Infection acquisition following intensive care unit room privatization

Arch Intern Med. 2011 Jan 10;171(1):32-8. doi: 10.1001/archinternmed.2010.469.

Abstract

Background: Patients in intensive care units (ICUs) often acquire infections, which impose a heavy human and financial burden. The use of private rooms may reduce the acquisition of certain pathogens, but the limited evidence on this topic is inconsistent.

Methods: We compared the rates of acquisition of infectious organisms in an ICU before and after a change from multibed to single rooms. As a control, we used acquisition rates in the ICU of a nearby university teaching hospital, which contained both multibed and single rooms, during the study period. We used a statistical model to adjust for background time trends common to both hospitals.

Results: The adjusted rate of acquisition of Clostridium difficile, vancomycin-resistant Enterococcus species, and methicillin-resistant Staphylococcus aureus combined decreased by 54% (95% confidence interval [CI], 29%-70%) following the intervention. The methicillin-resistant S aureus acquisition rate fell by 47% (95% CI,1%-71%), the C difficile acquisition rate fell by 43% (95% CI, 7%-65%), and the yeast acquisition rate fell by 51% (95% CI, 34%-64%). Twelve common and likely exogenous organisms and exogenous/endogenous organisms had a reduction in acquisition rates after the intervention; for 6 of them, this reduction was statistically significant. No effect was observed on the acquisition rate of coagulase-negative Staphylococcus species, the most common endogenous organism, for which no change would be expected. The adjusted rate ratio of the average length of stay in the ICU was 10% (95% CI, 0%-19%) lower after the intervention.

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

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clostridioides difficile / isolation & purification
  • Cohort Studies
  • Critical Care / methods
  • Critical Care / organization & administration*
  • Drug Resistance, Bacterial
  • Enterococcus / drug effects
  • Enterocolitis, Pseudomembranous / epidemiology
  • Enterocolitis, Pseudomembranous / prevention & control
  • Hospital Design and Construction*
  • Hospitals, University / statistics & numerical data*
  • Humans
  • Infection Control / methods*
  • Infection Control / organization & administration
  • Infections / transmission*
  • Intensive Care Units / organization & administration
  • Intensive Care Units / statistics & numerical data*
  • Interior Design and Furnishings
  • Methicillin-Resistant Staphylococcus aureus
  • Odds Ratio
  • Patients' Rooms* / organization & administration
  • Patients' Rooms* / standards
  • Patients' Rooms* / trends
  • Quebec / epidemiology
  • Sensitivity and Specificity
  • Staphylococcal Infections / epidemiology
  • Staphylococcal Infections / prevention & control
  • Staphylococcus aureus / isolation & purification
  • Vancomycin / pharmacology

Substances

  • Vancomycin