Ebook: Effects of Design on Health and Wellbeing

ARCH24, the 6th International Conference on Architecture, Research, Care and Health, was held at Aalto University, Espoo, Finland from 17–19 June 2024. The theme of the 2024 conference was ‘Effects of Design on Health and Wellbeing’.

The main objective of the ARCH conference series is to promote architectural research within the health and wellbeing sector, and to provide evidence-based data which will move the profession and design community forward. We are all aware that health and wellbeing can no longer be dealt with as a local issue, so the emphasis this year was on wider global reach and greater diversity and this 2024 conference brought together some 170 professionals from over 25 countries around the world.

This book contains 37 articles presenting academic research and submitted to the conference. These articles address topics on designing for social and emotional wellbeing, designing for the transformation of care delivery and culture, and designing for everyday environments to support, rehabilitate and care. Everything we design, matters. Our day-to-day environment can support our physical and sensory capacities. It can promote the inclusion and wellbeing of people of all ages, from children and young people to older adults. Design of the built environment plays an important role in health behaviours and the prevention of disease and can also support rehabilitation and the healing process. Current healthcare reforms are changing the ways that services are delivered. The design of care environments enables this transformation, and fosters user driven healthcare culture. These topics and many others are discussed in the following articles, which are grouped under eight headings:

∙ Research and design methods for better care environments

∙ Universal design and accessibility of care environments

∙ Sensory design in care facilities

∙ Healthcare design and care culture

∙ Youth wellbeing and environment

∙ Building an inclusive and sustainable society

∙ Housing design and home attachment

∙ Age-friendly environments and ageing in place.

We are thrilled with the many excellent articles submitted this year, and are confident that you will enjoy reading them here. The best practice papers are published in a separate publication in the Art + Design + Architecture series of Aalto University publications.

Dr. Ira Verma – Conference co-chair, Chair of ARCH24 Scientific Committee

Professor Laura Arpiainen – Conference co-chair

As an architect, I felt a strong moral urge to engage in research aimed at creating more human-centred healthcare environments, particularly in the context of palliative care. Being relatively new to this field 4 years ago, my primary goal then was to develop a deep understanding of these unique contexts, with a special focus on the people involved. To achieve this, I embarked on an immersive ethnographic study over the last few years, involving participant observations in three distinct palliative environments (i.e., day-care centre, hospice, and palliative care unit) and interviews with residents, family members, caregivers, volunteers, and maintenance staff. While preparing to present this study to an ethics panel, I believed I had covered all possible questions until I was unexpectedly asked, “How will you consider your own emotional well-being?” At that moment (in the 1st year of my PhD trajectory), I was unsure how to respond, but today (in the 4th year of my PhD), I would say that my approach was to verbally and visually document the entirety of the experience, including the positive, negative, and challenging aspects. Throughout my journey, I maintained a journal not only to express my thoughts and feelings but also to capture the methodological and ethical insights I had gained while conducting interdisciplinary research on the spatial experiences of individuals within palliative environments. This article serves as a comprehensive overview of all significant events preceding, during, and following the study. The insights were organised according to ‘the good, the bad, and the ugly’ to shed light on the complexities and nuances of conducting research in this unique and sensitive domain. In doing so, the aim of my contribution is to inspire novice researchers to embark on such research studies and offer them guidance along this undoubtedly beautiful yet occasionally challenging journey.

Observation tools are increasingly important in healthcare building design research. They enable us to understand how the design of healthcare buildings affects users’ health and organisational outcomes. Observations are used in case studies and pre- and post-occupancy evaluations. However, these case studies often struggle to pinpoint the specific design features responsible for observed outcomes. Additionally, harnessing collective knowledge from multiple cases can be challenging. This underscores the need for structured observations. The paper describes the lessons learnt from using three spatial observation tools as part of a study to assess a hospital ward design. Its goal is to reflect on the purpose, usability, advantages, disadvantages, and future improvements of these tools and to offer insights into their potential to support research on hospital ward design. The first tool, by the Centre for Health Design, utilizes a checklist-style matrix to evaluate the design of patient rooms, assessing 17 Evidence Based Design goals, including patient safety, worker safety and effectiveness, quality of care, patient experience, and organizational performance. The second tool is a one-time observation tool, a structured spatial inventory aimed at documenting design features throughout the entire hospital ward, covering elements such as room size, access to daylight, natural elements, furniture, safety measures, and more. It can be combined with the third tool; the recurring observation tool, which focuses on monitoring usage, users, their activities, and behaviour across various types of environments, including patient, staff, care, and supportive spaces. The last two observation tools were developed for the research project, adapting the Smart Sustainable Offices method for healthcare environments. This paper emphasizes the importance of selecting suitable observation tools for specific research objectives, providing guidance for working with observations and conducting pre-and post-studies. While not aimed at validating observation tools, it offers reflections to aid in development and use of observation tools. Finally, documenting spatial contexts enhances understanding of study findings, and reusing observation tools enables cross-study comparisons, with future potential for leveraging artificial intelligence.

