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Should hospitals provide all patients with single rooms?

BMJ 2013; 347 doi: (Published 24 September 2013) Cite this as: BMJ 2013;347:f5695
  1. Hugh Pennington, emeritus professor of bacteriology1,
  2. Chris Isles, consultant physician2
  1. 1University of Aberdeen, Aberdeen, UK
  2. 2Department of Medicine, Dumfries and Galloway Royal Infirmary, Dumfries DG1 4AP, UK
  1. Correspondence to: H Pennington mmb036{at}, C Isles chris.isles{at}

Hugh Pennington argues that having all private rooms would reduce hospital acquired infection and provide privacy, but Chris Isles says many patients seem more worried about being lonely in hospital and should be given the choice of shared rooms

Yes—Hugh Pennington

There is a consensus view in Europe and North America that single rooms in hospitals are important in preventing and controlling healthcare associated infections. Single rooms increase patients’ privacy, dignity, and confidentiality. And they give patients more control over their immediate environment; they sleep better because there is less noise. Single rooms facilitate family involvement in patient care and increase the opportunities for treatment at the bedside. They enable better bed management, abolish gender bed blocking (when a patient cannot be admitted to an empty bed because the others in the shared accommodation are of the opposite sex), and lead to fewer patient transfers.1 So why is there resistance to their universal provision?

Infection prevention and control

Opponents to the universal provision of single rooms in hospital have claimed that there is no evidence that they reduce hospital acquired infections. Such evidence is hard to get because it cannot be established by experiment and because confounding effects make controlled trials difficult to do and interpret.2 But the evidence that physical barriers are good at preventing the spread of microbes is strong. A recent study in Canada on the effect of changing intensive care unit arrangements from multibed to single rooms showed falls in rates of acquisition of Clostridium difficile of 43% (a rate ratio of 0.57) and meticillin resistant Staphylococcus aureus of 47% (rate ratio 0.53) after the change—which was also followed by a 10% lower adjusted rate ratio of length of stay.3

Norovirus is by far the commonest infection imported into hospitals. It is also the most transmissible. It produces its …

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