A comprehensive and impressive cluster randomised crossover study published in Lancet ID examines whether it makes sense to use single rooms (as compared with multi-bed bays) to apply contact precautions for patients known to be carrying ESBL-Enterobacteriaceae. I need to be careful what I say, because fellow bloggers Marc and Andreas are co-authors. However, the gist seems to be: don’t bother with single rooms for ESBL-E carriers – but many hospitals don’t have capacity to do that anyway, so this may not be a practice-changing finding in many parts of the world!
It is with great pleasure that I ask your attention for this article that appeared in the Economist. Yes, we still have low resistance rates in our hospitals and if you’re interested in how that happened, read it. The prosaic composition contains two parts; a very realistic thriller-like opening, followed by a second part with a rather unrealistic explanation. Both parts are separated by a short sentence of absolute nonsense. Time for a review. Continue reading
There are pros and cons of increasing the proportion of single rooms. One of the commonly-cited pros is a reduction in HCAI. A recent UK study provides some evidence that C. difficlie infection, and MSSA / E. coli BSIs are not reduced by a move to a hospital with more single rooms, but that norovirus control is more effective when you have more single rooms.
What an excellent start of 2017. A great study from the USA today in Lancet: In a pragmatic cluster-randomized crossover study they tested 4 patient room cleaning strategies on the effectiveness to reduce acquisition with relevant bacteria for the incoming patients. The conclusion states that “enhanced terminal room disinfection decreases the risk of pathogen acquisition.” Yet, this paper is so “data-dense” that you must read the methods (and supplements) to get the picture. In one shot: Not for C. diff, may be for MRSA and yes for VRE. Continue reading
An interesting review article examines the relationship between three related variables: the proportion of single rooms, the size of the patient room and patient proximity, and the availability of antiseptic hand rub, with various HCAI indicators. The bottom line is that both a move towards a higher proportion of single rooms and larger patient rooms are associated with reduced HCAI, and making hand gels more available improves compliance with their use (unsurprisingly).
Interesting publication being highlighted as part of the WHO hand hygiene day in Leeds, UK suggests through modelling that the type of care, number of surface contacts and the distribution of surface pathogens are most likely to affect the relative quantity of pathogens accried on hands. The paper is published in ‘Indoor Air’, (not a journal that inhabits my bedside table) and we do have to remember that, as G.E.P Box stated, “Essentially, all models are wrong. But some are useful”.
Following my blog last week reflecting on the debate published in the British Medical Journal on “Should hospitals provide all patients with single rooms?”, I asked the same question to Linkedin and Twitter. My informal poll received a total of 37 responses, which is not the largest survey you’ll ever see but probably a meaningful sample size. Overall, 54% of respondents answered ‘Yes’ and 45% answered ‘No’ (Figure).
An interesting feature of the survey was the difference between Linkedin and Twitter, with two third of respondents saying Yes on Linked vs. only 20% on Twitter. I suspect this is explained by the fact that most respondents on Twitter were frontline healthcare workers, who see first-hand the problems caused by placing patients in single rooms when they’d rather be in a bay, or when it compromises their safety.
As with most surveys, the listening to the comments that people make is probably more important than the answers they give, particularly to binary questions such as this one. The poll promoted some useful discussion on Linkedin, with several comments wrestling with the pros and cons of single rooms. I’ve collated a number of Tweets below, which illustrate the view of many frontline staff that a mixture of single rooms and bays is preferable:
- Healthcare Infection @HealthcareInfec, 4 Dec: “single rooms- a minimum requirement would be a good start & allows flexibility if needed. Certainly >50%.”
- AllisonClaireBradley @allisoncbradley, 3 Dec: “No for me too. Get so many requests from patients desperate to move out of isolation.”
- Craig Bradley @CraigBradleyF1, 3 Dec: “NO for so many reasons. We do well with 36%.”
- Sue Millward @suemillward1, 3 Dec: “Not all patients want to be alone, Some pts need to be watched! So NO.”
- Gary Thirkell @pollygary 3 Dec: “depends on speciality. Yes for some and no for others. Ability to adapt the room a possibility.”
- Infection Control @uhcw_inf_con 3 Dec: “No. Isolation has psychological impact on patients & can effect falls risk amongst other things. Need holistic care.”
Clearly, there are some inherent problems with polls, not least the fact that those with strong opinions are more likely to respond and I have no idea how many people saw the survey and decided not to vote. The roughly 50:50 split in opinion on the single room issue is similar to the survey of patients commissioned by the Scottish government, which found that 41% of patients would prefer to be admitted to a single room.
Should hospitals provide single rooms for all patients? Whilst I would definitely prefer a single room if admitted to hospital, there are some strong arguments for a mixture of single rooms and bays in some specialties. So, I agree with the English recommendation of 50% single rooms as a minimum requirement.