Infection Acquisition Following Intensive Care Unit Room Privatization

被引:83
作者
Teltsch, Dana Y. [1 ]
Hanley, James [1 ]
Loo, Vivian [2 ]
Goldberg, Peter [2 ]
Gursahaney, Ash [2 ]
Buckeridge, David L. [1 ,2 ]
机构
[1] McGill Univ, Dept Epidemiol Biostat & Occupat Hlth, Montreal, PQ H3A 1A3, Canada
[2] McGill Univ, Ctr Hlth, Montreal, PQ H3A 1A3, Canada
基金
加拿大健康研究院; 加拿大自然科学与工程研究理事会;
关键词
RESISTANT STAPHYLOCOCCUS-AUREUS; LACTAMASE-PRODUCING ENTEROBACTERIACEAE; SINGLE ROOMS; PSEUDOMONAS-AERUGINOSA; MRSA; COLONIZATION; TRANSMISSION; FACILITIES; HOSPITALS; RATES;
D O I
10.1001/archinternmed.2010.469
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. Arch Intern Med. 2011;171(1):32-38
引用
收藏
页码:32 / 38
页数:7
相关论文
共 27 条
[1]   Risk factors for nosocomial intensive care infection:: a long-term prospective analysis [J].
Appelgren, P ;
Hellström, I ;
Weitzberg, E ;
Söderlund, V ;
Bindslev, L ;
Ransjö, U .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2001, 45 (06) :710-719
[2]   Influx of extended-spectrum β-lactamase producing enterobacteriaceae into the hospital [J].
Ben-Ami, R ;
Schwaber, MJ ;
Navon-Venezia, S ;
Schwartz, D ;
Giladi, M ;
Chmelnitsky, I ;
Leavitt, A ;
Carmeli, Y .
CLINICAL INFECTIOUS DISEASES, 2006, 42 (07) :925-934
[3]  
Bergmans Dennis C.J.J., 2004, Hospital epidemiology and infection control, P321
[4]   Clostridium difficile infections related to antibiotic use and infection control facilities in two university hospitals [J].
Berild, D ;
Smaabrekke, L ;
Halvorsen, DS ;
Lelek, M ;
Stahsberg, EM ;
Ringertz, SH .
JOURNAL OF HOSPITAL INFECTION, 2003, 54 (03) :202-206
[5]   Characteristics of polyclonal endemicity of Pseudomonas aeruginosa colonization in intensive care units -: Implications for infection control [J].
Bonten, MJM ;
Bergmans, DCJJ ;
Speijer, H ;
Stobberingh, EE .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1999, 160 (04) :1212-1219
[6]  
BOYCE JM, 1994, INFECT CONT HOSP EP, V15, P105
[7]   Single rooms may help to prevent nosocomial bloodstream infection and cross-transmission of methicillin-resistant Staphylococcus aureus in intensive care units [J].
Bracco, David ;
Dubois, Marc-Jacques ;
Bouali, Redouane ;
Eggimann, Philippe .
INTENSIVE CARE MEDICINE, 2007, 33 (05) :836-840
[8]  
Burke John P., 2004, Hospital epidemiology and infection control, P273
[9]   Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study [J].
Cepeda, JA ;
Whitehouse, T ;
Cooper, B ;
Hails, J ;
Jones, K ;
Kwaku, F ;
Taylor, L ;
Hayman, S ;
Cookson, B ;
Show, S ;
Kibbler, C ;
Singer, M ;
Bellingan, G ;
Wilson, APR .
LANCET, 2005, 365 (9456) :295-304
[10]   Problems and solutions in hospital-acquired bacteraemia [J].
Correa, L ;
Pittet, D .
JOURNAL OF HOSPITAL INFECTION, 2000, 46 (02) :89-95