title: Improved ICU design reduces acquisition of antibiotic-resistant bacteria: a quasi-experimental observational study.
abstract: BACKGROUND
  The role of ICU design and particularly single-patient rooms in decreasing bacterial transmission between ICU patients has been debated. A recent change in our ICU allowed further investigation.
  
  
  METHODS
  Pre-move ICU-A and pre-move ICU-B were open-plan units. In March 2007, ICU-A moved to single-patient rooms (post-move ICU-A). ICU-B remained unchanged (post-move ICU-B). The same physicians cover both ICUs. Cultures of specified resistant organisms in surveillance or clinical cultures from consecutive patients staying >48 hours were compared for the different ICUs and periods to assess the effect of ICU design on acquisition of resistant organisms.
  
  
  RESULTS
  Data were collected for 62, 62, 44 and 39 patients from pre-move ICU-A, post-move ICU-A, pre-move ICU-B and post-move ICU-B, respectively. Fewer post-move ICU-A patients acquired resistant organisms (3/62, 5%) compared with post-move ICU-B patients (7/39, 18%; P = 0.043, P = 0.011 using survival analysis) or pre-move ICU-A patients (14/62, 23%; P = 0.004, P = 0.012 on survival analysis). Only the admission period was significant for acquisition of resistant organisms comparing pre-move ICU-A with post-move ICU-A (hazard ratio = 5.18, 95% confidence interval = 1.03 to 16.06; P = 0.025). More antibiotic-free days were recorded in post-move ICU-A (median = 3, interquartile range = 0 to 5) versus post-move ICU-B (median = 0, interquartile range = 0 to 4; P = 0.070) or pre-move ICU-A (median = 0, interquartile range = 0 to 4; P = 0.017). Adequate hand hygiene was observed on 140/242 (58%) occasions in post-move ICU-A versus 23/66 (35%) occasions in post-move ICU-B (P < 0.001).
  
  
  CONCLUSIONS
  Improved ICU design, and particularly use of single-patient rooms, decreases acquisition of resistant bacteria and antibiotic use. This observation should be considered in future ICU design.
authors.affiliation: Department of Anesthesia and Critical Care, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel. levinp@netvision.net.il
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Levin
authors.forename: Mila
authors.initials: M
authors.lastname: Golovanevski
authors.forename: Allon E
authors.initials: AE
authors.lastname: Moses
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
authors.forename: Shmuel
authors.initials: S
authors.lastname: Benenson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D005260:Female; D006749:Hospital Design and Construction; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents