The Bartlett School of Architecture


Paths of Resistant Pathogens

Paths of resistant pathogens in hospitals: architecture, design interventions and transmission risks

A hospital scene in a giant petri dish - drawing


This project aims to tackle issues of infection prevention and control, through a detailed architecturally informed analysis of transmission risks inherent in hospital design.

The emergence and spread of antimicrobial resistance (AMR) is a growing concern to global health. An estimated 700,000 or more people already die every year of infections from resistant strains of bacteria and other microbes*. Improving infection prevention and control is one important strategy to combat AMR. However, traditional approaches have shown limited benefit. For instance, educating healthcare workers to achieve higher rates of hand hygiene compliance has proven short-lived and ineffective.

The 15-month study, funded by The Arts and Humanities Research Council, aims to build on existing design research that has begun to shed light on the powerful role design can play in behaviour change. In particular, this project explores the following questions:

  • Do potential behaviour differences differ by agent category such as doctors, nurses, medical students, porters, cleaners, visitors etc?
  • How can modifications in the architectural design of a ward or the hospital affect contact patterns and minimise transmission risks?
  • How can spatial practices be re-organised to potentially have an impact on contact patterns, paths or hygiene compliance?
  • How can alternative warning signs and communications be designed to change behaviours?
  • What is the potential impact of interventions? Are they feasible given the trade-off of functionalities that need to be maintained? Are there other implications? 

*The Review on Antimicrobial Resistance, chaired by Jim O’Neill, December 2014 


'Paths' is a collaborative research project linking design research, spatial analysis, risk modelling and infection control. The project is led by:

and supported by:

  • Julia Backhaus (co-creation of design interventions and final exhibition/outputs) and Dr Alan Outten (Research Associate)

The main collaborators on the project are:

  • Public Health England (Dr Julie Robotham and Dr Timo Smieszek)
  • UCLH Infection Control and Prevention (Dr Vanya Gant and Annette Jeanes)

Observations and co-creation workshops are taking place at UCLH and St. George’s NHS Foundation Trusts. 


Ultimately, the aim of this project is better infection control by design. As such, the proposed research has the potential for a wide-ranging impact, from medical communities to architects, from staff and patients in hospitals to the general public. By working directly with partners rooted in medical practice and sciences, the team will articulate the role of design as a tool for communication and create awareness for design research.

The two hospitals involved in the project as sites of fieldwork will be immediate beneficiaries of the project. UCLH and St George’s will gain direct insights into the way their wards work and how agent paths form through the wider hospital system. They will learn the likely exposure and risk of pathogen transmission in their specific case emanating from hospital design. Through our direct and active involvement of Public Health England (PHE) as a collaborative partner and external consultant (advising on research design, supporting the project, leading on risk modelling), the project will be in a position to feed relevant findings into decision making processes and policies.

Potential outputs with real impact could include better infection control by design, releasing the benefits of understanding the complexity of the ‘whole system’ view of a hospital’s people and movement paths, reduction in AMR transmissions and doing all of this in a cost-effective way. The team anticipates that its findings will apply to other hospitals as well.

As a short project, this proposal is not likely to fully establish the impact of design perspectives to tackle AMR, but it will provide an excellent starting point for further conversations with PHE and other NHS partners. In addition to providing insights in its own right, collaboration will continue through potential future grant applications, thus furthering policy impact, such as testing design interventions.

AMR and how to combat the increasing problem of resistance is a topic that is of general interest to the public due to widespread public health implications. Most people will have had infections and antibiotic prescriptions in their life, so this will have direct relevance for many people, who might be able to imagine what would happen if antibiotics stopped working. We aim to raise the profile of the role of architectural design in AMR in general, as well as infection control in particular, by making the public aware of its impact.

building health design Research: Infection