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Design Bugs Out: Patient Bedside System

This radical redesign of the bedside cabinet reduces clutter, makes cleaning easier and offers patients easy-to-access storage.

The challenge

The familiar bedside cabinets in NHS hospitals, little changed in 40 years, are hard to clean, made from wood-based materials, difficult for patients to access, heavy and relatively immobile.

The project team identified five areas where design improvements could significantly reduce the spread of infection:

• Cleanability — make it easy to keep the product clean and free from germs

• Clutter reduction and organisation — enable patients to organise their belongings and reduce the amount of clutter around the bedside

• Patient empowerment — enable patients to do more for themselves, so fewer people need to touch surfaces and belongings

• Visibility — avoid dark, closed spaces where infected items can linger unnoticed

• Mobility — make the product easy to move around, so cleaners can do their work effectively.

Design solution

Hollington and Herman Miller worked with the infection control team at the Royal United Hospital (RUH) in Bath, holding workshops and testing prototypes with patients, staff and cleaners.

Patient perspective

Existing cabinets face the room rather than the patient and have cupboard spaces that are difficult for patients to access. They take no account of the storage needs of the patient and do not help them organise their belongings.

Although a traditional cabinet may have a friendly, domestic feel, patients say that safety and effectiveness are more important.

Healthcare staff perspective

A product that enables patients to do things for themselves would free staff to focus on more important clinical tasks. A light, mobile and open structure would be easier to keep clean, and easier to clean around.

Results

The Hollington design is a ‘bedside amenity’ rather than a piece of traditional furniture. The product is systematic, consisting of a light and mobile ‘cart’ that accommodates modular surfaces and containers and can be configured to suit different healthcare settings.

Design concept:

Cleanability: an open structure improves cleaning access, surfaces are smooth and edges and corners rounded, so cleaning can be more thorough with areas less likely to be missed out. Also, the containers can be removed for thorough cleaning.

Clutter reduction: patients can organise their belongings in special disposable carrier bags, reducing clutter and enabling easy cleaning of the tub. The bags’ contents can be easily accessed, as the bags can be pulled up onto the bed by their handles.

Patient empowerment: patients can more easily access their own belongings from the trays, containers and bags.

Patient empowerment: the unit is light and highly mobile, so patients can easily move it around themselves, and if a patient leans on it for support there are foot-locking castors.

Patient empowerment: the personal pod can be unclipped from the tub and can travel with a patient, to X-ray for example.

Visibility: replacing the cupboard with an open plastic tub is a big conceptual change, one welcomed by infection control specialists, nursing staff and patients in user trials. If a patient’s privacy is critical, the tub can be located with its high side facing the room.

Mobility: the cart is light and mobile, so it can easily be moved for cleaning access.

Future-proof: when needs and technologies change, new components can be introduced with no need to replace the whole product.

Easier maintenance: if a part breaks, it can be changed quickly and easily, in situ.

Technical innovations

• The use of moulded plastics makes infection control easier. Plastics are impervious and seamless, and can have smooth, rounded shapes. Assemblies can be made without screws or adhesives, and they are economical, hardwearing and recyclable.

• On antimicrobial coatings and additives, the team took the view that at present the risks outweigh possible benefits: antimicrobials may not be effective against any contaminant thicker than a few microns, their effectiveness may decline over time and users may be tempted to rely on perceived antimicrobial properties rather than take proper precautions against cross-infection. Also, continuous exposure to antimicrobial agents may cause the evolution of resistant strains.

• The team worked closely with colour and materials specialists Linda Barron and John Gould to determine the best plastics materials and develop an attractive and appropriate colour strategy. Professor Peter Borriello, former Director of the Centre for Infections at the Health Protection Agency (and a member of the DBO expert reference group), advised on the microscopic surface properties required for a plastic that would discourage bugs from sticking, and maximise the effectiveness of cleaning materials.

• Several plastics are employed in the cart, with melamine — an extremely tough, glossy, ceramic-like engineering plastic — used for the top surfaces and a special grade of polypropylene employed for the containers.

Design: Hollington

Manufacture: Herman Miller

You can see a video about the design of the Patient Bedside System here.

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