The role of built environment and private rooms for reducing hospital acquired infections

Increased use of private patient rooms may be an important adjunct to traditional process-based interventions to prevent hospital-acquired infections (HAIs) in inpatient settings. We examined whether private room assignment lowers the risk of developing hospital-acquired methicillin-resistant staphylococcus aureus (HA-MRSA) infection and whether percent private rooms at the hospital level explain hospital-to-hospital variation in HA-MRSA incidence. We used 2016 Texas Department of State Health Services inpatient data from 340 acute care hospitals to evaluate HA-MRSA incidence. We used matched cohorts generated from 2.7 million Texas inpatients to estimate attributable incidence and outcomes of HA-MRSA or other (methicillin-sensitive) staphylococcus infection. We also simulated potential financial impacts of an all-private room design for two dissimilar hospitals using the Monte Carlo method. MRSA and relevant conditions were assessed via ICD-10-CM diagnosis codes. We found a significant negative relationship between increased private room presence and use and HA-MRSA risk. The value of these protections can be quantified—we estimated each HA-MRSA infection prevented could have saved $12,100 in cost and reduced mortality risk by 4%. Additional simulation estimated substantial cost-savings, up to about $3 million, for a large public safety-net hospital if it were renovated to an all-private room design, with an 11% return on investment on average. Overall, our findings support renovation of existing bay-room oriented facilities to an all-private room design as an effective and potentially efficient means to increase inpatient safety. Our methods provide a useful means for policy makers, hospital boards, and others to evaluate the costs and benefits of such changes. Finally, we conclude that private room related metrics could provide an important quality indicator if included in public reporting.