However, the current structure of a familiar ICU as above has revealed a common drawback that patients are susceptible to infection with drug-resistant hospital-acquired bacteria, affecting the quality, results and costs of treatment. For that reason, the ICU has been redesigned with a completely new image. It is a new ICU with many individual rooms, each room has only one resuscitation bed. There is a lot of scientific evidence showing that this conversion is effective in reducing the rate of multidrug-resistant bacteria infection in hospitals in ICUs, in addition to creating a private space for patients. This design model is even more suitable for the current outbreak of COVID-19.
Below is a summary of some of the research that has contributed scientific evidence to support the new ICU structure:
Halaby et al. (2017) conducted a retrospective study that included two periods: between January 2002 and April 2009 (old ICU, multiple beds in a large room) and between May 2009 and March 2013 (new ICU, each bed in a single room). Each period included routine microbiological testing, which was performed on all patients admitted to the ICU and then twice a week. Multidrug-resistant bacteria were identified according to national guidelines, and bacterial strains detected during ICU admission were included in the analysis. To ensure comparability of the two periods, the “before” and “after” periods were chosen to be similar in terms of the following factors: number of patients admitted to the department, number of beds, and bed occupancy rates per year and month. Results showed that a significant and sustained reduction in the rate of multidrug-resistant bacteria was observed after transfer to the new ICU. The researchers concluded that the single-room ICU design significantly contributed to reducing cross-transmission of multidrug-resistant bacteria.
(Research work “Impact of single room design on the spread of multi-drug resistant bacteria in an intensive care unit” by the group of authors Halaby T and colleagues, published in the Journal of Antimicrobial Resistance & Infection Control, 2017 6:117).
Dana Y. Telsch et al. (2011) compared the rate of hospital-acquired infections in the ICU before and after changing the structure from a unit with multiple resuscitation beds arranged together in a large room to a unit with multiple individual rooms, each with only one resuscitation bed. The rate of hospital-acquired infections caused by Clostridium difficile, vancomycin-resistant Enterococcus, and methicillin-resistant Staphylococcus aureus decreased by 54% (95% confidence interval [CI], 29%-70%) after the intervention (ICU structural change). The rate of adjusted mean length of stay in the ICU was 10% lower (95% CI, 0%-19%) after the intervention.
(Research work “Infection Acquisition Following Intensive Care Unit Room Privatization” by the group of authors Halaby T and colleagues, published in the Journal Archives of internal medicine2011;171(1):32-38)
In the ICU design guidelines (2012), the structure of the ICU includes four main areas: (1) Patient Care Zone, including patient rooms and adjacent areas, the main function of which is direct patient care; (2) Clinical Support Zone, including functions closely related to patient care; not only in the patient room but also in other areas of the ICU; (3) Unit Support Zone, related to administrative management functions, supply of supplies, etc.; (4) Family Support Zone, areas designed to support patient relatives. According to this guideline, the patient care area is recommended to follow the model of separate patient rooms, each room has only 1 bed.