Single-patient Rooms Research Articles

Les chambres familiales en néonatologie : effets sur le nouveau-né prématuré, ses parents et l’équipe soignante. Revue systématique de la littérature

The quality of the environment is an essential point in the care of preterm newborns. The design of neonatal intensive care units (NICUs) (open-bay, single-patient room, single-family room) directly affects both the preterm newborns and their caregivers (parents, healthcare staff). The aim of this systematic review was to evaluate the impact of single-family rooms on the preterm newborn, its parents, and the staff. Single-family rooms improve outcome for the preterm newborn, with increasing parental involvement and better control of the environment (fewer inappropriate stimulations such as high levels of noise and illumination). This kind of NICU design also improves parental and staff satisfaction.

Single-room usage patterns and allocation decision-making in an Australian public hospital: a sequential exploratory study.

The aims are to (1) measure occupancy rates of single and shared rooms; (2) compare single room usage patterns and (3) explore the practice, rationale and decision-making processes associated with single rooms; across one Australian public health service. There is a tendency in Australia and internationally to increase the proportion of single patient rooms in hospitals. To date there have been no Australian studies that investigate the use of single rooms in clinical practice. This study used a sequential exploratory design with data collected in 2014. A descriptive survey was used to measure the use of single rooms across a two-week time frame. Semi-structured interviews were undertaken with occupancy decision-makers to explore the practices, rationale decision-making process associated with single-room allocation. Total bed occupancy did not fall below 99·4% during the period of data collection. Infection control was the primary reason for patients to be allocated to a single room, however, the patterns varied according to ward type and single-room availability. For occupancy decision-makers, decisions about patient allocation was a complex and challenging process, influenced and complicated by numerous factors including occupancy rates, the infection status of the patient/s, funding and patient/family preference. Bed moves were common resulting from frequent re-evaluation of need. Apart from infection control mandates, there was little tangible evidence to guide decision-making about single-room allocation. Further work is necessary to assist nurses in their decision-making. There is a trend towards increasing the proportion of single rooms in new hospital builds. Coupled with the competing clinical demands for single room care, this study highlights the complexity of nursing decision-making about patient allocation to single rooms, an issue urgently requiring further attention.

Die Einrichtung von Einzelzimmern auf neonatologischen Intensivstationen – Auswirkungen auf die Betreuung aus Sicht der Eltern

Single patient room design is not yet implemented in German neonatal intensive care units. Surveys from other countries revealed positive and negative implications on the staff, the patients and their families. The survey examines the perceptions of parents who experienced both facilities - the traditional multipatient ward and the individual patient room - during their babies' hospital stays. A standardized questionnaire was used to assess the perceptions of parents. The results were compared to international surveys. During their stay in the single patient room, parents noticed improvements in privacy and data protection and a reduction in harmful environmental stimuli affecting their babies. These results are comparable to those of international surveys. Single patient room design is mostly perceived as an improvement by parents. The room design can complement an implemented concept of developmental and family-centered care.

Moving to a Single Patient Room Design: Are There Physical and Psychological Effects on the Neonatal Intensive Care Unit Staff?

Purpose: The purpose of this study was to quantify the physical and psychological changes in staff health after moving from an open bay (OB) Neonatal Intensive Care Unit (NICU) to a single patient room (SPR) design. Subjects: 81 registered nurses, respiratory therapists, and neonatal nurse practitioners working in a 45 bed, regional referral, level IV NICU were recruited for the study. 59 participants completed all study activities. Design: A pre-post experimental design was used. Methods: The number of steps taken during a routine work shift were measured, for 3days, first in the OB NICU, and then in the SPR NICU, 3 months after the move. Blood pressure and body weight were measured in both locations as a measure of physical health. Participants also completed a questionnaire to assess chronic health conditions, musculoskeletal health, and involvement in weight control and exercise programs. Mental health was measured before and after the move with the Psychiatric Symptoms Index (PSI), and a brief survey about perception of the work environment, including space, light, and noise. Results: Participants walked, on average, nearly 900 steps more each day ( just over 1/3 of a mile) in the SPR NICU (6082.41) than the OB NICU (5185.23), p=0.014; physiologic parameters were unchanged. Hypertension was identified in 2 participants previously unaware of the condition; there were no changes in musculoskeletal complaints. Mental health was unchanged despite a significant increase in satisfaction with the amount of work and personal space (p<0.001), noise level (p<0.001), and natural light (p<0.001), in the new SPR NICU compared to the traditional OB NICU. NICU staff had high levels of anxiety and depression; 32% reported symptoms associated with clinical depression. Conclusions: New NICU designs and technological advances in monitoring and communication are thought to improve the quality of health care, family satisfaction and ease workflow burden for staff.There was a modest increase in the physical demands of the work environment in the SPR compared to OB NICU, which was neither beneficial nor harmful to staff’s physical health. Despite increased satisfaction with the physical space, psychological health was unchanged, with a high proportion of staff reporting symptoms associated with anxiety and depression. Although redesigned NICUs are appreciated for their aesthetics, the new work environment may not contribute to improvement in staff mental health.

