INFECTION CONTROL


Bad hospital design is killing patients


Leaders across the construction sector must understand the growing problem of antimicrobial resistance and embrace innovation to ensure patient safety into the future, says Christine Fears, head of publishing and research communications at the Healthcare Infection Society.


Hospital design is killing patients. Even when fully compliant with all regulations and guidance, unsafe environments are claiming lives. This year, a 20-year-old man died from multidrug-resistant sepsis while undergoing cancer treatment, caused by a bacterial infection picked up in a hospital in Manchester.1


A 10-year-old


girl contracted a Stenotrophomonas infection via her catheter after being admitted to a hospital in Glasgow for leukaemia treatment in 2017.2


A high-profile case in


Belfast saw three babies die and many more suffer from Pseudomonas aeruginosa, a bacterial infection which was linked to the taps in the ward.3 Reported as separate and individual incidents, these


deaths – caused by different microbes, and occurring in different cities across the UK – are connected: the patients’ infections could not be treated because the bacteria which caused them had become resistant to most available antimicrobial treatments. They caught these infections because the built hospital environment allows resistant microbes not just to survive, but to thrive. The examples presented here are just the visible cases,


the stories of young people who have died unnecessarily which have made it into the press. But each day antimicrobial-resistant organisms strengthen and spread within hospitals. We are living through a ‘silent pandemic’ of antimicrobial resistance (AMR), which threatens human life and poses existential questions for the continued practice of modern medicine.


What is antimicrobial resistance? Antimicrobial resistance (AMR) is a growing global threat, both in the UK – where the government estimates that it will kill over 35,000 people each year4 The Review on Antimicrobial Resistance,5


– and worldwide. led by Lord Jim


O’Neill, estimated in 2016 that by 2050, ‘10 million lives a year and a cumulative 100 trillion USD of economic output are at risk due to the rise of drug-resistant infections… Even today, 700,000 people die of resistant infections every year’. The year 2050 may seem far away, but we are well on the way already. The World Health Organization (WHO) stated in the Global Antibiotic Resistance Surveillance Report 2025 that antimicrobial resistance ‘is widespread, increasing and unevenly distributed’.6 At some point in their lives, everyone in the UK will


have taken antibiotics, antivirals, and other ‘antimicrobial’ drugs to help fight off an infection. Scientists in the early 20th century first started investigating how chemical and biological compounds could be engineered to target pathogens, with breakthroughs against syphilis by Paul Erlich and, famously, the discovery of penicillin by


Alexander Fleming. This kickstarted a century-long process of drug development against a range of bacteria, viruses, and other disease-causing microbes, greatly reducing human suffering and rendering once-deadly diseases curable with a quick course of antimicrobials. But the microbes fought back. In a Darwinian struggle against antimicrobials, many evolved to resist the effects of common drugs, and once-standard antimicrobial treatments have stopped working as effectively as a result. For a time, our innovation could keep up, but discovery of new antimicrobial classes peaked in the 1950s, and the last discovery of a new antibiotic class was in 1987. As a result, common infections have become harder to treat, and some, such as extensively drug-resistant tuberculosis, almost impossible. This is the phenomenon we call ‘antimicrobial resistance’, or AMR. The connection between how we build healthcare facilities and how that either helps or hinders the progress of AMR has been referred to by leaders in infection control as ‘the missing pillar of AMR’.7


Understanding and


acting on it is acutely important in this moment, as England embarks on the ambitious New Hospital Programme (NHP), the ‘biggest NHS hospital building programme in a generation’, in which 40 new hospitals have been promised by 2040.


Healthcare buildings as the frontline against AMR The built environment of the hospital is a battleground in the fightback against AMR, and everyone working in healthcare estates is on the frontline.


November 2026 Health Estate Journal 49


Dr Manjula Meda leads a group discussion at BEIPI’s first London workshop.


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