In professional interactive practices, space, time, human bodies, and material objects as well as written and oral language are dynamically implicated in a multimodal co-construction of meaning. A healthcare space – an operating room – is a typical example of such a social-semiotic, multimodal arrangement of communication modes which impacts the practices that are played out therein. Therefore, in designing healthcare spaces, it is important to allow for proactive inclusion and engagement of the categories of professionals who carry out their daily work in these spaces. Today, such involvement can be facilitated through mediation tools and simulation in Collaborative Virtual Environments (CVE). However, how collaboration unfolds and manifests at the micro-level of collaborative design interaction remains under-researched. The aim of this discussion paper is to introduce a social-semiotic approach to the analysis of multimodal collaborative design. We show how combinations of modes can trigger transformational shifts in levels of interaction.

The article aims to study the concepts, themes, and ideas behind the new typology of modern Finnish psychiatric hospitals by analyzing two recently built cases. Several new psychiatric hospitals were built in different regions of Finland in the last decade. They are built on the campuses of somatic central hospitals, they combine outpatient, inpatient, and day wards for many different age groups. They have public functions that serve the whole campus or the surrounding area. The vast gardens of previous facilities were replaced by balconies, enclosed yards, and roof terraces. In the absence of national guidelines on design, the new typology was formed, shaped by cooperation between the hospital administration, hospital staff, and the architects. The article analyzes the design briefs of two similar through inductive content analysis to derive the main themes mentioned in these documents. Then, it is analyzed how the themes were reflected in the final design of the buildings, highlighting the commonalities and differences of the two projects. Some of the most common themes were safety, functionality, centralization, cooperation, proximity, flexibility, renewing psychiatric care, isolation, changing patient demographics, family, privacy, stigma, therapeutic spaces, outdoor spaces, and working environment. They are reflected in the building design being more concerned with security, in more dense and compact floorplans, and in design solutions that make it possible to quickly adapt in crisis situations. The Case B, designed just few years later than Case A, is noticeably more focused on the security aspect. The article also provides an insight into how the typology of hospitals was influenced by societal and legislative changes as well as changes in psychiatric care.

The traditional architectural design of care institutions is characterised by limited privacy, autonomy, user involvement, and rigidity in scheduling. In contrast, the Person-Centred Care (PCC) model presents an alternative approach to care provision, emphasising the active participation of the care recipient, involvement of the family, flexible scheduling, as well as a close relationship between users and caregivers. This approach requires reorganising facilities into smaller, more compact, self-contained units, known as living units. In Spain, the public administration responsible for social and health care centres (Imserso) has initiated the process of adapting its buildings to enhance social integration and implement the PCC model at a national level. The aim of this study is to outline and analyse the participatory process involved in evaluating the architectural design for the transformation of two such buildings. The research design is a multicentred descriptive case study with data collected through group workshops. The results describe the findings of four workshops conducted with care providers and care recipients of both buildings. Incorporating a co-design process with building users should be a fundamental aspect throughout all project phases, as deinstitutionalisation involves empowering individuals to participate and be active agents in their environments.

This article deals with representation of the human body in architecture. The human body as a statically balanced symmetrical figure is an antique, time-bound representation of the body and it is important to challenge that image in a modern and more nuanced understanding of being human. To identify some of architecture’s reproductions of the human body, we make some historical cuts and exemplify representations of the body in architectural theory. First, we briefly describe the origin of Homo Bene Figuratus (Vitruvius introducing the doctrine of the well-formed body) and the image of the body characterised by geometric proportioning. We then exemplify similar renderings of Reference Man which followed the Vitruvian Man right up to the present. Le Corbusier’s “Le Modulor” follows the same path, in a modernist worldview, helped along by Ernst Neufertt’s ideas on theory of proportion, first stated in 1936, which standardisation have remained unchanged as essential reference. As a critical response to bodily reductive perceptions in architectural theory, we go beyond Reference Man and seek a broader in-sight into the understanding of human diversity and varieties of bodily abilities. Seen through a Universal Design perspective, a view of the human body as absolute geometric figure inscribed in fixed coordinates has difficulty representing ideas of human beings as a diverse group of bodies. This view also has difficulty representing the idea of the human body as changing through a lifetime. A fixed standard can overlook the human being as diverse in bodies and abilities and even come to leave out significant aspects of design such as health, social wellbeing, and sensory qualities of architecture. In our discussion, we go into more detail about the significance of representations of the ideal human body for the design of architecture and suggest what consequences it may have for architectural practice.

