Hospital infection; The move to single patient rooms at the McGill University Health Centre’s (MUHC) Glen site in 2015 resulted in significantly reduced rates of hospital acquired infections, suggests a study publish today in the highly respect journal JAMA: Internal Medicine published by the American Medical Association.
A team at the Research Institute of the McGill University Health Centre found that rates of both colonization and blood infections due to vancomycin resistant Enterococcus, a common multi drug resistant organism, fell immediately and dramatically after the relocation, suggesting an association between single patient rooms and reduce risk of hospital acquire infections. Their findings have important implications for infection control strategies in the context of the construction or renovation of hospitals.
While the move appear to be with a sustain decrease in the rates of nosocomial MRSA colonization; the reduction of CDI or MRSA infection was not statistically significant. Rates of infection at the Glen decrease by over 70% for VRE and over 30% for CDI. However, whereas the reduction in VRE was clearly in excess of changes in the province; the changes in CDI seem to mirror those which have been happening throughout Quebec and Canada.
“While we cannot prove causation in a study like this, the changes were so immediate; so striking that we are fairly convince they were mostly a result of the move,” notes senior and corresponding author Dr. Todd Campbell Lee, who is an investigator in the Infectious Diseases and Immunity in Global Health Program of the RI-MUHC and an infectious diseases specialist at the MUHC.
“However, the ongoing effort by the MUHC staff to keep the facilities rigorously clean; encourage excellent staff hand hygiene; also intervene more aggressively when outbreaks are discovered has help maintain our rates fairly low,” adds Dr. Lee, who is also an Associate Professor in the Faculty of Medicine at McGill University.
Hospital Infection Rates
The researchers used data provided by the provincial surveillance network of nosocomial infection (Surveillance provinciale des infections nosocomiales SPIN) of the Institut national de santé publique du Québec (INSPQ). The use of years of standardize provincial records for VRE colonization and CDI as a point of comparison was certainly helpful in strengthening the demonstrate association; because it reduced the chance our findings would be due to changes happening with time throughout the province.
“The Quebec Health ministry has develop strong and rigorous guidelines for the province to reduce the transmission of multidrug resistant organisms. The MUHC Infection Control team has been applying these guidelines strictly with excellent results,” says infectious diseases specialist Dr. Charles Frenette; who is a microbiologist and medical director of Infection Control at the MUHC.
Indeed, the MUHC Infection Control service has been fighting to control the transmission of multidrug drug resistant organisms for over a decade in all sites; adopting and constantly improving strategies such as screening of asymptomatic carriers; institution of contact precautions (using gloves and gowns for patient contact) and reinforcing hand hygiene compliance. The latter has improve from 44% in 2012 to 71% in 2017-18; through systematic auditing and feedback of cleaning and disinfecting.
Resistant gram negative bacteria
“These ‘superbugs’ are the new kids on the block, and the biggest challenge humanity faces in terms of antibiotic resistance,” says Dr. Frenette. “Many hospitals in Quebec and Canada have been struggling with the containment of these organisms; also for the moment the MUHC has been spared from significant nosocomial transmission.”
“They suspect that much like VRE, the spread of resistant gram negative bacteria; particularly those which are emerging in Canada and concentrated in hospitals, could be more easily contain in an exclusively single patient facility; when combine with continue infection control and hand hygiene measures, and a better use of antibiotics,” says Dr. McDonald.
This is the largest, most sophisticated study providing evidence in support for investment in the design of hospitals with single patient rooms. A next step, according to Dr. Lee, would be to analyze the economic impact of the drastic and sustained reduction of infections resulting from the move. Above all, the challenge for the future will be to keep infection control efforts sustained.