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

The influence of physical environment on health care-associated infections: A literature review

BACKGROUND

Health care-associated infections (HAIs) are a common issue in health care settings, caused by environmental microorganisms, leading to health risks and financial strain. Despite efforts to reduce HAIs, the role of the physical environment in reducing HAIs is not fully understood. This literature review aimed to identify physical environment variables contributing to HAIs.

METHODS

A literature search was conducted in scientific databases between 2016 and 2022 using keywords associated with infections and physical environment variables. After screening retrieved articles for eligibility, the articles were analyzed for relevant environmental and infection variables.

RESULTS

Out of 145, 27 articles were identified. The findings were grouped into 8 categories, including layout design, surfaces, behavior, lighting, Internet of Things, materials, airflow, and air quality, with sub-themes in each group.

CONCLUSIONS

The physical environment in health care facilities plays a crucial role in reducing and preventing the spread of HAIs. Proper design and construction of health care buildings, including ventilation and air conditioning systems, help prevent infection spread between functional areas. Antimicrobial materials, cleaning and disinfection protocols, and personal hygiene practices, such as hand hygiene, are key factors in infection control. The positioning of hand hygiene stations is also essential to improve compliance among health care professionals.

[The structural and spatial design of German intensive care units from the point of view of infection control measures : Survey among ICU-KISS participants]

INTRODUCTION

Intensive care unit (ICU) structural and spatial design may play a role in infection prevention and control.

METHODS

Between 09/2021 and 11/2021 we performed an online survey among ICUs in Germany, Austria and Switzerland.

RESULTS

A total of 597 (40%) of the invited ICUs answered the survey; 20% of the ICUs were built before 1990. The median number of single rooms with interquartile range is 4 (IQR 2-6). The median total room number is 8 (IQR 6-12). The median room size is 19 (IQR 16-22) m2 for single rooms and 31 (26-37.5) m2 for multiple bed rooms. Furthermore, 80% of ICUs have sinks and 86.4% have heating, ventilation, air conditioning (HVAC) systems in patient rooms. 54.6% of ICUs must store materials outside of storage rooms due to lack of space and only 33.5% have a room dedicated to disinfection and cleaning of used medical devices. Comparing ICUs built before 1990 and after 2011 we could show a slightly increase of single rooms (3 [IQR 2-5] before 1990 vs. 5 [IQR 2-8] after 2011; p < 0.001).

DISCUSSION

A large proportion of German ICUs do not meet the requirements of German professional societies regarding the number of single rooms and size of the patient rooms. Many ICUs lack storage space and other functional rooms.

CONCLUSION

There is an urgent need to support the construction and renovation of intensive care units in Germany with adequate funding.

Infection prevention and early warning in neonatal intensive care unit based on physiological sensor monitoring

The infection rate in the Neonatal Intensive Care Unit (NICU) is very high, which is also one of the important causes of morbidity and even death in critically ill neonates and premature infants. At present, the monitoring system of the Neonatal Intensive Care Unit is not very complete, and it is difficult to provide early warning of neonatal illness. Coupled with the untimely response measures, it has brought certain difficulties to the ward's infection prevention and control work. The rapid development of the Internet of Things (IoT) in recent years has made the application fields of various sensor devices more and more extensive. This paper studied infection prevention and early warning in the Neonatal Intensive Care Unit based on physiological sensors. Combined with a wireless network and physiological sensors, this paper built an intelligent monitoring system for the Neonatal Intensive Care Unit, which aimed to monitor various physiological data of newborns in real-time and dynamically, and gave early warning signals, so that medical staff could take preventive measures in time. The experiments showed that the monitoring system proposed in this paper could obtain the physiological information of neonates in time, which brought convenience to prevention and early warning work, and reduced the infection rate of neonatal wards by 7.39%.

Surgical site infection surveillance in German hospitals: a national survey to determine the status quo of digitalization

BACKGROUND

Surveillance of surgical site infections (SSI) relies on access to data from various sources. Insights into the practices of German hospitals conducting SSI surveillance and their information technology (IT) infrastructures are scarce. The aim of this study was to evaluate current SSI surveillance practices in German hospitals with a focus on employed IT infrastructures.