Hospitals, as institutions serving a diverse population, must address the needs of individuals with disabilities. While many nations prioritize a public health approach to hospital accessibility, this research contends that specialized strategies are vital to accommodate the complex requirements of all users. The study employs a mixed-method methodology. It encompasses an in-depth literature review on accessible design theories, cross-country comparisons of regulations in five nations (Greece, UK, USA, Australia, Sweden), and a survey evaluating existing accessibility within Greek hospitals. The review and cross-country comparisons underscore the pressing demand for specialized attention to wheelchair users and reveal a glaring absence of regulations catering to the visually and hearing impaired. The survey results illuminate a concerning trend of noncompliance with existing rules, underscoring the urgency for legislative actions and the establishment of international standards to ensure comprehensive accessibility. Although strides have been taken, strict adherence to regulations remains paramount. The research places paramount importance on social well-being and equity in healthcare access for individuals with disabilities. It is evident that individuals experience emotional difficulties when confronted with accessibility obstacles, underscoring the necessity to integrate emotional support into hospital design in conjunction with accessible design principles. The study aligns closely with the principles of equity, diversity, and inclusion, advocating for equal access to healthcare and specialized care for vulnerable populations. In conclusion, the research significantly contributes to the conference’s overarching theme by delving into the intricate interplay between design, social well-being, and emotional health within healthcare facilities. The primary focus on the inclusion of individuals with disabilities serves as a driving force in the pursuit of a more equitable and accessible healthcare landscape.

This paper presents the design, application, and results of experience-centered design sessions (ECD) involving nonverbal persons with dementia (PwD) and persons with profound intellectual and multiple disabilities (PwPIMD). This study is part of a larger interdisciplinary project dedicated to understanding the personhood of these persons within contexts of care and living. This study is grounded in the belief that sensory experiences and interactions can render their personhood visible, tangible, and accessible. With three participants from each group in six different care facilities, ECD sessions spanned four consecutive days. During these sessions, various tools aimed at providing sensory stimuli were introduced to the participants. These sessions were recorded and later analyzed using reflexive thematic analysis. The reactions, interactions, actions, or the lack thereof, with or without these designed tools, provided insights into which tools and approaches effectively rendered nonverbal personhood visible, tangible, and accessible. Additionally, this study also considers the already existing sensory stimuli within their care setting, which were also observed and included in the analysis. Through these ECD sessions, a metaphorical space was created between the participant, designer-researcher, other actors, and tools present in these facilities. This paper not only explores the immediate and latent results of these sessions on the nonverbal participants but also considers the impact on other actors present within these facilities during the sessions. The paper concludes by providing recommendations to design for nonverbal personhood for designer-researchers working with nonverbal persons in care, while also highlighting ways to include them into research to create new avenues for understanding, recognition, and inclusion.

Modern architecture has generated measurable requirements about users’ interactions with the built environment to create user-oriented architecture through meticulous full-scale testing with subsequent standardization. These requirements have entered the legal framework as minimum threshold values for basic demands that regulate building and physical planning. In the construction of the modern welfare society, building-related requirements have been associated with fundamental ethical values for the societal construction, e.g., equity, health, inclusion, and sustainable development. The programming of architecture through building requirements can be seen as giving the users a dosage of happiness through architecture. The modern welfare state defines an architectural happiness through is legal frameworks. This study analyzed thirteen questions from a 37-question questionnaire, distributed to 122 informants, in thirteen countries. The study aimed at establishing the contemporaneous understandings and uses of the concept of accessibility. The study concluded that, currently, the concept of accessibility has turned into a technical instrument that limits the quest for an increased fit between user demands and needs with the architectural design. Furthermore, there is a loose link between accessibility and sustainability. In conclusion, architectural happiness for the upcoming sustainable society of the 2030s needs to update the concept of accessibility so that the outcome – usability for future users – becomes apparent.

