SAFER HOSPITALS
Building safer and more cost-effective hospitals
Despite it being almost eight years since the issuing of the Hackitt report, its key recommendations remain largely unimplemented. This is particularly true in healthcare settings, where meaningful progress has been limited. As a result, legislation may now be needed to enforce change. In this article, Dr Manjula Meda, Dr Michael Weinbren, and health engineer George McCracken provide real life illustrations of why projects go wrong, and how simple solutions such as identifying risks at the inception of a project would make future hospitals radically safer, as well as saving significant sums of money.
The primary goal of constructing a replacement healthcare facility is to ensure that it is safer for its intended occupants. Safety has many dimensions; however, for the purposes of this article, the focus will primarily be on the risk of infection arising from the built environment. England is about to undertake one of the most ambitious
hospital construction programmes in the world. This comes at a time when the design, construction, installation, and commissioning industry has been described as in a ‘race to the bottom’. At the same time, antimicrobial resistance (AMR) in healthcare settings is presenting an increasingly serious challenge. Patients in English hospitals are already dying because of AMR, and unfortunately the worst may still be ahead. AMR is projected to become a leading cause of death.1 Many advances in modern medicine depend on effective antimicrobial agents to protect patients when they are vulnerable. Without such protection, these procedures will either carry significantly higher mortality rates or may no longer be practised because they will offer no advantage in patient outcomes. Strains of organisms resistant to all known antibiotics
have now been identified in UK hospitals. Even where one or two antibiotics remain effective against multidrug- resistant organisms (MDROs), infections caused by these strains often result in high mortality rates due to delays in identifying and administering appropriate treatment.2 The healthcare built environment – particularly wastewater systems – plays a critical role in driving AMR and MDRO transmission both within hospitals and beyond them into the wider community. In some cases, these organisms may even bypass wastewater treatment works, further increasing the risk of community spread. The purpose of this article is to highlight several key issues and areas where change is necessary if new hospitals are to protect the most vulnerable people in society. It is not intended to be comprehensive; the scope of an article of this length is limited. However, by presenting selected examples, it is hoped that the discussion will provide food for thought.
Assessing the safety of the hospital built environment As Florence Nightingale eloquently stated in 1863, “the very first requirement in a hospital is that it should do the sick no harm”. What she was referring to was the influence of the built environment on patient outcomes. Patients often entered hospitals with one illness but acquired additional diseases because of environmental factors related to hospital design. Hospitals can become breeding grounds for
antimicrobial resistance. Without effective antibiotics, the
Above left: Water outlets being stored on basement floor. Ingress of water and dirt can be seen running down wall below door.
Above right: A new water tank arrived on site for a new build project. The conditions of the manufacturer warranty stated that the tank must be filled immediately to retain the warranty. The tank was left filled with water for several weeks not connected to any pipework. It was only by chance that this was discovered requiring the tank to be discarded – if this had not been discovered it is quite likely the new water system would have been heavily contaminated from outset. The same incident has occurred at at least one other hospital.
Without effective antibiotics, the true cost of infections originating from the built environment is likely to become increasingly apparent. Antimicrobials can no longer serve as a temporary solution for deficiencies in design, construction, installation, or commissioning.
April 2026 Health Estate Journal 35
Dr Teresa Inkster
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