Impact of neonatal intensive care bed configuration on rates of late-onset bacterial sepsis and methicillin-resistant Staphylococcus aureus colonization

Infect Control Hosp Epidemiol. 2015 Oct;36(10):1173-82. doi: 10.1017/ice.2015.144. Epub 2015 Jun 25.


Background: Infections cause morbidity and mortality in neonatal intensive care units (NICUs). The association between nursery design and nosocomial infections is unclear.

Objective: To determine whether rates of colonization by methicillin-resistant Staphylococcus aureus (MRSA), late-onset sepsis, and mortality are reduced in single-patient rooms. DESIGN Retrospective cohort study.

Setting: NICU in a tertiary referral center.

Methods: Our NICU is organized into single-patient and open-unit rooms. Clinical data sets including bed location and microbiology results were examined over 29 months. Differences in outcomes between bed configurations were determined by χ2 and Cox regression.

Patients: All NICU patients.

Results: Among 1,823 patients representing 55,166 patient-days, single-patient and open-unit models had similar incidences of MRSA colonization and MRSA colonization-free survival times. Average daily census was associated with MRSA colonization rates only in single-patient rooms (hazard ratio, 1.31; P=.039), whereas hand hygiene compliance on room entry and exit was associated with lower colonization rates independent of bed configuration (hazard ratios, 0.834 and 0.719 per 1% higher compliance, respectively). Late-onset sepsis rates were similar in single-patient and open-unit models as were sepsis-free survival and the combined outcome of sepsis or death. After controlling for demographic, clinical, and unit-based variables, multivariate Cox regression demonstrated that bed configuration had no effect on MRSA colonization, late-onset sepsis, or mortality.

Conclusions: MRSA colonization rate was impacted by hand hygiene compliance, regardless of room configuration, whereas average daily census affected only infants in single-patient rooms. Single-patient rooms did not reduce the rates of MRSA colonization, late-onset sepsis, or death.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Cross Infection / epidemiology
  • Cross Infection / prevention & control*
  • Female
  • Humans
  • Incidence
  • Infant, Newborn
  • Infection Control / methods*
  • Intensive Care Units, Neonatal / organization & administration
  • Intensive Care, Neonatal / methods*
  • Intensive Care, Neonatal / organization & administration
  • Male
  • Methicillin-Resistant Staphylococcus aureus*
  • Outcome Assessment, Health Care
  • Patients' Rooms*
  • Proportional Hazards Models
  • Retrospective Studies
  • Sepsis / epidemiology
  • Sepsis / prevention & control*
  • Staphylococcal Infections / epidemiology
  • Staphylococcal Infections / prevention & control*