When Linda Lybert, President of the Healthcare Services Institute in the US, walked into the VIP wing of a large training hospital alongside its architect, she took one look at the nurses’ station and asked a single question: “Has the Health Department been here yet?” The answer was ‘no’. The nurses’ station was made of granite.
“Granite is a sponge you cannot squeeze,” Lybert told a recent ISSA Oceania webinar. “You cannot clean granite. Think about it for a minute. It’s the underground aquifer for our water system, so it’s collected all kinds of stuff. And if it’s given the right environment, it will grow.” The health department arrived the following day and required the surface to be removed entirely. That the material was ever specified in the first place points to a structural problem in how healthcare facilities are designed and built.
Architects and the cleanability blind spot
Across 37 presentations to architecture firms across the US and a further conference attended by more than 175 architects, Lybert opened each session with a simple question: How many of you read the cleaning and disinfection requirements of the materials you specify before you put them into a healthcare environment?
“I was lucky if one or two hands went up in the room,” Lybert said in the webinar. “Out of the 175 people in that room, five hands went up. So they don’t even think about the fact that you have to clean and disinfect these healthcare environments.”
Lybert argues the reason is that design priorities in healthcare construction have drifted toward what she describes as a “healing environment”, prioritising a home-like atmosphere over the practical demands of infection control. The result is facilities filled with materials that look impressive and clean poorly.
Dr Rodney Rohde, chair and Regent Professor at Texas State University, pointed to the impossible demands placed on cleaning teams as a direct consequence of poor design decisions, noting that in some US facilities, operating rooms are expected to be turned over in nine minutes. “Absolutely impossible,” Lybert responded. “You cannot clean all of the surface materials and the equipment and the lines. A lot of times we’re not even thinking about what we need to clean in between patients.”
The materials that harbour biofilm
The problem compounds when surface materials are considered through a biofilm lens. Whiteley Corporation executive chairman Professor Greg Whiteley, a pioneer of dry surface biofilm research, has long argued that the majority of surfaces in healthcare environments actively support microbial attachment. Even materials that appear hygienic can create ideal conditions for biofilm formation.
Brushed stainless steel grab rails are a clear example. Lybert noted that the textured finish applied to handrails, intended to improve grip, creates the precise micro-environment that microbes need to anchor and build a protective matrix. “Those are actually perfect locations for microbes to attach and begin to build biofilm,” she said, adding that cleaning direction relative to the grain of the texture matters enormously.
Rohde raised the broader issue of regulated materials controls, echoing a question raised by a webinar attendee: “If we know materials and certain types of things are problematic, perhaps they should in some sense be banned, especially in high critical areas like an operating room or an intensive care unit or nursery.” He suggested that even a published list of materials known to create cleaning difficulties could serve as a practical starting point for the design and construction industry.
A call for designed-in cleanability
Whiteley framed the challenge in terms of validation, arguing that cleaning systems need to be tested and proven in the actual built environment rather than assumed to work. “Unless you’ve tested the right system with the right test method, you can’t be sure it works,” he said, pointing out that wet and dry biofilm test methods differ substantially and that products validated under one set of conditions may perform very differently in a real healthcare setting.
“We need to start designing hospitals for cleaning and disinfection,” Lybert said, “because that’s one of the most important things that we do in a healthcare setting, along with taking care of patients.”
The granite nurses’ station is a striking symbol of that failure, but it is far from an isolated case.
