title: Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis.
abstract: BACKGROUND
  The influence of the hospital's infrastructure on healthcare-associated colonization and infection rates has thus far infrequently been examined. In this review we examine whether healthcare facility design is a contributing factor to multifaceted infection control strategies.
  
  
  METHODS
  We searched PubMed/MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) from 1990 to December 31st, 2015, with language restriction to English, Spanish, German and French.
  
  
  RESULTS
  We identified three studies investigating accessibility of the location of the antiseptic hand rub dispenser. Each of them showed a significant improvement of hand hygiene compliance or agent consumption with the implementation of accessible dispensers near the patient bed. Nine eligible studies evaluated the impact of single-patient rooms on the acquisition of healthcare-associated colonization and infections in comparison to multi-bedrooms or an open ward design. Six of these studies showed a significant benefit of single-patient bedrooms in reducing the healthcare-associated colonization and infection rate, whereas three studies found that single-patient rooms are neither a protective nor risk factor. In meta-analyses, the overall risk ratio for acquisition of healthcare-associated colonization and infection was 0.55 (95% CI: 0.41 to 0.74), for healthcare-associated colonization 0.52 (95% CI: 0.32 to 0.85) and for bacteremia 0.64 (95% CI: 0.53 to 0.76), all in favor of patient care in single-patient bedrooms.
  
  
  CONCLUSIONS
  Implementation of single-patient rooms and easily accessible hand rub dispensers located near the patient's bed are beneficial for infection control and are useful parts of a multifaceted strategy for reducing healthcare-associated colonization and infections.
authors.affiliation: Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Stiller
authors.affiliation: Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Salm
authors.affiliation: Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bischoff
authors.affiliation: Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
keywords: Hand hygiene compliance; Healthcare-associated infection; Hospital architecture; Hospital room size; Single-patient room; Ward design