Should hospitals offer all patients single rooms?

Date: Sep-25-2013The Scottish government has decided that all new hospitals should have 100% single rooms to offer privacy and reduce hospital acquired infections. On bmj.com, two experts debate the issue.

Hugh Pennington, Emeritus Professor of Bacteriology at the University of Aberdeen, argues that single rooms in hospitals "are important in preventing and controlling healthcare associated infections."

They also increase patients' privacy dignity, and confidentiality, as well as facilitating family involvement in patient care and increasing the opportunities for treatment at the bedside, he adds.

Opponents to the universal provision of single rooms have claimed that there is no evidence that they reduce hospital acquired infections, he writes, but "the evidence that physical barriers are good at preventing the spread of microbes is strong."

He argues that the universal provision of single rooms will considerably reduce the risk of common hospital infections such as norovirus, Clostridium difficile, and MRSA.

He also points to a 2008 Scottish government survey showing a rise in single room popularity and a marked decline in enthusiasm for shared accommodation among a representative sample of 990 adults across Scotland, compared with a 2007 survey by the Department of Health in England.

These results, he says, are compatible with "a trend in public expectations towards a wish for more privacy ... and should be accommodated."

Pennington also believes that arguments about "companionship" in hospital are misplaced, pointing out that "most patients [at the Mid-Staffordshire NHS Trust] were in multi-bed units; but for many their needs for water, care, and toileting went unmet."

"Patient safety is paramount. Privacy is desired by many. Delivering these things needs single rooms," he concludes.

But Chris Isles, Consultant Physician at Dumfries and Galloway Royal Infirmary, says many patients are worried about being lonely in hospital and should be given the choice of a shared room if that is what they prefer.

He too refers to the 2008 survey, but points out that "only 41% [of respondents] expressed a definite preference for a single room." And in his hospital, a smaller survey of 80 inpatients found only half who had experienced a stay in a single room wanted to return to one if readmitted.

"The prospect of spending several days alone in a single room clearly does not appeal to everyone," he writes.

A recent study from Canada reported an 11% increase in the risk of Clostridium difficile infection with each new exposure to a new hospital roommate. But Isles points out that the absolute risk of infection was only 0.5% and says "single room enthusiasts should note that 11% of nothing is nothing, and 11% of 0.5% is not very much more."

He strongly supports the need for "many more single rooms to isolate sick patients and patients with hospital acquired infection while at the same time meeting the needs of those who express a preference to be on their own." We could probably achieve this with an 80:20 or 70:30 single to shared split" he writes.

He says an "acceptable compromise" might be for the Scottish government to allow new hospitals "to decide what proportion of single rooms best meets the needs and preferences of the populations they serve, provided that this is at least 50% and, importantly, that all four-bedded rooms have separate showers and toilets for each patient."

"This would surely satisfy all parties," concludes Isles. "Dignity would be improved and all the advantages of having company would be preserved if that is what a patient prefers."
Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.