Controlling infection through design

By now, the majority of medical staff and administrators in acute care settings realize that hospital-acquired infections pose a lethal threat to patients—and to the economic survival of every group connected to that care. Most are increasingly alert to the issues that compromise infection control and avoid them at all costs.

In contrast, those who provide long-term care must recognize that infection control is a core concern for them as well. Perhaps they assume that because no one is being “cut open” and everyone seems fairly healthy—or at least stable—that infection doesn’t pose a deadly risk to residents and staff. Unfortunately for those professionals, and the hundreds of thousands of residents they serve, nothing could be further from the truth.

We don’t know as much about how infections start within the senior living environment as in acute care settings. But the essentials of infection transfer remain the same. Chronically ill residents frequently going in and out of facilities can just as easily acquire and spread infections in a SNF as in an acute care setting.

We do know that caregivers move from resident to resident, often failing to wash their hands between rooms. Communal living models are the perfect environment for the spread of infection because residents often share rooms, dining facilities, bathrooms, showers, wheelchairs and other equipment. The infection control protocol is likely not as rigorous as in the acute care setting and the spread of infection in older populations with compromised immune systems raises additional concerns.

However, the real gap between infection control in acute care environments and long-term care is the attention given to the design and composition of the environments themselves. For instance, many older nursing facilities have furniture or finishes that use inappropriate materials. Both the owner/operator and resident/family members want a “homelike” environment. Therein lies a real problem. All too common, residential furnishings found in these facilities do not meet healthcare design standards, fire codes, infection control guidelines or bariatric and incontinence considerations.


The future of infection control is looking brighter by the day. Now we have the technology to measure the spread of infection and can actually trace the hot spots where microbes live. Scientists can identify the hotspots and, collectively, we can work toward improving protocols. The resident’s bedrails, privacy cubicles, wall rails and room hardware are but a few of such hot spots.

Perhaps surprising to some professionals, architects and interior designers play an equally important role in infection prevention. The design team is responsible for working with facility management, including the healthcare provider and the epidemiologist when available.

When new senior living facilities are being planned or older facilities updated, the best projects bring the contractor on board early to create an Infection Control Risk Assessment Matrix of Precautions for Construction & Renovations (ICRA) since it’s been found that fully 5 percent of acquired infections are due to construction activity within a facility.

ICRA rates infection concerns from the less worrisome Type A, to the most dangerous Type D. The latter situation calls for major demolition and new construction.


Architects and interior designers play a significant role in planning space that improves safety habits. For example, designing a resident’s room with the sink near the bed and orientated so that the caregiver can wash his or her hands while facing the resident improves the odds of the caregiver washing before touching the resident.

The interior designer plays a major role in identifying “healthy” finishes, furniture and equipment. Not all interior designers will have the training or expertise necessary to make those decisions. For this reason, senior living facilities are encouraged to seek out advanced certified healthcare interior designers. Their knowledge and expertise not only apply to hospital settings but other medical environments such as the doctor’s office, ambulatory care facilities, nursing homes and other senior living facilities. These experts know that certain wall vinyl and glues can contribute to Aspergillus mold just as the healthcare architect understands the relationship between HEPA air filters and the reduction of Legionella bacteria.

Silestone solid surface countertops and antimicrobial carpet tile designed with moisture protective backing add infection control features. Photo by Lee Design Group

Healthcare interior designers understand the impact different paints, wall vinyl choices and carpets have with offgassing and specify products with low VOC properties. They incorporate drapery fabrics, cubicle curtains and furniture upholstery that can be cleaned with bleach and chlorine. When possible, building finishes and furniture are specified with natural antimicrobial properties, such as silver or copper, so that germs die faster and infection is prevented.


Today’s architects and interior designers have the advantage of specialized university-level education preparing them for the field of healthcare interior design. In addition, advanced certification programs are available allowing these professionals to set themselves apart by peer review and examination, which historically demonstrates their commitment to the healing environments required in healthcare settings.

One such example, Evidence-based Design Accreditation (EDAC), is offered so that the design community can learn from its past failures and successes and develop new design protocols based on collegiate quality research.

Being a healthcare architect and interior designer is a high calling. These professionals are passionate about their field. Not only do they create brand image and solve building problems, they impact quality of life and longevity while yielding better business results.

Recognition of the highly regulated, detail-oriented, research-based and fundamentally important role of a healthcare designer is why every healthcare manager should seek out those experts. Just a little education on the enormous stakes in terms of financial costs, legal liability and—most importantly—loss of human life, should motivate everyone connected with healthcare environments to exercise best practices in infection control at every level.

Dan Lee, AAHID, AIA, ASID, EDAC, is founder and president of Lee Design Group, PLLC, a Dallas-based design and architecture firm specializing in senior housing and healthcare design. For more information, email

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