Twenty years ago it was a “forgone conclusion” that some patients would contract a healthcare-associated infection (HAI), said Linda Dickey, senior director of quality, safety, and infection prevention at the University of California Irvine Medical Center.

Today, thanks to public reporting, reimbursement payments tied to HAI rates, and regulators expecting prevention measures to be put in place within healthcare environments, that perspective has changed a whole lot and the number of infections is on the downturn. “We are making progress,” she said. “However, we still have a lot to do.”

Dickey took part in a general session panel at the ASHE PDC Summit titled “Improving Infection Prevention and Control through Facility Design.” She was joined by Barbara Edson, vice president of clinical quality for the Health Research & Educational Trust (HRET), and Carolyn Gould, team lead of hospital infection prevention in the prevention and response branch of the division of healthcare quality and promotion at the Centers for Disease Control and Prevention, to present infection control efforts in the works today and what’s on the horizon.

Specifically, the group discussed environmental conditions that contribute to HAIs in hospitals.

With more than 1 million HAIs reported annually, costing $30 billion a year, Gould reminded of the dangers—for example, a bacterial strain like CRE that kills one in two people if in the bloodstream can be caused by something as simple as water splashing out of a sink.

She also outlined some efforts that can be made on the design side to prevent HAIs in the first place, starting with performing a safety risk assessment by bringing healthcare engineering experts to the table early on new projects and considering things like hand hygiene infrastructure, with strategies for positioning, accessibility, and availability.

Another consideration was reprocessing departments for cleaning and preparing clinical devices, ensuring that a suite has adequate sink and counter space, airflow, and a separation of clean and dirty items.

Designs should also support easy cleaning of surfaces, Gould said, removing barriers in materials and configuration and reducing hard-to-clean items like curtains and porous surfaces. For water-related infection control, she recommended designing bathrooms with splash zones for sinks and toilets and sinks in patient rooms surrounded by shelving and wall storage to avoid cluttered equipment around those wet areas.

Finally, Gould stressed the flow of patients, personnel, and equipment, specifically the need to use functional space planning to reduce the transmission of pathogens—for example, a rapid assessment and isolation area in EDs to limit other waiting patients’ exposure to potentially fatal infections.

Edson next outlined national efforts in place and recognized that the current state of infection control and prevention includes a multifaceted and multidisciplinary approach to work through technological interventions and create a culture of controlling HAIs within healthcare organizations. “You all are part of that team,” she said.

The problem is that despite knowledge of how to prevent infections, protocols aren’t yet wholly in place to do so. “Our challenge is getting that evidence-based practice into use,” she said.

One project, Engaging Partners in Infection Prevention and Control in Acute Care Hospitals, is working to improve implementation of infection control programs within hospitals with a disproportionately high number of outbreaks. Edson said the three-year project will serve as an infrastructure and support system in years to come, with guidelines expected to be created by 2018 to benefit the healthcare construction and renovation process.