Environmental Design Strategies to Decrease the Risk of Nosocomial Infection in Medical Buildings Using a Hybrid MCDM Model.

The prevention and control of nosocomial infection (NI) are becoming increasingly difficult, and its mechanism is becoming increasingly complex. A globally aging population means that an increasing proportion of patients have a susceptible constitution, and the frequent occurrence of severe infectious diseases has also led to an increase in the cost of prevention and control of NI. Medical buildings' spatial environment design for the prevention of NI has been a hot subject of considerable research, but few previous studies have summarized the design criteria for a medical building environment to control the risk of NI. Thus, there is no suitable evaluation framework to determine whether the spatial environment of a medical building is capable of inhibiting the spread of NI. In the context of the global spread of COVID-19, it is necessary to evaluate the performance of the existing medical building environment in terms of inhibiting the spread of NI and to verify current environmental improvement strategies for the efficient and rational use of resources. This study determines the key design elements for the spatial environment of medical buildings, constructs an evaluation framework using exploratory factor analysis, verifies the complex dominant influence relationship, and prioritizes criteria in the evaluation framework using the decision-making trial and evaluation laboratory- (DEMATEL-) based analytical network process (ANP) (DANP). Using representative real cases, this study uses the technique for order preference by similarity to ideal solution (TOPSIS) to evaluate and analyze the performance with the aspiration level of reducing the NI risk. A continuous and systematic transformation design strategy for these real cases is proposed. The main contributions of this study include the following: (1) it creates a systematic framework that allows hospital decision-makers to evaluate the spatial environment of medical buildings; (2) it provides a reference for making design decisions to improve the current situation using the results of a performance evaluation; (3) it draws an influential network relation map (INRM) and the training of influence weights (IWs) for criteria. The sources of practical problems can be identified by the proposed evaluation framework, and the corresponding strategy can be proposed to avoid the waste of resources for the prevention of epidemics.