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Impact of Neonatal Intensive Care Bed Configuration on Rates of Late-Onset Bacterial Sepsis and Methicillin-Resistant Staphylococcus aureus Colonization

Published online by Cambridge University Press:  25 June 2015

Samuel Julian ,
Carey-Ann D. Burnham ,
Patricia Sellenriek ,
William D. Shannon ,
Aaron Hamvas ,
Phillip I. Tarr  and
Barbara B. Warner
Samuel Julian*
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
Carey-Ann D. Burnham
Affiliation:
Departments of Pathology & Immunology and Pediatrics, Washington University School of Medicine, St. Louis, Missouri
Patricia Sellenriek
Affiliation:
St. Louis Children’s Hospital, St. Louis, Missouri
William D. Shannon
Affiliation:
Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
Aaron Hamvas
Affiliation:
Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, Illinois
Phillip I. Tarr
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
Barbara B. Warner
Affiliation:
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
*
Address correspondence to Samuel Julian, MD, Washington University School of Medicine, Department of Pediatrics, 660 S. Euclid Ave, Campus Box 8116, St. Louis, MO 63110 ([email protected]).
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Abstract

BACKGROUND

Infections cause morbidity and mortality in neonatal intensive care units (NICUs). The association between nursery design and nosocomial infections is unclear.

OBJECTIVE

To determine whether rates of colonization by methicillin-resistant Staphylococcus aureus (MRSA), late-onset sepsis, and mortality are reduced in single-patient rooms.

DESIGN

Retrospective cohort study.

SETTING

NICU in a tertiary referral center.

METHODS

Our NICU is organized into single-patient and open-unit rooms. Clinical data sets including bed location and microbiology results were examined over 29 months. Differences in outcomes between bed configurations were determined by χ2 and Cox regression.

PATIENTS

All NICU patients.

RESULTS

Among 1,823 patients representing 55,166 patient-days, single-patient and open-unit models had similar incidences of MRSA colonization and MRSA colonization-free survival times. Average daily census was associated with MRSA colonization rates only in single-patient rooms (hazard ratio, 1.31; P=.039), whereas hand hygiene compliance on room entry and exit was associated with lower colonization rates independent of bed configuration (hazard ratios, 0.834 and 0.719 per 1% higher compliance, respectively). Late-onset sepsis rates were similar in single-patient and open-unit models as were sepsis-free survival and the combined outcome of sepsis or death. After controlling for demographic, clinical, and unit-based variables, multivariate Cox regression demonstrated that bed configuration had no effect on MRSA colonization, late-onset sepsis, or mortality.

CONCLUSIONS

MRSA colonization rate was impacted by hand hygiene compliance, regardless of room configuration, whereas average daily census affected only infants in single-patient rooms. Single-patient rooms did not reduce the rates of MRSA colonization, late-onset sepsis, or death.

Infect Control Hosp Epidemiol 2015;36(10):1173–1182

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Supplement 10 , October 2015 , pp. 1173 - 1182
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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