Relocating an intensive care unit: An exploratory qualitative study

BackgroundAs new hospitals are built to replace old and ageing facilities, intensive care units are being constructed with single patient rooms rather than open plan environments. While single rooms may limit hospital infections and promote patient privacy, their effect on patient safety and work processes in the intensive care unit requires greater understanding. Strategies to manage changes to a different physical environment are also unknown. ObjectivesThis study aimed to identify challenges and issues as perceived by staff related to relocating to a geographically and structurally new intensive care unit. MethodsThis exploratory ethnographic study, underpinned by Donabedian's structure, process and outcome framework, was conducted in an Australian tertiary hospital intensive care unit. A total of 55 participants including nurses, doctors, allied health professionals, and support staff participated in the study. We conducted 12 semi-structured focus group and eight individual interviews, and reviewed the hospital's documents specific to the relocation. After sorting the data deductively into structure, process and outcome domains, the data were then analysed inductively to identify themes. FindingsThree themes emerged: understanding of the relocation plan, preparing for the uncertainties and vulnerabilities of a new work environment, and acknowledging the need for change and engaging in the relocation process. Discussion and conclusionsA systematic change management strategy, dedicated change leadership and expertise, and an effective communication strategy are important factors to be considered in managing ICU relocation. Uncertainty and staff anxiety related to the relocation must be considered and supports put in place for a smooth transition. Work processes and model of care that are suited to the new single room environment should be developed, and patient safety issues in the single room setting should be considered and monitored. Future studies on managing multidisciplinary work processes during intensive care unit relocation will add to the learnings we report here.

Do cost savings from reductions in nosocomial infections justify additional costs of single-bed rooms in intensive care units? A simulation case study

PurposeEvidence shows that single-patient rooms can play an important role in preventing cross-transmission and reducing nosocomial infections in intensive care units (ICUs). This case study investigated whether cost savings from reductions in nosocomial infections justify the additional construction and operation costs of single-bed rooms in ICUs. Materials and methodsWe conducted deterministic and probabilistic return-on-investment analyses of converting the space occupied by open-bay rooms to single-bed rooms in an exemplary ICU. We used the findings of a study of an actual ICU in which the association between the locations of patients in single-bed vs open-bay rooms with infection risk was evaluated. ResultsDespite uncertainty in the estimates of costs, infection risks, and length of stay, the cost savings from the reduction of nosocomial infections in single-bed rooms in this case substantially outweighed additional construction and operation expenses. The mean value of internal rate of return over a 5-year analysis period was 56.18% (95% credible interval, 55.34%-57.02%). ConclusionsThis case study shows that although single-patient rooms are more costly to build and operate, they can result in substantial savings compared with open-bay rooms by avoiding costs associated with nosocomial infections.

Quantifying patient bacterial exposure risk from reusable phlebotomy tourniquets in a New Zealand secondary level hospital.

This study aimed to assess for the presence of multi-drug resistant organisms (MDROs) on tourniquets and quantify the number of bacteria to which patients might be exposed with each blood collection episode. Tourniquets were randomly sampled in a 246-bed, secondary level, New Zealand hospital, which is currently non-endemic for MDROs. A 6-cm length of each tourniquet sampled was applied to the surface of an agar plate and the colony forming units (CFUs) were enumerated. All colonies were then screened for MDROs using standard methods. CFU counts per linear centimetre were multiplied by a range of patient arm circumference measurements. Comparison was also made between non-disinfected tourniquets left on the wards and phlebotomy service tourniquets after daily decontamination with a proprietary disinfectant. The median exposure risk from non-disinfected tourniquets was 173 CFUs per collect (95% CI, 104-861). None of the general ward tourniquets grew any MDROs but four out of five dedicated, single-patient reusable isolation room tourniquets grew MRSA. Disinfected tourniquets had few if any CFUs and CFU counts were significantly lower than non-disinfected tourniquets (P = 0.0001). The quantitative risk from reusable tourniquets appears low in the setting of MDRO non-endemicity, with the application of standard infection control practices.

The effectiveness of environmental strategies on noise reduction in a pediatric intensive care unit: creation of single-patient bedrooms and reducing noise sources.

