[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.

Sinks in patient rooms in ICUs are associated with higher rates of hospital-acquired infection: a retrospective analysis of 552 ICUs

BACKGROUND

Sinks in hospitals are a possible reservoir for healthcare-related pathogens. They have been identified as a source of nosocomial outbreaks in intensive care units (ICU); however, their role in non-outbreak settings remains unclear.

AIM

To investigate whether sinks in ICU patient rooms are associated with a higher incidence of hospital-acquired infection (HAI).

METHODS

This analysis used surveillance data from the ICU component of the German nosocomial infection surveillance system (KISS) from 2017 to 2020. Between September and October 2021, all participating ICUs were surveyed about the presence of sinks in their patient rooms. The ICUs were then divided into two groups: the no-sink group (NSG) and the sink group (SG). Primary and secondary outcomes were total HAIs and HAIs associated with Pseudomonas aeruginosa (HAI-PA).

FINDINGS

In total, 552 ICUs (NSG N=80, SG N=472) provided data about sinks, total HAIs and HAI-PA. The incidence density per 1000 patient-days of total HAIs was higher in ICUs in the SG (3.97 vs 3.2). The incidence density of HAI-PA was also higher in the SG (0.43 vs 0.34). The risk of HAIs associated with all pathogens [incidence rate ratio (IRR)=1.24, 95% confidence interval (CI) 1.03-1.50] and the risk of lower respiratory tract infections associated with P. aeruginosa (IRR=1.44, 95% CI 1.10-1.90) were higher in ICUs with sinks in patient rooms. After adjusting for confounders, sinks were found to be an independent risk factor for HAI (adjusted IRR 1.21, 95% CI 1.01-1.45).

CONCLUSIONS

Sinks in patient rooms are associated with a higher number of HAIs per patient-day in the ICU. This should be considered when planning new ICUs or renovating existing ones.

The Influence of Ventilation Measures on the Airborne Risk of Infection in Schools: A Scoping Review

OBJECTIVES

To review the risk of airborne infections in schools and evaluate the effect of intervention measures reported in field studies.

BACKGROUND

Schools are part of a country's critical infrastructure. Good infection prevention measures are essential for reducing the risk of infection in schools as much as possible, since these are places where many individuals spend a great deal of time together every weekday in a small area where airborne pathogens can spread quickly. Appropriate ventilation can reduce the indoor concentration of airborne pathogens and reduce the risk of infection.

METHODS

A systematic search of the literature was conducted in the databases Embase, MEDLINE, and ScienceDirect using keywords such as school, classroom, ventilation, carbon dioxide (CO2) concentration, SARS-CoV-2, and airborne transmission. The primary endpoint of the studies selected was the risk of airborne infection or CO2 concentration as a surrogate parameter. Studies were grouped according to the study type.

RESULTS

We identified 30 studies that met the inclusion criteria, six of them intervention studies. When specific ventilation strategies were lacking in schools being investigated, CO2 concentrations were often above the recommended maximum values. Improving ventilation lowered the CO2 concentration, resulting in a lower risk of airborne infections.

CONCLUSIONS

The ventilation in many schools is not adequate to guarantee good indoor air quality. Ventilation is an important measure for reducing the risk of airborne infections in schools. The most important effect is to reduce the time of residence of pathogens in the classrooms.

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

BACKGROUND

There is increasing interest in the effects of hospital and ward design on multi-faceted infection control. Definitive evidence is rare and the state of knowledge about current ward design is lacking.

OBJECTIVE

To collect data on the current status of ward design for intensive care units (ICUs) and to analyse associations between particular design factors and nosocomial infection rates.

METHODS

In 2015, operational infrastructure data were collected via an online questionnaire from ICUs participating voluntarily in the German nosocomial infection surveillance system (KISS). A multi-variate analysis was subsequently undertaken with nosocomial infection rates from the KISS database from 2014 to 2015.

FINDINGS

In total, 534 ICUs submitted data about their operational infrastructure. Of these, 27.1% of beds were hosted in single-bed rooms with a median size of 18m² (interquartile range 15-21m²), and 73.5% of all ICU beds had a hand rub dispenser nearby. The authors were able to match 266 ICUs in the multi-variate analysis. ICUs with openable windows in patient rooms were associated with lower device-associated lower respiratory tract infections [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.90]. ICUs with >40% two-bed rooms were associated with lower primary bloodstream infection rates (OR 0.66, 95% CI 0.51-0.86).

CONCLUSION

Only minor associations were found between design factors and ICU infection rates. Most were surrogates for other risk factors.