METHODS

German surgical departments actively participating in the national SSI surveillance module "OP-KISS" were invited in August 2020 to participate in a questionnaire-based online survey. Depending on whether departments entered all data manually or used an existing feature to import denominator data into the national surveillance database, departments were separated into different groups. Selected survey questions differed between groups.

RESULTS

Of 1,346 invited departments, 821 participated in the survey (response rate: 61%). Local IT deficits (n = 236), incompatibility of import specifications and hospital information system (n = 153) and lack of technical expertise (n = 145) were cited as the most frequent reasons for not using the denominator data import feature. Conversely, reduction of workload (n = 160) was named as the main motivation to import data. Questions on data availability and accessibility in the electronic hospital information system (HIS) and options to export data from the HIS for the purpose of surveillance, yielded diverse results. Departments utilizing the import feature tended to be from larger hospitals with a higher level of care.

CONCLUSIONS

The degree to which digital solutions were employed for SSI surveillance differed considerably between surgical departments in Germany. Improving availability and accessibility of information in HIS and meeting interoperability standards will be prerequisites for increasing the amount of data exported directly from HIS to national databases and laying the foundation for automated SSI surveillance on a broad scale.

Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis

OBJECTIVES

Assess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes.

DESIGN

Systematic review and narrative synthesis.

DATA SOURCES

Medline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022.

ELIGIBILITY CRITERIA

Eligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread.

DATA EXTRACTION AND SYNTHESIS

Data were extracted and synthesised narratively, according to the methods of Campbell et al. RESULTS: Of 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation. No clearly consistent conclusions could be drawn about overall benefits of single rooms. Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy and for reduced disturbances. By contrast, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies.

CONCLUSIONS

The lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness.

PROSPERO REGISTRATION NUMBER

CRD42022311689.

Implementing changes to reduce infections in ICU patients. Water services and waste systems

Background

Evidence linking the role of water services in transmission of infection to patients in ICUs has increased in recent years.

Aims

This research based commentary set out to identify potential solutions for water and wastewater systems in ICU settings.

Methods

Databases and open source information was used to obtain data on approaches to water and wastewater-related issues in ICU settings. This and the authors experiences have been used to describe approaches to these problems.

Findings

The lack of updated guidance has required some ICUs to develop unique responses, including 'water free' patient care combined with reduction in water services. The options consider guidance, compliance, training and education as key factors to successful outcomes and protecting vulnerable patients in ICU.

Discussion

The authors found a number of problems with water and wastewater systems in ICU to which there has not been a cohesive response in terms of guidance to support users and designers. The resultant void permits new projects to proceed with suboptimal and designs which place patients and staff at risk. As an interim measure a series of solutions suitable for existing units and new builds need to be considered.

Reducing Carbapenem-Resistant Enterobacteriaceae Using the Targeted Solution Tool: A Quality Improvement Project

BACKGROUND

Carbapenem-resistant Enterobacteriaceae (CRE) is a worldwide urgent health problem. Hand hygiene (HH) is an effective intervention to reduce the spread of CRE.

LOCAL PROBLEM

In 2017, an increase in the rate of health care-associated (HA) CRE colonization was observed in a large multiorgan transplant center in Italy. This study aimed to reduce the HA-CRE colonization rates by improving HH compliance.

METHODS

A pre-/post-intervention project was conducted from November 2017 through December 2020.

INTERVENTIONS

The DMAIC (Define, Measure, Analyze, Improve, and Control) framework was used to implement the HH Targeted Solution Tool (TST).

RESULTS

Hand hygiene compliance increased from 49% to 76.9% after the Improve phase ( P = .0001), and to 81.9% after the second Control phase ( P = .0001). The rate of HA-CRE decreased from 24.9% to 5.6% ( P = .0001).

CONCLUSIONS

Using the DMAIC framework to implement the TST can result in significant improvements in HH compliance and HA-CRE colonization rates.

