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

抗生素可能抑制感染而不消除感染，从而产生抗微生物药物耐药性（AMR）细菌和人与人之间的交叉感染。由于越来越多的细菌对现有抗生素产生耐药性，该项目既及时又重要。我们的研究比较了三家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，在更广泛的卫生保健环境中限制抗菌素耐药性。帕洛阿尔托研究中心的项目是与我们的三个合作伙伴囊性纤维化（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导致交叉感染。反过来，交叉感染导致高度耐药细菌的聚集，这些细菌大大降低了预期寿命，现在有可能逆转最近在生存方面取得的进展。与我们的临床合作伙伴的对话强调了通过物理隔离、隔离和遏制来预防交叉感染所采用的非常不同的材料和设计方法。尽管存在这些差异，但对呼吸道诊所建筑环境中的设计和实践问题的详细研究很少。这项研究将具有重要意义，因为CF诊所通过反思自己的实践可以学到很多东西。他们也有很多东西可以相互学习，在限制抗菌素耐药性方面可以为更广泛的临床社区提供很多东西。我们将CF作为一个范例的重点，在更常见的呼吸系统疾病和更广泛的感染控制的抗菌素耐药性缓解设计方法中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）的不同（有时是相互竞争的）AMR设计优先级可见。它将绘制出每个诊所不同的“现实世界”路径和旅程。它将探索如何通过诊所的布局来管理物理互动、接触和交流。它还将使我们的合作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，以限制抗菌素耐药性和交叉感染。我们的项目涉及视觉和定性研究方法的创新结合。我们将利用每个诊所的建筑布局图作为重点，与患者、临床医生、医院物业人员、卫生人员和设计师进行访谈。我们的采访还将利用该项目的平面艺术家的技能，他们专门从事实地工作插图，以视觉方式记录真实世界的经历和旅程。我们还将进行“行走采访”，将我们的受访者置于他们日常生活的流程中，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，记录诊所内高风险的关键地点，包括等候区、接待台、走廊、洗手池和洗手液等。这些视觉、图形和文本结果随后将用于每个诊所的共同设计讲习班，以改善当前和未来的抗菌素耐药性缓解。该项目汇集了一个高度多学科团队的专业知识，其中包括学术建筑师，医学和科学社会学家，微生物学家和平面艺术家。帕洛阿尔托研究中心将对以下方面产生积极影响：参与项目设计的三家合作诊所；患有CF和CF信托的人；更广泛的呼吸保健社区、国民保健制度和卫生部；医疗保健设计师和建筑师；抗生素耐药性的政策制定。

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.