title: Hospital ward design and prevention of hospital-acquired infections: A prospective clinical trial.
abstract: BACKGROUND
  Renovation of a general medical ward provided an opportunity to study health care facility design as a factor for preventing hospital-acquired infections.
  
  
  OBJECTIVE
  To determine whether a hospital ward designed with predominantly single rooms was associated with lower event rates of hospital-acquired infection and colonization.
  
  
  METHODS
  A prospective controlled trial with patient allocation incorporating randomness was designed with outcomes on multiple 'historic design' wards (mainly four-bed rooms with shared bathrooms) compared with outcomes on a newly renovated 'new design' ward (predominantly single rooms with private bathrooms).
  
  
  RESULTS
  Using Poisson regression analysis and adjusting for time at risk, there were no differences (P=0.18) in the primary outcome (2.96 versus 1.85 events/1000 patient-days, respectively). After adjustment for age, sex, Charlson score, admitted from care facility, previous hospitalization within six months, isolation requirement and the duration on antibiotics, the incidence rate ratio was 1.44 (95% CI 0.71 to 2.94) for the new design versus the historic design wards. A restricted analysis on the numbers of events occurring in single-bed versus multibed wings within the new design ward revealed an event incidence density of 1.89 versus 3.47 events/1000 patient-days, respectively (P=0.18), and an incidence rate ratio of 0.54 (95% CI 0.15 to 1.30).
  
  
  CONCLUSIONS
  No difference in the incidence density of hospital-acquired infections or colonizations was observed for medical patients admitted to a new design ward versus historic design wards. A restricted analysis of events occurring in single-bed versus multibed wings suggests that ward design warrants further study.
authors.affiliation: Alberta Health Services, Calgary and Area, Calgary, Alberta.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ellison
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta ; Institute for Public Health, University of Calgary, Calgary, Alberta.
authors.forename: Danielle
authors.initials: D
authors.lastname: Southern
authors.affiliation: Alberta Health Services, Calgary and Area, Calgary, Alberta ; Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta.
authors.forename: Donna
authors.initials: D
authors.lastname: Holton
authors.affiliation: Alberta Health Services, Calgary and Area, Calgary, Alberta ; Department of Community Health Sciences, University of Calgary, Calgary, Alberta.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Henderson
authors.affiliation: Department of Sociology, Faculty of Arts, University of Calgary, Calgary, Alberta.
authors.forename: Jean
authors.initials: J
authors.lastname: Wallace
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta ; Institute for Public Health, University of Calgary, Calgary, Alberta.
authors.forename: Peter
authors.initials: P
authors.lastname: Faris
authors.affiliation: Alberta Health Services, Calgary and Area, Calgary, Alberta ; Department of Community Health Sciences, University of Calgary, Calgary, Alberta ; Institute for Public Health, University of Calgary, Calgary, Alberta ; Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta.
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
authors.affiliation: Alberta Health Services, Calgary and Area, Calgary, Alberta ; Institute for Public Health, University of Calgary, Calgary, Alberta ; Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta ; Calvin, Phoebe and Joan Synder Institute for Chronic Diseases, Faculty of Medicine, University of Calgary and Alberta Health Services, Calgary and Area, Calgary, Alberta.
authors.forename: John
authors.initials: J
authors.lastname: Conly
keywords: Antibiotic-resistant organism; Controlled trial; Hospital-acquired infection; Incidence density; Multibed room; Physical plant; Single room; Ward design