Infection Acquisition Following Intensive Care Unit Room Privatization

Teltsch, Dana; Hanley, James A.; Loo, Vivian G.; Goldberg, Peter; Gursahaney, Ash; Buckeridge, David L.

doi:10.1001/archinternmed.2010.469

Cited by 107 publications

(93 citation statements)

References 23 publications

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“…[15][16][17][18][19] Most studies were performed in university hospitals, and some studies were limited to particular wards or rooms. In two studies, the interventions were undertaken in more than one hospital.…”

Section: Resultsmentioning

confidence: 99%

“…In two studies, the interventions were undertaken in more than one hospital. 17,20 Two other studies presented national or provincial data. 19,21 Study settings are detailed in Table I.…”

Section: Resultsmentioning

confidence: 99%

“…13 In another study, the opening of a new intensive care unit that only had single rooms presented a valuable opportunity to reduce CDI acquisition rates. 17 <B>Definition of CDI and HCA-CDI Some studies defined CDI as a positive result of the following tests: immuno-enzymatic assays for toxins A and B 18,20,[25][26][27]29,30,33 or toxin A alone; 16 a cytotoxicity assay; 13,15,23 a toxigenic culture; 13,17,23 or an amplification test for toxins gene. 18,31 Confirmation of diagnosis by endoscopy and/or by histology was reported twice.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Hospital management of Clostridium difficile infection: a review of the literature

Khanafer¹,

Voirin²,

Barbut³

et al. 2015

Journal of Hospital Infection

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Section: Resultsmentioning

confidence: 99%

“…In two studies, the interventions were undertaken in more than one hospital. 17,20 Two other studies presented national or provincial data. 19,21 Study settings are detailed in Table I.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Hospital management of Clostridium difficile infection: a review of the literature

Khanafer¹,

Voirin²,

Barbut³

et al. 2015

Journal of Hospital Infection

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“…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. Meta-analysis of infection rate from studies of single rooms is problematic because of different study designs, patient groups, types of infection or organism under consideration, and geographical setting.…”

Section: Introductionmentioning

confidence: 99%

“…The two studies, in neonatal and paediatric intensive care settings, showed a reduction of the mean number of infections in isolation or single rooms in comparison with multibedded bays. 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. In summary, an association of single room accommodation and decreased infection rates was repeatedly shown in intensive care settings including paediatric populations; however, for all other patient populations evidence of an association of single room accommodation and nosocomial infections is absent or equivocal.…”

Section: Introductionmentioning

confidence: 99%

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

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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.

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Time-Series Analysis of Health Care–Associated Infections in a New Hospital With All Private Rooms

et al. 2019

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associated infections are often caused by multidrug-resistant organisms and substantially factor into hospital costs and avoidable iatrogenic harm. Although it is recommended that new facilities be built with single-room, low-acuity beds, this process is costly and evidence of reductions in health care-associated infections is weak. OBJECTIVE To examine whether single-patient rooms are associated with decreased rates of common multidrug-resistant organism transmissions and health care-associated infections. DESIGN, SETTING, AND PARTICIPANTS A time-series analysis comparing institution-level rates of new multidrug-resistant organism colonization and health care-associated infections before (

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Infection Acquisition Following Intensive Care Unit Room Privatization

Abstract: Conversion to single rooms can substantially reduce the rate at which patients acquire infectious organisms while in the ICU.

Cited by 107 publications

References 23 publications

Hospital management of Clostridium difficile infection: a review of the literature

Hospital management of Clostridium difficile infection: a review of the literature

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

Time-Series Analysis of Health Care–Associated Infections in a New Hospital With All Private Rooms

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