Bed occupancy rates and hospital-acquired infections—should beds be kept empty?

• Published in: Clinical microbiology and infection Vol. 18; no. 10; pp. 941 - 945
• Main Authors: Kaier, K., Mutters, N.T., Frank, U.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Elsevier Ltd 01.10.2012; Blackwell Publishing Ltd; Elsevier Limited
• Subjects: Bed Occupancy - statistics & numerical data; Bed occupancy rates; Communicable Diseases - epidemiology; Communicable Diseases - microbiology; Cross Infection - epidemiology; Cross Infection - microbiology; hospital-acquired infections; Hospitals; Humans; infectious disease epidemiology; Methicillin-Resistant Staphylococcus aureus; Nosocomial infections; Staphylococcus infections; threshold; infectious disease epidemiology; methicillin-resistant Staphylococcus aureus; threshold; hospital-acquired infections; Bed occupancy rates
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/j.1469-0691.2012.03956.x

There is growing evidence that bed occupancy (BO) rates, overcrowding and understaffing influence the spread of hospital-acquired infections (HAIs). In this article, a systematic review of the literature is presented, summarizing the evidence on the adverse effects of high BO rates and overcrowding in hospitals on the incidence of HAIs. A Pubmed database search identified 179 references, of which 44 were considered to be potentially relevant for full-text review. The majority (62.9%) focused on methicillin-resistant Staphylococcus aureus-associated infection or colonization. Only 12 studies were found that provided a statistical analysis of the impact of BO on HAI rates. The median BO rate of the analysed studies was 81.2%. The majority of studies (75%) indicated that BO rates and understaffing directly influence the incidence of HAIs. Only three studies showed no significant association between BO rates and the incidence of HAIs. Interestingly, only one of the included studies detected a seasonal trend in the BO rate. The present review shows an association between BO rates and the spread of HAIs in various settings. Because the evidence on this topic is limited, we conclude that further research is needed in order to analyse the rationale of a threshold BO rate, because keeping beds empty is comparatively costly.