Time-Series Analysis of Health Care-Associated Infections in a New Hospital With All Private Rooms
Time-Series Analysis of Health Care-Associated Infections in a New Hospital With All Private Rooms
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DOI：
10.1001/jamainternmed.2019.2798
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发表时间：
2019-11-01
影响因子：
39
通讯作者：
Lee, Todd C.
中科院分区：
文献类型：
--
作者：
McDonald, Emily G.;Dendukuri, Nandini;Lee, Todd C.
重要性医疗保健相关感染通常是由多重耐药微生物引起的，并在很大程度上影响了医院成本和可避免的医源性损害。尽管建议新建的设施应采用单间、低敏度床位，但这一过程成本高昂，且减少医疗相关感染的证据不足。目的探讨单间病房是否与常见的多重耐药微生物传播和医疗相关感染率降低相关。一项时间序列分析，比较了研究前机构水平的新的多药耐药微生物定植率和卫生保健相关感染率。（2013年1月1日-2015年3月31日）和之后（2015年4月1日-2018年3月31日）搬到100%单人病房的医院。在加拿大历史上最大的医院搬迁中，加拿大蒙特利尔一家旧的三级医疗医院的住院患者被转移到一个新的350个床位的设施中，该医院主要由3人和4人混合病房组成，共有417个床位。主要结果和指标医院内耐万古霉素肠球菌（VRE）和耐甲氧西林金黄色葡萄球菌（MRSA）定植率、VRE和MRSA感染率、耐万古霉素肠球菌（VRE）和耐甲氧西林金黄色葡萄球菌（MRSA）艰难梭菌Clostridioides difficile结果与搬迁前27个月相比，搬迁后36个月内，医院内VRE定植率立即持续下降，（766 - 209例定植;发生率比[IRR]，0.25; 95% CI，0.19-0.34）和MRSA定植（从129到112定植; IRR，0.57; 95% CI，0.33-0.96），以及VRE感染（从55到14感染; IRR，0.30，95% CI，0.12-0.75）。CDI比率（236 - 223例感染; IRR，0.95; 95% CI，0.51-1.76）和MRSA感染（由二十七宗增至三十七宗; IRR，0.89，95% CI，0.34-2.29）没有减少。结论和相关性患者房间似乎与新的MRSA和VRE定植率和VRE感染率的持续下降相关;然而，移动与CDI或MRSA感染的减少无关。这些发现可能对医院建设在促进感染控制中的作用具有重要意义。
IMPORTANCE Health care-associated infections are often caused by multidrug-resistant organisms and substantially factor into hospital costs and avoidable iatrogenic harm. Although it is recommended that new facilities be built with single-room, low-acuity beds, this process is costly and evidence of reductions in health care-associated infections is weak.Objective To examine whether single-patient rooms are associated with decreased rates of common multidrug-resistant organism transmissions and health care-associated infections.DESIGN, SETTING, AND PARTICIPANTS A time-series analysis comparing institution-level rates of new multidrug-resistant organism colonization and health care-associated infections before (January 1, 2013-March 31, 2015) and after (April 1, 2015-March 31, 2018) the move to the hospital with 100% single-patient rooms. In the largest hospital move in Canadian history, inpatients in an older, tertiary care, 417-bed hospital in Montreal, Canada, that consisted of mainly mixed 3- and 4-person ward-type rooms were moved to a new 350-bed facility with all private rooms.EXPOSURES A synchronized move of all patients on April 26, 2015, to a new hospital with 100% single-patient rooms equipped with individual toilets and showers and easy access to sinks for hand washing.MAIN OUTCOMES AND MEASURES Rates of nosocomial vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) colonization, VRE and MRSA infection, and Clostridioides difficile (formerly known as Clostridium difficile) infection (CDI) per 10 000 patient-days.RESULTS Compared with the 27 months before, during the 36 months after the hospital move, an immediate and sustained reduction in nosocomial VRE colonization (from 766 to 209 colonizations; incidence rate ratio [IRR], 0.25; 95% CI, 0.19-0.34) and MRSA colonization (from 129 to 112 colonizations; IRR, 0.57; 95% CI, 0.33-0.96) was noted, as well as VRE infection (from 55 to 14 infections; IRR, 0.30, 95% CI, 0.12-0.75). Rates of CDI (from 236 to 223 infections; IRR, 0.95; 95% CI, 0.51-1.76) and MRSA infection (from 27 to 37 infections; IRR, 0.89, 95% CI, 0.34-2.29) did not decrease.CONCLUSION AND RELEVANCE The move to a new hospital with exclusively single-patient rooms appeared to be associated with a sustained decrease in the rates of new MRSA and VRE colonization and VRE infection; however, the move was not associated with a reduction in CDI or MRSA infection. These findings may have important implications for the role of hospital construction in facilitating infection control.