improved icu design reduces acquisition of antibiotic-resistant bacteria a quasi-experimental observational study改善icu设计可以减少耐药性细菌准实验观察研究的收购.pdfVIP

Levin et al. Critical Care 2011, 15:R211 /content/15/5/R211 RESEARCH Open Access Improved ICU design reduces acquisition of antibiotic-resistant bacteria: a quasi-experimental observational study 1* 1 2 1 2 Phillip D Levin , Mila Golovanevski , Allon E Moses , Charles L Sprung and Shmuel Benenson Abstract Introduction: The role of ICU design and particularly single-patient rooms in decreasing bacterial transmission between ICU patients has been debated. A recent change in our ICU allowed further investigation. Methods: Pre-move ICU-A and pre-move ICU-B were open-plan units. In March 2007, ICU-A moved to single- patient rooms (post-move ICU-A). ICU-B remained unchanged (post-move ICU-B). The same physicians cover both ICUs. Cultures of specified resistant organisms in surveillance or clinical cultures from consecutive patients staying 48 hours were compared for the different ICUs and periods to assess the effect of ICU design on acquisition of resistant organisms. Results: Data were collected for 62, 62, 44 and 39 patients from pre-move ICU-A, post-move ICU-A, pre-move ICU- B and post-move ICU-B, respectively. Fewer post-move ICU-A patients acquired resistant organisms (3/62, 5%) compared with post-move ICU-B patients (7/39, 18%; P = 0.043, P = 0.011 using survival analysis) or pre-move ICU- A patients (14/62, 23%; P = 0.004, P = 0.012 on survival analysis). Only the admission period was significant for acquisition of resistant organisms comparing pre-move ICU-A with post-move ICU-A (hazard ratio = 5.18, 95% confidence interval = 1.03 to 16.06; P = 0.025). More antibiotic-free days were recorded in post-move ICU-A (median = 3, interquartile range = 0 to 5) versus post-move ICU-B (medi