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

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. ⁵ 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. ⁷ A 2016 survey of corporate IPC directors identified an average of 58 minutes and 49 miles for travel to other facilities. ⁸ 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.