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Slightly buried in Richard Mazuch's article about hygiene in hospitals (see pages 33-37) is the terrifying statement that 'hand hygiene is not usually good and nurses are almost always better than doctors at washing their hands'.

This conjures up horrific images of Victorian-era surgeons moving from childbirth to childbirth without so much of a splash of water, followed by legions of women dying of puerperal fever.

How can doctors today be so remiss?

And what relationship, if any, does this have to architecture? The answer of course - and it is an explanation not an excuse - is that doctors are only human, they are very busy people and they can become careless. Which is where the architecture comes in. Mazuch's design of carefully considered and positioned handwashing stations, placed to be used not just by medical staff but also by visitors, could have a major impact. If this kind of move can lead to a major reduction in hospital-acquired infections, it could prove to be just as important as Joseph Bazalgette's introduction of a proper sewage system in London.

Hospital design has not had great press recently, but at this level of detail (even down to the choice of attractive colours) it is still crucially important and requires a proper architectural skill to get right. At the other end of the health spectrum, our Specifier's Choice this month is on the St John's Therapy Centre in southwest London (see pages 9-18). This LIFT project is a new building type and one that will become increasingly prevalent. The budgets are not generous and the architect has to accept compromises with a contractor that is carrying considerable risk. But that does not affect the plan, which determines the patient journey and to a great extent both the experience of the place and its efficacy. Designing for health may feel thankless on occasion, but these two very different projects demonstrate its importance.

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