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1.
Vincent  JL Nosocomial infections in adult intensive-care units.  Lancet 2003;361 (9374) 2068- 2077PubMedGoogle Scholar
2.
Appelgren  PHellström  IWeitzberg  ESöderlund  VBindslev  LRansjö  U Risk factors for nosocomial intensive care infection: a long-term prospective analysis.  Acta Anaesthesiol Scand 2001;45 (6) 710- 719PubMedGoogle Scholar
3.
Correa  LPittet  D Problems and solutions in hospital-acquired bacteraemia.  J Hosp Infect 2000;46 (2) 89- 95PubMedGoogle Scholar
4.
Garner  JSThe Hospital Infection Control Practices Advisory Committee, Guideline for isolation precautions in hospitals.  Infect Control Hosp Epidemiol 1996;17 (1) 53- 80PubMedGoogle Scholar
5.
The Facility Guidelines Institute, American Institute of Architects Academy of Architecture for Health, US Department of Health and Human Services, Guidelines for Design and Construction of Health Care Facilities. 2006 ed.  Washington, DC American Institute of Architects2006;
6.
Cepeda  JAWhitehouse  TCooper  B  et al.  Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study.  Lancet 2005;365 (9456) 295- 304PubMedGoogle Scholar
7.
Bracco  DDubois  MJBouali  REggimann  P Single rooms may help to prevent nosocomial bloodstream infection and cross-transmission of methicillin-resistant Staphylococcus aureus in intensive care units.  Intensive Care Med 2007;33 (5) 836- 840PubMedGoogle Scholar
8.
van de Glind  Ide Roode  SGoossensen  A Do patients in hospitals benefit from single rooms? a literature review.  Health Policy 2007;84 (2-3) 153- 161PubMedGoogle Scholar
9.
Loveday  HPPellowe  CMJones  SRPratt  RJ A systematic review of the evidence for interventions for the prevention and control of methicillin-resistant Staphylococcus aureus (1996-2004): report to the Joint MRSA Working Party (Subgroup A).  J Hosp Infect 2006;63 ((suppl 1)) S45- S70PubMedGoogle Scholar
10.
Dettenkofer  MSeegers  SAntes  GMotschall  ESchumacher  MDaschner  FD Does the architecture of hospital facilities influence nosocomial infection rates? a systematic review.  Infect Control Hosp Epidemiol 2004;25 (1) 21- 25PubMedGoogle Scholar
11.
Yoonchang  SWPeck  KRKim  OS  et al.  Efficacy of infection control strategies to reduce transmission of vancomycin-resistant enterococci in a tertiary care hospital in Korea: a 4-year follow-up study.  Infect Control Hosp Epidemiol 2007;28 (4) 493- 495PubMedGoogle Scholar
12.
Berild  DSmaabrekke  LHalvorsen  DSLelek  MStahlsberg  EMRingertz  SH Clostridium difficile infections related to antibiotic use and infection control facilities in two university hospitals.  J Hosp Infect 2003;54 (3) 202- 206PubMedGoogle Scholar
13.
Detsky  MEEtchells  E Single-patient rooms for safe patient-centered hospitals.  JAMA 2008;300 (8) 954- 956PubMedGoogle Scholar
14.
Boyce  JMJackson  MMPugliese  G  et al. The AHA Technical Panel on Infections Within Hospitals, Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities.  Infect Control Hosp Epidemiol 1994;15 (2) 105- 115PubMedGoogle Scholar
15.
Johanson  WG  JrPierce  AKSanford  JPThomas  GD Nosocomial respiratory infections with gram-negative bacilli: the significance of colonization of the respiratory tract.  Ann Intern Med 1972;77 (5) 701- 706PubMedGoogle Scholar
16.
Reddy  PMalczynski  MObias  A  et al.  Screening for extended-spectrum β-lactamase–producing enterobacteriaceae among high-risk patients and rates of subsequent bacteremia [published online ahead of print August 20, 2007].  Clin Infect Dis 2007;45 (7) 846- 852PubMed10.1086/521260Google Scholar
17.
Ben-Ami  RSchwaber  MJNavon-Venezia  S  et al.  Influx of extended-spectrum β-lactamase–producing enterobacteriaceae into the hospital [published online ahead of print February 27, 2006].  Clin Infect Dis 2006;42 (7) 925- 934PubMed10.1086/500936Google Scholar
18.
Bergmans Dennis  CJJBonten Marc  JM Nosocomial pneumonia. Glen  Mayhall C Hospital Epidemiology and Infection Control. Philadelphia, PA Lippincott Williams & Wilkins2004;321Google Scholar
19.
Burke John  P Nosocomial urinary tract infections. Glen  Mayhall C Hospital Epidemiology and Infection Control. Philadelphia, PA Lippincott Williams & Wilkins2004;273Google Scholar
20.
Glen Mayhall  C Hospital Epidemiology and Infection Control.  Philadelphia, PA Lippincott Williams & Wilkins2004;
21.
Wong Edward  S Surgical site infections. Glen  Mayhall C Hospital Epidemiology and Infection Control. Philadelphia, PA Lippincott Williams & Wilkins2004;288Google Scholar
22.
Freedman  DA The American statistician.  Am Stat 2006;60 (4) 299- 30210.1198/000313006X152207Google Scholar
23.
R Development Core Team, R: A Language and Environment for Statistical Computing.  Vienna, Austria R Foundation for Statistical Computing2008;
24.
Kropec  AHuebner  JRiffel  M  et al.  Exogenous or endogenous reservoirs of nosocomial Pseudomonas aeruginosa and Staphylococcus aureus infections in a surgical intensive care unit.  Intensive Care Med 1993;19 (3) 161- 165PubMedGoogle Scholar
25.
Bonten  MJBergmans  DCSpeijer  HStobberingh  EE Characteristics of polyclonal endemicity of Pseudomonasaeruginosa colonization in intensive care units: implications for infection control.  Am J Respir Crit Care Med 1999;160 (4) 1212- 1219PubMedGoogle Scholar
26.
Ulrich  RS Essay: evidence-based health-care architecture.  Lancet 2006;368(suppl)s38- s39Google Scholar
Original Investigation
January 10, 2011

Infection Acquisition Following Intensive Care Unit Room Privatization

Author Affiliations

Author Affiliations: Department of Epidemiology, Biostatistics, and Occupational Health (Ms Teltsch and Drs Hanley and Buckeridge) and McGill University Health Centre (Drs Loo, Goldberg, Gursahaney, and Buckeridge), McGill University, Montreal, Quebec, Canada.

Arch Intern Med. 2011;171(1):32-38. 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.

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