We navigate through the environment using our sensory stimuli. Sound is significant in guiding us through space and making us aware of time. Soundscape is an acoustic environment as perceived and experienced by a person. While an unfamiliar and chaotic soundscape can increase anxiety and stress, a well-designed soundscape can make the experience pleasant and improve moods. People with dementia suffer from a neurodegenerative disorder, leading to a progressive decline in cognitive health. Behavioural and psychological symptoms of dementia (BPSD) refer to a group of noncognitive behaviours that affect the prediction and control of dementia. Reducing the occurrence of BPSD is one of the main goals of dementia care. People with severe dementia usually live in nursing homes, long-term care facilities or memory care units where sensory perception is unfamiliar. The strange sensory stimuli add to the anxiety and distress of residents as care facilities are often not customized based on individual needs. Research shows that incorporating pleasant sounds into the environment, known as an ‘augmented soundscape,’ positively impacts behaviour and reduces BPSD. Most design tools and guidelines include eliminating unwanted noise. To date, there are no guidelines for sound augmentation in dementia care design. The previous study of sound selection showed promising results in sound augmentation and identifying sounds that a person with dementia may prefer during a specific time of the day. The sharpness and high-pitch sounds, such as animal localization, had positive results. Cricket sounds showed positive feedback during nighttime and evening; either its tranquillity made it favourable, or the continuous sound masked other noises during the night (like white noise). These results can be used to introduce sound augmentation guidelines. The goal is to introduce sound as a positive design implementation to enhance mood, reduce apathy and depression, lower anxiety and stress, and promote health.

Primary Care Services in Italy are evolving to promote the spread of social-health care facilities (e.g., CdC - Casa della Comunità/House of the Community). Many gaps have been detected in the field of designing for CdC, especially regarding designing welcome and waiting spaces. Sensory Design was identified as a suitable approach to design comfortable and customisable environments for the different CdC’s users. Sensory environments aim at favouring mental health, rehabilitation and comfort in healthcare facilities, reducing stress during the waiting time and before or during the medical intervention as a positive distraction. Scientific literature is still not expanded in this field. The contribution aims at studying the application of Sensory Design in an innovative context such as the CdC environment to support healthy and active ageing. This design approach favours the stimulation of primary senses and self-regulated emotions to generate positive feelings, reduce stress, promote relaxation, physical activity and recovery. According to a Theoretical Framework, best practices have been analysed to identify spatial and environmental sensory characters to be applied in designing CdC’s welcome and waiting spaces. The authors have identified four main categories of sensory features for CdC: i) innovative Spatial Models: designing the building according to a multisensory approach to stimulate and welcome people in an inclusive way; diffusing sensory equipment in public spaces (e.g., corridors, waiting spaces, etc.); designing sensory atrium or waiting spaces; providing snoezelen rooms as dedicated and specific rooms for sensory recovery; making environments adaptable trough portable sensory equipment; ii) Relaxing features to promote comfort and psychological support; iii) Physical activity promotion, according to the idea of healthy and active ageing; iv) the integration of sensory solutions by the use of digital technology.

This article adds to the conversation on sensory design in architecture and interior design, with a focus on acoustics in living and care environments for seniors and persons with memory decline. The demographic growth of aging populations and increases in dementia and memory disorders poses challenges for supply and design of appropriate care and living environments. We discuss the importance of understanding the role of senses, hearing in particular, in design and ultimately resident experience, functionality and quality of life. We argue that sensory design, especially aural environments, is not adequately taken care of in the design of many communal and care homes. We discuss the effects of aging and memory decline on hearing and its resultant challenges in cognitive behaviour and level of social inclusion and outline specific acoustical needs for this demographic. Through a case study of a seniorst’ residence in Helsinki Finland, acoustical measurements of noise levels (reverberation times) were conducted, and the results analysed against current standards. Field results as well as a table of acoustical design considerations is presented at the end of the article.

