McDonald Emily G, Dendukuri Nandini, Frenette Charles, Lee Todd C
Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.
Division of Infectious Diseases, Department of Medicine, McGill University, Montréal, Québec, Canada.
JAMA Intern Med. 2019 Nov 1;179(11):1501-1506. doi: 10.1001/jamainternmed.2019.2798.
Health care-associated infections are often caused by multidrug-resistant organisms and substantially factor into hospital costs and avoidable iatrogenic harm. Although it is recommended that new facilities be built with single-room, low-acuity beds, this process is costly and evidence of reductions in health care-associated infections is weak.
To examine whether single-patient rooms are associated with decreased rates of common multidrug-resistant organism transmissions and health care-associated infections.
DESIGN, SETTING, AND PARTICIPANTS: A time-series analysis comparing institution-level rates of new multidrug-resistant organism colonization and health care-associated infections before (January 1, 2013-March 31, 2015) and after (April 1, 2015-March 31, 2018) the move to the hospital with 100% single-patient rooms. In the largest hospital move in Canadian history, inpatients in an older, tertiary care, 417-bed hospital in Montréal, Canada, that consisted of mainly mixed 3- and 4-person ward-type rooms were moved to a new 350-bed facility with all private rooms.
A synchronized move of all patients on April 26, 2015, to a new hospital with 100% single-patient rooms equipped with individual toilets and showers and easy access to sinks for hand washing.
Rates of nosocomial vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) colonization, VRE and MRSA infection, and Clostridioides difficile (formerly known as Clostridium difficile) infection (CDI) per 10 000 patient-days.
Compared with the 27 months before, during the 36 months after the hospital move, an immediate and sustained reduction in nosocomial VRE colonization (from 766 to 209 colonizations; incidence rate ratio [IRR], 0.25; 95% CI, 0.19-0.34) and MRSA colonization (from 129 to 112 colonizations; IRR, 0.57; 95% CI, 0.33-0.96) was noted, as well as VRE infection (from 55 to 14 infections; IRR, 0.30, 95% CI, 0.12-0.75). Rates of CDI (from 236 to 223 infections; IRR, 0.95; 95% CI, 0.51-1.76) and MRSA infection (from 27 to 37 infections; IRR, 0.89, 95% CI, 0.34-2.29) did not decrease.
The move to a new hospital with exclusively single-patient rooms appeared to be associated with a sustained decrease in the rates of new MRSA and VRE colonization and VRE infection; however, the move was not associated with a reduction in CDI or MRSA infection. These findings may have important implications for the role of hospital construction in facilitating infection control.
医疗保健相关感染通常由多重耐药菌引起，在医院成本和可避免的医源性伤害中占很大因素。虽然建议新建设施配备单人、低急症病床，但这一过程成本高昂，且医疗保健相关感染减少的证据不足。
研究单人病房是否与常见多重耐药菌传播率和医疗保健相关感染率降低有关。
设计、地点和参与者：一项时间序列分析，比较了迁至100%单人病房医院之前（2013年1月1日至2015年3月31日）和之后（2015年4月1日至2018年3月31日）机构层面新的多重耐药菌定植率和医疗保健相关感染率。在加拿大历史上最大规模的医院搬迁中，加拿大蒙特利尔一家拥有417张床位的老年三级护理医院的住院患者，该医院主要由3人和4人混合病房组成，迁至一家拥有350张床位的新设施，所有病房均为单人病房。
2015年4月26日所有患者同步迁至一家拥有100%单人病房的新医院，病房配备独立卫生间和淋浴设施，且方便使用水槽进行洗手。
每10000患者日的医院获得性耐万古霉素肠球菌（VRE）和耐甲氧西林金黄色葡萄球菌（MRSA）定植率、VRE和MRSA感染率以及艰难梭菌感染（CDI）率。
与搬迁前的27个月相比，在医院搬迁后的36个月期间，医院获得性VRE定植（从766例定植降至209例定植；发病率比[IRR]，0.25；95%CI，0.19 - 0.34）和MRSA定植（从129例定植降至112例定植；IRR，0.57；95%CI，0.33 - 0.96）立即且持续下降，VRE感染（从55例感染降至14例感染；IRR，0.30，95%CI, 0.12 - 0.75）也下降。CDI率（从236例感染降至223例感染；IRR，0.95；95%CI，0.51 - 1.76）和MRSA感染率（从27例感染增至37例感染；IRR，0.89，95%CI，0.34 - 2.29）没有下降。
迁至全为单人病房的新医院似乎与新的MRSA和VRE定植率及VRE感染率持续下降有关；然而，搬迁与CDI或MRSA感染减少无关。这些发现可能对医院建设在促进感染控制中的作用具有重要意义。
