UNASSIGNED: Previous studies have yielded varying conclusions regarding the impact of single-patient room design on nosocomial infection in the intensive care unit (ICU). We aimed to examine the impact of ICU single-patient room design on infection control.
UNASSIGNED: We conducted a comprehensive search of PubMed, Embase, the Cochrane Library, Web of Science, CNKI, WanFang Data, and CBM databases from inception to October 2023, without language restrictions. We included observational cohort and quasi-experimental studies assessing the effect of single- versus multi-patient rooms on infection control in the ICU. Outcomes measured included the nosocomial infection rate, incidence density of nosocomial infection, nosocomial colonization and infection rate, acquisition rate of multidrug-resistant organisms (MDROs), and nosocomial bacteremia rate. The choice of effect model was determined by heterogeneity.
UNASSIGNED: Our final analysis incorporated 12 studies involving 12,719 patients. Compared with multi-patient rooms in the ICU, single-patient rooms demonstrated a significant benefit in reducing the nosocomial infection rate (odds ratio [OR]: 0.68; 95% confidence interval [CI]: 0.59, 0.79; p < 0.00001). Analysis based on nosocomial infection incidence density revealed a statistically significant reduction in single-patient rooms (OR: 0.64; 95% CI: 0.44, 0.92; p = 0.02). Single-patient rooms were associated with a marked decrease in nosocomial colonization and infection rate (OR: 0.44; 95% CI: 0.32, 0.62; p < 0.00001). Furthermore, patients in single-patient rooms experienced lower nosocomial bacteremia rate (OR: 0.73; 95% CI: 0.59, 0.89; p = 0.002) and lower acquisition rate of MDROs (OR: 0.41; 95% CI: 0.23, 0.73; p = 0.002) than those in multi-patient rooms.
UNASSIGNED: Implementation of single-patient rooms represents an effective strategy for reducing nosocomial infections in the ICU.
UNASSIGNED: https://www.crd.york.ac.uk/PROSPERO/).

Nosocomial coronavirus disease 2019 (COVID-19) is a major airborne health threat for inpatients. Architecture and ventilation are key elements to prevent nosocomial COVID-19 (NC), but real-life data are challenging to collect. We aimed to retrospectively assess the impact of the type of ventilation and the ratio of single/double rooms on the risk of NC (acquisition of COVID-19 at least 48 h after admission). This study was conducted in a tertiary hospital composed of two main structures (one historical and one modern), which were the sites of acquisition of NC: historical (H) (natural ventilation, 53% single rooms) or modern (M) hospital (double-flow mechanical ventilation, 91% single rooms). During the study period (1 October 2020 to 31 May 2021), 1020 patients presented with COVID-19, with 150 (14.7%) of them being NC (median delay of acquisition, 12 days). As compared with non-nosocomial cases, the patients with NC were older (79 years vs. 72 years; p < 0.001) and exhibited higher mortality risk (32.7% vs. 14.1%; p < 0.001). Among the 150 NC cases, 99.3% were diagnosed in H, mainly in four medical departments. A total of 73 cases were diagnosed in single rooms versus 77 in double rooms, including 26 secondary cases. Measured air changes per hour were lower in H than in M. We hypothesized that in H, SARS-CoV-2 transmission was favored by short-range transmission within a high ratio of double rooms, but also during clusters, via far-afield transmission through virus-laden aerosols favored by low air changes per hour. A better knowledge of the mechanism of airborne risk in healthcare establishments should lead to the implementation of corrective measures when necessary. People\'s health is improved using not only personal but also collective protective equipment, i.e., ventilation and architecture, thereby reinforcing the need to change institutional and professional practices.

