The Importance of Design

It’s the second week of the Airborne Infection Control Course and Monday morning started out with interesting lectures from Alan Ricks and Michael Murphy from the Mass Design group. They brought a unique perspective informed by their work as architects in Boston, Rwanda and Haiti. To summarize, Alan and Michael argued that a focus on norms, standards, and codes in architecture is important but insufficient. Facilities must be adapted to the local context and designed with sustainability in mind. Public health and architecture should be more tightly integrated. After the Mass Design group, there was a presentation from a physician from India, Dr. Shankar Dapkekar. He and colleagues had established a “cough corner” in a busy hospital, essentially implementing F-A-S-T. It was a solid effort, and we hope they are able to publish their experiences soon.

Those presentations led Tom Yates and I to an interesting conversation afterwards.  How to reduce TB transmission in health facilities (particularly in Sub-Saharan Africa)? There are a wide variety of health facilities scattered across the continent, from enormous urban hospitals like Maputo Central Hospital where I previously worked, to smaller hospitals, clinics, and rural health posts. Reducing TB transmission will require a mix of interventions as is frequently discussed on the GHDonline discussion forum. Facilities need much better natural ventilation (cross-ventilation, stack ventilation, etc), but that won’t get the job done in all settings, so UVGI and F-A-S-T will also play an important role. Tom is interested in studying the impact of improved natural ventilation in the smaller clinics in South Africa where the majority of care is provided and I am interested in the enormous teaching hospitals where the majority of nurses and doctors train. There’s plenty of work to go around, as Dr. von Delft and colleagues have written.

Based on what I’ve seen over the years, this all comes down to money. How much are donors and governments willing to invest on infrastructure/design? Nosocomial drug resistant TB transmission could be prevented (like the famous Tugela Ferry outbreak) if hospitals have good administrative/environmental controls as well as rapid diagnostics and effective MDR-TB/ XDR-TB treatment. Easier said than done, and the amount of money for TB infection control is minuscule when compared to the burden of disease from drug-resistant TB.

Rural Health Facility
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Nosocomial Transmission of Extensively Drug-Resistant Tuberculosis in a Rural Hospital in South Africa, Gandhi et al, JID 2013
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Some dialogue from twitter about XDR-TB transmission

One thought on “The Importance of Design

  1. Good filters can also clean the air. We use Sanders Filters on fans in Africa to scrub the air. The non restrictive filter works on all low flow systems as a flat pad. It must be configured into a tapered cube for high flow systems.

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