Use of single-bed rooms may decrease the incidence of hospital-acquired infections in geriatric patients: A retrospective cohort study in Central Denmark region

Abstract

Objective Patients accommodated in single-bed rooms may have a reduced risk of hospital-acquired infections (HAIs) compared to those in multi-bed rooms. This study aimed to examine the effect of single-bed accommodation on HAIs in older patients admitted to a geriatric ward. Methods A retrospective cohort study of patients admitted to geriatric wards in a university hospital in Central Denmark Region linked to a move to a newly built hospital, involving all consecutively admitted patients aged 65 years and over from 15 September to 19 December 2016 and a similar cohort admitted in the same three months in 2017. We compared the incidence of HAIs in patients in single-bed accommodation to those in multi-bed accommodation using retrospective review of electronic patient records, with all infections verified microbiologically or by X-ray with onset between 48 hours after admission to 48 hours after discharge from hospital. Results In total 446 patients were included. The incidence of HAIs in multi-bed accommodation was 30% compared to 20% in single-bed accommodation. The hazard ratio was 0.62 (95% Confidence Interval 0.43–0.91, p = 0.01) for single-bed accommodation. This finding remained robust after adjustment for age, sex, infection at admission, risk of sepsis, use of catheter, treatment with prednisone or methotrexate, and comorbidity index. Conclusion Accommodation in single-bed rooms appeared to reduce HAIs compared to multi-bed rooms in two geriatric wards. This finding should be considered as hypothesis-generating and be examined further using an experimental design.

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

“…(26,35,36,67,71,72,88,95) Hospital-acquired infection rates were shown to be reduced in single rooms in six studies. (26,36,67,69,71,87,88) However, in Maben et al,(26) this finding depended on the ward mix: Clostridium difficile infections were reduced in single rooms where the split with shared accommodation was half and half, whereas all shared accommodation performed better than all single rooms. In Darley et al(67) this finding was only for C difficile , whereas hospital-acquired MRSA rates did not differ by accommodation type.…”

“…Routine care was assessed in adults in 10 studies(8,69,75,77,79,80,84,87,89,93) and eight involved mixed age populations and care levels that stated or were assumed to include adults and routine care. (26,35,36,67,71,72,88,95) Hospital-acquired infection rates were shown to be reduced in single rooms in six studies.…”

“…Fifty-three publications, including two evidence syntheses, reported on length of stay associated with single-room accommodation (see Figure 5 and supplementary Table 16). (7–13,15–20,22–27,35,36,40,41,43,46–49,52,53,55,56,60–63,65,69,73–75,85,91,96,96,107,112,113,125,134,143,147–149) Twenty-eight were before-and-after studies, 23 were contemporaneous studies, one used mixed study designs, and two were evidence syntheses. Five of the studies were classified as being of low quality but only seven fell into the high-quality category.…”

“…Of 20 studies assessing routine care, 18 concerned adults and the elderly. (7,8,22,26,27,35,36,41,63,65,69,77,112,113,134,143,147,149) Among these, eight found that length of stay was shorter in single rooms,(7,16,26,27,41,65,112,147,149) but in the study by Maben et al(26) this was true only for an older people’s ward and not for a medical assessment unit, and in that by Lawson and Phiri,(27) while it was true for non-surgical orthopaedic patients and psychiatric patients, no difference was seen for surgical orthopaedic patients. One study found that length of stay was shorter in shared accommodation among older patients with dementia, overall and among those who had experienced inpatient falls.…”

“…(22) No difference in overall length of stay was reported in seven studies, including two evidence syntheses. (8,35,36,63,69,134,143) The two studies of routine care in children by Kinnula and colleagues showed no difference between accommodation types in one (96) but longer duration of admissions among children in shared accommodation in another. (97) Intensive care…”