Why do some hospitals make it so hard for doctors to wash their hands?

Ever since Hungarian doctor Ignaz Philipp Semmelweis realized over a century ago that fewer people died when their doctors washed their hands, the procedure has been standard practice for medical professionals. And yet, there are still hospitals that require doctors to interrupt their “flow,” to take extra steps or go to separate facilities or rooms to sterilize their hands.

The positioning of sinks in patient rooms, the type of lighting in surgical theaters, the placement of windows in rehabilitation centers, and many other design issues were on the agenda last week at a conference on “The Design of the 21st Century Hospital” held at the Technion. It turns out that the way a hospital is built and designed — its external and internal architecture — has a great deal to do with how well patients feel, how fast they recover, and whether they go home fully healed.

A 2004 study called “The Role of the Physical Environment in the Hospital of the 21st Century,” authored by several doctors and architects, cited “scientific studies that document the impact of a range of design characteristics, such as single-rooms versus multi-bed rooms, reduced noise, improved lighting, better ventilation, better ergonomic designs, supportive workplaces and improved layouts that reduce errors, reduce stress, improve sleep, reduce pain and drugs, and improve other outcomes.”

And, indeed, the number, location, and position of hand-washing stations directly affects the health of patients, the study said. “Several studies of hand washing in high-acuity units with vulnerable patients have found that as few as one in seven staff members wash their hands between patients,” the study said. “Compliance rates in the range of 15 percent to 35% are typical; rates above 40% to 50% are the exception.” Studies show, however, that “installing alcohol-based hand-cleaner dispensers at bedsides usually improves adherence.”

Speaking at the Technion conference, Professor Paul Barach, a world expert on patient safety and health facility design, said that technological advances in medical treatment notwithstanding, 21st century doctors dare not forget the basics. Hospital design is one important way to ensure that that does not happen, he said.

“We need to look at the building as part of the treatment,” he said. “Architects who design hospitals need to come into the hospitals and closely observe what goes on there, in order to experience it as patients do.” Thus armed, he said, they would be able to design hospitals that encourage patients to get better.

Barach’s comments echoed those made by Professor Yehuda Kalay, the dean of the Technion’s School of Architecture. Among the problems in Israeli hospitals is the fact that they are always full, with 97 percent of beds taken at any one time. Architects, he said, needed to remember that they were serving the patient almost as much as doctors were.

“It takes years to plan and build a hospital, and during that time the technology can change a great deal,” he said. Architects should be up to speed on the latest medical developments and theories, and should design with an eye to the future, taking into account the limitations of funding or space.

One aspect of the 21st century hospital that is especially relevant to Israel is security, and the director of Israel’s National Insurance Institute, Professor Shlomo Mor-Yosef, discussed the new underground patient facility at Haifa’s Rambam Hospital. The 2,000-bed underground hospital is designed to keep patients and staff safe dozens of meters below ground even while missiles and rockets are falling above ground, in case the city faces an attack like the one it suffered during the Second Lebanon War in 2006.

Other speakers at the event included Professor Naomi Bitterman of the Technion’s Architecture Department; Professor Eliyahu Shalev, the dean of the Technion’s Medical School, and Haifa Mayor Yona Yahav.

Bitterman said she was intrigued by the exchanges between medical and architecture professionals, “each of whom has their own terminology, culture, and ways of thinking. It’s important, however, to remember that we are talking about patients when we discuss this subject. Architects, and doctors, must always remember who is the client, and whom we are here to serve.”