Re-thinking the patient environment

As part of the Department of Health’s HCAI Technology Innovation Programme, the Design Council were tasked to come up with new designs for hospital furniture and equipment that would help the fight against MRSA and other Healthcare Associated Infections (HCAIs).
Design bugs out
The project was called Design Bugs Out and in April 2009, prototypes of innovative new designs were unveiled. The prototypes used cutting edge techniques to rethink the bedside environment, patient transport and everyday medical equipment, making them much easier to clean. They are also designed to influence patient and staff behaviour to reduce the likelihood of exposure to HCAIs.
A ‘21st century commode’ (portable toilet) was designed to be easy to take apart for cleaning, and which practically eliminates the hard-to-clean gaps and joins that characterise current designs.
A redesigned porter’s chair was created which is durable, comfortable, and cleverly uses design to make it easy to clean while reducing the number of obvious user ‘touchpoints’ where infection can be spread.
Also in the collection was an ‘intelligent’ mattress which changes colour when it becomes compromised by body fluids.
In addition, a patient bedside system comprising bedside storage and over-bed table which eliminates hard-to-clean corners, is made of special durable, scratch-resistant materials, and is easier for patients to use unaided.
What’s more, a unique new patient chair has been developed which pioneers a system of magnetised, removable cushions with easy-change laundered covers that make the chair clean, safe and comfortable.
A curtain clip was designed which through a unique design and magnetic mechanism, provide an easily sanitised ‘grab-zone’ and also keep the curtains securely closed.
A wipeable, polythene-covered blood-pressure cuff with magnetic closures which can be used instead of hard-to-clean Velcro fastenings was also developed.

Top designers
Through a national competition the Design Council appointed some of the UK top designers and manufacturers, renowned for design icons from Virgin Atlantic’s Upper Class airline seats to Herman Miller chairs and Parker pens, to work on the furniture and porter’s chair. A specialist healthcare team from the Helen Hamlyn Centre, Royal College of Art developed the designs for everyday equipment, such as the self-timing cannula, blood pressure cuff and ‘intelligent’ mattress.
Teams of designers and manufacturers, were asked to set out how they would tackle the design challenges, which were identified following extensive research in hospitals across the UK involving nurses, patients, cleaners, porters and other healthcare staff. A panel of the UK’s most respected experts in the fields of design, healthcare, microbiology, nursing and patient care was assembled to assess which items in the hospital environment, if redesigned, could have the most potential to reduce patient’s exposure to HCAIs through contact with their immediate surroundings.

Infection control
So what evidence is there that new furniture and equipment will help in the battle against HCAIs?
A study entitled ‘Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning’ (Lancet Vol 8 Feb 2008 101-113) concluded that: “The greatest risk for patients is contaminated near-patient hand-touch sites in clinical areas. This is borne out by studies that have seeded viral or other molecular fragments onto a door handle or a telephone, and then charted their movements over the course of a few days.     Such studies show the importance of sites that human hands touch more frequently, and can be used as an indicator for what might happen regarding the spread of MRSA.”
Anecdotal research among healthcare staff who regularly clean ward-based furniture and equipment indicates that redesigning furniture and equipment to enable better cleaning could have two benefits. Firstly it will improve the efficiency of cleaning – creating items which are easier to clean, for example by eliminating crevices, joins and hard-to-reach contours. Secondly it overcomes inertia around cleaning awkward items – if items which have previously been difficult to maintain are made easier and quicker to clean, the regularity of cleaning is likely to increase.

Design for Patient Dignity
The Department of Health also teamed up with the Design Council to help improve the experience of patients in hospitals. The Design Design for Patient Dignity project involved designers, manufacturers, healthcare experts, staff and patients to design a variety of solutions which enhance and promote privacy and dignity in hospitals. They include patient clothing, new ward layouts, washing and toilet facilities and systems to help patients feel more secure as they move between wards.

Design concepts

The design concepts and prototypes included a Bed Pod which creates a private, patient-controlled bed environment; a Capsule Washroom to rapidly refit wards to create single-sex toilet and washing facilities; and a
Reclining Day Chair – a unique hybrid between a wheelchair and a bed which provides greater comfort and security for patients being moved around the hospital.
Other prototypes included Novel Screening Systems to enhance privacy and dignity and a Flexible Signage System to allow staff to designate same-sex areas. A Universal Patient Gown was also created to keep the wearer’s body covered while being warmer and more comfortable
The Department of Health asked the Design Council to run Design for Patient Dignity to help encourage innovation in the way care environments are planned and to help find design-based solutions to some of the privacy and dignity issues that patients experience.
“When people are ill they can feel anxious and deprived of their confidence and self-respect. That is why it is so important to be treated in a safe and healing environment where trust and dignity can be sustained. Simple, elegant solutions such as those launched could help restore peace of mind and thereby improve chances of recovery.”

Listening to patients
The work followed extensive research into what issues matter most to patients, staff and experts, such as being able to discuss personal details without other patients hearing, being in a same-sex ward or bay, having same-sex toilet and washing facilities, having personal control over their environment, and improving hospital nightwear and gowns.
Patients contributed their experiences and ideas to the design process, meaning that the prototypes have been developed to meet the needs of the people using them. The result is prototypes that provide workable solutions to privacy and dignity issues that matter the most to patients.
The teams were appointed following a nationwide search for designers and specialist manufacturers who could together develop designs, as well as create prototypes and put them into full-scale production for introduction to hospitals.
Over 60 design teams applied to the challenge, and were judged by a panel of the UK’s most respected experts in design, patient care, hospital management and nursing.

Several of the above-mentioned designs, such as the commode developed for the Design Bugs Out project, have been put into production following successful feedback from hospitals.

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