Monitoring microbial communities in intensive care units over one year in China

Healthcare-associated infections (HAIs) seriously threaten patient health in intensive care units (ICUs). Profiling the microbial composition and diversity in ICU is important to prevent HAI-related spreading. Given that microbial communities vary across different environments, the time-scale characteristics of pathogens in ICUs have not been explored in China. In our study, to study the bacterial communities of two different ICUs in China, we proceeded dynamic monitoring using 16S rRNA sequencing for a whole year among the bed sheets, bed rails, shared pulse oximeters, bedside lockers, nurses' hands, floor, and carts. Our results showed that the microbial composition significantly changed within months. Significant differences in alpha and beta diversities were also observed among the 12 sampling months in each ICU. Additionally, we found the persistence of several HAI-related bacteria, including Acinetobacter, Pseudomonas, Staphylococcus, Escherichia, and Enterococcus. Source tracking analysis showed that most bacteria in both ICUs came from buildings or human skin. With deep investigations of hospital microbial surveillance on a long-term time-scale, we hope that these results will provide constructive guidelines to prevent the spread of HAIs in ICUs.

Infection prevention and control considerations regarding ventilation in acute hospitals

Infection prevention and control team members (IPCTM) are often intimidated by aspects of ventilation as they relate to healthcare, because they consider them technical and outside their area of comfort and expertise. However, engineers, estates departments and planners need IPCTM input to ensure appropriate design and use. The main areas of importance centre on the operating theatre, the provision of air-controlled ventilated isolation rooms, and how to respond to major outbreaks/pandemics. Concentrating on basic principles of infection prevention and control, developing relationships with key departments and individuals, and applying best practice to these and other areas as they arise, are of great value. Some background, information and suggestions are provided for IPCTM with a view to providing simple practical advice in these areas.

Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005-2020)

BACKGROUND

The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005-2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge.

PURPOSE AND AIM

This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities.

METHOD AND RESULT

Each source reviewed was classified as one of the five types-opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays-and into nine content categories: nature engagement and outdoor views; family accommodations; intensive care unit (ICU), neonatal ICU, and pediatric ICU spatial configuration and amenity; noise considerations; artificial and natural lighting; patient safety and infection control; portable critical care field hospitals and disaster mitigation facilities including COVID-19; ecological sustainability; and recent planning and design trends and prognostications.

CONCLUSIONS

Among the findings embodied in the 135 literature sources reviewed, single-bed ICU rooms have increasingly become the norm; family engagement in the ICU experience has increased; acknowledgment of the therapeutic role of staff amenities; exposure to nature, view, and natural daylight has increased; the importance of ecological sustainability; and pandemic concerns have increased significantly in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review includes topics noticeably overlooked or underinvestigated in the 2005-2020 period and priorities for future research.

Bacterial colonization dynamics and antibiotic resistance gene dissemination in the hospital environment after first patient occupancy: a longitudinal metagenetic study

BACKGROUND

Humans spend the bulk of their time in indoor environments. This space is shared with an indoor ecosystem of microorganisms, which are in continuous exchange with the human inhabitants. In the particular case of hospitals, the environmental microorganisms may influence patient recovery and outcome. An understanding of the bacterial community structure in the hospital environment is pivotal for the prevention of hospital-acquired infections and the dissemination of antibiotic resistance genes. In this study, we performed a longitudinal metagenetic approach in a newly opened ward at the Charité Hospital (Berlin) to characterize the dynamics of the bacterial colonization process in the hospital environment after first patient occupancy.

RESULTS

The sequencing data showed a site-specific taxonomic succession, which led to stable community structures after only a few weeks. This data was further supported by network analysis and beta-diversity metrics. Furthermore, the fast colonization process was characterized by a significant increase of the bacterial biomass and its alpha-diversity. The compositional dynamics could be linked to the exchange with the patient microbiota. Over a time course of 30 weeks, we did not detect a rise of pathogenic bacteria in the hospital environment, but a significant increase of antibiotic resistance determinants on the hospital floor.

CONCLUSIONS

The results presented in this study provide new insights into different aspects of the environmental microbiome in the clinical setting, and will help to adopt infection control strategies in hospitals and health care-related buildings. Video Abstract.

