Single rooms may help to prevent nosocomial bloodstream infection and cross-transmission of methicillin-resistant Staphylococcus aureus in intensive care units.

Abstract

Nosocomial infections remain a major problem in intensive care units. Several authorities have recommended housing patients in single rooms to prevent cross-transmission of potential pathogens, but this issue is currently debated. The aim of the present study was to compare the rate of nosocomial cross-contamination between patients hosted in single rooms versus bay rooms. Prospective observational data acquisition over 2.5 years. A 14-bed medico-surgical ICU, composed of six single-bed rooms plus a six-bed and a two-bed bay room served by the same staff. All patients admitted from 1 July 2002 to 31 December 2004. None. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in admitted patients was 1.1% and acquisition rate 2.4%. The incidence density of MRSA acquisition was 4.1 [95% CI 2.7-6.3]/1,000 patient-days in bay rooms versus 1.3 [0.5-3.4]/1,000 patient-days in single rooms (p<0.001). Pseudomonas spp. acquisition rate was 3.9 [2.5-6.1]/1,000 patient-days in bay rooms versus 0.7 [0.2-2.4]/1,000 patient-days in single rooms (p<0.001), and Candida spp. colonization was 38.4 [33.3-44.1]/1,000 patient-days in bay rooms versus 13.8 [10.2-18.6]/1,000 patient-days (p<0.001). By multivariate analysis, the relative risk of MRSA, Pseudomonas aeruginosa and Candida spp. acquisition in single rooms or cubicles versus bay rooms was 0.65, 0.61 and 0.75 respectively. These data suggest that in an institution where MRSA is not hyperendemic, infection control measures may be more effective to prevent cross-transmission of microorganisms in patients housed in single rooms.