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Richard Mazuch, partner at Nightingale Associates in London, explains the handwashing and infection-control issues that are affecting the healthcare industry With the recent rise in the so-called 'superbugs', such as aspergillus, MRSA, legionella, listeria, salmonella, SARS, E.

coli and staphylococcus, the issue of 'control of infection' has never been higher in the public consciousness. At any one time, one in 10 patients have a Hospital Acquired Infection (HAI). Patients contracting an HAI spend an average 2.9 times longer in hospital, at an estimated cost of ú1 billion to the NHS each year.

An uncomfortable percentage of patients also die as a result.

Legislation covering the subject is wide, ranging from Health and Safety Executive guidance and Building Regulations to Health Technical Memoranda and Hospital Building Notes.

Conferences have addressed the subject, publications talk about it, and specific associations have been set up to disseminate current best practice. Notwithstanding this, the problems and the bugs continue to thrive.

Hand hygiene is the single most important factor in the prevention of cross infection.

The research of Semmelweiss, in Vienna in the 19th century concerning hands as a vehicle for infection is now being revisited. Clinical staff's hands are said to be the main vector of infection in hospitals. It is generally acknowledged that hand hygiene is not usually good and that nurses are almost always better than doctors at washing their hands.

In addition, there is a growing train of thought that all patients' visitors should now be required to pass through a 'hand-wash station' when entering the hospital environment.

Hospital infection-control teams often issue hand-hygiene guidelines to all departments identifying method, duration and drying, together with appropriate hand-cleansing agents, from a bar of soap or liquid soap through to antiseptic and alcohol-based hand-cleaning agents.

In terms of architecture, interior design and specification, we can have an impact on infection control.

Integrated Pre-plumbed Sanitaryware (IPS) units go a long way to reducing infection as they are fabricated off site, and therefore all surfaces are tight, flush and sealed. Waste traps, hot and cold plumbing and waste-water pipework are hidden behind a wipe-clean laminate surface. For further protection, some laminates include 'built-in active hygiene' in the form of a Microban antibacterial product which inhibits the growth of bacteria.

All sanitaryware is normally selected carefully from ranges that are specifically designed for clinical use and to avoid potential cross infection.

This might be as simple as ensuring that there are no overflows in clinical areas and the use of concealed wastes.

When it comes to selecting taps, the choices can be complex, ranging from the use of simple elbow-action taps to more sophisticated items such as infrared-action taps and foot-operated soap dispensers.

Specialist Dart Valley Systems has teamed up with washroom manufacturer Twyford Bushboard to offer the optimum in hygiene and reliability with 'no-touch' brassware. These systems have demonstrated increased levels of hand hygiene. This is because their ease of use enhances hand-hygiene compliance as well as the obvious point, which is that you don't need to touch them to operate them, thus avoiding the risk of cross contamination. Interestingly, there has been recent concern about the use of deck-mounted, swan-neck taps. The concern appears to be about the column of unsealed water that remains in the neck of the tap after use.

A solution to this may be to specify wall-mounted, bib, mixer taps that avoid this issue.

With automated taps, in addition to the clinical benefits, whole-life cost reduction is achieved through savings in water and energy usage as the water is 'delivered on demand' and, when used in conjunction with mixing valves, delivers a constant temperature.

The specification of floor finishes around the perimeter of clinical wash hand basins is also critical. It is essential that the floor finish at the perimeter is coved to ensure ease of washing and avoidance of dirt accumulation. Coves created with a cove former, such as those manufactured by Gradus, are preferred to the set-in type coving which presents a weak line of defence in the joint between the set-in coved skirting and the floor fi nish, even if the two components are welded together. The coved vinyl floor finish is then bestcap sealed to form a skirting.

Both Altro and Gradus offer multiple cap options relative to wall finishes.

Though infection control is paramount in the design of the clinical wash basins, it is also important that the aesthetics and overall design of the IPS units are carefully considered. These are assemblies that inhabit treatment and consultant exam rooms, as well as inpatient wards. They must be understood and integrated within the overall context. Even the colour of these units can have an impact on the patient.

Some manufacturers have even addressed these issues in their new ranges. We favour light colours such as warm and cool whites, parchment and indeed pastel shades of blues and greens in these situations.

In carefully studying all the component parts of the typical clinical handbasin scenario, Nightingale Associates has design-developed a true 'infection-control station' capable of impacting on the battle against the 'super bugs' in healthcare settings such as inpatient wards, ITUs, A&E treatment rooms, isolation rooms, resuscitation, polytrauma and operating theatres.

CASE STUDY: Ziggurat Penthouse, Clerkenwell, London Form Architecture The awkward configuration of the shell space actually proved to be a positive generator for the overall design of this 670m 2 penthouse. A good deal of ingenuity had to be used to create luxurious but practical bath and kitchen areas within the relatively tight spaces available.

BATHROOM The narrow glass-lined master bathroom space has a linear plan arrangement, with a double-ended bath housed within a full-length limestone bench which forms a surface for the bowl-type hand basins at each end. Parallel with the bench, a glass screen divides the narrow open area, providing the necessary enclosure for the wet room shower.

A sliding door provides privacy for the WC/bidet area at the end of the space.

Unusual details include the custom-designed fibreoptic shower heads, which allow the owner to bathe under an unusual lighting effect, and integrated aluminium and mirror-faced panels which slide to reveal storage over the basins and to enclose the low-level 'horizon view' window slot above the bath when required.

KITCHEN The kitchen has been located at the heart of the open-plan living areas and has been completely integrated into the architecture of the space.

One counter is a slot cut out of the rear wall which contains storage, appliances and ventilation.

The other - completing the practical galley arrangement - is a long bar counter which shields and contains the space.

The kitchen has been made from custom-made acrylic-lacquer finish MDF carcasses, set out on a 700mm module - to suit the unusual 700mm width, integrated appliances were used, resulting in 700mm square doors for the under-counter units.

All facings are in white acrylic lacquer with concealed edge-pull handle details. Counters are steel, and the splashback and bar facings and worktop are made from glass.

Ziggurat Specification BATHROOM Wall-hung WC and bidet: Duraplus from Duravit Kaldewei Classic white steel bath: CP Hart Bateige Bleu limestone top: Stone Age White vanity basins: Philippe Starck Shower: Grohe Relaxaplus 28-178 Taps: Vola Towel rails: Imperial Glass coating: Ritec Clearshield Shower drain - stainless-steel channel and Heelguard linear grille: ACO Fulbora Shower controls: Grohe Grohetec Custom-made drencher shower heads, incorporating fibre-optic lighting: Andrewson Fibre-Optic Lighting Ironmongery: d-line from Allgood Metal laminate lining to joinery niches: Deralam KITCHEN Silk-screen-painted glass: Kite Glass Stainless-steel worktops with built-in sinks:

GEC Anderson Kitchen appliances: Smeg and Miele Taps: Vola Mini MR11 recessed low-voltage uplights:

Light Years Flooring: Bateige Bleu limestone from Stone Age

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