| Project Name: |
Infection Risk Comparison |
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| Co-Investigator: |
Conly, Baylis, Ghali, Friesen, and White |
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Randomized trial assessing hospital environmental design
features for their impact on infection risk on a ‘low infection risk’ unit
(W21C) versus a traditional medical ward
With the construction of the new W21C and its features designed
to reduce hospital-acquired infection and colonization, the opportunity exists
to rigorously study the impact of design, construction and engineering controls
on specific hospital-acquired infections and colonization. In the first year of
clinical operation, the incidence density of hospital-acquired infections with
marker organism such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin
resistant Enterococcus (VRE), and Clostridium difficile appear to have
declined by almost 70% relative to infection rates present prior to the opening
of the clinical care space on the W21C. Given that there were no major changes
in the type of patients or staff present in the clinical setting, this finding
leads us to hypothesize that it is the design features of the new ward (e.g.
abundance of private rooms, individual toilet assignments for each patient,
abundance of sinks for hand-washing) that were the major factor contributing to
the lower infection rates. The alternate explanation for the lower infection
rates is that the general infection control behaviours of medical team members
(e.g. hand-washing, respect of isolation precautions, etc) may have improved
over time, such that the lower infection rates on W21C may reflect the benefits
of that system change, rather than benefits from the new ward’s unique design
features. Given the pre-post study design used to derive the above-mentioned
data on reductions in hospital-acquired infection control rates, we are
uncertain as to which factor (i.e. ward design features vs. infection control
behaviours of health care providers) is most important in reducing nosocomial
infection
rates.
The objective of this research (to be led by W21C team members
Conly, Baylis, Ghali, Friesen, and White in collaboration with Calgary-based
infection control experts) is to conduct a randomized controlled trial to
isolate the ‘design feature factor’ and assess its relationship to rates of
nosocomial infection. This will be done through concealed random allocation of
patients to care on the new W21C versus usual care on a control medical ward at
Foothills Medical Centre, on which patients with similar clinical case-mix
typically receive care. The feasibility of this type of patient-level
randomization to ward locations within Foothills Medical Centre has been
established. In parallel to the random allocation proposed within Foothills
Medical Centre, the research will also involve a parallel assessment of
nosocomial infection rates on the medical teaching unit at the Peter Lougheed
Medical Centre (PLC). The ward location at the PLC has a traditional design; its
inclusion permits a second contemporaneous comparator, that will increase
confidence in the value of W21C design features if our hypothesis of lower
infection rates is confirmed. The primary outcomes of interest will be incidence
rates of hospital-acquired VRE, MRSA (infection and colonization), and Clostridium difficile. In parallel to
the outcome analysis, the team will conduct a detailed ‘process analysis’ using
a combination of both quantitative and qualitative methods to assess the infection
control behaviours of providers in all 3 study settings (i.e. W21C, the
comparator ward at Foothills Medical Centre, and the comparator ward at the
PLC). The resulting data on infection control processes will have considerable
policy relevance as it will guide policy into addressing the growing problem of
nosocomial infections in Canadian hospitals (-- potentially leading to a policy
of phased redesign and renovation of hospital ward design over coming years in
keeping with contemporary environmental design concepts).
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