Healthcare Environment Control, Optimisation and Infection Risk Assessment (HECOIRA)

医院建筑对于支持有效的病人治疗至关重要。有强有力的证据表明，患者环境的设计会影响健康和舒适度、康复率，并可能导致和控制感染的传播，特别是那些具有空气传播成分的感染。英国最近的监测估计，每年有6%的患者在住院期间感染，入院人数为1590万，总计近100万人。大约20%的感染被认为与环境直接相关。医院建筑的发展速度与医学进步的速度不一样，许多临床医生在治疗患者时处于次优状态。此外，最近对医疗保健建筑的审查主要集中在其能源使用上，并且越来越多的人担心，在没有正确了解患者风险的情况下，根据能源和成本效率做出决定。这是适得其反的；建筑物的效率节约导致临床交付的风险和成本增加。由于NHS承诺减少经常性收入成本，以支持减少220亿英镑的国家资金缺口，因此必须从整体上考虑建筑物，并适当考虑建筑物对患者预后的影响。提供良好的患者环境的一个主要障碍是拥有可用的工具来评估风险，并以响应的方式调整环境和操作。目前用于设计和运营医疗建筑以及选择技术的工具很擅长模拟能源，但从健康和感染控制的角度来看，这些工具非常有限。我们之前的研究开发了新的方法来模拟医院环境及其对感染风险的影响。在这个项目中，我们的目标是在这些方法的基础上开发和测试新的基于计算的工具，以评估、监测和控制医院中感染控制、舒适和健康的真实患者环境。我们将开发物理、环境、微生物和人类参数模型，并将其与环境传感器数据结合起来，建立新的工具来动态模拟医院环境。这些项目将侧重于解决现有病房的挑战，这些病房通常受到当前建筑设计的限制，在许多情况下，通过开窗自然通风。我们将建立一个将传感器与实时流体动力学模拟模型连接起来的系统，以实现对环境条件的实时监测，并允许做出快速适应的预测。这将通知和控制诸如开窗、加热器和额外冷却等方面，以优化患者环境的舒适度和空气质量参数。除此之外，我们将开发一个定量病原体暴露模型，可以比较空气和表面传播的相对风险以及不同设计和感染控制策略的可能有效性。该工具将支持决策和情景测试，并提供一个有价值的交互式培训工具，以展示病原体、人与物理环境之间的相互作用。该项目与临床医生有重要的互动，他们管理复杂的病房环境和广泛的患者，以及医院设计、规范和运营方面的行业专业知识。我们将在实际病房开发和测试我们的方法，以了解他们的挑战，测量条件的可变性，并评估我们的模型如何以及在哪里可以最好地用于实践。通过与业界伙伴紧密合作，我们将了解如何将我们的试验工具应用于设计和屋苑管理，以及它们在哪些方面可以为指导和管治提供信息。该项目将提供新的基于风险的方法来评估医疗保健环境，以支持决策、培训、设计和未来指导。

Hospital buildings are critical for supporting effective patient treatment. There is strong evidence that the design of patient environments influences well-being and comfort, recovery rates and can both cause and control transmission of infections, particularly those with an airborne component. Recent surveillance in England estimates 6% patients a year contract an infection while in hospital, which with hospital admissions of 15.9 million, totals almost 1 million people. Around 20% of infections are thought to be directly related to the environment. Hospital buildings have not progressed at the same rate as medical advances and many clinicians are treating patients in sub-optimal conditions. In addition recent scrutiny of healthcare buildings has been dominated by a focus on their energy usage, and there is increasing concern that decisions are made on energy and cost efficiency grounds without proper understanding of the risk to patients. This is counter-productive; efficiency savings in buildings leads to increased risks and hence costs in clinical delivery. With the NHS commitment to reduce recurrent revenue costs in supporting reduction of the national £22bn funding shortfall, it is essential that buildings are considered holistically and that the influence on patient outcomes is properly factored in. A major barrier to delivering good patient environments is having usable tools to assess risks and adapt the environment and operations in a responsive manner. Current tools for designing and operating healthcare buildings and selecting technology are good at modelling energy, but are very limited from a health and infection control perspective. Our previous research developed new methods for modelling hospital environments and their influence on infection risk. In this project we aim to build on these approaches to develop and test novel computational based tools to assess, monitor and control real patient environments in hospitals for infection control, comfort and well-being. We will develop and couple models of physical, environmental, microbial and human parameters together with environmental sensor data to build new tools to dynamically model hospital environments. These will focus on addressing challenges with existing wards which are often constrained by the current building design and in many cases are naturally ventilated via opening windows. We will build a system that links sensors with a real-time fluid dynamics simulation model to enable live monitoring of environmental conditions and allow predictions to be made for rapid adaption. This will inform and control aspects like window opening, heaters and additional cooling to optimise the patient environment for comfort and air quality parameters. Alongside this we will develop a quantitative pathogen exposure model that can enable comparison of the relative risk of air and surface transmission and likely effectiveness of different design and infection control strategies. This tool will support decision making and scenario testing, as well as provide a valuable interactive training tool to demonstrate the interactions between pathogens, people and the physical environment. The project has significant interaction with clinicians who manage complex ward environments and a wide range of patients, and expertise in industry in the design, specification and operation of hospitals. We will develop and test our approaches on real wards to understand their challenges, measure variability in conditions and evaluate how and where our models can best be used to inform practice. By working closely with industry partners we will understand how our pilot tools can be deployed in design and estates management and where they may inform guidance and governance. The project will deliver new risk based ways of assessing healthcare environments that support decisions, training, design and future guidance.