It is now normal for patients to share rooms with up to five other people. In some hospitals, this includes accommodation men and women in the same roomdespite the seriousness safety and ethical concerns.

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

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

Many may see shared rooms as a cost savings. But one of the key arguments for individual rooms in hospitals is the cost and damage of bacterial infections and resistance.

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

They also reduce the need for room transfers within the hospital, which increases the risk of transmission of infection between patients.

There is strong evidence that single occupancy rooms result in reduced infections in intensive care units. And further research has also found that single occupancy reduces hospital transmission of Covid-19.

In New Zealand, single rooms are prioritized for patients known to be infectious. But the key word here is known. This policy fails to recognize that a large proportion of transmissible infections are unknown at the time of ward placement.

However, even when the infection is known, our hospitals cannot meet the basic rules due to the lack of single rooms. Just 30% of Wellington and Hutt hospital rooms are single occupancy, for example.

Without single occupancy as standard in hospitals, infection control will remain compromised.

Delirium and dementia

Individual rooms are also required for older adults. New Zealand’s population is ageing; as a result, patients with delirium and dementia requiring hospitalization will increase.

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

Prevention and management of delirium requires a low-stimulus environment, uninterrupted sleep, and light and noise control, which cannot be achieved in common hospital rooms.

Research has shown a reduction in delirium with single cameras.

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

They can be extremely distressing to the patient and those around them and, like delirium, cannot be managed to a basic standard of care in a shared room.

The prevalence of dementia will more than double by 2050. And yet, New Zealand’s hospitals are ill-prepared to cope with this increase in demand.

The right to security, privacy and dignity

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

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

Unfortunately, patients frequently share with those who cannot manage their own behavior. Although the risks to women have been highlighted, no patient should be put at risk or frightened by the behavior of another patient.

Dignity and privacy are also fundamental patient rights, with privacy covered by both the Health Information Privacy Code and the Health and Disability Patients’ Rights Code.

Hospital patients often need assistance with dressing, showering and toileting. Many admissions involve vomiting, diarrhea or incontinence. And the design that relies on curtains to maintain privacy makes that right a farce.

Research and complaints make it clear that patients do not believe their privacy is adequately protected in common spaces.

Some might argue for multi-bed rooms on the basis that some patients prefer company. However, patient surveys on privacy and confidentiality are overwhelmingly in favor of single occupancy.

Consideration of costs

Although there is an increase in initial costs when building single rooms due to the larger hospital footprint, research has found that there is no compelling economic evidence in favor of multi-bed rooms.

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

The case for single-occupancy hospital rooms on clinical, ethical and legal grounds is collectively unequivocal.

New Zealand must follow international best practice and introduce single occupancy rooms as a basic standard for new hospital builds and upgrades.

Failure to do so would ignore the lessons learned in the Covid-19 pandemic, ignore the needs of an aging population and continue to make New Zealand’s patients’ rights code a fairy tale.

Sign up to Daily Ha free newsletter curated by our editors and delivered straight to your inbox every weekday.