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Due to the limited studies related to healthcare services future expanding demand, required resources and utilities, and related environmental and economic challenges; this research is carried out to complement other researchers in other economic sectors to identify the gaps, highlight good potentials of sustainability achievements and recommend necessary actions. This research investigates the future expanding demand of healthcare services; the environmental and economic challenges related to this expand and its environmental and economic impacts and the opportunities to overcome these impacts in order to improve healthcare services sustainability and performance. The research follows a SLR to discover earlier works related to environmental sustainability in buildings and healthcare facilities. The environmental challenges related to expanding in healthcare facilities found in the literature are increase in energy consumption and waste generation. The environmental impacts related to these challenges are excessive CO2 and GHG emissions. The economic impacts are escalations of project expenditures, operating expenditures and utilities expenditures. The research uses SD Analysis, as a methodological approach, to framework and understands different healthcare system elements and to develop models that are representing the dynamic relations between these elements. Bahrain healthcare system is selected as a research context due to the availability of good quality healthcare secondary data, the small size of the country that makes it a good model to implement and test new concepts, the limited country resources, and the country keenness to implement sustainability plans to meet sustainability objectives. This research numerically tests and subsequently, supports the implication of stated environmental and economic challenges. It also develops a number of important technical parameters and indicators such as energy and water benchmarks for different healthcare facilities. The research also determines another two sources of environmental challenges related to expanding in healthcare facilities. The first challenge is excessive water consumption. Availability of enough treated water for healthcare applications, especially in countries with limited fresh water resources and depending on 90% of its water need on desalination like Bahrain, a tangible environmental challenge needs to be addressed. The second one is a group of environmental challenges related to the practicing of healthcare services that can expose personnel and environment to high risks. These challenges need to be efficiently managed to improve the environmental sustainability and the social sustainability of healthcare facilities. The research also investigates the effectiveness of a number of mitigation measures used to overcome the environmental and economic negative impacts, such as using energy efficiency technologies, renewable-based energy resources and waste energy recovery. In this regard, the research numerically tests and subsequently supports the implication of stated environmental and economic impacts and the effectiveness of tested measures in mitigating the undesirable results on healthcare facilities. The developed SD Model, as one of the main contributions of this research, is considered as a strategic planning and decision-making administrative tools to forecast future healthcare facilities demand and required resources. It is also considered as a risk assessment tool to assess environmental challenges related to utilities and its environmental and economic impacts in order to improve healthcare facilities sustainability and performance. The potential of utilities saving and utilities expenditures saving in healthcare buildings are high and it is recommended to work toward energy efficiency and renewable energy deployment to achieve sustainable healthcare buildings. Recovery of energy from Medical Waste incineration to be kept under consideration as it is offsetting double the quantity of CO2e emissions resulting from the incineration process. Safe recycling of wastewater of some healthcare processes is highly recommended as it can reduce water consumption and contributes to the reduction of healthcare facilities CO2e emissions. Sources of gray water and gray water applications must be carefully selected to avoid any contradiction with Infection Control regulations or other healthcare regulations. It is recommended to conduct utilities assessment studies on wide sample of healthcare facilities to avoid low peaks and odd operation periods.

Escherichia coli are usually regarded as a harmless human colonic flora. However, pathogenic strains of E. coli have been associated with infections that could range from infected mucosal surfaces by intestinal pathogenic E. coli to the more severe cases of disseminated infections throughout the body by the extraintestinal pathogroups. The main focus of this project was to investigate the genomic contents of pathogenic bloodstream infection (BSI)-associated E. coli strains. This is because the genome contents of the E. coli BSI-associated isolates have not been well studied, with only few reports indicating that the pathogenincity of these strains could be attributed to horizontally acquired DNAs known as genomic islands (GEIs). The genomic contents of 10 clinical BSI-associated E. coli strains, isolated at the Leicester Royal Infirmary were investigated in this study. The first approach used to investigate the genomic contents of these strains was by interrogating the downstream ends of tRNA genes for their GEI contents by the sequential PCR strategy tRIP-PCR (tRNA interrogation for pathogenicity islands) followed by the SGSP-PCR (single genome specific primer-PCR). In this approach the flanking regions of the tRNA sites were used to first screen the tRNA genes for their GEIs followed by amplifying the boundaries of the identified GEIs. In the second approach termed Microarray-Assisted mobilome Prospecting (MAmP), the physical genome size of the tested strains obtained by the pulsed-field gel electrophoresis (PFGE) is compared to the sum total of the bits of the genome detected or visualized by the array. The difference between the two measurements is used to estimate the size of the novel, non-microarray-represented mobile genome (mobilome) present in the tested strains. Remarkably, despite only studying 10 E. coli strains, associated with a single disease type the tRIP-PCR method has identified at least 3 GEIs that contain novel sequences, and 46 GEIs, resembling uropathogenic E. coli CFT073-like entities. One particular strain E105 had 13 tRNA sites occupied with GEIs. On the other hand, an average novel, non-microarray-borne mobilome of (219 kb /strain) was obtained by the MAmP which, corresponds with previous studies. The strategies used in this study had proved successful in addressing and identifying mobilome-rich strains. Therefore, using such approaches in combination with whole genome sequencing progects could prioritize the strains and the genomic regions that need to be sequenced. Such prioritization would avoid sequencing of hundreds of isolates to identify their novel gene pool and would reduce the cost of genomic sequencing. Moreover, applying such approaches for the identification of new virulence genes and/or pathogenic mechanisms could lead to significant improvements in the treatment of E. coli infections.