Dettenkofer M, Seegers S, Antes G, Schumacher M, Daschner F; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2002; 18: abstract no. 81.
University Hospital of Freiburg, Hugstetter Str. 55, Freiburg, mdet@iuk3.ukl.uni-freiburg.de; sseegers@iuk3.ukl.uni-freiburg.de
BACKGROUND/OBJECTIVES: To review the evidence on the effects of interventions to improve hospital design and construction on the occurrence of nosocomial infections (NI). Technical facilities such as air conditioning / HVAC systems do not fall within the scope of this study. Design: Systematic review of experimental and non-experimental hospital architecture intervention studies in intensive care units (ICU), surgical departments (SD), isolation units (IU), and hospitals in general (HG). METHODS: DATA SOURCES: Studies dating from 1975 in English, French, German, Italian and Spanish, regardless of format, identified in seven medical databases, reference lists, personal collections, and expert consultation. Main Outcome Measure: Nosocomial (hospital-acquired) infection. RESULTS: 178 scientific articles were identified (ICU: 41; SD: 83; IU: 7; HG: 47), however, none of these described a meta-analysis, systematic review or a randomised controlled trial. The majority of articles were categorised in the lowest level of evidence (expert judgement, consensus statements, reports). Of the 178 articles, only 17 described completed concurrent or historical cohort studies matching the inclusion criteria (ICU: 9; SD: 4; IU: 2; HG: 2). The interventions generally included a move to other (new) premises or renovation (more space per hospital bed, more single rooms, better facilities). However, in many studies the staff / patient ratio was also improved. Some studies showed lower infection rates after intervention, but one cannot generalise on this finding because confounders could not be controlled completely and study populations were frequently small. DISCUSSION: The lack of stringent evidence linking hospital design and construction with the prevention of NI is partly attributable to the complex, multifactorial nature of these infections, and it is likely that some improvement will be seen if basic conditions such as the availability of sufficient space, isolation capacity, and facilities for hand washing are met. However, to our present knowledge other factors, especially the improper hand hygiene of medical staff (which in turn is a more severe problem in narrow, overcrowded, wards) have greater impact. Well-designed studies that systematically investigate interventions to prevent NI, in this case improvement of hospital architecture, are required.
Publication Types:
Keywords:
- Architecture as Topic
- Case-Control Studies
- Cohort Studies
- Communicable Diseases
- Cross Infection
- Hospital Departments
- Hospital Design and Construction
- Hospitals
- Humans
- Hygiene
- Infection Control
- Intensive Care Units
- Patient Isolation
- hsrmtgs
Other ID:
UI: 102274697
From Meeting Abstracts