Noise is a substantial problem for both patients and healthcare workers in hospitals. This study aimed to determine the effectiveness of environmental strategies (creating single-patient rooms and reducing noise sources) in noise reduction in a pediatric intensive care unit. Noise measurement in the unit was conducted in two phases. In the first phase, measurements aimed at determining the unit's present level of noise were performed over 4 weeks in December 2013. During the month following the first measurement phase, the intensive care unit (ICU) was moved to a new location and noise-reducing strategies were implemented. The second phase, in May 2014, measured noise levels in the newly constructed environment. The noise levels before and after environmental changes were statistically significant at 72.6 dB-A and 56 dB-A, respectively (p < .05). Single-patient rooms and noise-reducing strategies can be effective in controlling environmental noise in the ICU.

Methods to assess human occupancy and occupant activity in hospital patient rooms

Human occupants have a profound influence on indoor environments, although there is limited information on means to cost-effectively assess occupant metrics in all types of buildings. Multiple measures of occupancy (i.e., the number of occupants and the duration of their presence) and occupant activity (i.e., the number of occupant movements through room doorways) were investigated in ten single-patient rooms in a new hospital in Chicago, Illinois as part of the Hospital Microbiome Project, with the overarching goal of determining occupant characteristics to inform an investigation of interactions between humans and microbial communities. Four relatively low-cost, non-invasive methods to estimate time-resolved occupancy and occupant activity were developed using data from (1) CO2 concentration sensors installed in patient rooms and the supply air streams serving each room and (2) non-directional doorway beam-break sensors installed at each patient room doorway. A method that utilized data from both sensors produced the most accurate estimates and was used to characterize time-varying occupancy and occupant activity. Daily occupancy varied among rooms, with median values ranging from 0 to 3 persons per hour. Occupant activity exhibited less variation on average (approximately 8 doorway movements per hour), but reached high levels on certain days for some patient rooms. No consistent relationship was observed between estimated occupancy and occupant activity, indicating that one metric cannot be inferred from the other. This study shows that this dual-sensor methodology provides a relatively inexpensive, non-invasive, accurate approach to estimate occupancy and occupant activity in an environment with rigorous privacy and security limitations.

Ebola fever: reconciling planning with risk in U.S. hospitals.

The authors of this commentary believe that current recommendations from the Centers for Disease Control and Prevention to prevent transmission of Ebola to health care workers are appropriate. Addi...

Molecular epidemiological analysis suggests cross-infection withPseudomonas aeruginosais rare in non-cystic fibrosis bronchiectasis

To the Editor: In both cystic fibrosis (CF) and non-CF bronchiectasis (NCFBr) chronic Pseudomonas aeruginosa infection is adversely prognostic [1, 2]. In CF, epidemic infections with specific clones of P. aeruginosa are associated with further adverse outcomes [3, 4]. This cross-infection risk has led to segregation of patients [5]. There are few data on P. aeruginosa cross-infection in NCFBr. As a result, segregation in NCFBr has not been addressed in guidelines [6]. Our aim was to undertake a cross-infection study in NCFBr. This was undertaken in an adult bronchiectasis service in the north-east of England (UK) that is separated from the regional CF unit (sited 2 miles (3 km) away). The service was initiated in 2007 with a weekly specialist clinic without a Pseudomonas -specific clinic. When NCFBr patients are hospitalised, there is a preference for cubicle-based (single-patient room) management, but when cubicles are unavailable, patients are managed in six-bed bays. All patients had computed tomographic confirmation and had predominantly idiopathic or post-infectious bronchiectasis with CF excluded following current guidelines [6]. The study had ethical permission and Caldicott approval (Newcastle and North Tyneside National Research Ethics Service Committee). 56 isolates were selected for analysis. Six were chosen from CF patients as laboratory controls. 50 were NCFBr isolates collected between 2008 and 2011 from …

The Role of the Hospital Environment in the Prevention of Healthcare-Associated Infections by Contact Transmission

OBJECTIVE: This article describes the role of the hospital environment in the spread of pathogens by direct and indirect contact. In addition, the prevention of transmission through interventions involving the built environment is discussed. BACKGROUND: The hospital environment can become contaminated with pathogenic microorganisms, some of which can persist for long periods of time. Although contamination is common, the contribution of the hospital environment to the development of healthcare-associated infections remains unclear. In part spurred by the development of newer technologies to enhance environmental cleaning or to prevent contamination, research into the role of the environment in causing healthcare-associated infections has accelerated. TOPICAL HEADINGS: A review of the recent literature finds an increasing body of evidence implicating contaminated surfaces in patient care areas in the transmission of pathogens and the development of infections. Single-patient rooms and optimally placed alcohol hand rub dispensers and other design features can mitigate infection risk. Enhanced environmental cleaning including touchless technologies and self-cleaning surfaces can reduce environmental contamination and may prevent infections. CONCLUSIONS: The hospital environment contributes to transmission of pathogens in hospitals and to the development of healthcare-associated infections. Newer technologies to prevent environmental contamination or to enhance cleaning are promising although additional studies with the endpoints of reduction of infections are needed before the role of these technologies is known.

