BACKGROUND: As new hospitals are built to replace old and ageing facilities, intensive care units are being constructed with single patient rooms rather than open plan environments. While single rooms may limit hospital infections and promote patient privacy, their effect on patient safety and work processes in the intensive care unit requires greater understanding. Strategies to manage changes to a different physical environment are also unknown.
OBJECTIVE: This study aimed to identify challenges and issues as perceived by staff related to relocating to a geographically and structurally new intensive care unit.
METHODS: This exploratory ethnographic study, underpinned by Donabedian\'s structure, process and outcome framework, was conducted in an Australian tertiary hospital intensive care unit. A total of 55 participants including nurses, doctors, allied health professionals, and support staff participated in the study. We conducted 12 semi-structured focus group and eight individual interviews, and reviewed the hospital\'s documents specific to the relocation. After sorting the data deductively into structure, process and outcome domains, the data were then analysed inductively to identify themes.
RESULTS: Three themes emerged: understanding of the relocation plan, preparing for the uncertainties and vulnerabilities of a new work environment, and acknowledging the need for change and engaging in the relocation process.
CONCLUSIONS: A systematic change management strategy, dedicated change leadership and expertise, and an effective communication strategy are important factors to be considered in managing ICU relocation. Uncertainty and staff anxiety related to the relocation must be considered and supports put in place for a smooth transition. Work processes and model of care that are suited to the new single room environment should be developed, and patient safety issues in the single room setting should be considered and monitored. Future studies on managing multidisciplinary work processes during intensive care unit relocation will add to the learnings we report here.

BACKGROUND: Renovation of a general medical ward provided an opportunity to study health care facility design as a factor for preventing hospital-acquired infections.
OBJECTIVE: To determine whether a hospital ward designed with predominantly single rooms was associated with lower event rates of hospital-acquired infection and colonization.
METHODS: A prospective controlled trial with patient allocation incorporating randomness was designed with outcomes on multiple \'historic design\' wards (mainly four-bed rooms with shared bathrooms) compared with outcomes on a newly renovated \'new design\' ward (predominantly single rooms with private bathrooms).
RESULTS: Using Poisson regression analysis and adjusting for time at risk, there were no differences (P=0.18) in the primary outcome (2.96 versus 1.85 events/1000 patient-days, respectively). After adjustment for age, sex, Charlson score, admitted from care facility, previous hospitalization within six months, isolation requirement and the duration on antibiotics, the incidence rate ratio was 1.44 (95% CI 0.71 to 2.94) for the new design versus the historic design wards. A restricted analysis on the numbers of events occurring in single-bed versus multibed wings within the new design ward revealed an event incidence density of 1.89 versus 3.47 events/1000 patient-days, respectively (P=0.18), and an incidence rate ratio of 0.54 (95% CI 0.15 to 1.30).
CONCLUSIONS: No difference in the incidence density of hospital-acquired infections or colonizations was observed for medical patients admitted to a new design ward versus historic design wards. A restricted analysis of events occurring in single-bed versus multibed wings suggests that ward design warrants further study.
La rénovation d’une unité d’hospitalisation générale a permis d’étudier la conception des établissements de santé comme facteur pour prévenir les infections nosocomiales.
Déterminer si une unité d’hospitalisation contenant surtout des chambres individuelles s’associe à un taux plus faible d’infections nosocomiales et de colonisations.
Un essai prospectif contrôlé avec répartition aléatoire des patients a permis de comparer les résultats dans diverses « anciennes » unités (surtout des chambres à quatre lits dont les toilettes sont partagées) à ceux dans des unités « rénovées » (surtout des chambres individuelles dotées de toilettes individuelles).
D’après l’analyse de régression de Poisson et après rajustement en fonction du temps à risque, il n’y avait pas de différences (P=0,18) dans les résultats primaires (2,96 par rapport à 1,85 événements sur 1 000 patients-jour, respectivement). Après rajustement compte tenu de l’âge, du sexe, de l’indice de Charlson, de l’admission en provenance d’un établissement de soins, d’une hospitalisation dans les six mois précédents, de la nécessité d’isolement et de la durée de l’antibiothérapie, le ratio d’incidence était de 1,44 (95 % IC 0,71 à 2,94) pour les nouvelles chambres par rapport aux anciennes. Une analyse restreinte du nombre d’événements qui se produisent dans les nouvelles unités de chambres individuelles plutôt que de chambres communes a révélé une densité d’incidence de 1,89 par rapport à 3,47 événements sur 1 000 patients-jour, respectivement (P=0,18), et un ratio d’incidence de 0,54 (95 % IC 0,15 à 1,30).
Il n’y avait pas de différence dans la densité d’incidence des infections nosocomiales ou des colonisations chez les patients admis dans une nouvelle unité plutôt qu’une ancienne. D’après une analyse restreinte des événements qui se produisent dans des unités de chambres individuelles plutôt que de chambres communes, la conception des unités devrait faire l’objet d’études plus approfondies.