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Impact of moving to a new hospital build, with a high proportion of single rooms, on healthcare-associated infections and outbreaks

https://doi.org/10.1016/j.jhin.2017.06.027Get rights and content

Summary

Clostridium difficile infection, meticillin-sensitive Staphylococcus aureus (MSSA) and Escherichia coli bacteraemia rates, and bed-days lost during norovirus outbreaks at North Bristol NHS Trust were analysed over a five-year period to determine whether moving to a new-build hospital with 75% single rooms reduced healthcare-associated infection rates. C. difficile, MSSA bacteraemia and E. coli bacteraemia showed no change in the rate of decline after the move. Bed-days lost due to norovirus were significantly lower after the move. Increased availability of single rooms had an impact on the transmission of highly contagious norovirus infection, dispersed via the airborne route, in contrast to bacterial infections, which may originate from patient's own colonizing flora and are not widely dispersed through airborne spread.

Introduction

Isolation of patients with transmissible infections is a major component of hospital infection control strategies. Although some evidence demonstrating a relationship between increased availability of single rooms and a reduction in healthcare-associated infection (HCAI) rates has been reported for intensive care settings [1], [2], it has not been shown elsewhere in the acute hospital environment. In 2014, North Bristol National Health Service (NHS) Trust (NBT), a large acute hospital trust in South West England, relocated from a dual-site hospital to a new purpose-built design on a single site. All clinical patient areas (excluding the maternity unit, neonatal intensive care unit and two elderly care wards) moved into the new build. This included renal dialysis and transplant, neurosurgery, burns, plastic surgery, orthopaedic and trauma, acute medicine, acute surgery and the emergency department. The total number of acute beds decreased from approximately 1200 to 1000. The wards in the old building had been either Nightingale layout or wards comprising four-bedded bays. There were just 10% single rooms distributed across both sites, resulting in frequent failure to isolate all patients with transmissible infections. The new building was designed with 75% single rooms in all wards, and 100% single rooms in the intensive care unit. In the initial design stages, the infection control team (ICT) sought guidance on the number or proportion of side rooms that should be incorporated into a hospital. Health Technical Memoranda (HTM) documentation (documents issued by the UK Government giving comprehensive guidance on the design, installation and operation of building and engineering technology used in health care) were reviewed, but no HTM, or any other NHS guidance before 2011, gave recommendations on the proportion of single rooms in an acute hospital. Since then, HTM guidance has been published recommending that at least 50% of beds in any refurbishment or new hospital build should be single en-suite rooms [3]. In the early design stage, it was anticipated that the ability to isolate most, or all, patients with transmissible infection would reduce HCAI rates significantly, particularly for C. difficile and norovirus.

Section snippets

Methods

The study was conducted in NBT as a retrospective analysis of mandatory reporting data of healthcare-associated cases of C. difficile infection (HA-CDI) and meticillin-sensitive S. aureus (MSSA) bacteraemia from April 2011 to the end of March 2016. Public Health England coordinates the mandatory surveillance of defined infections acquired in hospital. It has been mandatory for all NHS acute trusts to report all cases of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia since April

Results

HA-MSSA bacteraemia rates showed an insignificant decline over the five-year study period [rate ratio 0.93/year, 95% confidence interval (CI) 0.82–1.05, P=0.22]. Mean incidence rates in the periods before and after the move were 7.2 and 6.2 per 100,000 bed-days, respectively.

The incidence of E. coli bacteraemia declined significantly over the study period (rate ratio 0.88/year, 95% CI 0.78–1.00, P=0.04). Cases per 100,000 bed-days fell from a mean of 21.1 before the move to 16.3 after the move.

Discussion

Working in a large acute hospital in the years before and following a move into a brand-new modern building offered a unique opportunity to directly observe the impact of increased single rooms on transmissible infections. The ICT were involved in the design of the new hospital more than 10 years before the building was finally ready to accept patients. In 2005–2006, NBT rates of HA-CDI were, year-on-year, much higher than the national average. It was anticipated that increased capacity to

Conflict of interest statement

None declared.

Funding sources

None.

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