title: Impact of neonatal intensive care bed configuration on rates of late-onset bacterial sepsis and methicillin-resistant Staphylococcus aureus colonization.
abstract: BACKGROUND
  Infections cause morbidity and mortality in neonatal intensive care units (NICUs). The association between nursery design and nosocomial infections is unclear.
  
  
  OBJECTIVE
  To determine whether rates of colonization by methicillin-resistant Staphylococcus aureus (MRSA), late-onset sepsis, and mortality are reduced in single-patient rooms. DESIGN Retrospective cohort study.
  
  
  METHODS
  NICU in a tertiary referral center.
  
  
  METHODS
  Our NICU is organized into single-patient and open-unit rooms. Clinical data sets including bed location and microbiology results were examined over 29 months. Differences in outcomes between bed configurations were determined by χ2 and Cox regression.
  
  
  METHODS
  All NICU patients.
  
  
  RESULTS
  Among 1,823 patients representing 55,166 patient-days, single-patient and open-unit models had similar incidences of MRSA colonization and MRSA colonization-free survival times. Average daily census was associated with MRSA colonization rates only in single-patient rooms (hazard ratio, 1.31; P=.039), whereas hand hygiene compliance on room entry and exit was associated with lower colonization rates independent of bed configuration (hazard ratios, 0.834 and 0.719 per 1% higher compliance, respectively). Late-onset sepsis rates were similar in single-patient and open-unit models as were sepsis-free survival and the combined outcome of sepsis or death. After controlling for demographic, clinical, and unit-based variables, multivariate Cox regression demonstrated that bed configuration had no effect on MRSA colonization, late-onset sepsis, or mortality.
  
  
  CONCLUSIONS
  MRSA colonization rate was impacted by hand hygiene compliance, regardless of room configuration, whereas average daily census affected only infants in single-patient rooms. Single-patient rooms did not reduce the rates of MRSA colonization, late-onset sepsis, or death.
authors.affiliation: 1Department of Pediatrics,Washington University School of Medicine,St. Louis,Missouri.
authors.forename: Samuel
authors.initials: S
authors.lastname: Julian
authors.affiliation: 2Departments of Pathology & Immunology and Pediatrics,Washington University School of Medicine,St. Louis,Missouri.
authors.forename: Carey-Ann D
authors.initials: CA
authors.lastname: Burnham
authors.affiliation: 3St. Louis Children's Hospital,St. Louis,Missouri.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sellenriek
authors.affiliation: 4Department of Internal Medicine,Washington University School of Medicine,St. Louis,Missouri.
authors.forename: William D
authors.initials: WD
authors.lastname: Shannon
authors.affiliation: 5Department of Pediatrics,Northwestern Feinberg School of Medicine,Chicago,Illinois.
authors.forename: Aaron
authors.initials: A
authors.lastname: Hamvas
authors.affiliation: 1Department of Pediatrics,Washington University School of Medicine,St. Louis,Missouri.
authors.forename: Phillip I
authors.initials: PI
authors.lastname: Tarr
authors.affiliation: 1Department of Pediatrics,Washington University School of Medicine,St. Louis,Missouri.
authors.forename: Barbara B
authors.initials: BB
authors.lastname: Warner
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration; D015931:Intensive Care, Neonatal / Q000379:methods* / Q000458:organization & administration; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D017063:Outcome Assessment, Health Care; D010362:Patients' Rooms; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control*