This discussion paper explores the complex relationship between color and healthcare spaces, starting with the emerging prominence of white surfaces in early twentieth-century European hospital design. It examines the sociopolitical and sustainability implications of an apparently neutral color preference, noting case studies such as the mining of ilmenite ore in Madagascar, where the production of white pigment for titanium dioxide in paint correlates to ecological habitat degradation. The narrative also examines the global implications of mass-produced design practices and the hegemony of whiteness as something replacing colorful local color traditions with neutral hues. By exploring the interior design, materiality, and sensory qualities of white healthcare spaces, the paper discusses the association with hygiene and global influence on healthcare environments. The paper also examines the role of architectural education in shaping designers’ preferences for white and neutral color palettes in general and in healthcare settings, questioning the artificiality inherent in the prevailing white aesthetic. It also questions the latent remnants of racism in the preferential use of white, rooted in its historical association with 1930s modernism and rejection of “primitivism” in design. It further explores the role of color used as bright primary hues juxtaposed with white, in functions such as in wayfinding and a sense of “scientific” precision to how designers use color within these architectural contexts from applying principles from environmental and psychological science. In conclusion, this narrative unravels the historical, environmental, and sociocultural dimensions that led to white as a neutral color in design perceived as objective fact. It advocates for a more nuanced approach in healthcare environments and for design choices that prioritize diverse needs, experiences, and cultural sensitivities. The paper will encourage readers to critically assess the hegemony of white in healthcare design compared to the vibrancy of color in indigenous design traditions worldwide.

This research provides insights into childbirth as a sensitive experience, from the perspective of its user, “woman in labour,” as well as from the perspective of the event itself, “the childbirth,” and the birth space, with its spatial and ambiantal configurations. By adopting an in-situ approach, we conducted a spatial and ambiantal characterization of two childbirth different contexts; Tunis and Grenoble. Along this work, we used various methods such as ethnographic observation and semistructured interviews with mothers and midwives, when following visits to the birth spaces in Grenoble. Our experimental protocol was refined by introducing the capture of emotions, notably through the analysis of electrodermal activity variation, for the case of the Maternity and Neonatology Center in Tunis. In correlation with observations and interviews, the analysis of electrodermal activity reveals the mother’s emotional state. Subsequently, we undertook a transposition and synthesis of significant ambiantal situations encountered in the birth space in Grenoble and Tunis, during labour phase of childbirth. Six ambiantal situations-types are identified and distributed across two dimensions: luminous and kinesthetic. The results of this research are extremely useful to guide the choices in design of birth space while at the same time considering the well-being of woman in labour. We will end with an ambiantal project that proposes interventions on spatial quality by introducing an ambiantal dimension to the birth space.

The integration of art into healthcare facility design has been widely recognised as a best practice for enhancing patient experiences and improving health outcomes. Evidence-based design aims to identify the most effective art types and themes for various healthcare scenarios. However, the current body of research on healthcare art is still evolving, with limited data available for populations with special needs. This study explores potential opportunities for enhancing built environment art accessibility for people with blindness or low vision (PBLV) in healthcare facilities. The research methodology consists of two steps: 1) A literature review that establishes a foundation for understanding healthcare art and accessible art adaptations for PBLV in the context of galleries and museums; 2) Case studies of three art programmes in London healthcare trusts, which included interview-surveys with senior professionals working on art implementation in healthcare spaces. The interviews and case studies were conducted through the lens of knowledge on accessible art for museums and galleries. The results of the literature review provided valuable insights into the concept of healthcare art and the variety of accessible art forms for PBLV in museums and galleries. This laid the groundwork for exploring which of these solutions can be applied in healthcare facility contexts. The interviews and case studies revealed several practical approaches that can assist healthcare providers and guide policymakers in creating more accessible healthcare art programmes. In conclusion, this article identifies potential opportunities for improving the accessibility of built environment arts for PBLV in healthcare settings, contributing to the ongoing effort to create more inclusive and engaging healthcare environments.

In Europe, most countries are facing common healthcare challenges that lead to a need for innovation, effectiveness and efficiency in the healthcare systems. This is often addressed through actions and intentions including enhanced primary and integrated care. However, these developments seem to be progressing slowly and non-uniformly, nor is there knowledge exchange, and the full implications of these changes on healthcare design are still unfolding. The research presented investigates what are the current trends in healthcare systems and the effects on design transformations, focusing on the Swedish experience. In Sweden, a reform known as “Nära Vård” [Close Care], aims to “reconstruct” the core of the healthcare service around primary care. It strives to bring care “closer” to people and communities concerning access to both care and the facilities where it is delivered. The objective of this paper is to understand what can be learnt from the Swedish experience; the research presented aims at investigating the effects of the Close Care reform on primary care facilities design. The study was conducted from April to July 2023, and it consisted of: i) desk research and literature review; ii) data collection through 12 interviews with experts; iii) data analysis through qualitative content analysis; iv) study visits to local care facilities. From the interviews, 10 factors for change and 9 challenges emerged. Moreover, it appears that the organisational structure of the Swedish healthcare system caters for regional and individual projects’ interpretations of how to bring care “closer” to the patients; this variation allows for a broader understanding of the advantages and drawbacks of each organisational model and design, and it reinforces the idea that there is no “one-size-fits-all” for close care. This diversity points to a need for a project evaluation program of the ongoing experiences, aimed at assessing the performance and effectiveness of each approach.

