院内感染(NI)视角下综合医院建筑的布局优化研究

基于院内感染（NI）对综合医院带来的新挑战，分析NI在综合医院的发生机制，明确空间环境的风险因子，提出其布局设计的优化策略和路径，旨在帮助设计师通过空间环境干预应对NI挑战，降低其对公众健康的危害。以综合医院为研究对象，通过交叉文献阅读明确了其NI发生过程及途径，空间环境影响NI的方式，构建了NI-空间环境机制框架；其次利用专家访谈方法等，分析了综合医院的NI风险影响因子，并进行风险度和优化度分析，将其归纳为功能布置、设施与材料、物理环境三个层面，最后从应对NI风险的角度提出了阻隔感染链条、遏制感染源和控制感染环境的布局设计优化策略。研究对于促进院内感染与建筑设计的交叉研究，指导后疫情时代医院建筑的设计有着显著意义。

Layout Optimization of a General Hospital from the Perspective of Nosocomial Infection (NI)

After the outbreak of COVID-19, hospitals experienced a number of nosocomial infection (NI)-related problems when admitting and treating the infected, threatening the health of staff and patients. As the environmental carrier of the infection chain, the spatial layout and physical environment in general hospitals are of great significance in controlling NI. In this study, the mechanism of NI in general hospitals was analyzed from the perspective of architectural planning and design, the risk factors of the spatial environment were clarified, and the optimization strategy for the layout design was proposed. This study is of great significance to the structural design of general hospital buildings in the post-Covid-19 era. Firstly, an NI-spatial environment mechanism framework of general hospitals was established based on a cross-literature review, expert interviews, and risk intervention evaluation methods. The significance of the built environment of hospitals in the triangle infection chain was emphasized. Some specific suggestions, such as controlling the infection sources and blocking infection exposure, were given. Secondly, the NI risk factors were analyzed through a combination of the literature review, expert interviews, and professional evaluations. These NI risk factors corresponded to seven high NI risk departments in general hospitals. The results show that circulation planning and the function layout are the most important risk factors, with the highest degree of risk. They are the main optimization targets for architectural design. Facilities and space materials are also significant risk factors, which can be mitigated through hand hygiene compliance. The risk of daylighting and ventilation is high, but the degree of intervention is low. This is reflected in reproduction control of the source of infection. Based on the above analysis, some NI response paths for design were proposed: (1) architectural designs can cut off the contact with NI and block the continuity of the infection chain by optimizing the functional layout. Specific methods for this include reducing crowding and non-essential contact. (2) The source of the NI infection can be inhibited through the surface processing of facilities and materials, including restricting pathogen accumulation on the skin and in the environment. (3) General hospitals can restrict the propagation of NI by making changes to the physical environment. Introducing natural factors is a major means for this, such as introducing natural ventilation and the use of lights. Further, the hospital architecture is the environmental carrier of the pathogens. The essence of NI control is to cut off the triangle chain of infection at any stage. The design and planning of general hospitals can interfere in almost all links of the infection chain. Therefore, NI control will become an important issue for general hospitals in the post-Covid-19 era. In the future, the design and research of NI should establish a life-cycle and full-process design concept, implementing the NI control principle in each stage of general hospital construction and maintenance