Optimal Design of Paired Built Environment Interventions for Control of MDROs in Acute Care and Community Hospitals

Marietta M. Squire, Gareth K. Sessel, Gary Lin, Edward N. Squire, Takeru Igusa

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: Our goal was to optimize infection control of paired environmental control interventions within hospitals to reduce methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococci (VRE). Background: The most widely used infection control interventions are deployment of handwashing (HW) stations, control of relative humidity (RH), and negative pressure (NP) treatment rooms. Direct costs of multidrug-resistant organism (MDRO) infections are typically not included in the design of such interventions. Methods: We examined the effectiveness of pairing HW with RH and HW with NP. We used the following three data sets: A meta-analysis of progression rates from uncolonized to colonized to infected, 6 years of MDRO treatment costs from 400 hospitals, and 8 years of MDRO incidence rates at nine army hospitals. We used these data as inputs into an Infection De-Escalation Model with varying budgets to obtain optimal intervention designs. We then computed the infection and prevention rates and cost savings resulting from these designs. Results: The average direct cost of an MDRO infection was $3,289, $1,535, and $1,067 for MRSA, CRE, and VRE. The mean annual incidence rates per facility were 0.39%, 0.034%, and 0.011% for MRSA, CRE, and VRE. After applying the cost-minimizing intervention pair to each scenario, the percentage reductions in infections (and annual direct cost savings) in large, community, and small acute care hospitals were 69% ($1.5 million), 73% ($631K), 60% ($118K) for MRSA, 52% ($460.5K), 58% ($203K), 50% ($37K) for CRE, and 0%, 0%, and 50% ($12.8K) for VRE. Conclusion: The application of this Infection De-Escalation Model can guide cost-effective decision making in hospital built environment design to improve control of MDRO infections.

Original languageEnglish (US)
Pages (from-to)109-129
Number of pages21
JournalHealth Environments Research and Design Journal
Issue number2
StatePublished - Apr 2021


  • CRE
  • MRSA
  • VRE
  • admissions
  • built environment
  • cleaning
  • colonized
  • cost savings
  • direct cost
  • handwashing
  • healthcare-associated infection
  • hospital
  • infection control
  • multidrug-resistant organism
  • patient safety
  • quality improvement

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Public Health, Environmental and Occupational Health


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