Survival rate in patients with ICU-acquired infections and its related factors in Iran's hospitals

BACKGROUND

Hospital-acquired infections (HAIs) are a well-known cause of morbidity and mortality in hospitalized patients. This study aimed at investigating the survival rate in patients with ICU-acquired infections (ICU-AIs) and its related factors in Iran's hospitals.

METHODS

Data were obtained from the Iranian Nosocomial Infections Surveillance (INIS), which registers all necessary information on the main types of infection from different units of each included hospital. One thousand one hundred thirty-four duplicate cases were removed from the analysis using the variables of name, father's name, age, hospital code, infection code, and bedridden date. From 2016 to 2019, 32,998 patients diagnosed with ICU-AI from about 547 hospitals. All patients were followed up to February 29, 2020.

RESULTS

The median age of patients with ICU-AIs was 61 (IQR = 46) years. 45.5, 20.69, 17.63, 12.08, and 4.09% of infections were observed in general, surgical, internal, neonatal and pediatric ICUs, respectively. Acinetobacter (16.52%), E.coli (12.01%), and Klebsiella (9.93%) were the major types of microorganisms. From total, 40.76% of infected patients (13,449 patients) died. The 1, 3, 6-months and overall survival rate was 70, 25.72, 8.21 1.48% in ICU-AI patients, respectively. The overall survival rate was 5.12, 1.34, 0.0, 51.65, and 31.08% for surgical, general, internal, neonatal and pediatric ICU, respectively. Hazard ratio shows a significant relationship between age, hospitalization-infection length, infection type, and microorganism and risk of death in patients with ICU-AI.

CONCLUSIONS

Based on the results, it seems that the nosocomial infections surveillance system should be more intelligent. This intelligence should act differently based on related factors such as the age of patients, hospitalization-infection length, infection type, microorganism and type of ward. In other words, this system should be able to dynamically provide the necessary and timely warnings based on the factors affecting the survival rate of infection due to the identification, intervention and measures to prevent the spread of HAIs based on a risk severity system.

Use of single-bed rooms may decrease the incidence of hospital-acquired infections in geriatric patients: A retrospective cohort study in Central Denmark region

OBJECTIVE

Patients accommodated in single-bed rooms may have a reduced risk of hospital-acquired infections (HAIs) compared to those in multi-bed rooms. This study aimed to examine the effect of single-bed accommodation on HAIs in older patients admitted to a geriatric ward.

METHODS

A retrospective cohort study of patients admitted to geriatric wards in a university hospital in Central Denmark Region linked to a move to a newly built hospital, involving all consecutively admitted patients aged 65 years and over from 15 September to 19 December 2016 and a similar cohort admitted in the same three months in 2017. We compared the incidence of HAIs in patients in single-bed accommodation to those in multi-bed accommodation using retrospective review of electronic patient records, with all infections verified microbiologically or by X-ray with onset between 48 hours after admission to 48 hours after discharge from hospital.

RESULTS

In total 446 patients were included. The incidence of HAIs in multi-bed accommodation was 30% compared to 20% in single-bed accommodation. The hazard ratio was 0.62 (95% Confidence Interval 0.43-0.91, p = 0.01) for single-bed accommodation. This finding remained robust after adjustment for age, sex, infection at admission, risk of sepsis, use of catheter, treatment with prednisone or methotrexate, and comorbidity index.

CONCLUSION

Accommodation in single-bed rooms appeared to reduce HAIs compared to multi-bed rooms in two geriatric wards. This finding should be considered as hypothesis-generating and be examined further using an experimental design.

A neural network for prediction of risk of nosocomial infection at intensive care units: a didactic preliminary model

OBJECTIVE

To propose a preliminary artificial intelligence model, based on artificial neural networks, for predicting the risk of nosocomial infection at intensive care units.

