14 June 2024
HIS Trustee Dr Shanom Ali featured in this month's 'Looking deeper: The Journal of the Water Safety Forum'.
Susan Pearson from 'Looking deeper' spoke to Dr Shanom Ali on how designs for new healthcare facilities must consider strategies to minimise infection control issues.
Dr Shanom Ali is the lead for the Environmental Research Laboratory (ERL) — a multi-disciplinary microbiology diagnostics and research facility based in London, an associate professor at University College London and the London School of Hygiene and Tropical Medicine and a trustee for the Healthcare Infection Society.

Dr Ali discusses how well-informed thinking on infection prevention and control (IPC) should impact on design to reduce risks behind the very serious IPC issues that can occur in new facilities — and also reflects on how design that improves the overall patient experience can be achieved without compromising patients’ safety. Dr Ali is quoted in this article in a personal capacity.

How has your work at the ERL informed your thoughts on the infection prevention and control (IPC) considerations needed when new hospitals are designed?

The ERL, which comprises a team of healthcare scientists and academics, provides academic research and consultancy to address anti-microbial resistance (AMR) and infection control management, as well as exploring novel antimicrobial therapeutics (medicines and treatments) and diagnostics. For the last 15 years the ERL has also been providing an environmental screening and surveillance service, developing considerable experience in investigating infection control outbreaks and “looking for the unusual.”

How you design, build and test new hospitals is currently being widely discussed. However, there is not much of a focus on the patient environment, hospital building and environmental monitoring until there’s an IPC issue.

Shanom Website

How you design, build and test new hospitals is currently being widely discussed. However, there is not much of a focus on the patient environment, hospital building and environmental monitoring until there’s an IPC issue. "We have some guidelines such as ‘Health Building Notes (HBN)’ to guide the design of hospitals and wards and the Health Technical Memorandums (HTMs) to support how we test (air, surfaces and water) to monitor the patient environment. However, I don’t think we’ve got it right for existing buildings. There is little consultation with IPC in the early design stages for new hospitals."

In clinical settings, when it comes to training and development, most of the clinical interest is in patient to patient transmission and the clinical side of microbiology, as opposed to the environmental microbiology aspect, i.e. the influence of air, water and surfaces.

"There is an assumption that you can swab a surface or extract some air and a result comes out and it’s as easy as that...”

There needs to be an understanding that the matrix being tested (air, surface, water) will determine what kind of test is used: for example, swabs shouldn’t be used for testing water samples. When sampling surfaces, the swab needs to be the correct one for the type of surface being tested and the target organism. A swab that works for E. coli may not work for MRSA or Clostridioides difficile.

Looking at other considerations, for example, in water sampling: 100 mL samples are usually taken for routine water monitoring for Pseudomonas aeruginosa, however, monitoring of Legionella is more difficult. These require 1 litre samples, with a mass of 1 kg per
bottle to be collected. Logistically these add up to a huge weight across the thousands of samples that might be generated from numerous outlets across many wards. While swabs are small, the size of Legionella samples makes for complex logistics around storage and transport — and this needs consideration in planning design.

In the meantime, as NHS England’s New Hospitals Programme1 is rolled out, a new standardised hospital design has been proposed, designated ’Hospital 2.0’: “we have to consider what can be built now that will [both] cover enough of the infrastructure [and allow us to] add new tech and new innovations and new ways of working with it.”

How do the latest design trends to improve patients’ experiences impact on IPC?

Rooftop gardens
Mental health and mental wellbeing are increasingly, quite rightly, under discussion, particularly for long term patients who may feel trapped between their four walls. The idea ‘to bring the outdoors in’ in the form of rooftop gardens and other greenery is therefore very welcome, especially in cancer hospitals where patients can walk on grass, breathe the air, see the trees and sit
amongst ‘nature’.

However, this vegetation brings infection control risks with it: soil, compost and the plants themselves may harbour pathogenic microorganisms that can be particularly dangerous for immuno-compromised patients. This can pose a number of challenges...

Continue reading Dr Ali's interview here

This interview was published by Looking deeper: the Journal of the Water Safety Forum

Dr Ali is a speaker at the HIS 'Water safety in healthcare' course.