UNASSIGNED: It has been suggested that single rooms for patients improve patient dignity and privacy and reduce infection transmission, but they can be socially isolating. It is not well understood how single rooms affect long-stay patients.
UNASSIGNED: To understand the experience of being an inpatient in a ward with single-room design.
UNASSIGNED: A qualitative, phenomenological study was conducted using semi-structured interviews with patients (n=10) in a newly built cancer hospital with a 100% single-room haematology ward. Interviews were analysed using Colaizzi\'s (1978) seven-step analysis.
UNASSIGNED: Patients described their experiences of their acute stay using the concepts of privacy, isolation and independence, as well as enabling sleep. Privacy enabled patients to have their own toilet, was perceived to aid infection control and provided silence. Privacy came at a cost of isolation, but patients re-framed this as expected and necessary for self-preservation. Furthermore, they were unsure as to whether other patients would reciprocate social contact and instead relied on the healthcare team. Patients sought independence during their acute stay as it enabled them to control the environment and create a space for healing. The ability to sleep and be rested was also a critical feature of patients\' stay.
UNASSIGNED: The research highlighted that haematology patients prefer single rooms. However, because they experienced isolation, it also highlighted the importance of facilitating and enabling peer support within the haematology setting.

UNASSIGNED: To identify, examine, and map literature on the experiences of single-room hospital accommodation, exploring what is known about how single-room accommodation in hospitals is viewed by patients and nurses.
UNASSIGNED: Worldwide, hospital design is changing to mainly single-room accommodation. However, there is little literature exploring patients\' and nurses\' experiences of single-room designs.
UNASSIGNED: Scoping review following the Joanna Briggs Institute guidance on scoping reviews.
UNASSIGNED: We conducted the search in medical databases for scientific and gray literature. The four authors independently used a data extraction tool to include sources from the searches. The sources were discussed during the process, and in case of a disagreement between two reviewers, the third and fourth reviewer would be invited to participate in the discussion until consensus was achieved.
UNASSIGNED: We included 22 sources published during the period 2002-2020, with a majority (n = 16) during the period 2013-2020. The sources were distributed on 10 different countries; however, England dominated with 14 publications. We found three main maps for reporting on patients\' experiences: (1) personal control, (2) dignity, and (3) by myself. For the nurses\' experiences, we found four main maps: (1) the working environment, (2) changes of nursing practice, (3) privacy and dignity, and (4) patient safety.
UNASSIGNED: We suggested that patients\' and nurses\' experiences are predominantly interdependent and that the implications of single-room accommodation is a large and complex issue which goes beyond hospital design.

Single-room accommodation in hospitals divides the opinions of both healthcare professionals and patients alike. While some hail this change as a benchmark for quality and flexible healthcare provision, others view the move from cohorted bays to isolated single rooms as an impedance to effective work practices and even risking patient safety. This article will present the evidence surrounding single-room infrastructure redesign, with particular reference to staffing, patient preference and overall care delivery. It also introduces the single room as an example of adaptable and flexible healthcare infrastructure, vital to creating health architecture fit for the 21st century.

Current strategies for new and redesigned intensive care units (ICUs) involve incorporation of single occupancy rooms. These changes have largely been made for infection control and patient privacy reasons. However, there is limited literature available on how to manage the transition of an ICU from shared room to a single room environment.
The aim of this study was to evaluate staff members\' perceived effectiveness of a multicomponent intervention to facilitate transition from a shared to a single room setting.
This qualitative study was conducted in a 20-bed ICU of an Australian tertiary teaching hospital. In total, 24 staff members were interviewed in five groups and five individual interviews 6 months after the ICU relocation.
Three themes emerged from data analysis: (1) facilitating staff members\' transition and engagement during relocation planning; (2) simulating new work processes for the single room setting; and (3) supporting nurses working in the single rooms. The components of the intervention, including the change agent, the relocation working party, Assistance, Coordination, Contingency, Education, Supervision, and Support nurse rounding model, and the safe single room model, were perceived as important strategies to support the relocation transition. The regular newsletter and the information dissemination strategy informed by the social networking survey were viewed to improve communication. Staffing levels and education models that are suitable for the single room setting were identified as areas for improvement.
A systematic change management approach, clear communication, staff engagement, and continuously monitoring new work processes are important strategies to ensure the success of the relocation. Delivery of education in the clinical area needs to be further explored to ascertain the impact of a single room environment on its delivery. Intervention co-creation involving research team members and the clinical staff was important in building change management capacity, which may contribute to intervention sustainability and continued clinical practice improvement.

