The evidence speaks: Reducing HCAI through improved patient isolation
A series of studies have shown that increasing the proportion of single room accommodation for patients reduces the rate of HCAI.
The Rediroom has been designed to offer the middle ground between single rooms and multi-occupancy bays – providing many of the benefits of single rooms (more privacy,improved hand hygiene, and better containment of pathogens) and multi-occupancy bays (patient visibility, and reduced cost in terms of staffing)
The Rediroom offers flexible patient isolation, allowing hospitals to rapidly flex isolation capacity to meet demand, balancing changing clinical and patient priorities, has been designed to deliver droplet and contact precautions, and frees up existing hard-walled permanent isolation rooms for other priority patients.
Department of Health,2008
The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance
One of the criteria of the ‘Hygiene Code’ is that healthcare providers should provide adequate isolation facilities, which are sufficient to minimise the spread of infection. Many NHS hospitals lack an adequate number of rooms suitable for isolating patients in order to minimise the spread of infection.
National Audit Office,2009
Reducing Healthcare Associated Infections in Hospitals in England
This National Audit Office report found that 23% of NHS Trusts identified insufficient facilities to isolate patients as driver of healthcare-associated infection.
Healthcare Infection Control Practices Advisory Committee (HICPAC),2007
2007 Guideline for isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
This guideline outlines the requirements for patient isolation, aimed at healthcare facilities in the US. This guideline recommends that contact,droplet and airborne isolation is performed in single rooms.
Health Protection Scotland, 2015
Transmission Based Precautions Literature Review: Patient Placement (Isolation/Cohorting)
This guideline recommends that patients who are known or suspected to be infected with microorganism spread by the contact or droplet route should be cared for in single rooms when available.
Research Studies 研究报告
Mitchell BG, Williams A, Wong Z, O’Connor J. Infection, Disease & Health 2017;22;129-35.
Assessing a temporary isolation room from an infection control perspective: A discussion paper
A study considered the infection prevention and control characteristics and potential benefits of the Rediroom. The Rediroom was installed in a simulated clinical environment, and its function from an Infection Prevention and Control (IPC) viewpoint was assessed against standards or guidelines, for assembly and dismantling, and for cleanability, as judged by the removal of fluorescent markers. Rediroom was found to be fully compliant with 17 of 19 relevant guidelines or standards, and partially compliant with the other two. The two guidelines rated as partially compliant were storage and use of personal protective equipment, and provision of additional storage capacity. Another limitation was the lack of a sink for hand hygiene inside the room, but there is provision for alcohol gel to be situated both inside and outside the Rediroom. The review of assembly and dismantling of the Rediroom identified limited infection control risk. Impressively, the Rediroom was installed in less than 5 minutes! Finally, the cleaning assessment found that the UV fluorescent markers were fully removed from 23 (96%) of the 24 surfaces marked, and partially removed from the other surface. Whilst this cleaning assessment was not performed in clinical practice, it demonstrates that the Rediroom does not present a barrier to cleaning in principle.
Mitchell BG, Williams A, Wong Z. Am J Infect Control 2017;45;1231-7..
Assessing the functionality of temporary isolation rooms.
An Australian study evaluated various functional characteristics of the Rediroom using a mixed methods approach involved video recording, interviews, and objective temperature and humidity measurements within a crossover intervention study, concluding that the Rediroom had similar functional performance to performing patient care in an open plan area. In this study, a Rediroom was evaluated in a simulated clinical ward environment. Participants undertook a range of clinical nursing activities in a Rediroom or in a control area, including transferring patients, administration of medications, measurement of observations, performing an aseptic technique, bed bathing a patient, and cardiopulmonary resuscitation. A network analysis of staff movements in the room, and staff feedback via interviews and a questionnaire were used to evaluate the functionality of the Rediroom vs. control area. Temperature and humidity was measured in the Rediroom and control area. The time taken and the number of movements required to complete clinical nursing activities was broadly similar in the Rediroom and control area. A network analysis of the two activities that involved the most individual movements showed that there was close similarity in the pattern of movements in the Rediroom and control area. Recurring themes from interviews with staff were a sense of restriction, temperature, and management of critically ill patients. However, it is important to note that the Rediroom was not compared against another single room, but against an open plan area. It is likely that the sense of restriction and temperature themes would be less prominent if the Rediroom was compared to an isolation room.
Moore G, Ali S, FitzGerald G et al. J Hosp Infect 2010; 76; 103-7
Ward assessment of Smartideas Project: Bringing source isolation to the patient
A UK Department of Health led initiative led to the development of a Temporary Side Room, which was evaluated in a clinical setting. The Temporary Side Room was a semi-permanent installation, with expandable walls designed to fit over most bed spaces. Questionnaires were issued to staff, patients, and visitors; environmental samples were collected; and hand hygiene audits performed. 53 patients were isolated, which resulted in less bed blocking than would have occurred if the Temporary Side Room was not installed. Patients and staff were concerned about limited space and communication. Hand hygiene compliance was significantly improved in the Temporary Side Room. There was no evidence of reduced environmental contamination, although the levels identified were low.
Keward J, Bradshaw P, Otter JA. Infect Prev 2017;18:67-71.
Reducing the number of missed isolation days in a paediatric high-dependency unit using semi-permanent pods.
Three semi-permanent pods were implemented in a paediatric ICU to improve the availability of single rooms for isolation. This reduced the number of ‘missed’ isolation days from 58% to 14%, thus reducing the risks of transmission. These temporary isolation rooms had to be installed by a company and were ‘semi-permanent’, so provided limited flexibility in patient accommodation.