An architectural investigation into the microbiome of the built environment at two selected South African hospitals

Abstract

This thesis presents an investigation into the hospital microbiome of the built environment. The researcher characterised the microbial landscape of two Western Cape hospitals through a multi-disciplinary approach. The researcher employed an integrated cross-disciplinary methodology that combined spatial analytics, environmental monitoring and microbial sampling and sequencing. This thesis presents the first South African hospital microbiome classification. Buildings may influence the health and well-being of their occupants through healthcare acquired infection (HAI). HAI contributes to two thirds of all patient readmissions. The researcher suggests a paradigm shift in building ecology to approach this established public health concern. The relationship between microorganisms and the built environment is much more prevalent than previously recognised. The built environment is a landscape that consists of distinct series of landscapes connected by micro and macro ecosystems. These ecosystems are local and unique, integrated, and dependent on the adjacent environment. Microbiology of the built environment (MoBE) combines built environment studies by merging soft and hard science with seemingly unrelated but systemic dependable study fields. These study fields include engineering, architecture, microbiology, the health sciences, epidemiology, anthropology and sociology. As with all new emerging fields, relationship interplay and interpolation of data parameters in each field dictate the scope of discovery. What constitutes a “healthy” indoor environment is yet to be determined, characterised or defined. One needs to understand the manner in which to process various known and unknown dynamic factors. Indoor environments are complex by nature - extremely integrated, dynamic ecosystems - and require a vast interdisciplinary field of researchers. This study found that not only do indoor built environment biomes change seasonally, but the indoor conditions of the built environment also experience seasonal variations. Room types and potentially building types, can be distinguished through their microbiomes, as is reflected by the unique biomes associated with each hospital room type investigated. The factors that determine the biome are still unclear but represent possibilities for future research investigation. The researcher considers the following as pertinent findings of the research: 1) Design guidelines for health, in architecture and engineering, are realised where microorganisms are considered. 2) There is confirmation of seasonal variations in the composition of hospital microbiomes. 3) The data provide an indicator list that represents the core species associated with a South African Western Cape hospital biome. 4) This thesis contributes to and confirms the association of known Healthcare associated infection (HAI) pathogens through sequencing and culture, identifying both presence and viability. 5) This thesis contributes to the MoBE research agenda at various levels. The thesis pursued health and design associated understanding to stimulate public health centred architectural response, and improve indoor building environments for the user. It investigated the spatial relationships of indoor environments and the composition and distribution of the local microbiome. A methodology for infection prevention and control (IPC), building assessment and operational guidance proposes further development.