Pathways, Practices and Architectures: Containing Antimicrobial Resistance in the Cystic Fibrosis Clinic (PARC)

途径、实践和架构：控制囊性纤维化诊所 (PARC) 中的抗生素耐药性

• 批准号: AH/R002037/1
• 负责人: Nik Brown
• 金额: $ 25.49万
• 依托单位: University of York
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=AH%2FR002037%2F1
• 关键词: Pathways; Practices; Architectures; Containing; Antimicrobial

Antibiotics may suppress infections without eliminating them, giving rise to antimicrobial-resistant (AMR) bacteria and cross-infection between people. This project is both timely and important because of the increasing numbers of bacteria acquiring resistance to existing antibiotics. Our research compares the way three outpatient lung infection clinics attempt to control AMR and cross-infection through the design, practices and architectural layout of their built environments. It further seeks to learn lessons from this to limit AMR in wider healthcare settings. The PARC project has been co-designed in close collaboration with our three partner cystic fibrosis (CF) clinics. CF is just one of many life-threatening conditions characterised by long-term antibiotic treatment giving rise to cross-infection. In turn, cross-infection leads to clusters of highly resistant bacteria which significantly reduce life expectancy and now threaten to reverse recent improvements in survival. Dialogue with our clinical partners highlights the very different material and design approaches taken to prevent cross-infection through physical isolation, segregation and containment. Despite these variations, detailed research into questions of design and practice within the built environment of respiratory clinics is sparse. This research will be significant because CF clinics have much to learn by reflecting on their own practices. They also have much to learn from each other, and much to offer the wider clinical community in limiting AMR. Our focus on CF as an exemplar has far broader relevance in design approaches to AMR mitigation in more common respiratory disorders and in infection control more generally. This research will make visible the different and sometimes competing AMR design priorities of key stakeholders (including people with CF, clinicians, designers, hygiene personnel, etc.). It will map the differing 'real world' pathways and journeys through each clinic. It will explore how physical interaction, contact and exchanges are managed through the layout of the clinics. It will also enable our partner clinics and their users to explore scope for redesigning practice and repurposing clinical space to limit AMR and cross-infection. Our project involves an innovative combination of visual and qualitative research methods. We will be using the architectural layout plans of each clinic as a focus for interviews with patients, clinicians, hospital estates personnel, hygiene staff and designers. Our interviews will also draw on the skills of the project's graphic artist who specialises in fieldwork illustration to visually record real world experiences and journeys. We will also be undertaking 'walking interviews' placing our respondents within the flow of their routines, and using photography to chronicle risky spaces and objects. The project has an observational component to document key sites of high risk within the clinics including waiting areas, reception desks, corridors, wash basins and hand sanitisers, etc. These visual, graphic and textual findings will subsequently be used in co-design workshops at each of the clinics to improve present and future AMR mitigation. The project brings together the expertise of a highly multidisciplinary team involving an academic architect, sociologists of medicine and science, micro-biologists and a graphic artist. PARC will have a positive impact upon: our three partner clinics who have been involved in the design of the project; people with CF and the CF Trust; the wider respiratory healthcare community, the NHS and Department of Health; healthcare designers and architects; policy making on AMR.

抗生素可能会抑制感染而不会消除它们，从而产生耐药性（AMR）细菌和人与人之间的交叉感染。该项目是及时和重要的，因为越来越多的细菌获得对现有抗生素的耐药性。我们的研究比较了三个门诊肺部感染诊所试图通过其建筑环境的设计，实践和建筑布局来控制AMR和交叉感染的方式。它进一步寻求从中吸取教训，以在更广泛的医疗环境中限制AMR。PARC项目是与我们的三个囊性纤维化（CF）诊所密切合作共同设计的。CF只是许多危及生命的疾病之一，其特征是长期抗生素治疗引起交叉感染。反过来，交叉感染导致高度耐药的细菌集群，这些细菌显著降低了预期寿命，现在有可能逆转最近的生存改善。与我们的临床合作伙伴的对话强调了通过物理隔离，隔离和遏制来防止交叉感染所采取的非常不同的材料和设计方法。尽管有这些变化，详细的研究呼吸诊所的建筑环境内的设计和实践的问题是稀疏的。这项研究将是重要的，因为CF诊所有很多东西要学习，通过反思自己的做法。他们也有很多东西可以相互学习，并在限制AMR方面为更广泛的临床社区提供了很多东西。我们对CF的关注作为一个范例，在更常见的呼吸系统疾病和更普遍的感染控制中，对AMR缓解的设计方法具有更广泛的相关性。这项研究将使关键利益相关者（包括CF患者、临床医生、设计师、卫生人员等）的AMR设计优先级不同，有时甚至相互竞争。它将通过每个诊所绘制不同的“真实的世界”路径和旅程。它将探讨如何通过诊所的布局管理身体互动，接触和交流。它还将使我们的合作伙伴诊所及其用户能够探索重新设计实践和重新利用临床空间的范围，以限制AMR和交叉感染。我们的项目涉及视觉和定性研究方法的创新组合。我们会以每间诊所的建筑布局图为重点，与病人、临床医生、医院人员、卫生人员和设计师进行访谈。我们的采访也将借鉴该项目的图形艺术家谁在实地考察插图专业的视觉记录真实的世界的经验和旅程的技能。我们还将进行“步行采访”，将我们的受访者置于他们的日常生活中，并使用摄影来记录危险的空间和物体。该项目有一个观察部分，记录诊所内的高风险关键地点，包括候诊区，接待台，走廊，洗手盆和洗手液等。这些视觉，图形和文本的结果将随后用于每个诊所的联合设计研讨会，以改善当前和未来的AMR缓解。该项目汇集了一个高度多学科团队的专业知识，其中包括一名学术建筑师、医学和科学社会学家、微生物学家和一名图形艺术家。PARC将对以下方面产生积极影响：我们的三个合作诊所，他们参与了项目的设计; CF和CF信托基金会的人;更广泛的呼吸保健社区，NHS和卫生部;医疗保健设计师和建筑师; AMR的政策制定。

项目成果

Economic imaginaries of the Anti-biosis: between 'economies of resistance' and the 'resistance of economies'

抗生的经济想象：“抵抗经济”与“经济抵抗”之间

• DOI: 10.1057/s41599-018-0178-5
• 发表时间: 2018
• 期刊: Palgrave Communications
• 影响因子: 4
• 作者: Brown N

Caring through distancing: Spatial boundaries and proximities in the cystic fibrosis clinic.

通过疏远进行护理：囊性纤维化诊所的空间边界和邻近度。

• DOI: 10.1016/j.socscimed.2020.113531
• 发表时间: 2020
• 期刊: Social science & medicine (1982)
• 作者: Buse C

Immunitary Life - A Biopolitics of Immunity

免疫生命 - 免疫的生物政治学

• DOI: 10.1057/978-1-137-55247-1_1
• 发表时间: 2019
• 作者: Brown N

'Anatomospheres: a 'respiratory politics' of buildings and breath'

“Anatomospheres：建筑和呼吸的‘呼吸政治’”

• 发表时间: 2018
• 期刊: Discover Society
• 作者: Nik Brown

Assembling atmospheres, encountering care: Risk, affect, and safety in the cystic fibrosis clinic

营造氛围，接受护理：囊性纤维化诊所的风险、影响和安全

• DOI: 10.1016/j.wss.2022.100077
• 发表时间: 2022
• 期刊: Wellbeing, Space and Society
• 作者: Martin D