The Effect of Single-Room Care Versus Open-Bay Care on the Incidence of Bacterial Nosocomial Infections in Pre-Term Neonates: A Retrospective Cohort Study

Abstract

Introduction Nosocomial infections (NIs) are a major source of iatrogenic harm in neonatal intensive care units (NICUs). The influence of the infrastructure of NICUs on NIs is not well documented. This study aims to examine the effect of single-room units (SRU) versus open-bay units (OBU) on the incidence of NIs, including central-line-associated bloodstream infections (CLABSI), in preterm neonates. Methods All preterm neonates (< 32 weeks gestational age) admitted to our NICU were included. Two study periods were compared: one prior to (May 2015–May 2017) and one following (May 2017–May 2019) transition from OBU to SRU. Incidence density (number of infections per 1000 patient-days) and cumulative incidence (number of infections per 100 neonates) for NIs were calculated. CLABSIs were calculated per 1000 central-line days. U chart analysis was performed to determine special-cause variation in quarterly CLABSI and NI rates. Multivariate competing risk regression was performed to identify independent NI risk factors. Results Of the 712 included infants, 164 (23%) infants acquired ≥ 1 NIs. No differences were found in incidence density (13.68 vs. 12.62, p = 0.62) or cumulative incidence of NI (23.97 vs. 22.02, p = 0.59) between OBU and SRU. CLABSIs showed a similar non-significant reduction after the move (14.00 vs. 10.59, p = 0.51). U chart analysis did not identify unit transition as a potential source of special-cause variation for CLABSI and NI. Competing risks regression analysis revealed longer duration of invasive mechanical ventilation as a significant risk factor for NI (subhazards ratio: 1.03 per day on ventilation, p = 0.01). Conclusion Single-rooms are not associated with a significant reduction in NIs in the NICU. This study therefore does not add evidence that could support the transition to SRUs if based only on a large multimodal infection control strategy. Recommendations to build SRUs would require a wider justification, also taking into account other SRU benefits. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-020-00380-9.

Comparison of neonatal morbidity and mortality between single-room and open-bay care: a retrospective cohort study

“…The scientific evidence on the benefits of SRU is lacking and it remains controversial whether the available data justify the costs associated with the transformation from OBU to SRU. Apart from the independent association between single-room care and sPDA, our findings indicate that the SRU model is not associated with a reduced risk of severe morbidity and mortality in preterm neonates and are in line with our previous findings regarding the lack of association between single-room care, NEC (25 vs 17 episodes, p=0.36) and the incidence of nosocomial infection (13.68 vs 12.62 per 1000 patient-days, p=0.62) 11. We were thus unable to provide new evidence to support the theoretical benefits of single-room care.…”

“…High-grade IVH was defined as IVH grade 3 or any grade of IVH complicated by PVHI and/or PHVD. Necrotising enterocolitis and late-onset sepsis were not included as major morbidity outcomes as these outcomes have been previously reported on in relation to unit transition 11. Data for neonates who were screened for BPD and ROP following discharge from the NICU were retrieved from the hospitals to which they were discharged to.…”

“…Nevertheless, unfavourable effects have also been reported, including higher workloads, lower infant language scores at 2 years of age and increased maternal stress 4 9 10. Moreover, results regarding the association between single-room care, hospital-acquired infection rates and colonisation with multidrug-resistant organisms likewise remain inconclusive 6 11–15. As such, additional evidence describing the association between single-room care and a broad range of morbidity outcomes in preterm neonates is required in the decision to transition away from open-ward facilities.…”

The clinical, humanistic, and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions. A narrative synthesis systematic literature review

“…Eighteen studies reported mortality (see Figure 3 and supplementary Table 2). (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) Ten were before-and-after studies and the others were contemporary studies. Only one article scored less than 50% for quality and two had high quality scores.…”

“…Twenty-three studies were found that assessed maternity and neonatal care (see Figure 3 and supplementary Table 4). (10,11,15,(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57) Most (n=14) were before-and after studies and the remainder were contemporaneous studies. Three studies were low quality and only one had a highquality score.…”