title: ICU ward design and nosocomial infection rates: a cross-sectional study in Germany.
abstract: BACKGROUND
  There is increasing interest in the effects of hospital and ward design on multi-faceted infection control. Definitive evidence is rare and the state of knowledge about current ward design is lacking.
  
  
  OBJECTIVE
  To collect data on the current status of ward design for intensive care units (ICUs) and to analyse associations between particular design factors and nosocomial infection rates.
  
  
  METHODS
  In 2015, operational infrastructure data were collected via an online questionnaire from ICUs participating voluntarily in the German nosocomial infection surveillance system (KISS). A multi-variate analysis was subsequently undertaken with nosocomial infection rates from the KISS database from 2014 to 2015.
  
  
  RESULTS
  In total, 534 ICUs submitted data about their operational infrastructure. Of these, 27.1% of beds were hosted in single-bed rooms with a median size of 18m2(interquartile range 15-21m2), and 73.5% of all ICU beds had a hand rub dispenser nearby. The authors were able to match 266 ICUs in the multi-variate analysis. ICUs with openable windows in patient rooms were associated with lower device-associated lower respiratory tract infections [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.90]. ICUs with >40% two-bed rooms were associated with lower primary bloodstream infection rates (OR 0.66, 95% CI 0.51-0.86).
  
  
  CONCLUSIONS
  Only minor associations were found between design factors and ICU infection rates. Most were surrogates for other risk factors.
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany. Electronic address: andrea.stiller@charite.de.
authors.forename: A
authors.initials: A
authors.lastname: Stiller
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schröder
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Gropmann
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Schwab
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Behnke
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Geffers
authors.affiliation: Institute of Industrial Building and Construction Design, Technical University Carolo Wilhelmina Braunschweig, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Sunder
authors.affiliation: Institute of Industrial Building and Construction Design, Technical University Carolo Wilhelmina Braunschweig, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Holzhausen
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Gastmeier
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005858:Germany / Q000453:epidemiology; D006749:Hospital Design and Construction; D006801:Humans; D007362:Intensive Care Units; D011795:Surveys and Questionnaires
keywords: Infection control; Intensive care unit; Nosocomial infection; Ward design