METHODS

An artificial neural network is designed that employs supervised learning. The generation of the datasets was based on data derived from the Japanese Nosocomial Infection Surveillance system. It is studied how the Java Neural Network Simulator learns to categorize these patients to predict their risk of nosocomial infection. The simulations are performed with several backpropagation learning algorithms and with several groups of parameters, comparing their results through the sum of the squared errors and mean errors per pattern.

RESULTS

The backpropagation with momentum algorithm showed better performance than the backpropagation algorithm. The performance improved with the xor. README file parameter values compared to the default parameters. There were no failures in the categorization of the patients into their risk of nosocomial infection.

CONCLUSION

While this model is still based on a synthetic dataset, the excellent performance observed with a small number of patterns suggests that using higher numbers of variables and network layers to analyze larger volumes of data can create powerful artificial neural networks, potentially capable of precisely anticipating nosocomial infection at intensive care units. Using a real database during the simulations has the potential to realize the predictive ability of this model.

Nurses' Perception of Safety on Hospital Interior Environments and Infectious Diseases: An Exploratory Study

Introduction

Healthcare environments consist of a variety of different fomites containing infectious agents. From the 2003 outbreaks of Severe Acute Respiratory Syndrome to the recent concerns about the Ebola and Zika viruses, interest in the role of healthcare environment fomites in spreading infectious diseases has increased. Because of a high risk of being exposed to infections, the goal of this study was to learn how hospital interior environments impact nurses' perceptions of safety about infectious diseases.

Methods

Semistructured, in-depth interviews were conducted with six nurses at a public hospital.

Results

The following three themes were identified: (1) perceptions of safety from infectious diseases were diverse among the participants; (2) various interior environments in hospital settings can prevent as well as promote the spreading of infectious diseases; and (3) the different perceptions influenced the ways participants developed their contrasting behaviors of treating interior environments to cope with their fears (e.g., how they open doors).

Conclusion

The findings from this study contribute to the existing body of knowledge on designing hospital interior environments to better understand nurses' perception of infectious diseases.

Private patient rooms and hospital-acquired methicillin-resistant Staphylococcus aureus: A hospital-level analysis of administrative data from the United States

OBJECTIVE

To use hospital-level data from the US to determine whether private patient rooms (PPRs) are associated with fewer in hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) infections.

METHODS

We retrospectively analyzed Texas Inpatient Public Use Data with discharges between September 2015 and August 2016 merged with American Hospital Association annual survey data. We used negative binomial regression to estimate the association between the proportion of PPRs within a hospital and the count of discharges with HA-MRSA infections, adjusting for potentially confounding variables.

RESULTS

We analyzed data for 340 hospitals and 2,670,855 discharges. HA-MRSA incidence within these hospitals was 386 per 100,000 discharges (95% CI: 379, 393) and, on average, 62.73% (95% CI: 58.99, 66.46) of rooms in these hospitals were PPRs. PPRs were significantly associated with fewer HA-MRSA infections (unadjusted IRR = 0.973, 95% CI: 0.968, 0.979; adjusted IRR = 0.992, 95% CI: 0.991, 0.994; p<0.001 for both); at the hospital level, as the percentage of PPRs increased, HA-MRSA infection rates decreased. This association was non-linear; in hospitals with few PPRs there was a stronger association between PPRs and HA-MRSA infection rate relative to hospitals with many PPRs.

CONCLUSION

We identified 0.8% fewer HA-MRSA infections for each 1% increase in PPRs as a proportion of all rooms, suggesting that private rooms provide substantial protection from HA-MRSA. Small changes may not induce significant improvements in HA-MRSA incidence, and hospitals seeking tangible benefits in HAI reduction likely need to markedly increase the proportion of PPRs through large-scale renovations. The effect of private rooms is disproportionate across hospitals. Hospitals with proportionately fewer PPRs stand to gain the most from adding additional PPRs, while those with an already high proportion of PPRs are unlikely to see large benefits. Our findings enable hospital administrators to consider potential patient safety benefits as they make decisions about facility design and renovation.

