Private ICU Rooms Reduce Infection Risk

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A new report in the January 10 issue of Archives of Internal Medicine notes infection rates are reduced when hospital intensive care units (ICUs) are converted to private rooms.

Dana Y. Teltsch, MSc, PhDc, and colleagues from McGill University, Montreal, compared the rates of patient-acquired infections before and after a change from multi-bed rooms to single, private rooms (Montreal General Hospital; the intervention hospital). As a control, they also used data from patients who were admitted to a similar multi-bed facility at a second university hospital (Royal Victoria Hospital; the comparison hospital).

The 25-bed adult ICU of the comparison hospital remained unchanged during the study time frame from 2000 to 2005; composed of rooms with 2, 5, or 6 beds and 8 single rooms.

Prior to the intervention, the 24-bed adult ICU at the intervention hospital consisted of 2 large rooms of 12 beds, 2 private rooms within each larger room, and a total of 4 sinks. The ICU in this intervention hospital was moved in March 2002 to a new location within the hospital with 24 beds, each in a private room containing a sink, and 2 additional sinks in an area outside the private rooms.

The patient-nurse ratio was the same in both hospitals and remained constant during the study period. This ratio was 1:1 for 30% of beds and 2:1 for 70% of beds. Alcohol-based hand gels were available during the study in a ratio of 1 per 2 beds in both hospitals. The products that were used were identical between the 2 hospitals.

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The authors compared infection rates for a total of 19,343 ICU admissions at both hospitals between 2000 and 2005; contributing 85 995 patient-days at risk.

Following the intervention, the adjusted rate of acquisition of Clostridium difficile, vancomycin-resistant Enterococcus species, and methicillin-resistant Staphylococcus aureus (MRSA) combined decreased by 54% (95% confidence interval [CI], 29%-70%).

The MRSA 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%).

The adjusted rate ratio of the average length of stay in the ICU was 10% (95% CI, 0%-19%) lower after the intervention.

Healthcare-associated infections (HAIs) occur in about 30 % of patients in intensive care units (ICUs) and are associated with substantial morbidity and mortality,” the authors write as background information in the article. β€œIn ICU patients, these infections are associated with an increased length of stay of eight to nine days, and the resulting additional cost from excess stay alone is estimated to be $3.5 billion per year in the United States.”

This study was funded in part by grants from the Canadian Institutes of Health Research and the Natural Sciences and Engineering Research Council.

Source
Dana Y. Teltsch; James Hanley; Vivian Loo; Peter Goldberg; Ash Gursahaney; David L. Buckeridge; Infection Acquisition Following Intensive Care Unit Room Privatization; Arch Intern Med. 2011;171(1):32-38.

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