Effect of Private Patient Rooms on Central Line-Associated Blood Stream Infection (CLABSI)

Objective: Private hospital rooms have long been hypothesized to lower the risk of hospital-acquired infection. However, the evidence base is weak and consists mostly of expert opinion and several smaller studies that include one or two hospitals. Within the field of architecture, there is much interest in “evidence-based design” and how private rooms and other design elements influence patient satisfaction and health outcomes. To assess this gap, we assessed the impact of private rooms on the incidence of central line-associated blood stream infections (CLABSI) for 1.3 million patients treated at 344 Texas hospitals. Design: Data sources included the Texas inpatient data, American Hospital Association data, and patient satisfaction data (HCAHPS). The dependent variable was the overall CLABSI rate at each hospital, as defined by AHRQ’s Patient Safety Indicators. Explanatory variables included the percentage of acute-care beds in private rooms, patient satisfaction scores, nurses per bed, hospital type, and various other patient and hospital characteristics. Percentage of private rooms was considered as both a structural (architectural) and as a process measure of quality. A zero-inflated Poisson regression model was used for the hospital-level analysis, and logistic regression with random effects was fitted to the patient-level data. For the patient-level analysis, the percentage of private rooms was treated as a fixed effect, i.e., an architectural feature. Finding:Hospitals with mostly semi-private rooms had 20% more CLABSIs than hospitals with a majority of private rooms (640 vs. 541; p Conclusions: Hospitals with mostly private rooms were found to have “positive external effect” that lowered the risk of a CLABSI for all patients, regardless of whether they were assigned to a private room. Conversely, hospitals with mostly semi-private rooms were found to have “negative external effect” that increased CLABSI risk for all patients, even those assigned to a private room. On the margin, assignment to a private room offered a modest reduction in the risk of a CLABSI.