Emily G. McDonald
Moving patients from a hospital with mostly ward-type rooms to a new hospital with exclusively private rooms appeared to be associated with a sustained decrease in the rates of new MRSA colonization and vancomycin-resistant enterococci, or VRE, colonization and infection, according to findings published in JAMA Internal Medicine. However, researchers reported that the move was not associated with a reduction in MRSA infection or Clostridioides difficile infection.
According to Emily G. McDonald, MD, MSc, assistant professor of medicine at McGill University, and colleagues, “it is recommended that new facilities be built with single-room, low-acuity beds,” a costly process that has not been proven to reduce health care-associated infections.
“Single-patient rooms have a lot of benefits for the patient such as improved comfort and privacy,” McDonald Infectious Disease News. “We demonstrated they are also associated with the prevention of certain infections, which is paramount for patient care, and is a strong argument for investing in this type of infrastructure.”
McDonald and colleagues compared institution-level rates of new multidrug-resistant organism colonization and health care-associated infections before and after a synchronized move in 2015 of every patient from a 417-bed “old hospital” in Montreal “made up of mostly multibed rooms,” according to McDonald. They were moved to a new hospital with 350 beds, all in private single-patient rooms equipped with individual showers and toilets and easy access to sinks for hand-washing.
The researchers reported an “immediate and sustained” reduction in nosocomial VRE colonization, from 766 cases in the 27 months before the hospital move to 209 cases in the 36 months after it (incidence rate ratio [IRR] = 0.25; 95% CI, 0.19-0.34). Cases of MRSA colonization were reduced from 129 to 112 (IRR = 0.57; 95% CI, 0.33-0.96), and VRE infections from 55 to 14 (IRR = 0.30; 95% CI, 0.12-0.75). C. difficile infections ticked down from 236 to 223 (IRR = 0.95; 95% CI, 0.51-1.76), an insignificant rate, according to the study. MRSA infections increased from 27 to 37 (IRR = 0.89; 95% CI, 0.34-2.29).
“The hospital has a strong infection control team, and we have increased our hand hygiene compliance over the last few years,” McDonald said. “This has probably helped to maintain the rates of infection and colonization from creeping back up over time. We were surprised to find that rates of C. difficile were not impacted by the move.”
The researchers hypothesized that C. difficile infections are likely related to other risk factors such as exposure to broad spectrum antibiotics, according to McDonald.
In a related editorial, D. Kirk Hamilton, PhD, an endowed professor of health facility design at Texas A&M University, said the rise of antibiotic resistance has shown that private rooms can be an “important line of defense” against infection.
“Some might romanticize the days when a nurse could look across a Nightingale open ward and see every patient, but as infection control is further prioritized, hospitals will invest the additional dollars for private rooms,” Hamilton wrote. “Private rooms alone, however, as shown in the study by McDonald and colleagues, will not be sufficient to combat the growing risk of MRSA and C. difficile.” – by Joe Gramigna
Disclosures: Hamilton reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. McDonald reports research salary support from the Fonds de recherche Sante du Québec.