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The role of intensive care unit (ICU) design and particularly single-patient rooms in decreasing bacterial transmission between ICU patients has been debated. Phillip D. Levin, of the Department of Anesthesia and Critical Care at Hadassah-Hebrew University Medical Center in Jerusalem, and colleagues, report that a recent change in their ICU allowed further investigation.
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 more than 48 hours was compared for the different ICUs and periods to assess the effect of ICU design on acquisition of resistant organisms.
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 percent) compared to post-move ICU-B (7/39, 18 percent, p=0.043, p=0.011 using survival analysis) or pre-move ICU-A (14/62, 23 percent, 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) versus 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 percent) occasions in post-move ICU-A vs 23/66 (35 percent) in post-move ICU-B (p<0.001).
The researchers emphasize that improved ICU design, and particularly use of single-patient rooms decreases acquisition of resistant bacteria and antibiotic use, and that this should be considered in future ICU design. Their research was published in Critical Care.
Reference: Levin PD, Golovanevski M, Moses AE, Sprung CL and Benenson S. Improved ICU design reduces acquisition of antibiotic resistant bacteria: a quasi-experimental observational study. Critical Care 2011, 15:R211 doi:10.1186/cc10446