The End of General Hospitals
There are design elements that limit the possibility of hospital-borne infection, including ultraviolet light and biologic surfaces. There is also a greater emphasis on including track systems for lifts for getting patients out of bed and moving them without injury to the patient or the staff.
Consider Hospitalists and Other Staff
How will the hospital of the future accommodate hospitalists?
“We’re certainly seeing more hospitalists,” says Dr. Tingwald. “As you have sicker patients in the hospital, it’s harder for their primary care physicians to manage them, so we’re going to see even more hospitalists. This means that we have to provide space for them; both offices, because they don’t have other office space, and sleeping accommodations, which means private rooms with bath, as well as lounge space.”
Hospitals will provide appealing space for physicians because it will help them recruit hospitalists. Improving lounges and other staff spaces will be a goal of future hospital designs.
“There will be a lot more emphasis on good environments for work and for support services,” predicts Dr. Tingwald. “This will increase the attraction and retention of top staff. You’ll see things like fitness centers, and basic additions like enough parking spaces.”
As hospital facilities move toward more patient-centered care, with flexible layouts and space designed for patient safety, the working environment is certain to become more conducive to providing good care and working efficiently. It will also become more comfortable, convenient, and pleasant for hospitalists and other staff. And that is something to look forward to. TH
Writer Jane Jerrard wrote the first three installments of the “Future” series.
FLASHBACK
Cadaver Particles
—Ignaz Semmelweis, 1861
Death stalked the halls of the First Division of the Allegemeine Krankenhaus (Vienna General Hospital), a large teaching hospital in Austria. Healthy post-partum women suddenly become febrile and died from puerperal sepsis (childbed fever). In the mid-19th century, this problem was seen in hospitals across Europe, though rarely in home deliveries. It was a seemingly insoluble dilemma. Opinions varied on the etiology. Was it miasmas, the paint on the walls, were the beds too close, or was it clogged milk glands? Complacency and acceptance of status quo were, to some, the easiest solution.
In the mid-1800s Hungarian Physician Ignaz Semmelweis was given an appointment as an assistant in obstetrics at the Allegemeine Krankenhaus. He had adopted the Austrian paradigm of clinical and pathologic anatomy. The answer to any question lay in the autopsy. It seemed like the more autopsies they did, the more women died. The death of Semmelweis’ colleague, Jakob Kolletschka (who was initially injured when his knife slipped during an autopsy of a woman who died of puerperal fever and then died himself of symptoms similar to those that killed the woman) gave Semmelweis the vital clue.
He realized that something carried on unwashed surgeons’ hands from infected cadavers caused the disease to occur in the women. These “cadaver particles” were transmitted from the morning autopsies to the women on the wards by the unwashed hands of students and faculty. Adopting proper hygiene could save thousands of lives. Properly washed hands were the simple answer. This also explained the mystery of why the puerperal fever rate was lower on the midwife-run wards where they did not do autopsies.
Decades before Pasteur and Lister, accepting that their own hands brought death was a bitter pill for the great men of obstetrics to swallow. Unfortunately for Semmelweis and the women who continued to die, it was years before Oliver Wendell Holmes incontrovertibly published his essay, “The Contagiousness of Puerperal Fever” in 1843 in the New England Quarterly Journal of Medicine. That essay showed the source of puerperal fever. Despite his clinical success Semmelweis was unable to persuade his fellow physicians.
The nosocomial spread of infection on unwashed hands rings true to this day. We spend our days gloved, gowned, and masked in the battle against MRSA, VRE, and other pathogens. Whether soap or alcohol, when we scrub our hands we should remember that it is more than a ritual. It’s a duty to prevent the spread of disease.
—Jamie Newman, MD, FACP
