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

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

Jones et al. compared rates of LOS before and after the relocation of a neonatal intensive care unit and special care nursery [27] . Data from July to December 2007 was extracted retrospectively for the control group on the old campus and prospectively from July to December 2008 for the intervention group on the new campus. Yu et al. conducted a case-control study to analyze the risk factors for health-care associated severe acute respiratory syndrome (SARS) outbreaks among hospital wards in Hong Kong and Guangzhou [28] . Environmental and administrative factors as well as host factors on 48 case wards (SARS patients were admitted and a super spreading event occurred) and 76 control wards (SARS patients were admitted but no super spreading event occurred) were analyzed. The super spreading event was defined as ≥ 3 cases of SARS in a ward during a period of 2-10 days after index patient admission or a cluster of ≥ 3 cases of SARS during a period of 8 days with unknown sources. The univariate analysis demonstrated that the minimum distance between beds of ≤ 1m is a significant risk factor associated with health-care associated outbreaks of SARS (OR 3.71, 95% CI: 1.67 to 8.20; P < 0.001). Similarly, the multivariate analysis revealed that a having a minimum distance between beds of ≤1m was a significant risk factor in the hospitals in Guangzhou (OR 5.41, 95% CI: 1.51 to 19.30; P = 0.009). However, the association was insignificant at hospitals in Hong Kong (OR 5.13, 95% CI: 0.89 to 29.57; P = 0.07). Overall, a minimum distance between beds of ≤1m was a significant risk factor associated with health-care associated outbreaks of SARS at all participating hospital wards (OR 3.36, 95% CI: 1.38 to 8.16; P = 0.008).