infection control & hospital epidemiology october 2015, vol. 36, no. 10 original article
Impact of Neonatal Intensive Care Bed Configuration on Rates of Late-Onset Bacterial Sepsis and Methicillin-Resistant Staphylococcus aureus Colonization
Samuel Julian, MD;1 Carey-Ann D. Burnham, PhD;2 Patricia Sellenriek, M(ASCP)SM, MBA;3 William D. Shannon, PhD;4 Aaron Hamvas, MD;5 Phillip I. Tarr, MD;1 Barbara B. Warner, MD1
background. Infections cause morbidity and mortality in neonatal intensive care units (NICUs). The association between nursery design and nosocomial infections is unclear.
objective. To determine whether 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 data sets including bed location and microbiology results were examined over 29 months. Differences in outcomes between bed configurations were determined by χ2 and Cox regression. patients. All NICU patients.
results. Among 1,823 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=.039), whereas 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, whereas average daily census affected only infants in single-patient rooms. Single-patient rooms did not reduce the rates of MRSA colonization, late-onset sepsis, or death.
Infect. Control Hosp. Epidemiol. 2015;36(10):1173–1182
Late-onset infections continue to cause substantial morbidity and mortality in neonatal intensive care units (NICUs),1–3 increasing length of stay and costs.4 Although many studies have examined the impact of environmental factors on noso- comial infections, the cornerstone of which is proper hand hygiene by healthcare workers,5 the role of room configuration is less well defined. Many pathogens are transmitted via surfaces and fomites,6 and multipatient rooms are more difficult to decontaminate because of their greater number of surfaces and higher traffic. These concerns contributed to
single-patient rooms becoming the standard design in healthcare facilities.7,8 Although improvements in air quality and nosocomial infections have been attributed to the change from open-unit to single-patient room facilities,8,9 these NICU bed configurations have not been directly compared contemporaneously. Our NICU, which has both single-patient and open-unit beds, provided an opportunity to test the hypothesis that infants in single-patient rooms have a lower risk of methicillin-resistant Staphylococcus aureus (MRSA) colonization, late-onset sepsis, and death.
Affiliations: 1. Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri; 2. Departments of Pathology & Immunology and
Pediatrics, Washington University School of Medicine, St. Louis, Missouri; 3. St. Louis Children’s Hospital, St. Louis, Missouri; 4. Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri; 5. Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois.
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2015/3610-0007. DOI: 10.1017/ice.2015.144 Received February 16, 2015; accepted May 26, 2015; electronically published June 25, 2015
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