Architectural interventions to mitigate the spread of SARS-CoV-2 in emergency departments.

INTRODUCTION: Emergency departments (EDs) are a critical entry gate for infectious agents into hospitals. In this interdisciplinary study, we explore how infection prevention and control (IPC) architectural interventions mitigate the spread of emerging respiratory pathogens using the example of SARS-CoV-2 in a prototypical ED. METHODS: Using an agent-based approach, we integrated data on patients' and healthcare workers' (HCWs) routines and the architectural characteristics of key ED areas. We estimated the number of transmissions in the ED by modelling the interactions between and among patients and HCWs. Architectural interventions were guided towards the gradual separation of pathogen carriers, compliance with a minimum interpersonal distance, and deconcentrating airborne pathogens (higher air exchange rates (AERs)). Interventions were epidemiologically evaluated for their mitigation effects on diverse endpoints. RESULTS: Simulation results indicated that higher AERs in the ED (compared with baseline) may provide a moderate level of infection mitigation (incidence rate ratio (IRR) of 0.95 (95% confidence interval (CI) 0.93-0.98)) while the overall burden decreased more when rooms in examination areas were separated (IRR of 0.78 (95% CI 0.76-0.81)) or when the size of the ED base was increased (IRR of 0.79 (95% CI 0.78-0.81)). The reduction in SARS-CoV-2-associated nosocomial transmissions was largest when architectural interventions were combined (IRR of 0.61 (95% CI 0.59-0.63)). CONCLUSIONS: These modelling results highlight the importance of IPC architectural interventions; they can be devised independently of profound knowledge of an emerging pathogen, focusing on technical, constructive, and functional components. These results may inform public health decision-makers and hospital architects on how IPC architectural interventions can be optimally used in healthcare premises.

ICU ward design and nosocomial infection rates: a cross-sectional study in Germany.

BACKGROUND: There is increasing interest in the effects of hospital and ward design on multi-faceted infection control. Definitive evidence is rare and the state of knowledge about current ward design is lacking. OBJECTIVE: To collect data on the current status of ward design for intensive care units (ICUs) and to analyse associations between particular design factors and nosocomial infection rates. METHODS: In 2015, operational infrastructure data were collected via an online questionnaire from ICUs participating voluntarily in the German nosocomial infection surveillance system (KISS). A multi-variate analysis was subsequently undertaken with nosocomial infection rates from the KISS database from 2014 to 2015. FINDINGS: In total, 534 ICUs submitted data about their operational infrastructure. Of these, 27.1% of beds were hosted in single-bed rooms with a median size of 18m2 (interquartile range 15-21m2), and 73.5% of all ICU beds had a hand rub dispenser nearby. The authors were able to match 266 ICUs in the multi-variate analysis. ICUs with openable windows in patient rooms were associated with lower device-associated lower respiratory tract infections [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.90]. ICUs with >40% two-bed rooms were associated with lower primary bloodstream infection rates (OR 0.66, 95% CI 0.51-0.86). CONCLUSION: Only minor associations were found between design factors and ICU infection rates. Most were surrogates for other risk factors.

[Are complaints an element for health-care monitoring? Analysis of the user statistics of the federal commissioner for patient issues between 2004 and 2007]. / Beschwerden als Baustein eines gesundheitlichen Versorgungsmonitorings? Eine Nutzeranalyse des Amtes der Bundespatientenbeauftragten für den Zeitraum 2004 bis 2007.

BACKGROUND: The inclusion of patient perceptions in the assessment of health-care quality has gained in importance in recent years. The main instruments applied for this purpose are different types of patient interviews. Complaint data have rarely been used thus far. METHODS: On the basis of 19 117 complaints and inquiries to the office of the federal government commissioner for patient issues, this article examines to what extent this data source can be systematically used in health-care research and describes which groups of persons addressed their concerns to the commissioner for patient issues between the years 2004 and 2007. In this context, an investigation is done to determine whether reported or reconstructed data on sociodemographic characteristics are sufficient for analysis. A comparison with population-wide data also indicates to what extent the results can be considered representative for the concerns of patients or insurants in Germany. The letters and inquiries were subjected to a quantitative content analysis. RESULTS: The terms "gender", "region" and "insurance status" can be consistently encoded in a high percentage of those who make complaints and inquiries. The items "age" and "employment status" can be reconstructed to a lesser degree. However, a structural comparison of "responders" and "non-responders" shows that the results from the sample with these characteristics can be generalised for all concerns addressed. Data on the education and migration background were insufficient for analysis. Compared to the general population, a disproportionately high number of older and/or retired people (EM/EU pension) as well as unemployed persons and persons from Berlin and the new federal states contact the commissioner for patient issues. However, changes over time show a successive approach to population-wide distributions. CONCLUSIONS: The results recommend this unique data source for continuous coverage. The data documentation should thus be further standardised and integrated into a complaint management system that includes all relevant complaint offices in Germany.