Being admitted to a private room in a hospital’s intensive care unit can dramatically decrease the likelihood of a patient contracting an infection, a recent McGill study suggests.
About one in three patients admitted to hospital ICUs contract some sort of infection, which increases the length of the average hospital stay by eight to nine days. In the United States, this is estimated to cost health care providers $3.5 billion each year.
But putting patients in private rooms, rather than in shared rooms with curtain partitions, can cut the rate of infection by certain types of bacteria in half.
“There are three types of bacteria that are really at the focus of infection control efforts: Methicillin-resistant Staphylococcus aureus, Clostridium difficile and vancomycin-resistant enterococci,” said Dana Teltsch, a McGill PhD candidate who was the study’s lead author. “For the three of them combined, the reduction was 54 per cent, and this is a very serious reduction.”
Teltsch’s study, published last week in Archives of Internal Medicine, detected decreases in 12 types of bacteria, six of which were large enough to be statistically significant. While other studies have investigated the effect of making rooms private, Teltch said, hers compared a greater variety of bacteria, with more conclusive results.
To conduct the study, Teltsch compared data from the Montreal General Hospital and the Royal Victoria Hospital over a period of five years during which the Montreal General Hospital carried out renovations that made all ICU rooms private. The Royal Victoria Hospital, however, had a mixture of shared and private rooms in its ICU.
“The two populations are, by and large, comparable in the severity of illness,” said Dr. Peter Goldberg, the director of adult critical care at the McGill University Health Centre and a co-author of the study. This similarity made the two hospitals ideal for purposes of comparison.
Because both hospitals are part of the MUHC, Teltsch said, they also followed the same infection-control management and other practices, enabling her to hone in on one variable: the types of rooms.
In the time since Teltsch’s data set was collected, the Royal Victoria Hospital has switched to private rooms in its ICU as well, Goldberg said. That makes the two centres exceptions among Montreal hospitals, however, most of which still use shared rooms.
“Hospitals with a mix of private and shared rooms still confine patients with infections to individual rooms,” Goldberg said. But it can take doctors up to 72 hours after a patient is admitted to determine whether or not he has an infection.
“In that 72 hours, you may have come into contact with many people: staff, other patients,” Goldberg said. “By putting a patient straightaway into a private room, you have essentially put them in isolation, so that they don’t have the ability to transmit.”
Teltsch’s study may encourage more hospitals to abandon shared ICU rooms, but that may also fuel a rise in costs for hospitals. In addition to the cost of renovations, Goldberg said, hospitals may need to hire more nurses in order to monitor patients in individual rooms, rather than a single shared one.
Separate rooms may also change doctors’ and nurses’ practices in the ICU, Goldberg added. If patients are treated in separate rooms, he said, nurses may be more inclined to wash their hands as they move from patient to patient.
“Private rooms are not only barriers [to infection],” Goldberg said. “They are also instigators of different behaviours.”