Evidence-based design became a focus of study in the 1980s. This movement paired design choices with structured, formal scientific research. Rather than relying on anecdotal evidence of design choices, researchers systematically tracked data on patient outcomes. One recent study, for example, was able to demonstrate a reduction in the use of pain medications by patients in rooms with a view towards nature. 

Evidence-based design can focus on various aspects of hospital function. Decisions about design are influenced by what we know about human psychology and stress, medical treatments, infection control, financial considerations, efficiency, and human movement/traffic flow. Ultimately, the goal of evidence-based design is to improve patient outcomes, safety, and administration.

After thousands of years of medical care provided in homes and religious buildings, health care moved into the public sphere. Buildings were constructed solely for medical purposes, with patient quarters, staff facilities, and specialized equipment. However, no other era saw as much transformation in healthcare as the years between Florence Nightengale in the 1840s and the golden age of antibiotics in the 1940s. Today's post will examine the transformation of hospital spaces during this time period.

With life, there is illness. Some of the earliest examples of life on Earth, bacteria, show evidence of invasion by viruses. Our earliest recorded history includes written accounts of individuals trying to make sense of illness and injury. These early records, and the experiments and efforts that accompanied them, are the first examples of the scientific method which resulted in all our modern advances, including evidence-based design.

Today's post wraps up the usual suspects when it comes to pathogens contributing to hospital acquired infection. These pathogens, while less prevalent than those mentioned in earlier posts, still pose a danger to immunocompromised patients in healthcare settings. 

Watching and waiting, always lurking around the next corner, these three pathogens are both found everywhere and highly resistant, a 1-2 punch for vulnerable patients. They reside in the environment as well as on our bodies, some of them in mucuous membranes. These membranes are perfect homes for bacteria: Moist, warm, and often dark. So while they survive for long periods of time without resources, with access to an environment with little competition they will quickly reproduce and become dangerous, especially if they find a way into our bodies. Keep an eye over your shoulder for these ninja pathogens.

Today's trio of pathogens are stealthy, living on our bodies without causing us harm but wreaking havoc when they find a way inside a bacteria-free, or sterile part of our body (lungs, bloodstream, internal organs, and others). Typically they are surrounded by other species of bacteria in our intestines or on our skin, using all their energy to battle it out for resources with the other species of bacteria that surround them. This keeps them in check. However, if they are able to enter the sterile parts of our body through an incision or medical device, they find themselves in a new territory with absolutely no competition. With uncontested resources, they quickly reproduce and create an infection which can cause great harm, and even death.

Staphylococcus might as well be the mob when it comes to hospital acquired infections. Strains from this bacterial crime family account for 38% of all HAIs and affect all the major sites for infections. Because it is a part of our natural human flora (our own personal biome), it has ready access to opportunities to enter the body, either through an incision or a medical device. 

It is estimated that there are  5×10³⁰ bacteria on Earth. That's 5,000,000,000,000,000,000,000,000,000,000, or 5 nonillion. We have not even begun to identify them all, and new strains are evolving all the time. We not only coexist with bacteria on Earth, they outnumber us by such a mind-boggling degree that we cannot even conceive it. Consider this: There are currently just over 7 billion humans on earth, and one spoonful of rich soil contains approximately 10 trillion bacteria. And our bodies? Bacterial cells outnumber human cells 10 to 1. (But don't worry, you're not a zombie. They make up only 3% of our body mass. But still.)

We were in the hospital room when the nurse came in holding a bag of clear liquid. She casually mentioned that she was giving my husband Rich lactated ringer. As she started to wind the tubing through the pump I asked, “What is lactated ringer?” She stopped and just looked at the bag. I continued, “What makes it different than just saline?”

“Well, it has more … It can … Well, the blood … COME ON NURSING SCHOOL, don’t fail me now!"

Often the words of a concerned family member capture the experience of infection control far better than any researcher or specialist. We read with great sympathy a recent letter to the editor of the Buffalo News by a man whose mother is fighting an infection she may have contracted during a hospital stay. The comments below the online post are full of personal stories that reveal that most, if not all of us, have personal stories having to do with a loved one contracting an infection from a healthcare setting.