DEMAND for healthcare services is growing rapidly in Bangladesh because of an increasing prevalence of chronic diseases among its ageing population. It is, therefore, essential to build new hospitals and restructure the existing ones to incorporate new technologies that could improve the quality of healthcare services delivery in a safe and satisfying work environment.
The physical environment must be carefully considered in planning and building hospitals and other healthcare facilities as it plays a significant role in mitigating potential workplace hazards and the burden of work-related injuries and illnesses among the healthcare staff. A specific focus on healthy design can improve the work environment by decreasing occupational injuries and exposure to hazards and by increasing the overall job satisfaction of health workers. A work environment that is safe by design can help improve health and well-being of the staff, their job satisfaction, morale and productivity and can facilitate the retention and recruitment of staff.
Healthcare workers constitute a large and expanding group in Bangladesh. Improving the work environment can help to reduce staff stress and fatigue and improve the efficiency of healthcare services delivery and patient safety. Hospitals are among the most expensive facilities to build because of the complex infrastructure, expensive diagnostic, treatment, health and safety equipment, government regulations and safety codes. Deciding to invest in hospital design and determining which elements to incorporate into a new facility requires a clear understanding of the intended operational process and outcomes. Constructing hospitals provides an opportunity to consider how improved designs and new/different equipment can impact the health, safety and comfort of both patients and staff.
Research indicates that an effective prevention method for workplace injuries and illnesses changes the physical work environment. For an example, flooring and proper signage can prevent falls, installed ceiling-mounted lifts to transfer or reposition patients can reduce musculoskeletal injuries and proper ventilation can reduce hospital-acquired infection. As a result, these design factors must be carefully considered when designing or renovating facilities. As part of a comprehensive programme, the physical environment can also have a major impact on revenue generation and cost avoidance, making it an important long-term investment.
The physical environment plays a critical role in improving the health, safety and satisfaction of hospital workers. The health and safety of the occupants of a building can be improved by altering the environment through improved lighting, air quality, noise reduction and by implementing new engineering controls such as ergonomic desks, improved workplace designs, and mechanical lifting devices. The spread of infection can be reduced by efficient ventilation, sinks for hand-washing, waste disposal units and negative pressure rooms for patient suffering from contagious diseases.
Providing an adequate lighting in healthcare settings can be beneficial for patients and staff. Daylight is critical to employee functioning as it has psychological and physiological effects. Several studies have documented the importance of light in reducing depression, decreasing fatigue, improving alertness, and modulating circadian rhythms. Furthermore, the presence of windows in workplace and an access to daylight have been linked with increased satisfaction with the work environment. A newly designed hospital with high ceilings and large windows can bring in as much natural light as possible. Natural light should be incorporated into the lighting design for both its physiological benefits and lower cost and because it is environmentally friendly and is something that is preferable to most people. Finally, a proper lighting in hospital setting is essential to reduce slip and fall injuries for workers and patients.
Healthcare employees are at a serious risk of contracting infectious diseases from patients because of airborne and surface contamination. The spread of nosocomial infection among patients is also a concern.
Factors such as poor ventilation and fungal contamination of the ventilation system have been linked to the spread of nosocomial infections. One study that has examined the relationship between indoor environmental factors and nasal inflammation among nursing personnel finds the contamination of air ducts to be the source of infection. Another study conducted on severe acute respiratory syndrome in China finds that isolating SARS patients in wards with proper ventilation can reduce the viral load of the ward and prevent the outbreak of SARS among healthcare workers when coupled with strict personal protection measures in isolation units. Finally, an evaluation of 17 hospitals in Canada shows that tuberculosis infection among healthcare workers was associated with a ventilation of less than two air exchanges per hour in non-isolation patient rooms. The studies support the importance of having an adequate and properly maintained ventilation to ensure healthcare worker and patient safety in hospitals.
The work environment must be modified when possible to ensure that employees have a comfortable working posture. Employees should be trained in how to adjust their desk and chair height and the angle to achieve optimal settings. Lighting and other work conditions must be considered when furniture and equipment are positioned in workplace. Nursing station desks should be ergonomically designed with inputs from workers. Lab workers should be provided with desks that are ‘cut out’ so that the worker can get closer to the microscope to prevent strain injuries and muscle fatigue.
Hand-washing is one of the simplest and most efficient ways to prevent the spread of infection. Improper or infrequent hand-washing may be a factor in the spread of disease in a hospital setting. Infection with methicillin-resistant Staphylococcus aureus has become endemic in hospitals around the world despite concerted efforts by infectious disease control professionals. Methicillin-resistant Staphylococcus aureus is transmitted between patients through hospital staff. Hand-washing is widely recognised as the single most important prevention factor of colonisation and infection.
Hospital staff report several reasons for poor hand-washing compliance such as inconvenient sink locations, shortage of sinks, lack of time, lack of soap or paper towels and forgetfulness. Designing healthcare facilities to make hand-washing practice more convenient may increase compliance. Studies have found that providing numerous, conveniently located alcohol-rub dispensers or washing sinks can increase compliance. In particular, evidence suggests that installing alcohol-based hand-cleaner dispensers at bedsides usually improves adherence. When the sink-to-bed ratio is higher, a higher frequency of hand-washing is observed.
As demands for healthcare services continue to rise with a rapidly growing and ageing population, there is an immense need for the construction of healthcare facilities and also for the replacement, renovation and expansion of the old ones. Demand for health care cannot be met without the presence and engagement of healthy health workers who do not face increased risks for occupational injuries and illnesses. As more patients are cared for out of hospitals, the patients requiring acute hospital admissions require more specialised and intensive care with extensive use of new technologies. A large body of evidence states that characteristics of the physical environment are critical components of any programme aiming at improving the quality of patient care as well as staff safety.
New hospitals should be built in consultation with health and safety professionals to ensure that the construction meets the highest engineering standards with respect to occupational health and patient safety.
Hasnat M Alamgir is a professor of pharmacy, East West University, Dhaka, Bangladesh.
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