A Decision-Making Algorithm for Rearchitecting of Healthcare Facilities to Minimize Nosocomial Infections Risks

Most of the healthcare facilities (HFs) have to face the nosocomial infections (NIs), which increase the rates of morbidity, mortality, and financial burden on the HFs and the patients. The control of the NIs is a global issue and requires additional effort. Because the pathogenic microbes can be transmitted among all the HF departments, the layout and design of the HFs (or the department configuration) is considered to play a significant role in control of the NIs. A few of the departments transmit the microbes more than other departments, called ‘cause’, while some other departments are more infected than others, called ‘effect’. Here, the researchers have stated that both the cause and effect departments are risky. This research tried to propose a comprehensive mathematical algorithm for choosing the high-risk department(s) by applying the NI and the managerial criteria to minimize NIs through rearchitecting of the HFs. To develop the algorithm, the researchers applied the multiple criteria decision-making (MCDM) methods. They used Decision-Making Trial and Evaluation Laboratory (DEMATEL) and modified weighted sum method (WSM) methods, and their hybrid, along with a modified nominal group technique (NGT) for data collection. The proposed algorithm was later validated by implementation in a HF as a case study. Based on all results of the algorithm, the high-risk departments in the HF were identified and proposed to be eliminated from the HF in such a way that the facility would retain its functionality. The algorithm was seen to be valid, and the feasibility of the algorithm was approved by the top managers of the HF after the algorithm was implemented in the case study. In conclusion, the proposed algorithm was seen to be an effective solution for minimizing the NIs risk in every HF by eliminating the high-risk departments, which could simplify the HF manager’s decisions.

Overcrowding in a neonatal intermediate care unit: impact on the incidence of multidrug-resistant gram-negative organisms

BACKGROUND

Overcrowding, reduced nurse to patient ratio, limited distance between incubators and absence of microbiological surveillance have been shown to promote spread of multidrug-resistant gram-negative organisms (MDRGN) in patients with birthweight < 1500 g. Patients > 1500 g treated on an intermediate care unit are unrepresented in recent literature. We therefore intended to present data obtained from a short-term overcrowded neonatal intermediate care unit (NIMCU) at a level III (international categorization) perinatal center at University Hospital Frankfurt, Germany.

METHODS

During a 25 day overcrowding (OV) and 28 day post-overcrowding period (POST-OV) on NIMCU, epidemiological data obtained from continuously hold microbiological surveillance were investigated and compared to the last 12 months of ward-regular bed occupancy preceding OV (PRAE-OV).

RESULTS

During OV, the number of patients simultaneously treated at the NIMCU increased from 18 to 22, resulting in a reduced bed-to-bed space. Nurse: patient ratio was 4:22 during OV compared to 3:18 during PRAE-OV. Cumulative incidence of MDRGN was 4.7% in OV and 2.4% POST-OV compared to 4.8% to PRAE-OV, respectively, without any significant variations. During OV and POST-OV, septic episodes due to MDRGN were not observed. In one case, potential nosocomial transmission of Enterobacter cloacae resistant to Piperacillin and 3rd/4th generation cephalosporins was observed.

CONCLUSIONS

Prevention of nosocomial spread of MDRGN in an overcrowded NIMCU is based on staff's diligent training and adequate staffing. Concise microbiological surveillance should be guaranteed to escort through overcrowding periods. In our setting, impact of bed-to-bed distance on MDRGN transmission seemed to be less strong.

Safety and Security Concerns of Nurses Working in the Intensive Care Unit: A Qualitative Study

Intensive care units (ICUs) exist to serve as a safe place for critically ill patients to receive care from skilled practitioners. In this qualitative study, ICU nurses shared their perspectives on elements that promote safety and security on their units. After obtaining institutional review board approval, participants participated in telephone interviews with a nurse researcher who has experience as a bedside ICU nurse. Five categories and 14 themes were identified and then confirmed using member checking. Results indicate that participants prefer to provide care in ICUs with no more than 12 to 14 beds and provide the following: visibility of patients and coworkers; more than 1 way to exit; and can be locked in case of emergency or threat. Nearly all respondents mentioned adequate staffing as the most important attribute of a safe, secure care environment for patients and families. More research is needed to identify design features that make the most impact on providing a safe, secure ICU environment.