Impact of Neonatal Intensive Care Bed Configuration on Rates of Late-Onset Bacterial Sepsis and Methicillin-Resistant Staphylococcus aureus Colonization

Abstract

Objectives Infections cause significant morbidity and mortality in neonatal intensive care units (NICUs). The association between nursery design and nosocomial infections has not been delineated. We hypothesized that rates of colonization by methicillin-resistant Staphylococcus aureus (MRSA), late-onset sepsis, and mortality are reduced in single-patient rooms. Design Retrospective cohort study. Setting NICU in a tertiary referral center. Methods Our NICU is organized into single-patient and open-unit rooms. Clinical datasets including bed location and microbiology results were examined over a 29-month period. Differences in outcomes between bed configurations were determined by Chi-square and Cox regression. Patients All NICU patients. Results Among 1823 patients representing 55,166 patient-days, single-patient and open-unit models had similar incidences of MRSA colonization and MRSA colonization-free survival times. Average daily census was associated with MRSA colonization rates only in single-patient rooms (hazard ratio 1.31, p=0.039), while hand hygiene compliance on room entry and exit was associated with lower colonization rates independent of bed configuration (hazard ratios 0.834 and 0.719 per 1% higher compliance, respectively). Late-onset sepsis rates were similar in single-patient and open-unit models as were sepsis-free survival and the combined outcome of sepsis or death. After controlling for demographic, clinical and unit-based variables, multivariate Cox regression demonstrated that bed configuration had no effect on MRSA colonization, late-onset sepsis, or mortality. Conclusions MRSA colonization rate was impacted by hand hygiene compliance, regardless of room configuration, while average daily census only affected infants in single-patient rooms. Single-patient rooms did not reduce the rates of MRSA colonization, late-onset sepsis or death.

Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis

“…Ultimately, we identified a total of nine studies, in which single-patient bedrooms are compared with multiple patient bedrooms or with an open ward design with regard to the patient's acquisition of a healthcare-associated colonization with MDRO or infection with any pathogen. These nine studies examined the infectious outcomes of bacteremia, ventilator associated pneumonia, lower respiratory tract infection, gastrointestinal infection, infection of the eye and urinary tract infections (Table 1) [16][17][18][19][20][21][22][23][24].…”

“…The studies were conducted in the United States [17,20,24], Canada [16,18], Israel [19,21,23], and France [22]. All but one of the studies were performed in intensive care units.…”

“…The analyzed intervention was the implementation of single patient rooms following ward renovation or moving to a newly built unit. While three studies collected data of the intervention and the control group simultaneously, other studies investigated the same ward before and after the constructional change [16][17][18]. Additionally, three studies defined hospital-acquired infection and colonization as events occurring ≥ 72 h after admission in contrast to ≥ 48 h after admission [16,17,24].…”

“…Six studies showed a significant benefit of singlepatient bedrooms in reducing the healthcare-associated colonization with MDRO and infection rate [18][19][20][21][22][23]. However, three studies found that single-patient rooms are neither a protective factor nor a risk factor for colonization and HAI [16,17,24]. A meta-analysis of these nine studies showed a significant benefit of singlepatient bedrooms in reducing the healthcare-associated colonization and infection rate compared with patient care in multiple patient bedrooms or with an open ward design (RR: 0.55, 95% CI: 0.41 to 0.74, Fig.…”

Influence of Ag content on the antibacterial properties of SiC doped hydroxyapatite coatings

“…rhinosinusitis [56,57], and food poisoning [58][59][60]. It may be also involved in systemic infections [61,62]. The pathogen commonly found in acute and chronic infections of the hearing aid with both children [63,64] and adults [65,66].…”