Do isolation rooms reduce the rate of nosocomial infections in the pediatric intensive care unit?

Ben‐Abraham, Ron; Keller, Natan; Szold, Oded; Vardi, Amir; Weinberg, Marius; Barzilay, Zohar; Paret, Gideon

doi:10.1053/jcrc.2002.35809

Cited by 50 publications

(36 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A 20% reduction in costs associated with infection was reported by Sadler et al 85 In a casecontrol study of 78 patients in open space and 115 in single rooms in Israel meeting almost all National Institute for Health and Care Excellence (NICE) methodology criteria, the mean number of infections per child was 1.87 in isolation rooms compared with 3.62 in multiple bedrooms. 56 In a study based on expert opinions, meeting some of the NICE criteria, Harrison 83 found an 11% decrease in hospital-acquired infection when a US hospital moved to a new single room building. A reduction in hospital-acquired infection, from 17.7% to 5.9%, was also registered in a small neonatal ICU moving from an open design to single rooms, 56 although this study could not be assessed for quality.…”

Section: Infection Controlmentioning

confidence: 99%

“…56 In a study based on expert opinions, meeting some of the NICE criteria, Harrison 83 found an 11% decrease in hospital-acquired infection when a US hospital moved to a new single room building. A reduction in hospital-acquired infection, from 17.7% to 5.9%, was also registered in a small neonatal ICU moving from an open design to single rooms, 56 although this study could not be assessed for quality. Similar results were found in a large retrospective cohort study of 2519 burns patients, which reported that the incidence of gram-negative bacteraemia was 31.2% in open wards and 12% in single rooms.…”

Section: Infection Controlmentioning

confidence: 99%

“…In a non-empirical study, Gallant and Lanning 156 claim that patients remaining in one single acuity-adaptable room throughout their stay tended to recover faster, with patient stay in a hospital in California reduced from 9.5 to 5.4 days in five diagnostic diagnosis-related groups. Ben-Abraham et al 56 found the LOS to be lower for patients in isolation rooms in a paediatric ICU: an average of 11 days for patients in single rooms compared with 25 days for those in six-bed units. 56 Thompson et al, 153 in a good-quality retrospective study, found the LOS of burns patients was similar for the periods before, during and after the renovation of the burns isolation units to single room accommodation.…”

Section: Length Of Staymentioning

confidence: 99%

“…Ben-Abraham et al 56 found the LOS to be lower for patients in isolation rooms in a paediatric ICU: an average of 11 days for patients in single rooms compared with 25 days for those in six-bed units. 56 Thompson et al, 153 in a good-quality retrospective study, found the LOS of burns patients was similar for the periods before, during and after the renovation of the burns isolation units to single room accommodation. A retrospective study meeting almost all quality criteria found heart transplant patients had longer stays if treated in a single room (9.5 days) than in ward-based accommodation (6.1 days).…”

Section: Length Of Staymentioning

confidence: 99%

“…A subsequent review by Whitehead et al 54 identified two additional studies between 2001 and 2006. The two studies, in neonatal 55 and paediatric intensive care settings, 56 showed a reduction of the mean number of infections in isolation or single rooms in comparison with multibedded bays (further detail of these studies is in Appendix 1); reduced HCAI rates may also be related to shorter LOS associated with single rooms. More recent studies all conducted in ICUs [57][58][59][60] have shown a reduction in several types of infections including MRSA and C. diff.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Maben

Griffiths

Penfold

et al. 2015

Health Services and Delivery Research

177

View full text Add to dashboard Cite

BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract