Author Dr Michael Detsky and Dr Edward Etchells from University of Toronto, Canada advocated single-patient rooms using reasons that studies have shown that reduction in airborne-related and contact related nosocomial infections. However, the authors acknowledged that the evidence is less compelling when it comes to reducing MRSA (methicillin-resistant staphylococus aureus) colonisation.
Here are the reasons put forward by the authors to support single-patient rooms:
1. Single rooms are easier to clean and decontaminate
2. Health care professionals may be more likely to perform hand-hygiene between rooms than between beds
3. Single rooms can reduce the need for patient transfer - the point made is that patient transfers within hospital can be potentially harmful because of missed treatment, reduced monitoring, increased psychological stress, higher chance of medication error
4. Single rooms can enhance patient flow - the authors quoted a study that 85 beds in single rooms can offer the same capacity as 100 beds in multi-bed patient rooms. It is not hard to see that for example when you a 4-bedded room and one male patient is put in there, the other 3 neds cannot be occupied by female patients.
5. Single rooms offer better privacy, rest and family support. Family members can visit single rooms more freely to offer support and share information with healthcare team.
6. Noise level in single room is lower and hence lower stress level - noise levels have been shown to be associated with increased blood pressure, heart rates etc.
7. patients in single rooms have their own toilet and bathroom. According to the authors, toilets are important sources of nosocomial infection.
According to the authors, there are disadvantages for single rooms as well:
1. additional walking and time needed to move from room to room.
2. loss of room-mates who can potentially help summon help
3. increased construction cost for single rooms - but can better utilisation of single rooms offset the higher capital costs?
This not withstanding, the authors said that it is easier to build single rooms once than to teach thousand of individuals to be attentive to patient privacy when patient care is provided in multi-bed room.
What are the practices overseas? According to authors,
a. France has adopted single rooms for all new hospitals built for the past 20 years
b. British, dutch and Nowegian hospitals are moving more towards single rooms.
c. According to 2006 American Institute of Architects guidelines - single patient rooms are a minimum requirement for new medical and surgical wards.
There is a "Ward of the 21st century" in Calgary, Canada where single room is a cornerstone feature of a multi-faceted research initiative in hospital design (http://www.w21c.org/). this will be good piece to watch!
Personally, I think most of the points raised about the benefits of single-rooms for patients are valid, however, we have to be careful to note that it is not a panacea for patient safety and hospital infection.
If the society decide to move into only single-room hospital, the impact of increased cost cannot be denied and this naturally translates into higher burden for the patient, the insurers, the employers and the government. The magnitude of this burden needs to be better understood.
Of course, human behavior and good habits must continue to be inculcated for the heath care professionals, the public and patients. Hand hygiene, cough etiquette, consciousness for patient privacy and better visitor control will always continue to be key ingredients in basic patient safety in hospitals.
Will Singapore move from its multi-bed class system in her public hospitals to one where there will only be single rooms remain to be seen. The fact that single rooms will lead to better bed utilisation than multi-bed rooms is perhaps true, especially so in Singapore where gender, bed class and medical condition segregation is a consistent practice. I was speaking to be a senior clinician recently and he told me that while we are pondering this question, some of the more progressive hospitals in China have already started to adopted this practice.
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