Impact of Open Versus Closed Intensive Care Unit (ICU) System on Hospital Acquired Infection

Sharayah, Ahmad; Osman, Ramy; Shaikh, Nasreen; Hajjaj, N.; Weiner, Shayna; Eng, Margaret

doi:10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6472

Cited by 2 publications

(6 citation statements)

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“…This assumption was further supported by the significantly lower VAP, another frequent ICU-acquired infection, in the closed unit model group than in the mandatory critical care consultation model group. Other studies have also shown a reduced VAP rate after conversion to a closed unit model [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 94%

Impact of staffing model conversion from a mandatory critical care consultation model to a closed unit model in the medical intensive care unit

Cho

Choi

et al. 2021

PLoS ONE

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Background The intensive care unit (ICU) staffing model affects clinical outcomes of critically ill patients. However, the benefits of a closed unit model have not been extensively compared to those of a mandatory critical care consultation model. Methods This retrospective before-after study included patients admitted to the medical ICU. Anthropometric data, admission reason, Acute Physiology and Chronic Health Evaluation II score, Eastern Cooperative Oncology Group grade, survival status, length of stay (LOS) in the ICU, duration of mechanical ventilator care, and occurrence of ventilator-associated pneumonia (VAP) were recorded. The staffing model of the medical ICU was changed from a mandatory critical care consultation model to a closed unit model in September 2017, and indices before and after the conversion were compared. Results A total of 1,526 patients were included in the analysis. The mean age was 64.5 years, and 954 (62.5%) patients were men. The mean LOS in the ICU among survivors was shorter in the closed unit model than in the mandatory critical care consultation model by multiple regression analysis (5.5 vs. 6.7 days; p = 0.005). Central venous catheter insertion (38.5% vs. 51.9%; p < 0.001) and VAP (3.5% vs. 8.6%; p < 0.001) were less frequent in the closed unit model group than in the mandatory critical care consultation model group. After adjusting for confounders, the closed unit model group had decreased ICU mortality (adjusted odds ratio 0.65; p < 0.001) and shortened LOS in the ICU compared to the mandatory critical care consultation model group. Conclusion The closed unit model was superior to the mandatory critical care consultation model in terms of ICU mortality and LOS among ICU survivors.

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Section: Discussionmentioning

confidence: 94%

Impact of staffing model conversion from a mandatory critical care consultation model to a closed unit model in the medical intensive care unit

Cho

Choi

et al. 2021

PLoS ONE

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“…1 The presence of an intensivist contributes to a reduced LOS due to better resource use, shorter duration of mechanical ventilation, and decreased hospitalacquired infections. 1,5 Of these hospital acquired infections, central lineassociated blood infections, catheterassociated urinary tract infections, and ventilatorassociated pneumonia were all reduced in a closed ICU with prompt intensivist intervention. 1,5 A study by Miller et al, which systematically evalu ated a cohort of patients sharing similar demographic characteristics in a unified hospital system across the same time span, sought to determine the differ ential impact of a closed vs. an open ICU model on clinical outcomes.…”

Section: Results Reduced Mortality and Improved Patient Outcomes In A...mentioning

confidence: 99%

“…1,5 Of these hospital acquired infections, central lineassociated blood infections, catheterassociated urinary tract infections, and ventilatorassociated pneumonia were all reduced in a closed ICU with prompt intensivist intervention. 1,5 A study by Miller et al, which systematically evalu ated a cohort of patients sharing similar demographic characteristics in a unified hospital system across the same time span, sought to determine the differ ential impact of a closed vs. an open ICU model on clinical outcomes. The preliminary analysis revealed an unadjusted inhospital mortality rate of 9.6% and 8.9% in the open and closed units, respectively (p = 0.42).…”

Section: Results Reduced Mortality and Improved Patient Outcomes In A...mentioning

confidence: 99%

“…2 Furthermore, Sharayah et al reported that in a hospital open system that recently transitioned to the closed ICU system, a significant reduction in hospital-acquired infection rates occurred. 5 For example, there was a 19.3% reduction in central lineassociated bloodstream infections and a 100% reduction in catheterassociated urinary tract infections and ventilatorassociated pneumonia. 5 In patients admitted with sepsis, the closed ICU model leads to significant improvements in survival rates at discharge, overall survival rates, and decreased LOS compared to the open model.…”

Section: Lower Rates Of Healthcare-associated Infections In Closed Icusmentioning

confidence: 99%

“…Many studies have reported that closed ICU models have reduced mortality rates, 2,3 improved resource management, 4 reduced hospital acquired infections, and decreased hospital length of stay (LOS). 5,6 In contrast, some studies indicate that open ICUs are more feasible and reliable in resource limited countries and result in fewer psychological complications, less emotional stress, and more perti nent social standards. 7 Nevertheless, statistically significant differences in some clinical outcomes and parameters between open or closed ICUs vary widely in different studies.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The benefits of a closed ICU: a systematic review

Belkin,

Fernandez-Nava,

Sheikh

et al. 2024

The Chronicles

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This study compared closed and open intensive care unit (ICU) models in terms of patient outcomes. Closed ICUs had reduced mortality rates, shorter lengths of stay, and lower healthcare-associated infection rates. Intensivists in closed ICUs contributed to better outcomes due to their expertise and competence. Enhanced interdisciplinary collaboration, improved communication, and coordination in closed ICUs led to higher patient and family satisfaction. In addition, closed ICUs were more cost-effective, with better resource use and reduced healthcare costs. Overall, closed ICU models have advantages in patient outcomes, better resource use, cost-effectiveness, and patient satisfaction compared to open ICU models. Key words: Intensive care unit, ICU, patient outcomes, resource utilization, quality of care.

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Impact of Open Versus Closed Intensive Care Unit (ICU) System on Hospital Acquired Infection

Cited by 2 publications

References 0 publications

Impact of staffing model conversion from a mandatory critical care consultation model to a closed unit model in the medical intensive care unit

Impact of staffing model conversion from a mandatory critical care consultation model to a closed unit model in the medical intensive care unit

The benefits of a closed ICU: a systematic review

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