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Can J Infect Dis Med Microbiol. 2014 Sep;25(5):265-70.

Hospital ward design and prevention of hospital-acquired infections: A prospective clinical trial.

Author information

1
Alberta Health Services, Calgary and Area, Calgary, Alberta.
2
Department of Community Health Sciences, University of Calgary, Calgary, Alberta ; Institute for Public Health, University of Calgary, Calgary, Alberta.
3
Alberta Health Services, Calgary and Area, Calgary, Alberta ; Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta.
4
Alberta Health Services, Calgary and Area, Calgary, Alberta ; Department of Community Health Sciences, University of Calgary, Calgary, Alberta.
5
Department of Sociology, Faculty of Arts, University of Calgary, Calgary, Alberta.
6
Alberta Health Services, Calgary and Area, Calgary, Alberta ; Department of Community Health Sciences, University of Calgary, Calgary, Alberta ; Institute for Public Health, University of Calgary, Calgary, Alberta ; Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta.
7
Alberta Health Services, Calgary and Area, Calgary, Alberta ; Institute for Public Health, University of Calgary, Calgary, Alberta ; Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta ; Calvin, Phoebe and Joan Synder Institute for Chronic Diseases, Faculty of Medicine, University of Calgary and Alberta Health Services, Calgary and Area, Calgary, Alberta.

Abstract

in English, French

BACKGROUND:

Renovation of a general medical ward provided an opportunity to study health care facility design as a factor for preventing hospital-acquired infections.

OBJECTIVE:

To determine whether a hospital ward designed with predominantly single rooms was associated with lower event rates of hospital-acquired infection and colonization.

METHODS:

A prospective controlled trial with patient allocation incorporating randomness was designed with outcomes on multiple 'historic design' wards (mainly four-bed rooms with shared bathrooms) compared with outcomes on a newly renovated 'new design' ward (predominantly single rooms with private bathrooms).

RESULTS:

Using Poisson regression analysis and adjusting for time at risk, there were no differences (P=0.18) in the primary outcome (2.96 versus 1.85 events/1000 patient-days, respectively). After adjustment for age, sex, Charlson score, admitted from care facility, previous hospitalization within six months, isolation requirement and the duration on antibiotics, the incidence rate ratio was 1.44 (95% CI 0.71 to 2.94) for the new design versus the historic design wards. A restricted analysis on the numbers of events occurring in single-bed versus multibed wings within the new design ward revealed an event incidence density of 1.89 versus 3.47 events/1000 patient-days, respectively (P=0.18), and an incidence rate ratio of 0.54 (95% CI 0.15 to 1.30).

CONCLUSIONS:

No difference in the incidence density of hospital-acquired infections or colonizations was observed for medical patients admitted to a new design ward versus historic design wards. A restricted analysis of events occurring in single-bed versus multibed wings suggests that ward design warrants further study.

KEYWORDS:

Antibiotic-resistant organism; Controlled trial; Hospital-acquired infection; Incidence density; Multibed room; Physical plant; Single room; Ward design

PMID:
25371689
PMCID:
PMC4211350

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