Introduction: The reform of the health and social services in Finland includes the modernization of both work processes and facilities. This means a transition to patient reception rooms and office facilities that are in shared use. However, research on the associations of shared workspaces with well-being is rare. The aim of this study is to investigate how healthcare professionals rate the functionality of the shared workspaces and how it is associated with work engagement and perceived stress. Methodology: Questionnaires were administered in five healthcare organizations (N=329). Pearson’s correlation coefficients and linear regression were used to test which functionality factors of shared workspaces were associated with work engagement and perceived stress. Unadjusted models, as well as models adjusted for age, gender, managerial position, and use of spaces, are reported. Results: The perception of the safety of the facilities was the strongest predictor of work engagement and perceived stress in shared patient reception rooms. Furthermore, the perceptions on how well the facilities supported interaction and collaboration between teams/units predicted work engagement and perceived stress in both reception rooms and activity-based workspaces (ABW). Positive ratings of how well the facilities supported interaction and collaboration were associated with higher work engagement and lower stress. The perceived availability of spaces for quiet work predicted higher work engagement but not perceived stress. However, when adjusted for the use of spaces (assigned or non-assigned seating), non-assigned seating emerged as a stronger predictor of work engagement than perceived availability for quiet spaces. Given that disturbance of speech was common in ABWs, organizations and designers should focus on creating ABWs that enable undisturbed interaction and collaboration.

The door between the semi-public corridor and the single-occupancy patient room of a newly built University Medical Centre in the Netherlands has been heavily debated during its Evidence Based Design (EBD) and experience-informed design. It was also heavily debated since the wards came into use in 2018. It is well known that, regarding door design, a trade-off has to be made between aspects such as privacy, visibility, and safety. This makes our case study exemplary for the trade-offs to be made in EBD practice. This study traces back to how the design decisions for the door, dating from 2011, were made. Safety, privacy, control, and support for the social and emotional wellbeing of patients, relatives, and staff were the aim, but this is not experienced as such by all concerned. This case study evaluation highlights the tension between EBD principles and everyday practice, where the interplay between ‘bricks, bytes, and behavior’ has to be considered, and every consciously debated design solution might bring new and unforeseen challenges elsewhere. Our practice-based research combines the analysis of documentation on the design decision-making process with evaluation interviews with nurse managers in 2019. Our findings on ‘the (Dutch) patient door debate’ can contribute to awareness of trade-offs to be made in health facility design, complemented with supportive IT systems and efficient and effective staff workflows. It can enhance the understanding of the many aspects that need to come into consideration during design dialogues with experts and end-users.

The symbiotic relationship between healthy hospital design and infection prevention and control (IPC) is crucial to developing a safe healthcare environment. Collaborative efforts in mitigating the risk of hospital-acquired infections (HAIs) are needed and will decrease morbidity, mortality rates, and costs. HAIs not only impact patient health but also tarnish the reputation of healthcare institutions. This paper delves into the distinctions between exogenous-derived and endogenous-derived HAIs, elucidating their sources, transmission mechanisms, and preventive strategies. Exogenous-derived HAIs can be prevented by a well-designed hospital layout which minimize contamination. Endogenous-derived HAIs originate from the patient’s own microbial flora, necessitating tailored infection prevention strategies such as antimicrobial prophylaxis. Standard precautions and transmission-based precautions, as outlined by the Centers for Disease Control and Prevention (CDC), form the cornerstone of infection control efforts. Hospital design should facilitate compliance with these measures, ensuring a microbial-safe environment conducive to patient recovery. Interdisciplinary collaboration between architects, healthcare professionals, and infection control experts are needed to integrate infection control principles into hospital design processes effectively. Key considerations include optimizing patient flows, separating clean and dirty materials, and implementing robust ventilation systems to mitigate airborne transmission risks. Furthermore, selecting appropriate surface materials resistant to microbial growth and enabling effective cleaning and disinfection protocols are important to maintain a microbial safe hospital environment. Most importantly, the shift towards single-occupancy rooms represents a significant stride in infection prevention, minimizing the risk of cross-contamination compared to multi-occupancy wards. Scientific evidence supports the efficacy of single-occupancy rooms in reducing microbial contamination and preventing HAIs.