Levin PD, Golovanevski M, Moses AE, Sprung CL, Benenson S.; Crit Care. 2011 Sep 14;15(5):R211. [Epub ahead of print]
Introduction: The role of intensive care unit (ICU) design and particularly single patient rooms in decreasing bacterial transmission between ICU patients has been debated. A recent change in our ICU allowed further investigation.
Methods: Pre-move ICU A and pre-Move ICU-B were open plan units. In March 2007, ICU-A moved to single patient rooms (post-move ICU-A). ICU-B remained unchanged (post-move ICU-B). The same physicians cover both ICUs. Culture of specified resistant organisms in surveillance or clinical cultures from consecutive patients staying >48 hours was compared for the different ICUs and periods to assess the effect of ICU design on acquisition of resistant organisms.
Results: Data were collected on 62, 62, 44 and 39 patients from pre-move ICU-A, post-move ICU-A, pre-move ICU-B and post-move ICU-B. Fewer post-move ICU-A patients acquired resistant organisms (3/62, 5%) compared to post-move ICU-B (7/39, 18%, p=0.043, p=0.011 using survival analysis) or pre-move ICU-A (14/62, 23%, p=0.004, p=0.012 on survival analysis). Only admission period was significant for acquisition of resistant organisms comparing pre- to post-move ICU-A (Hazard Ratio 5.18, 95%Confidence Interval 1.03-16.06, p=0.025). More antibiotic free days were recorded in post-move ICU-A (median 3, Inter Quartile Range 0-5) vs post-move ICU-B (0, IQR 0-4, p=0.070) or pre-move ICU-A (0, IQR 0-4, p=0.0174). Adequate hand hygiene was observed on 140/242 (58%) occasions in post-move ICU-A vs 23/66 (35%) in post-move ICU-B (p<0.001).
Conclusions: Improved ICU design, and particularly use of single patient rooms decreases acquisition of resistant bacteria and antibiotic use. This should be considered in future ICU design.
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