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Background: At LAC+USC Medical Center in East Los Angeles, a move to a new facility presented a unique opportunity to assess the impact of ward design elements on hospital transmission of MRSA, based on the prevalence of MRSA colonization and institutional rates of MRSA infections. Ward design was most changed by reducing the number of shared rooms in the old facility (four 6-bed rooms, two 4-bed rooms and two single bed rooms per ward) to the new facility (24 single and 4 double bed rooms per ward).
Objective: To demonstrate that the transition from multiple occupancy rooms to private or double rooms would reduce the transmission of MRSA, based on modern hospital design and infection control theory. Also, to show that a reduction in hospital transmission of MRSA corresponds with a decline in the overall hospital rate of MRSA infection.
Methods: Colonization rates were determined by nasal swabs collected at two points in time, once before and once after the move, on patients on wards selected for an historically high prevalence of MRSA infection. Data were collected representing ward design elements including number of roommates, presence and distance to the closest hand-washing station. Case review for each patient sampled was completed to assess for additional risk factors. MRSA infection rates in the two facilities were determined by reviewing laboratory culture data and chart review; simple colonization based on screening nasopharyngeal swabs was excluded from infection rates.
Results: 16.4% (18/110) of patients in the old facility were MRSA colonized compared to 5.5% (6/109) of patients sampled after the move to the new facility (p=0.0065). There was no significant difference between the two groups with regards to age, gender, race/ethnicity, previous hospitalization in the last 90 days, or ICU stay on current admission. In the studied wards, the average number of beds per room was 2.8:1.1 (old:new), roommates per patient 1.8:0.06, sinks per room 1.02:1, distance to sink from patient's bed in feet 12.1:5.3 and distance to alcohol dispenser from patient's bed in feet 13.1:13.3. MRSA infection rates significantly declined after the move in November 2008 from a six-month average of (old:new) 71.1:12.2 cases per 1,000 patient-days (two-sample t (10) = 5.35, p = 0.03) (Figure1). Infection sites were primarily bloodstream, soft-tissue abscess, and bone.
Conclusions: Our experience and data suggest that changes in ward design, specifically a reduction in the number of multiple-patient rooms to single bed rooms, likely contributed to the significant decrease in the rate of colonization by MRSA and the rates of infection with MRSA in the hospital setting.
