential infection carriers, as well as the characteristics of items like commodes, bedside cabinets, mattresses and curtains, and clinical components, which make them hard to clean. One of the “quick-fix” projects, undertaken by designers at the RCA’s Helen Hamlyn Centre, included the incorporation of a layer of hydrochromic ink into the covering of a new mattress which changes colour as soon as fluids seep through to the foam core – immediately alerting staff to a contamination risk. Because the mattress cover can be clearly seen each time nurses change the bed, contamination should be far easier and quicker to spot, enabling mattress disposal, when required, to be far faster than with existing processes. The project has also targeted the bedside cabinet – existing designs resemble domestic cupboards, but their complex internal spaces, inaccessible surfaces, angular joints and rough, absorbent materials make effective cleaning extremely difficult. The solution is a mobile patient bedside system that can be configured to suit different clinical settings and patient needs, with a design that makes it easy to disassemble and clean on a regular basis. Further design projects have included a wipe-clean blood pressure cuff secured using magnets instead of Velcro, which is easier to clean; and a magnetic curtain clip which can be used with common curtain bay configurations, which provides a single, wipe-clean, touch-point for staff and patients.