British Medical Association calls for reduced hospital bed occupancy to stop superbugs

Below is an excerpt from the British Medical Association report, Tackling Healthcare Associated Infections Through Effective Policy Actions.  This report was prepared under the auspices of the Board of Science of the British Medical Association.  The circumstances are similar to Ontario in many ways --  except that the bed occupancy is much higher here than it is in Britain, with Ontario bed occupancy rates currently running at about 97.9%.   

Bed occupancy 

Evidence from various retrospective surveys suggests that bed occupancy level is associated with HCAIs (health care acquired infections), and in particular MRSA.

In 2005, the House of Commons Committee of Public Accounts noted that high levels of bed occupancy are not consistent with effective infection control policies.  A high bed occupancy may potentially impact in several ways, including:

•increasing the proximity of patients and therefore the risk of direct and indirect patient-to-patient contact

•making it more difficult to clean thoroughly between patients or to leave beds ‘fallow’(not in use)

•reducing the ability to isolate patients when there is an outbreak of infection

•increasing the frequency with which patients are moved around a hospital, thus increasing the risk of inappropriate mixing of high risk and low risk patients.

Several recent retrospective studies found a significant and positive relationship between bed occupancy levels and rates of MRSA, with high bed occupancy leading to higher infection rates.  In 2007, the DH (Department of Health) reported that 40 per cent of hospitals in the NHS in the UK operate at 85 per cent bed occupancy and over, and that 15 per cent at 90 per cent bed occupancy. Ecological analysis by the DH suggested that when all other variables are constant, a Trust with an occupancy rate above 90 per cent could expect a 10.3 per cent higher MRSA rate compared to a Trust with an occupancy rate below 85 per cent.

The bed turnover interval is also an important factor in hospital bed management, with turnover intervals being found to be negatively correlated to MRSA rates. Following analysis, the influence of turnover intervals on rates of MRSA was suggested to be greater than those of bed occupancy levels per se.

At a time of rising patient admissions, bed occupancy levels in the UK have increased due to the continued reduction in the number of available hospital beds.

In England the average number of available beds for all specialties (excluding day only) has decreased from 186,091 in 2000-01 to 160,297 in 2007-08.  In Scotland the average available staffed beds for all acute specialties has fallen from 18,456 in 2000 to 17,466 in 2007.

This problem has been compounded by the introduction of the private finance initiative (PFI) which has led to a downsizing of hospital and community health care provision. 

 The report goes on to recommend that "reducing bed occupancy rates should be considered a priority in the development of policies relating to the number of available beds, admissions targets, and bed management practices."

So far, there are no signs that the policy on bed occupancy is going to change in Ontario, however.