Fewer Health Care-Associated Infections With All Private Rooms

By Will Boggs MD

August 24, 2019

NEW YORK (Reuters Health) - The move from an older, tertiary-care hospital with ward-type rooms to a completely new facility with all private rooms was associated with decreases in the rates of health care-associated infections and colonization, researchers from Canada report.

"Single-patient rooms have many advantages besides infection control; however, we demonstrate that for organisms most likely to be acquired in the hospital they can have dramatic effects on colonization, and by extension, infection," said Dr. Todd C. Lee from McGill University Health Center, in Montreal, Canada.

"However, ongoing attention needs to be paid to infection control measures, including hand hygiene and institutional cleanliness, coupled with antibiotic stewardship efforts, if the goal is a long-lasting and pervasive control program," he told Reuters Health by email.

In 2015, the original Royal Victoria Hospital (constructed in 1893) closed, and all patients were moved to a newly constructed hospital consisting entirely of single-patient rooms.

Dr. Lee's team took advantage of this relocation to compare institution-level rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) colonization and hospital-acquired MRSA, VRE, and Clostridioides difficile infection (CDI) rates during the 27 months before and 36 months after the hospital move.

For VRE, there were immediate and significant drops in colonization (by 75%) and infections (by 70%) after the move, which persisted during the following months, the researchers report in JAMA Internal Medicine, online August 19.

MRSA colonization decreased 43% immediately following the move, but there was no concomitant decrease in MRSA infections. There were no significant changes in CDI rates following the relocation.

"We think this points to an important conceptual point about single-patient rooms," Dr. Lee said. "They can only prevent the acquisition of new pathogen colonization - they cannot undo what the patient already is carrying with them. So, they will have a much larger effect on infections where the hospital is the predominant source of acquisition (e.g., VRE, rare types of serious Gram-negative infections)."

"Once a pathogen gains a significant footprint in the community, nursing homes, or outside hospitals - such that many more patients arrive already colonized vs. the risk of transmission in your hospital - other means of reducing infections become more important," he said.

Dr. Lona Mody of the University of Michigan, in Ann Arbor, who studies infection prevention and control in hospitals, told Reuters Health by email, "With antimicrobial resistance increasing worldwide, this study highlights the importance and value of completely redesigning our current healthcare facilities and systems, paying attention to environment and environmental cleaning. In fact, reducing antimicrobial resistance is just one of the many reasons to modernize our healthcare facilities."

"With new information and studies such as this, the time is really ripe to redesign our healthcare facilities to make them safer and patient-centric in order to effectively help them at the worst times in their lives," said Dr. Mody, who was not involved in the new study. "Clearly more needs to be done - having a patient voice will be important."

Dr. Alon Vaisman of the University of California, San Francisco, who also was not involved in the research, recently published a study showing no increased risk in hospital-onset CDI associated with multiple-bed rooms. He told Reuters Health by email, "The reason MRSA and C. difficile did not fall may be due to the fact that the transmission of C. difficile and MRSA may have more to do with other interventions rather than single-bed design - hand hygiene rates, environmental cleaning, and disposal of waste. There are numerous variables that dictate transmission."

"Although it appears that the drop in infections coincided with the move, we should not assume this was all due to the single-bed room design," he said. "There are a multitude of differences between an old and brand new hospital to consider from an infection-control point of view - sink design, management of waste, flooring, staffing, the ability to clean surfaces of appliances/walls/common spaces/nursing station, flow through a unit, stretchers, multi-use equipment, and many more variables. None of these variables were adjusted or accounted for. Therefore, it is unclear how much each contributed to the observations or whether it was even the single-bed room design that was responsible at all for the drop."

SOURCE: https://bit.ly/2KLDbi8 and https://bit.ly/2ZoTd5S

JAMA Intern Med 2019.