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Environmental Transmission of Clostridium difficile: Association Between Hospital Room Size and C. difficile Infection

Published online by Cambridge University Press:  05 February 2015

Justine Jou ,
John Ebrahim ,
Frances S. Shofer ,
Keith W. Hamilton ,
John Stern  and
Jennifer H. Han
Justine Jou
Affiliation:
Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
John Ebrahim
Affiliation:
Department of Medicine, New York University, New York, New York
Frances S. Shofer
Affiliation:
Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Keith W. Hamilton
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
John Stern
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Jennifer H. Han*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
*
Address correspondence to Jennifer H. Han, MD, MSCE, Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 811 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 (jennifer.han@uphs.upenn.edu).
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Abstract

OBJECTIVE

To evaluate the association between hospital room square footage and acquisition of nosocomial Clostridium difficile infection (CDI).

METHODS

A case-control study was conducted at a university hospital during the calendar year of 2011. Case patients were adult inpatients with nosocomial CDI. Control patients were hospitalized patients without CDI and were randomly selected and matched to cases in a 2:1 ratio on the basis of hospital length of stay in 3-day strata. A multivariate model was developed using conditional logistic regression to evaluate risk factors for nosocomial CDI.

RESULTS

A total of 75 case patients and 150 control patients were included. On multivariate analyses, greater square footage of the hospital room was associated with a significantly increased risk of acquiring CDI (odds ratio for every 50 ft2 increase, 3.00; 95% CI, 1.75–5.16; P<.001). Other factors associated with an increased risk of CDI were location in a single room (odds ratio, 3.43; 95% CI, 1.31–9.05; P=.01), malignant tumor (4.56; 1.82–11.4; P=.001), and receipt of cefepime (2.48; 1.06–5.82; P=.04) or immunosuppressants (6.90; 2.07–23.0; P=.002) within the previous 30 days.

CONCLUSIONS

Greater room square footage increased the risk of acquisition of CDI in the hospital setting, likely owing to increased environmental contamination and/or difficulty in effective disinfection. Future studies are needed to determine feasible and effective cleaning protocols based on patient and room characteristics.

Infect Control Hosp Epidemiol 2015;00(0): 1–5

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 5 , May 2015 , pp. 564 - 568
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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