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Infect Control Hosp Epidemiol. 2015 Oct;36(10):1173-82. doi: 10.1017/ice.2015.144. Epub 2015 Jun 25.

Impact of neonatal intensive care bed configuration on rates of late-onset bacterial sepsis and methicillin-resistant Staphylococcus aureus colonization.

Author information

1
1Department of Pediatrics,Washington University School of Medicine,St. Louis,Missouri.
2
2Departments of Pathology & Immunology and Pediatrics,Washington University School of Medicine,St. Louis,Missouri.
3
3St. Louis Children's Hospital,St. Louis,Missouri.
4
4Department of Internal Medicine,Washington University School of Medicine,St. Louis,Missouri.
5
5Department of Pediatrics,Northwestern Feinberg School of Medicine,Chicago,Illinois.

Abstract

BACKGROUND:

Infections cause morbidity and mortality in neonatal intensive care units (NICUs). The association between nursery design and nosocomial infections is unclear.

OBJECTIVE:

To determine whether rates of colonization by methicillin-resistant Staphylococcus aureus (MRSA), late-onset sepsis, and mortality are reduced in single-patient rooms. DESIGN Retrospective cohort study.

SETTING:

NICU in a tertiary referral center.

METHODS:

Our NICU is organized into single-patient and open-unit rooms. Clinical data sets including bed location and microbiology results were examined over 29 months. Differences in outcomes between bed configurations were determined by χ2 and Cox regression.

PATIENTS:

All NICU patients.

RESULTS:

Among 1,823 patients representing 55,166 patient-days, single-patient and open-unit models had similar incidences of MRSA colonization and MRSA colonization-free survival times. Average daily census was associated with MRSA colonization rates only in single-patient rooms (hazard ratio, 1.31; P=.039), whereas hand hygiene compliance on room entry and exit was associated with lower colonization rates independent of bed configuration (hazard ratios, 0.834 and 0.719 per 1% higher compliance, respectively). Late-onset sepsis rates were similar in single-patient and open-unit models as were sepsis-free survival and the combined outcome of sepsis or death. After controlling for demographic, clinical, and unit-based variables, multivariate Cox regression demonstrated that bed configuration had no effect on MRSA colonization, late-onset sepsis, or mortality.

CONCLUSIONS:

MRSA colonization rate was impacted by hand hygiene compliance, regardless of room configuration, whereas average daily census affected only infants in single-patient rooms. Single-patient rooms did not reduce the rates of MRSA colonization, late-onset sepsis, or death.

PMID:
26108888
PMCID:
PMC5089903
DOI:
10.1017/ice.2015.144
[Indexed for MEDLINE]
Free PMC Article

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