We aimed to determine how often Clostridium difficile toxin gene PCR assay (CDPCR)-negative patients were appropriately removed from single room contact isolation. Hospital databases were used to collect information on glutamate dehydrogenase (GDH)-positive, toxin-negative inpatients (February-April 2015). Of 60 CDPCR-negative patients, only two (3%) were removed from single room isolation. At least 36% of 53 CDPCR-positive results did not influence bed management. In conclusion, identification of C. difficile toxigenic status did not impact significantly on decisions whether to continue single room isolation. Cost-benefit analysis should be undertaken before CDPCR testing is introduced.

BACKGROUND: Norovirus is frequently introduced to the hospital and is a frequent cause of hospital outbreaks. Recognition of the factors that facilitate or impede norovirus transmission is an important step to effectively prevent hospital outbreaks.
OBJECTIVE: To investigate risk factors for norovirus outbreaks in hospital settings.
METHODS: Clinical data, ward setting, and norovirus genotype were collected from all 65 norovirus-positive index cases in outbreaks and all 186 sporadic norovirus cases at 192 wards in southern Sweden during 2010-2012 in a nested case-control study. Uni- and multivariate statistical analyses were conducted.
RESULTS: Outbreak was independently associated with the number of patients sharing a room with the norovirus case (odds ratio (OR): 1.9 per additional patient in the room; P < 0.01), vomiting (OR: 2.6; P = 0.04), age >80 years (OR: 3.2; P < 0.01), comorbidity (OR: 2.3; P = 0.05), and onset of symptoms after admission to the ward (OR: 3.5; P < 0.01) in the multivariate analysis. Infection with genotype GII.4 was found to be strongly associated with outbreak in the univariate analysis (OR: 5.7; P < 0.01). Moreover, associations between GII.4 and vomiting (OR: 2.5; P = 0.01) and old age (OR: 4.3: P < 0.01) were found.
CONCLUSIONS: This is the first study to investigate clinical, ward and genotype risk factors for norovirus hospital outbreaks. Recognition of these factors may help direct and prioritize infection control actions based on the outbreak risk. The results also suggest that the outbreak association with GII.4 partly may be explained by an enhanced ability to induce vomiting.

BACKGROUND: Single rooms are in short supply in many hospitals.
OBJECTIVE: To evaluate the impact of introducing semi-permanent pods to convert multi-occupancy bays into single occupancy pods.
METHODS: We performed a 24-month pre-post observational study in a 15-bed paediatric high dependency unit. Three semi-permanent pods were installed in February 2013, in the middle of the 24-month period. The percentage of missed isolation days and the proportion of days for which >4 patients required isolation (which would exceed existing isolation facilities) were compared for the year prior to the pods with the first year of pod use using a Fisher\'s exact tests.
RESULTS: Missed isolation days fell from 58.2% (662/1138; 95% confidence interval [CI], 55.3-61.0) pre-pod to 14.8% (205/1382; 95% CI, 13.0-16.8) during the first year of pod use (P <0.001). The percentage of days for which >4 patients required isolation was 74.5% overall (95% CI, 70.5-78.8), and increased from 63% (95% CI, 56.2-69.4) pre-Pod to 86% (95% CI, 80.9-90.3) during pod use (P <0.001).
CONCLUSIONS: The introduction of three semi-permanent pods was feasible in our paediatric HDU setting and reduced the number of missed isolation days, and hence transmission risk, for important hospital pathogens.

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.