ICU ward design and nosocomial infection rates – a cross sectional study in Germany

Summary Background There is increasing interest in the effects of hospital and ward design on multifaceted infection control. Definitive evidence is rare and the state of knowledge about current ward design is lacking. Objective The purpose of this study was to collect data on the current status of ward design on intensive care units (ICUs) and to analyze associations between particular design factors and nosocomial infection rates. Methods In 2015 we collected operational infrastructure data via an online-questionnaire from ICUs participating voluntarily in the German nosocomial infection surveillance system (KISS). We subsequently performed a multivariate analysis with available nosocomial infection rates deriving from the KISS database from 2014 to 2015. Findings 534 ICUs submitted data about their operational infrastructure. 27.1% of beds are hosted in single-bed rooms with a median size of 18m2 (IQR, 15-21). 73.5% of all ICU beds are equipped with a hand rub dispenser nearby. We were able to match 266 ICUs in our multivariate analysis. ICUs with windows in the patient´s rooms that can be opened were associated with lower device-associated lower respiratory tract infections (OR 0.73; CI95 0.58-0.90). The percentage of double-bed rooms >40% was associated with lower primary blood stream infection rates (OR 0.66; CI95 0.51-0.86). Conclusion Only minor associations between design factors and ICU infection rates were found. Most of them were surrogates for other risk factors.