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Single hospital rooms fail to cut infection rate


Giving patients their own hospital room does not improve infection rates or lengths of stay and may increase the likelihood of falls, research seen exclusively by Nursing Times shows.

The unpublished study, by York Health Economics Consortium and The Hillingdon Hospital Trust, was commissioned by the Department of Health, and reveals that patients like single rooms but outcomes are not necessarily any better.

The study was based on a nine month analysis of 1,289 patients in gastroenterology, haematology and general medicine wards, as well as 120 patient questionnaires.

While previous studies have shown more than two thirds of patients preferred shared accommodation, at Hillingdon the vast majority – 92 per cent – wanted to spend their next stay in a single room.

Hillingdon’s lead research nurse for patient experience Sarah McDonagh said: “For many the fact they had their own bathroom was a huge component of satisfaction… a real privacy and dignity issue.”

However, asked if they had feelings of isolation, 12 per cent of patients said yes, and 18 per cent said they felt lonely.

Patients were treated in three types of room with varying degrees of privacy, one of which could not be easily seen from the hospital corridor.

Ms McDonagh said that, anecdotally, patients preferred rooms with better visibility of nurses.

However, there was no evidence lengths of stay were lower in single rooms and a small reduction in infections in the study wards was attributed to declining rates of
C difficile across the hospital.

The change also increased cleaning costs by 75 per cent, while medication costs rose by 28 per cent – partly balanced out by lower costs for sleep medication.

Ms McDonagh also told Nursing Times a small rise in falls had been identified in the single rooms, which had resulted in a staff education drive on the issue.

She said: “Over half of the falls were associated with access to the bathroom. Nurses are making sure they carry out regular observations, asking patients if they need the toilet and if they have enough to drink.”

The Department of Health has said single rooms should comprise between 20 and 50 per cent of all accommodation in new hospital developments. Maidstone and Tunbridge Wells Trust is building the first hospital made up entirely of single rooms.

RCN head of policy Howard Catton said there was “undoubtedly” a need to increase single side rooms in the interests of dignity. But it was vital to have bays for those wanting social interaction.

In a Nursing Times survey in January, more than two thirds of nurses said single rooms made it more difficult to observe patients.


Readers' comments (8)

  • Oh don't worry, evidence like ths won't stop the idiots in charge and the government from forging ahead with their plans to have every patient treated in something akin to a private en suite hotel room.

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  • What is the point of taking time and money to do research if no notice is taken of the results. Most of us are aware that whilst there are some benefits to an increase in the number of single rooms, there are more disadvantages to some patients and staff than advantages. Why is privacy considered more important than safety? Care is not improved with single rooms. I have seen an increase in depression and isolation with long stay patients.

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  • Latterlife Midwife

    I can't speak about long term patients, but I can say that single rooms are wonderful for maternity patients. They all ask for private rooms but most cannot afford to pay for the few we have.

    My experience in the States was the same. My large hospital there had only private or semi-private (two-bedded) rooms for all types of patients. Many wished they could have private rooms, but again, there weren't enough. It was really not that big a deal for staff to care for everyone safely and efficiently.

    There are areas for patients to socialise if they desire, but they are happy to have their own much quieter space for resting, sleeping, bonding with their babies, visiting with company, and needless to say, to toilet/shower. I am really proud to be moving into England's first fully private-room hospital in January.

    Wards everywhere really must go. Please, keep your minds open and give this concept the support it needs to work well.

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  • Jane, when have the idiots in charge ever listened to clinical opinion or evidence? They just forge ahead with populist policies regardless.

    And Latterlife, the pros and cons have been much debated on here before. There are areas of course where single rooms are a benefit (provided there is enough staff to deal with them); your area is one, infectious diseases is another for example. However at the end of the day whilst we all try to take privacy and dignity and patients comfort into account, it can NEVER be the primary reason for allocating rooms. Clinical reasons and practical reasons must ALWAYS be paramount. Bays have many proven CLINICAL advantages, and maybe you should keep your own mind open to the fact that yours is a specialised area where things that work in your area are not suitable for the majority of areas.

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  • After reading 'Latterlife Midwife's' comments it obviously depends upon the age group and type of patient in which we nurse, whether a single room is a good option or not????

    The ward in which I work is within a brand new build. It comprises of 6 bays with 4 beds in each bay, and it has 8 single rooms, all with ensuite shower-rooms.

    Majority of the patients are elderly averaging 70yrs and up. Often with Demensia, or confused due to UTI's and many addmitted from falls causing Fractured Neck of Femur's

    Puttuing these patient's in 'Single rooms' in my opinion is rediculous.
    We know from their addmission that they are 'high risk fallers' and yet we put in rooms where we can not see them to monitor them.

    The wards are run on 'MINIMUM STAFFING LEVELS' Which, is totally 'UNSAFE' This particular ward is a 'U' shape and even the patient's within the bays cannot be seen by the nursing staff.

    As Jane rightly states 'Why is privacy considered more important than safety? Care is not improved with single rooms. I have seen an increase in depression and isolation with long stay patients'.

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  • In Addtion to the above comments, patient's are often put into these sjngle rooms for isolation and reducing the risk of infection. If you have a patient who is at HIGH RISK of FALLING, you can not shut the door, becasue you can not see the patient if they fall. Therefore, this goes against the need for Isolation

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  • We have patients isolated on intensive care and it significantly cuts infection rates down because there is usually only 1 nurse looking after the patient and the nurse isn't allowed out the room. It's different in icu though I know but it is demoralising for the nurse looking after that patient. No social interaction. People reluctant to come in when help is needed. Not allowed any stimulus of any sort.

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  • Its great to see this debate growing, however I would like to throw in a few thoughts in favour.
    1. I would challenge nurses to look at their 4 bed bays now and see how many of the 4 patients they can really see from the door - probably only 2 as the others are sat back tucked behind the curtain (same for 6 bed bays)
    2. Infection prevention is as much about clinical practice as it is about room design, practitioners and clinicians et al, still need to wash their hands and maintain good standards of practice.
    3. Being in a single room does not mean that you need to be in that room for the duration of your stay with never leaving!!
    4. as soon as a patient becomes unwell for varying reasons - infection, impending death, noisy they are moved into a single room which negates all the views put so far.
    5. The piece de resistance when nurses say that people like socialising, and are lonely in a single room: So where do we send them in a hurry when its time for discharge or we need the bed - HOME ALONE!!

    My point is that you do not have to be in the same bedroom to socialise, creation of social spaces to watch the world go by without doors (never go back to the old day room) allows variable social interaction without being dictatorial as nurses.

    Throughout my nursing career I have worked in a multitude of settings including single rooms, multi-bed bays, I still made it my place to speak and see each patient I was working with, life was short of nursing staff throughout - no change there

    PS why are we still not working with families so much more in the adult in patient spheres of care??

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