Converting Hospital Floor plans into Converting Hospital Floor plans into Converting Hospital Floor plans into Converting Hospital Floor plans into

Maps for Spatial Analysis in GISMaps for Spatial Analysis in GISMaps for Spatial Analysis in GISMaps for Spatial Analysis in GISMaps for Spatial Analysis in GISMaps for Spatial Analysis in GISMaps for Spatial Analysis in GISMaps for Spatial Analysis in GIS

Grahame S. Davis, MScCentre for Infection Prevention and Management (CIPM)Imperial College London

About CIPM

• Tackling the issue of healthcare acquired infection (HCAI) via amultidisciplinary approach that includes:� organisational research� social marketing� epidemiology� epidemiology� laboratory-based programmes� education

• 4 work streams:� Innovation Adoption & Behaviour Change� Network in Clinical Infection & Diagnostics� Infection Surveillance� Capacity Building

Outline of Presentation

1) Healthcare Acquired Infections (HCAIs) in UK

2) 3D Analysis Theory using GIS2) 3D Analysis Theory using GIS

3) Development of hospital floorplans

4) Future Work

1) HCAIs in UK

• Serious problem in most countries with surveillance worldwide

• Estimated in the UK, that 8.2% of patients will become infected whilstin hospital (1,2)

• Costs estimated at around £1billion per year (3)

• In NHS, this equates to:� increased waiting time� decrease in availability of beds� reduced overall resources (4)

(1) Stone, PW. Am J Infect Control 2005 (3) Kearney G. J Environ Health 2008

(2) Kho, A. Am J Infect Control 2006 (4) Kistemann, T. Int J Hygiene Environ Health 2000

1) HCAIs in UK

• HCAIs cause severe complication in patients & lead to otherwisepreventable mortality

• Utilisation of spatial analysis within a hospital setting could providebetter understanding of the factors related to HCAI infectiontransmission.transmission.

• This could improve control of HCAIs through:� faster identification of possible outbreaks� reducing the likelihood of transmission

• Yet mapping indoors has a number of challenges.

2) 3D Analysis Theory using GIS

• Small area-analysis of micro-spatial environments has expanded

• Recent applications include:

� Urban planning

� Analysing layouts of buildings & how they are used (5)

� Improving response to emergencies within buildings (6)

(5) Lee, J. Geographic Information Science 2004 (6) Kwan, MYW. Hong Kong Journal of Paediatrics 2009

2) 3D Analysis Theory using GIS

In Health::

• Mapping distribution of SARS within a vertical indoor environment

• Micol et al. created a prototype of a Hospital GIS dedicated to the• Micol et al. created a prototype of a Hospital GIS dedicated to theinvestigation of HCAIs (7)

• Kruger et al. propose the use of GIS as an early warning system for theemergence of drug-resistant strains (8)

• Kho et al. created medical dashboard linked into hospital databases (9)

(7) Micol, R. Proceedings AMIA Symposium 2002 (8) Kruger, H. Abs of the ICAAC 2002

(9) Kho, A. Am J Infect Control 2006

3) Development of Hospital Floorplans

The Study Area

• Imperial College Healthcare NHS Trust in London.

• One of the largest NHS Trusts in UK• One of the largest NHS Trusts in UK

• 3 major hospitals:� Charing Cross Hospital� Hammersmith Hospital� St. Mary’s Hospital

• 2 specialised hospitals:� Queen Charlotte’s & Chelsea� Western Eye Hospital

3) Development of Hospital Floorplans

Steps in Design

• Development of Floor plans

• Introducing The 3rd Dimension

• Transfer into ArcGIS

3) Development of Hospital Floorplans

Floorplans

• Architectural floor plans for our 3 main hospitals

• Stored in CAD (Computer-aided Design) format.• Stored in CAD (Computer-aided Design) format.

Ward Surveys

• Visual surveys carried out of clinical areas to ensure accuracy of thefloorplans, encompassing around 100 wards.

• The main discrepancies observed were designation of side room use,sink sites and removal of minor interior walls.

3) Development of Hospital Floorplans

Adaptions in AutoCAD

• Used for structural information by the Estates department

• Range of symbols and notations had to be removed prior to conversionfor use in ArcGIS.

• The layers removed include:� architectural data (i.e. room codes)� notations of room areas (i.e. ceiling heights)

3) Development of Hospital Floorplans

3D representations of floorplans

• Floor plans need to be combined into a 3D structure• Floor plans need to be combined into a 3D structure

• Values for heights of the walls & ceilings defined within the CADfloorplans

• Used to create 3D representations of the individual floors by extrudingthe surfaces to the required vertical height

AutoCAD

3) Development of Hospital Floorplans

Transfer to ArcGIS

• AutoCAD files can be directly imported into ArcGIS• AutoCAD files can be directly imported into ArcGIS

• To use the files for mapping, the layers had to be separated

• Achieved by extracting each layer individually & exporting it as aseparate shape file

4) Future Work

Creation of 3D Buildings

• Floor plans will be combined to create a 3D representation of thehospital buildings.

• Requires a 3D coordinate that incorporates a z coordinate related tothe elevation i.e. (x, y, z) or (1m, 3m, 5.7m).

• Ceiling heights which were used for individual floors lack informationon the inter-floor distances

• These 3D building maps will then be transferred into ArcGIS..

4) Future Work

Considerations of Indoor Mapping

• Development of an accurate 3D geo ref system for the interior ofbuildings

• Method to measure distance across floors within the building

• Indoor environment involving physical structures:� Relative path distance

• Modelling connectivity relationships of internal structures:� horizontal directions (on a floor) defined by corridors� vertical direction (among floors) defined by stairways & elevators.

4) Future Work

Testing With Trial Data

• Use of generated & real datasets to test model

• Necessary to identify issues or highlight required revisions• Necessary to identify issues or highlight required revisions

• Maps to be updated dependant on alterations to the hospital environment

Display of Data

• Must define how data will be displayed to ensure standardisation of results

4) Future Work

Analysis of HCAI Distribution

• Utilisation of these maps as a research tool identifying:� Potential clusters� Areas of interest for further investigation. � Areas of interest for further investigation.

• Utilise ArcGIS extensions to visualise & analyse the distribution of cases

• Evaluation of clusters will take two steps:� Statistical analysis to determine if ‘true’ cluster� Epidemiological investigations to determine significance of localised risk

factors.

Conclusion

• Production of significant information by GIS relies on the accuracy & level of detail of the data available

• Requires up-to-date maps of the wards & accurate locational data for the • Requires up-to-date maps of the wards & accurate locational data for the cases or factors of interest

• Dynamic hospital environment where patient movement, bed relocation and ward closures must all be addressed

• There are many other issues that may arise during the development of these maps

Conclusion

• The application of GIS in hospital based healthcare is an area of growing interest.

• The utilisation of spatial analysis within a hospital setting could provide better • The utilisation of spatial analysis within a hospital setting could provide better understanding of the factors related to HCAI infection transmission and help improve control

Acknowledgements

• I would like to thank my supervisors Dr. Lydia Drumright and Dr. Nick Sevdalis for their help and support.

• I would also like to thank the numerous people within the Infection • I would also like to thank the numerous people within the Infection Prevention & Control teams and the Estates department for their on-going help with my project.

Want to know more?

Grahame S. Davis

Centre for Infection Prevention and Management (CIPM)Division of Infectious Diseases and ImmunityDepartment of Medicine8th Floor Commonwealth Building8th Floor Commonwealth BuildingImperial College LondonDu Cane RoadLondon W12 0NN

Email: g.davis10@imperial.ac.uk