1. Rosenberg, Karen
  2. Todd, Betsy


According to this study:


* Switching to single-patient rooms led to a notable and sustained decrease in the rates of new methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) colonization and VRE infection, but not of Clostridioides difficile or MRSA infections.



Article Content

Health care-associated infections are common, costly, and harmful to patients. One proposed strategy to reduce the transmission of multidrug-resistant organisms and prevent certain health care-associated infections is to place patients in single-bed rooms. Following the relocation in April 2015 of the Royal Victoria Hospital, a tertiary-care hospital in Montreal, Quebec, Canada, with multibed rooms, to a newly built facility with private rooms, researchers examined the rates of vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection and of Clostridioides difficile infection (CDI) using a time-series analysis.


The old hospital rooms were a mixture of three- and four-bed units and a few private rooms. The new hospital includes 350 single-patient rooms with dedicated handwashing sinks, new beds and furniture, and, except for two critical care units, private bathrooms and showers. Surveillance cultures were taken from all medical, surgical, and critical care patients on admission and weekly thereafter, and positive clinical cultures were tracked. The hospital's general infection control practices did not change at the time of the move. Aggregate data from other Quebec hospitals were used to control for temporal trends during the study period.


In 36 months of follow-up, the hospital's incidence of VRE colonization was reduced from 766 to 209 cases, lowering the mean unadjusted rate from 35 to 6.6 per 10,000 patient-days. MRSA colonization incidence dropped from 129 to 112 cases, from a rate of 5.9 to 3.5. VRE infections were also reduced, from 55 to 14 cases, lowering the mean unadjusted rate from 2.5 to 0.4, although MRSA infection rates were not. For CDI, there was no immediate-level change or statistically significant temporal trends. The absolute decrease of nearly 35% in the rates of CDI during the studied years paralleled changes across Quebec and Canada.


The researchers posit that the immediate drop in VRE and MRSA colonization and VRE infection rates was largely due to the switch to single rooms. Quality improvement efforts after the move, they conclude, have been useful in the maintenance of this success.-BT


McDonald EG, et al JAMA Intern Med 2019 Aug 19 [Epub ahead of print].