139 Evidence of Pseudomonas aeruginosa super-shedding from individual patients leading to airborne dissemination in a UK CF centre

Objectives: The extent and mechanism of cross-infection with Pseudomonas aeruginosa (PA) in specialist cystic fibrosis (CF) units remain controversial. Prevention of droplet spread by segregation and use of single patient rooms is advised by most authorities. Despite these measures, many centres continue to report outbreaks of clonal “epidemic” strains. We conducted an aerobiological study to examine airborne dispersal of PA in a large CF centre in the UK. Methods: Microbiological air sampling was conducted in outpatient and inpatient areas inhabited by patients known to harbour the Liverpool Epidemic Strain (LES) of PA. A volumetric air sampler was placed at least 1m from patients, working at a rate of 100 L/min with a sampling time of 10min. Any colonies growing on Pseudomonas selective agar were identified by phenotypic and molecular methods and the number of colony-forming units (CFUs) counted. Conclusion: Out of 177 samples obtained from 8 separate patient environments, 33 (19%) grew PA. Contamination was greater in patient rooms than corridor areas; 23% (29/125) vs 10% (4/51) respectively. Rooms inhabited by 3 of 8 patients yielded positive growth. Corridor air was positive in the vicinity of 1 patient’s closed room. Samples from this patient’s room demonstrated much higher counts than those from other rooms (mean 61CFU/m3 vs 0−3CFU/m3). These data confirm that PA can contaminate air >1m from patients and suggest that certain patients may act as “super-shedders”. Ventilation strategies and infection control precautions in CF centres should take into account the possibility of true airborne transmission of PA.

140 Population structure of Pseudomonas aeruginosa and the prevalence of epidemic clones in patients with cystic fibrosis over four years

Objectives: The extent and mechanism of cross-infection with Pseudomonas aeruginosa (PA) in specialist cystic fibrosis (CF) units remain controversial. Prevention of droplet spread by segregation and use of single patient rooms is advised by most authorities. Despite these measures, many centres continue to report outbreaks of clonal “epidemic” strains. We conducted an aerobiological study to examine airborne dispersal of PA in a large CF centre in the UK. Methods: Microbiological air sampling was conducted in outpatient and inpatient areas inhabited by patients known to harbour the Liverpool Epidemic Strain (LES) of PA. A volumetric air sampler was placed at least 1m from patients, working at a rate of 100 L/min with a sampling time of 10min. Any colonies growing on Pseudomonas selective agar were identified by phenotypic and molecular methods and the number of colony-forming units (CFUs) counted. Conclusion: Out of 177 samples obtained from 8 separate patient environments, 33 (19%) grew PA. Contamination was greater in patient rooms than corridor areas; 23% (29/125) vs 10% (4/51) respectively. Rooms inhabited by 3 of 8 patients yielded positive growth. Corridor air was positive in the vicinity of 1 patient’s closed room. Samples from this patient’s room demonstrated much higher counts than those from other rooms (mean 61CFU/m3 vs 0−3CFU/m3). These data confirm that PA can contaminate air >1m from patients and suggest that certain patients may act as “super-shedders”. Ventilation strategies and infection control precautions in CF centres should take into account the possibility of true airborne transmission of PA.

Bibliotherapy: tracing the roots of a moral therapy movement in the United States from the early nineteenth century to the present.

Bibliotherapy: tracing the roots of a moral therapy movement in the United States from the early nineteenth century to the present.

Clinician Perceptions of a Changing Hospital Environment

The purposes of this study were to describe how a move into a new hospital influenced the work environment, how long it takes clinicians to adjust to such a significant change, and how much a new hospital work environment helps the practice shift toward patient- and family-centered care (PFCC). Creating a healthy work environment to keep patients safe and staff engaged in the mission of the organization is perhaps one of the most important roles of hospital administrators and nursing leaders. A descriptive and comparative design was used to investigate how clinicians perceive, evaluate, and adjust to a new hospital environment, and how much a healthy work environment helps the practice shift toward patient- and family-centered care. Perceived stress was significantly higher than baseline 15 months after the move into the new hospital (p < 0.0000), and employees with 3 or more years of service had significantly higher stress than others (p < 0.000). Nurses had the second lowest mean stress score (x = 12.5). The PFCC score increased significantly (p < 0.007). The single-patient room model increased the workload of many clinicians, and their stress increased after 15 months. There were additional burdens not measured that also may have added to the stress of the participants. The new hospital enabled a significant practice shift toward PFCC. Healing environments, organizational transformation, patient-centered care, pediatric, satisfaction.

