Infection rates at two hospitals dropped after transfer to rooms for a single patient

The move to single rooms at the Glen site of the McGill University Health Center (MUHC) in 2015 resulted in a significant reduction in nosocomial infection rates, suggests a study published today in the well-respected journal. JAMA: Internal Medicine published by the American Medical Association. A team from the Research Institute of the McGill University Health Center (RI-MUHC) discovered that colonization rates and blood infections due to the Vancomycin-resistant Enterococci (VRE), a common multi-drug resistant organism, immediately dropped and dramatically relocated, suggesting an badociation between single-patient rooms and a reduced risk of nosocomial infections. Their findings have important implications for infection control strategies in the context of building or renovating hospitals.

"The single-patient room experience at the MUHC Glen has many benefits: privacy, privacy, comfort, noise reduction, and improved sleep quality." This study also found that private rooms could also help reduce life-threatening infections, "said the study's lead author, Dr. Emily Gibson McDonald, is a researcher in the Global Infectious Diseases and Immunity in Health program. Center for Research and Evaluation of Outcomes (CORE) of the RI-MUHC, a subspecialist in internal medicine at the MUHC and an Assistant Professor in the Faculty of Medicine at McGill University.

The RI-MUHC team performed a time series badysis of the rates of several infections over a 65-month period before and after the relocation of the former Royal Victoria Hospital, which included many care of 3 to 4 people. type rooms, at the new 350-bed Glen facility, which exclusively includes private rooms, most of which are equipped with individual toilets and showers and easy access to sinks for handwashing.

In addition to VRE, they examined two other common nosocomial infections, or those contracted in hospitals, that were multidrug-resistant: methicillin-resistant infections. Staphylococcus aureus (MRSA) and Clostridioides difficult (CDI), formerly known as Clostridium difficile. The evolution of infection rates was compared to that of the province of Quebec to provide an estimate of all the changes occurring in the province.

Although the move appeared to be badociated with a sustained decrease in nosocomial colonization rates by MRSA, the reduction in CDI or MRSA infections was not statistically significant. Glen infection rates decreased by more than 70% for VRE and more than 30% for IDUs. However, while the reduction in VRE was clearly greater than the changes in the province, the changes in the CDI appear to reflect those in Quebec and Canada.

"Although we can not prove causality in a study like this, the changes have been so immediate and striking that we are pretty confident that they result mainly from the move," notes Dr. Todd Campbell Lee, author principal and corresponding author, who is an investigator. in the MUHC's Global Infectious Disease and Immunity Program and an infectious disease specialist at the MUHC. "However, the constant efforts of MUHC staff to keep the facilities clean, encourage excellent hand hygiene and intervene more aggressively when outbreaks are discovered have kept our rates low," said Dr. Lee, also a partner. Professor at the Faculty of Medicine at McGill University.

The importance of infection control strategies

The researchers used data provided by the provincial nosocomial infection surveillance network (SPIN) of the National Institute of Public Health of Quebec (INSPQ). The use of standardized provincial data on colonization with VRE and CDI as a point of comparison was certainly helpful in reinforcing the badociation demonstrated, as it reduced the chances that our results were due changes that occur over time in the province.

"The Quebec Ministry of Health has developed strict and stringent guidelines aimed at reducing the transmission of multidrug-resistant organisms to the province." The MUHC infection control team is implementing these recommendations with excellent results. results, "says Dr. Charles Frenette, a specialist in infectious diseases. a microbiologist and medical director of infection control at the MUHC.

In fact, the MUHC's infection control department has been fighting for more than 10 years at all sites to fight against the transmission of multidrug-resistant organisms by constantly adopting and improving strategies such as the screening of asymptomatic carriers. in place of precautions of putting in contact (use of gloves and blouses contact) and reinforce the respect of the rules of hygiene of the hands. The latter increased from 44% in 2012 to 71% in 2017-2018, thanks to systematic audits and feedback on cleaning and disinfection.

Protection against "superbugs"

In addition, by badogy with VRE, the results of this study suggest that private rooms may also have an impact on the reduction of highly resistant Gram-negative infections, including those that produce carbapenemase, which are often resistant to all antibiotics. current, and cause serious infections.

"These" superbugs "are the newcomers and the biggest challenge facing humanity in terms of antibiotic resistance," said Dr. Frenette. "Many hospitals in Quebec and Canada are fighting against the confinement of these organisms and, for the time being, the MUHC has been spared from significant nosocomial transmission."

"We believe that, like VRE, the spread of resistant Gram-negative bacteria, particularly those that occur in Canada and are concentrated in hospitals, could be more easily contained in a single-patient facility, when combined Continuous infection control of hygiene measures and better use of antibiotics, "says Dr. McDonald.

It is the largest and most sophisticated study providing evidence to support investments in the design of hospitals with rooms for a single patient. According to Dr. Lee, another step would be to badyze the economic impact of the drastic and lasting reduction of infections resulting from the move.

Above all, the challenge for the future will be to maintain infection control efforts.