Recent Zealand needs to rethink multi-bed hospital rooms

How New Zealand laments its hospitals – where they are located, how they should be staffed and how they should be financed – the debate misses a key element: the need for single rooms in all public hospitals.

It is now normal for patients to stay in shared rooms with up to five other people. In some hospitals, this includes housing men and women in the same room, despite solemn injuries safety and ethical issues.

But it shouldn’t be like this. For many reasons, including infection control, privacy and cost, fresh hospitals and renovations must rely on single-occupancy rooms.

Our new research brings together both the clinical and ethical arguments for adopting single rooms for all patients as the most basic standard of care.

Infection control

Many people may see shared rooms as a cost savings. However, one of the key arguments for separate rooms in hospitals is the costs and damages associated with infections and bacterial resistance.

Single rooms reduce the risk by eliminating exposure to common sources of infection such as touched surfaces, unfiltered air, toilets and water systems.

They too reduce the need to move rooms in hospital, which increases the risk of transmitting infection between patients.

There is forceful evidence that single rooms are affected reducing the number of infections in intensive care units. AND further research also found that single accommodation reduced the risk of Covid-19 transmission in hospital.

In Recent Zealand, the priority is single rooms for patients known to be infectious. But the key word is here known. This policy does not take into account the fact that a gigantic proportion of infectious diseases are unknown at the time of admission.

However, even when the infection is known, our hospitals are unable to meet basic guidelines due to the lack of single rooms. For example, only 30% of hospital rooms in Wellington and Hutt are designated for single apply.

Without single occupancy as the standard in hospitals, infection control will remain at risk.

Delirium and dementia

Separate rooms are also required for older people. Recent Zealand’s population is aging; as a result, the number of patients with delirium and dementia requiring hospitalization will augment.

Delirium affects approximately 25% of hospitalized patients and is associated with a longer stay, more complications, and an increased risk of death.

Prevention and treatment of delirium requires a low-stimulus environment, undisturbed sleep, and delicate and noise control that cannot be achieved in shared hospital rooms.

Tests showed a reduction in delirium for single rooms.

The behavioral and psychological symptoms of dementia also pose significant challenges in hospital. Symptoms include hallucinations, delusions, sleep disturbances, depression, inappropriate sexual behavior and aggression.

They can be very disturbing for the patient and those around him and, like delirium, basic standard of care cannot be provided in the common room.

By 2050, the incidence of dementia will more than double. Yet Recent Zealand’s hospitals are ill-prepared to cope with rising demand.

The right to safety, privacy and dignity

Shared spaces in hospitals clearly undermine clinical care, but also violate human and patient rights.

One of the most basic human rights is “personal security”. No one should share a room with patients who are agitated, aggressive or sexually inappropriate due to delirium or dementia.

Unfortunately, patients often share with those who are unable to control their own behavior. While threats to women as has been emphasized, no patient should feel threatened or frightened by another patient’s behavior.

Dignity and privacy are also fundamental patient rights, and privacy is covered by both provisions Health Information Privacy Code and Code of patient rights regarding health and disability.

Hospital patients often need facilitate dressing, showering and toileting. Many admissions are associated with vomiting, diarrhea or urinary incontinence. And the design relying on curtains for privacy makes it a farce.

Tests AND complaints clearly show patients that they do not believe their privacy is adequately protected in shared spaces.

Some may advocate for multi-bed rooms, arguing that some patients prefer company. However, patient surveys regarding privacy and confidentiality overwhelmingly favor single-occupancy rentals.

Cost consideration

Although the initial costs for building single rooms augment due to the larger hospital space, tests concluded that there was no compelling economic evidence in favor of shared rooms.

The potential savings in future pandemics – in terms of mortality, patient transfer and disease transmission – should not be underestimated. Better management of delirium and dementia will also reduce length of stay and costs.

Collectively, the case for single-occupancy hospital rooms on clinical, ethical and legal grounds is clear.

Recent Zealand must follow international best practice and introduce single rooms as the primary standard when building and refurbishing fresh hospitals.

Failure to do so would ignore the lessons learned from the Covid-19 pandemic, fail to take into account the needs of an aging population and would further render Recent Zealand’s Patient Rights Code a fairy tale.