The New Standard

Nurse leaders influence decisions related to single patient rooms or multioccupancy room designs. The purpose of this facility design article is to expand nurse leaders' knowledge and competency in health facility design enabling them to lead design efforts and the transition to new facilities and models of care. This article describes the new standard of all-private rooms for adult and neonatal ICU care and defines the benefits of the single family room design on patients, families, and providers.

Healing environment: A review of the impact of physical environmental factors on users

In recent years, the effects of the physical environment on the healing process and well-being have proved to be increasingly relevant for patients and their families (PF) as well as for healthcare staff. The discussions focus on traditional and institutionally designed healthcare facilities (HCF) relative to the actual well-being of patients as an indicator of their health and recovery. This review investigates and structures the scientific research on an evidence-based healthcare design for PF and staff outcomes. Evidence-based design has become the theoretical concept for what are called healing environments. The results show the effects on PF and staff from the perspective of various aspects and dimensions of the physical environmental factors of HFC. A total of 798 papers were identified that fitted the inclusion criteria for this study. Of these, 65 articles were selected for review: fewer than 50% of these papers were classified with a high level of evidence, and 86% were included in the group of PF outcomes. This study demonstrates that evidence of staff outcomes is scarce and insufficiently substantiated. With the development of a more customer-oriented management approach to HCF, the implications of this review are relevant to the design and construction of HCF. Some design features to consider in future design and construction of HCF are single-patient rooms, identical rooms, and lighting. For future research, the main challenge will be to explore and specify staff needs and to integrate those needs into the built environment of HCF.

Outbreak of pandemic 2009 influenza A/H1N1 infection in the hematology ward: fatal clinical outcome of hematopoietic stem cell transplant recipients and emergence of the H275Y neuraminidase mutation

We report an outbreak of pandemic 2009 influenza A/H1N1 virus (2009 H1N1) infection that occurred in the hematology ward of our institution during the 2010–2011 influenza season. A total of seven hospitalized patients with hematologic tumors, including five recipients of hematopoietic stem cell transplantation (HSCT), successively developed rapid influenza detection test (RIDT)-positive influenza A; four patients had laboratory-confirmed 2009 H1N1 infection. Three HSCT recipients required mechanical ventilation support and two were admitted to the intensive care unit; they died of progressive respiratory failure despite receiving available anti-viral drugs. We implemented outbreak-control measures including transferal of RIDT-positive patients to a single-patient room and chemoprophylaxis with oseltamivir. We note that the H275Y neuraminidase mutation was detected in respiratory specimens from three patients, who were administered therapeutic or prophylactic dosages of oseltamivir. The present report demonstrates that the nosocomial 2009 H1N1 outbreak in the hematology ward led to fatal clinical outcomes and the emergence of a resistant virus at a markedly high rate.

A European survey of nosocomial infection control and hospital-acquired pneumonia prevention practices

We aimed to examine organizational, structural and routine infection control measures provided by European ICUs and staff practices in ventilator-associated pneumonia prevention in relation with current recommendations. European ICU staffs were invited to complete a web-based 20 closed-item questionnaire. 675 nurses and 886 physicians from 13 countries answered the questionnaire. Median number of respondents per country was 118.0 (64.5-155.5). Availability and organizational aspects of infection control revealed wide variations between countries. Among them, single-patient rooms was the aspect with the lowest availability (median availability 38%), but the largest variation ranging from 15 to 84%. Self-reported median adherence rate to recommendations was 72% (34.5-83.0) with a strong correlation between nurses and physicians responses (r²=0.96; p<0.0001). Sub-glottic drainage (31%), and infrequent ventilatory-circuit change (24%) were the measures with the lowest adherence rate whereas preferential use of oral intubation (90%) and of NIV (84%) and use of HMEs (82%) were the three with the highest rate. Organization of infection control was consistently self-reported. Disparities among countries were more frequent for specific actions regarding airway management, and even moreso for controversial issues (subglottic drainage, closed-suction systems). This European survey shows a 72% overall adherence rate to VAP prevention measures; with strong agreements between physician and nurses but considerable differences among countries for availability and organization aspects of infection control, providing healthcare authorities with figures for future programs.