Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis

Stiller, Andrea; Salm, Florian; Bischoff, Peter; Gastmeier, Petra

The purpose of this review was to systematically identify and analyze primary research studies, wherein infrastructural measures were examined as determining factors for infection control. Our research reveals a strong correlation between hospital ward design and healthcare-associated colonization and infection rates. According to our analysis, the implementation of single-patient rooms and the installation of easily accessible antiseptic hand rub dispensers near patient beds are two important facilitators for infection control. Research data about the relationship between the patient room size or the proximity between patients in adjacent beds and the colonization or rates of infection is scarce. We identified three studies, which had entirely different study environments and outcomes. Jones et al. investigated the space per cot in a neonatal intensive care unit. They concluded that a significant association exists between a higher square footage per cot and lower late-onset sepsis rates [27] . Jou et al. determined an increased risk of nosocomial C. difficile infection in patient rooms with larger square footage [26] . Due to the characteristics of the evaluated pathogen C. difficile, it is likely that spores contaminated the surface. This is attributable to the fact that a larger room allows more surface to be contaminated, which leads to an increased transmission risk as cleaning in a larger room could be performed rather inadequately [29] . However, transmission seems to be a minor issue for infection with C. difficile. Widmer et al. presented a very low rate of transmission in their prospective observational study during an 11-year study period: transmission was detected in 1.3% (6/472) of all contact patients [30] . Another structural aspect was investigated by Yu et al., who investigated the association between the distance between beds and the outcome severe acute respiratory syndrome [28] . They concluded that a minimum of ≥1m between beds is needed to reduce the risk of transmission and thus infection. As this outcome describes a pathogen, which is transmitted via droplet infection, it is questionable to transfer their results to other pathogens. More research is needed on this specific topic to further analyze the implications for infection control measures.