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What can building information modeling do for you? A perspective on integration into infection prevention and control programs for patient safety

Published online by Cambridge University Press:  05 November 2024

Scott C Roberts*
Affiliation:
Division of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
Trini A Mathew
Affiliation:
HealthTAMCycle3 PLLC, Troy, MI, USA
Windy D Tanner
Affiliation:
Yale School of Public Health, New Haven, CT, USA
Richard A Martinello
Affiliation:
Division of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
*
Corresponding author: Scott C Roberts; Email: scott.c.roberts@yale.edu
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Abstract

Type
Letter to the Editor
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Introduction

Infection prevention and control (IPC) is integral to the functioning of any healthcare facility. In the United States, the Centers for Medicare & Medicaid Services requires healthcare facilities to have IPC programs as a condition of participation, which have core responsibilities as outlined by the Centers for Disease Control and Prevention (CDC). 1,2 The built environment of the healthcare facility is well known to be a potential source of infectious hazards that can be transmitted via air, surfaces, and water. 3 Understanding physical infrastructure better positions IPC teams to mitigate risk.

Building information modeling (BIM), a novel tool that can complement IPC programs, is a software system that provides a 360-degree view of a healthcare facility and serves as a repository for designs and other information about the built environment.

What is BIM?

BIM is defined as the “digital representation of physical and functional characteristics of a facility.4 BIM provides a 3-dimensional representation of the infrastructure and contents of a building and serves as an opportunity to leverage digital platforms as tools for working through a building life cycle, from earliest conception to demolition. This allows for multidisciplinary collaboration amongst facilities teams, including architects, developers, and engineers to note a few.

Why use BIM for healthcare facilities?

BIM has been utilized for various phases of healthcare facility development, including site planning, visualization and modeling of buildings, and predictive analysis of performance. Reference Pikas, Koskela, Sapountzis, Dave and Owen5 BIM use in existing healthcare facilities occurs as well, with examples including providing information on room occupancy, air pressurization of rooms, 2-dimensional blueprints, and 3-dimensional views ranging from entire buildings to single rooms, allowing in-depth visualization of objects in single patient, staff, or common area rooms.

The National Institute of Building Sciences guidelines provide information on using BIM for “asset management, space management,” as well as “disaster planning and management” to assist in emergency settings. 6 This also allows for planning and awareness of patient transport routes within a facility. A specific route of transport from patient arrival in an ambulance, through the facility to a designated isolation room can be devised, for example, in a way that most optimally prevents exposure to others. This can be particularly useful when patients are infected with high-impact pathogens (eg, Ebola virus) or transmissible biological agents.

Leveraging BIM for IPC workflow and program optimization

Successfully optimizing BIM features can help support daily IPC team workflow. For example, rooms on a unit can be annotated, helping to “visualize” areas impacted by an outbreak. Similarly, places within the built environment that undergo construction and require an infection control risk assessment, or those that sustain damage related to plumbing, water leaks, and flooding, can be annotated and reviewed at a later date or visualized for planning purposes.

Room occupancy can be leveraged to determine options for transmission-based isolation, as well as the frequency and time needed for room turnover. The IPC team can also annotate rooms with known admissions of certain multidrug-resistant organisms of interest to determine patterns and trends of developing healthcare-associated infections. Three-dimensional visualization of rooms can also assist in the investigation in real time. At our own facility for instance, the management of a case of nosocomial Legionella infection changed when the use of BIM allowed real-time visualization of the room’s water supply at the patient room level to confirm that a sink and shower were not present in an ICU room, rendering in-room investigation of water sources unnecessary. The investigation was refocused on central water sources at the unit level, including water and ice supply at the nurse’s station. This occurred at an ICU in far proximity from our IPC team location, where manual walkthrough to evaluate unit-level water sources would have been more challenging.

Future impact

As healthcare organizations expand their geographical footprint, IPC teams will be challenged to respond and support staff at different facilities. Reference Stevens, Wright and Kaye7 A 2016 survey of corporate IPC directors identified an average of 58 minutes and 49 miles for travel to other facilities. Reference Barnes, Zirges and Tomac8 In health systems where there may be limited staff to support IPC programs, or where facilities far away are managed by off-site IPC teams, leveraging BIM can assist facility leadership to partner with IPC at other sites. This agility in supporting distant healthcare facilities, at times crossing state lines and time zones, will also assist in decreasing the carbon footprint.

Future development of BIM features, such as object recognition using artificial intelligence, can also assist with labeling objects of interest within the BIM. For example, the BIM could be used to rapidly identify the location and number of sinks in a circumstance where an IPC team determines sinks may be involved in an outbreak.

We also anticipate the possibility of using BIM in combination with virtual reality headsets to allow a user to navigate the virtual environment. Beyond the potential benefits to IPC, this may also allow patients and families to acquaint themselves within the facility in preparation for a clinical encounter.

Limitations on BIM adoption include added technology and staffing costs. Access to sensitive areas of a facility should be limited to certain categories of healthcare personnel to avoid security threats.

In conclusion, BIM can help support IPC functions by efficiently providing critical building information and improving the ability to understand 3-dimensional relationships between spaces, which can support activities such as outbreak investigation, emergency preparedness and response, and responding to environmental situations such as water intrusions.

Acknowledgments

We wish to thank Ann Monks and Juan Rodriguez for their assistance in supporting this work.

Financial Support

This publication is supported by the CDC of the US Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2,542,348 with 100% funded by the CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by the CDC/HHS or the US Government.

HIPSTER team:

Yale New Haven Health System: Eileen Blake, MPH; Jamie Trumpler, MBA; Noelle Frye, MA; Elin Nilsen; Hyung Paek, MD; Michael Boyce, PhD; Cheryl Mayeran, MPH; Tony Polcaro, CTS; Antonietta Hallet; Lindsey Greene-Upshaw.

Emory University: Nitu Kashyap, MD.

Yale School of Medicine: Richard Martinello, MD; Scott Roberts, MD; Thomas Murray, MD, PhD; David Peaper, MD, PhD; Leigh Evans, MD; Kim Hieftje, PhD; Asher Marks, MD; Veronica Weser, PhD; Erin Truesdell, PhD; Abigail Crocker, RN.

Yale School of Public Health; Windy Tanner, MSPH, PhD.

Yale School of Engineering and Applied Science: Jordan Peccia, PhD; Lucien Dieter, PhD Student; Hannah Healy, PhD.

HealthTAMCycle3, PLLC: Trini Mathew, MD, MPH.

Disclosures

All authors report no conflicts of interest in relation to this work.

Footnotes

**

SCR and TAM have equally contributed to this manuscript.

References

Code of Federal Regulations. Condition of participation: Infection prevention and control and antibiotic stewardship programs. 42 CFR 482.42. https://www.ecfr.gov/current/title-42/section-482.42. Accessed July 10, 2024.Google Scholar
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