Hostname: page-component-745bb68f8f-f46jp Total loading time: 0 Render date: 2025-01-14T22:45:17.021Z Has data issue: false hasContentIssue false
  • English
  • Français

Does the Architecture of Hospital Facilities Influence Nosocomial Infection Rates? A Systematic Review

Published online by Cambridge University Press:  02 January 2015

M. Dettenkofer ,
S. Seegers ,
G. Antes ,
E. Motschall ,
M. Schumacher  and
F. D. Daschner
M. Dettenkofer*
Affiliation:
Institute of Environmental Medicine and Hospital Epidemiology, University Hospital of Freiburg, Freiburg, Germany
S. Seegers
Affiliation:
Institute of Environmental Medicine and Hospital Epidemiology, University Hospital of Freiburg, Freiburg, Germany
G. Antes
Affiliation:
German Cochrane Center, Institute of Medical Biometry and Medical Informatics
E. Motschall
Affiliation:
Institute of Medical Biometry and Medical Informatics, University of Freiburg, Freiburg, Germany
M. Schumacher
Affiliation:
Institute of Medical Biometry and Medical Informatics, University of Freiburg, Freiburg, Germany
F. D. Daschner
Affiliation:
Institute of Environmental Medicine and Hospital Epidemiology, University Hospital of Freiburg, Freiburg, Germany
*
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Freiburg, Germany
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To review the evidence regarding the effects of interventions to improve hospital design and construction on the occurrence of nosocomial infections.

Methods:

Systematic review of experimental and non-experimental, architectural intervention studies in intensive care units (ICUs), surgical departments, isolation units, and hospitals in general. The studies dated from 1975, and were in English, French, German, Italian, and Spanish. Regardless of format, the studies were identified through seven medical databases, reference lists, and expert consultation.

Results:

One hundred seventy-eight scientific articles were identified; however, none of these described a meta-analy-sis, systematic review, or randomized, controlled trial. Most of the articles were categorized at the lowest level of evidence (expert judgment or consensus statements). Only 17 described completed concurrent or historical cohort studies matching the inclusion criteria (ICUs, 9; surgical departments, 4; isolation units, 2; hospitals in generai, 2). The interventions generally included a move to other premises or renovation. However, in many studies, the staff-to-patient ratio was also improved. Some studies showed lower infection rates after intervention, but this finding cannot be generalized because of confounding and fre-quently small study populations.

Conclusions:

The lack of stringent evidence linking hospital design and construction with the prevention of nosocomial infection is partly attributable to the multifactorial nature of these infections, and some improvement will be seen if basic conditions such as the availability of sufficient space, isolation capac-ity, and facilities for handwashing are met. However, to our knowledge, other factors, especially the improper hand hygiene of medical staff, have greater impact.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 1 , January 2004 , pp. 21 - 25
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Ayliffe, GAJ, Babb, JR, Taylor, L, Wise, R. A unit for source and protective isolation in a generai hospital. BMJ 1979;2:461–465.CrossRefGoogle Scholar
2.Garner, JS. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle ScholarPubMed
3.Noskin, GA, Peterson, LR. Engineering infection control through facility design. Emerg Infect Dis 2001;7:354–357.CrossRefGoogle ScholarPubMed
4.Ayliffe, GAJ, Babb, JR, Taylor, LJ. The hospital environment. In: Ayliffe, GAJ, Babb, JR, Taylor, LJ, eds. Hospital-Acquired Infection: Principles and Prevention, ed. 3. Oxford: Butterworth-Heinemann; 1999:109–121.Google Scholar
5.Bundesgesundheitsamt, Kommission “Erkennung, Verhutung und Bekämpfung von Krankenhausinfektionen.” Krankenhausinfektionen: Sechs Anlagen aus dem baulich-funktionellen Bereich. [Federal Health Office. Identification, prevention and control of hospital-acquired infections.] Bundesgesbl 1979;22:181–200.Google Scholar
6.Gastmeier, P, Daschner, F, Ruden, H. Guidelines for infection prevention and control in Germany: evidence- or expert-based? J Hosp Infect 1999;43(suppl):301–305.CrossRefGoogle ScholarPubMed
7.Frank, U, Gastmeier, P, Ruden, H, Daschner, FD. The organization of infection control in Germany. J Hosp Infect 2001;49:9–13.CrossRefGoogle ScholarPubMed
8.Hauer, T, Ruden, H, Daschner, F. Requirements of the German “Gesetzliche Unfaleversicherung (GUV)” for hospitals participating in the treatment of occupational accident victims: a critical commentary with recommendations of the National Center for Hospital Hygiene Standards. Chirurg 1998;69:924–929.CrossRefGoogle Scholar
9.Mindorff, CM, Cook, DJ. Critical review of the hospital epidemiology and infection control literature. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control, ed. 2. Philadelphia: Lippincott Williams and Wilkins; 1999:1273–1281.Google Scholar
10.Agency for Health Care Policy and Research. Publication 92-0032:100-107. In: Bassler, D, Antes, G, Forster, J. Evidenz-Basierte Medizin und Metaanalysen in der Padiatrischen Praxis. [Evidence-Based Medicine and Meta-Analyses in Paediatric Practice.] Pädiatrische Praxis 2000;58:569–576.Google Scholar
11.Goldmann, DA, Durbin, WA, Freeman, J. Nosocomial infections in a neonatal intensive care unit. J Infect Dis 1981;144:449–459.CrossRefGoogle Scholar
12.Hartenhauer, U, Diemer, W, Gahler, R, Ritzerfeld, W. Nosokomiale Infektionen in der Operativen Intensivmedizin: Ergebnisse einer 5-jahrigen prospektiven Erhebung. [Nosocomial infections in surgical intensive medicine: results of a 5-year prospective analysis.] Anasthesiol Intensivmed Notfallmed Schmerzther 1990;25:93–101.CrossRefGoogle Scholar
13.Huebner, J, Frank, U, Kappstein, I, et al.Influence of architectural design on nosocomial infections in intensive care units: a prospective 2-year analysis. Intensive Care Med 1989;153:179–183.CrossRefGoogle Scholar
14.Larson, E, Hargiss, CO, Dyk, L. Effect of an expanded physical facility on nosocomial infections in a neonatal intensive care unit. Am J Infect Control 1985;13:16–20.CrossRefGoogle Scholar
15.Martiny, H, von Strempel, A, Ruden, H. Zwei Intensivpflegestationen mit Einbett-und Vierbettzimmern-baulich-funktionelle und hygienische Untersuchungen. Hygiene & Medizin 1982;7:524–529.Google Scholar
16.Mullin, B, Rouget, C, Clement, C, et al.Association of a private isolation room with ventilator-associated Acinetobacter baumannii pneumonia in a surgical intensive-care unit. Infect Control Hosp Epidemiol 1997;18:499–503.CrossRefGoogle Scholar
17.Preston, GA, Larson, E, Stamm, WE. The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med 1981;70:641–645.CrossRefGoogle Scholar
18.Smith, G, Smylie, HG, McLauchlan, J, Logie, JR. Ward design and wound infection due to Staphylococcus pyogenes. J R Coll Surg Edinb 1980;25:76–79.Google ScholarPubMed
19.Vincent, J, Bihari, DJ, Suter, PM, et al.The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) study. JAMA 1995;274:639–644.CrossRefGoogle ScholarPubMed
20.Hansis, M, Dorau, B, Hirner, A, et al.Changes in hygienic standard and infection rates in a new surgical unit. Hygiene & Medizin 1997;22:226–238.Google Scholar
21.Leisner, H. Postoperative wound infection in 3,200 clean operations. Acta Chirurgica Scandinavia 1976;142:83–90.Google Scholar
22.Millar, KJ. The impact of a new operating theatre suite on surgical wound infections. Australian and New Zealand Journal of Surgery 1979;49:437–440.CrossRefGoogle ScholarPubMed
23.van Griethusen, A, Spies-van Rooijen, N, Hoogenboom-Verdegaal, A. Surveillance of wound infections and a new theatre: unexpected lack of improvement. J Hosp Infect 1996;34:99–106.CrossRefGoogle Scholar
24.Chattopadhyay, B. Control of infection wards: are they worthwhile? J Hosp Infect 2001;47:88–90.CrossRefGoogle ScholarPubMed
25.McKendrick, GD, Edmond, RT. Investigation of cross-infection in isolation ward of different design. Journal of Hygiene 1976;76:23–31.CrossRefGoogle ScholarPubMed
26.Kibbler, CC, Quick, A, O'Neill, AM. The effect of increased bed numbers on MRSA transmission in acute medical wards. J Hosp Infect 1998;39:213–219.CrossRefGoogle ScholarPubMed
27.Maki, DG, Alvarado, CJ, Hassemer, CA, Zilz, MA. Relation of the inanimate hospital environment to endemie nosocomial infection. N Engl J Med 1982;507:1562–1566.CrossRefGoogle Scholar
28.Ben-Abraham, R, Keller, N, Szold, O, et al.Do isolation rooms reduce the rate of nosocomial infections in the pediatrie intensive care unit? J Crit Care 2002;17:176–180.CrossRefGoogle Scholar
29.Lankford, MG, Zembower, TR, Trick, WE, Hacek, DM, Noskin, GA, Peterson, LR. Influence of role models and hospital design on hand hygiene of healthcare workers. Emerg Infect Dis 2003;9:217–223.CrossRefGoogle ScholarPubMed
30.Pittet, D, Hugonnet, S, Habarth, S, et al.Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.CrossRefGoogle ScholarPubMed
31.Egger, M, Zellweger-Zahner, T, Schneider, M, Junker, C, Lengeler, C, Antes, G. Language bias in randomised controlled trials published in English and German. Lancet 1997;350:326–329.CrossRefGoogle ScholarPubMed
32.Larson, E, Kretzer, EK. Compliance with handwashing and barrier precautions. J Hosp Infect 1995;30(suppl):88–106.CrossRefGoogle ScholarPubMed
33.Kaplan, LM, McGuckin, M. Increasing handwashing compliance with more accessible sinks. Infection Control 1986;7:408–410.CrossRefGoogle ScholarPubMed
34.Schultz, JK, Professional Advisory Committee. Does windowless OR environment affect behavior? AORNJ 1979;30:26–28.CrossRefGoogle ScholarPubMed
35.American Institute of Architects. Guidelines for Design and Construction of Hospital and Health Care Facilities, 1996-97. Washington, DC: American Institute of Architects Press; 1996.Google Scholar
36.Carter, CD, Barr, BA. Infection control issues in construction and renovation. In: Herwaldt, LA, Decker, MD, eds. A Practical Handbook for Hospital Epidemiologists. Thorofare, NJ: Slack; 1997:317–330.Google Scholar
37.Harvey, MA. Critical-care-unit bedside design and furnishing: impact on nosocomial infections. Infect Control Hosp Epidemiol 1998;19:597–601.CrossRefGoogle ScholarPubMed
38.Bartley, J, Bjerke, NB. Infection control considerations in critical care unit design and construction: a systematic risk assessment. Critical Care Nursing Quarterly 2001;24:43–58.CrossRefGoogle ScholarPubMed