Single-Room Hospitals Benefit Nurses and Patients

By Aricka Flowers

Several European countries, including France, Britain and the Netherlands, either already have or are working toward exclusively single-room hospitals. Now it's time for America to get on the single-room hospital bandwagon, according to Toronto physicians, Michael E. Detsky and Edward Etchells. The pair co-authored a report in the August 2008 edition of Journal of the American Medical Association suggesting that all new hospital construction in America feature single-room facilities.

In their report, Detsky and Etchells argue the hospital layout would help lower infection rates and reduce medical errors; and it appears there is evidence to back their claim. According to an article in the Los Angeles Times, Methodist Hospital in Indianapolis experienced a 67-percent drop in medication errors in its coronary intensive care unit when it switched to single rooms. Meanwhile, officials at Bronson Methodist Hospital in Kalamazoo, Mich. saw an 11-percent decrease in infection rates when it switched to a single-room institution in 2000.

"Private hospital rooms are a significant step forward in patient safety compared to semi-private rooms or open wards," says Richard Van Enk, PhD, director of infection control and epidemiology at Bronson Methodist Hospital. "Patients in semi-private rooms eventually share their microbial flora as they share their space, and staffs are less likely to wash their hands between patients in a semi-private room environment than when they leave each private room to enter the next. Private rooms are also safer with regard to medical errors. Most errors are caused by distractions or momentary lapses of concentration by staff, and such distractions are more likely when there are two or more patients in a room, each requiring different medications, monitors and procedures for the healthcare staff to keep track of." 

Some health care professionals, like Mary Eng Huntsinger, RN, MSN, CNS, NP, say there are procedures that staff members must remember to do in order to stave off the spread of disease - regardless of the type of room.

"Procedures such as hand washing, use of appropriate infection control equipment and attire, proper cleaning of rooms and equipment will have a great impact on preventing the spread of infections," she says. "If you do not follow proper infection control policy and procedures, you will have problems with infection; even with private rooms."

Huntsinger went on to say that single rooms not only improve patient care, they go a long way toward improving patients' emotional and psychological wellbeing and, ultimately, their overall health. Huntsinger worked at single-room hospitals and witnessed firsthand how private rooms help patients and families through stressful times.

"Single rooms help create a more culturally-sensitive environment and provide more privacy," says Huntsinger. "Patients can bring more items from home to make them comfortable. In a single-patient room, family members can come and go without worrying about disturbing other patients and vice versa.... families and friends help provide emotional support for patients to relax and get better."

But, Huntsinger says nurses should be prepared to walk more between rooms if they are changing from semi-private to single-patient rooms.  

"Depending on the facility, nursing units and patient rooms can be designed to be so large and spacious that it seems almost like a hotel," she says. "In those situations, it makes patient care more challenging for nurses due to the sheer distance between rooms. If nurses needed assistance, help is farther away and care may not be as timely as we would like. Also, patients may feel somewhat isolated in a large room."

Nancy Hughes, the director of the American Nurses Association's Center of Occupational and Environmental Health, says several other unique challenges arise when a hospital is made up exclusively of single rooms.

"There are issues of whether the floor is set up with a centralized nursing station or a decentralized one, if everything is kept in the room, whether computers are being used at the bedside and if medication is kept in the room," says Hughes. "There are a lot of factors and it depends on how the other services [used] to support the patient are laid out."

Right now, a number of single-room trials are taking place at facilities like Kaiser Permanente's Garfield Health Innovations Center in San Leandro, Calif. Hughes visited the center and believes these tests are important to ensuring that new and renovated hospitals have highly-functional work spaces for nursing and other hospital staff.   

"When you think of the amount of money being spent on remodeling and building facilities and the long-term impact they will have, it's very important to have the best information to make these changes," says Hughes. "That way, we can have the best outcomes for everyone involved: the patients, their families and the nurses and other health care workers who spend their time providing care."

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