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Examining the association between hospital-onset Clostridium difficile infection and multiple-bed room exposure: a case-control study

Published online by Cambridge University Press:  31 July 2018

Alon Vaisman Open the ORCID record for Alon Vaisman [Opens in a new window] ,
Michael Jula ,
Jessica Wagner  and
Lisa G. Winston
Alon Vaisman*
Affiliation:
Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, California Division of Infectious Diseases, University of Toronto, Toronto, Canada
Michael Jula
Affiliation:
Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
Jessica Wagner
Affiliation:
Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
Lisa G. Winston
Affiliation:
Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California Division of Infectious Diseases, University of California–San Francisco, San Francisco, California
*
Author for correspondence: Alon Vaisman, Room 5H22, Zuckerberg San Francisco General Hospital, 1001 Portero Ave 94110. E-mail: alon.vaisman@utoronto.ca
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Abstract

Objective

To determine whether assignment to a multiple-bed room increased the risk of hospital-onset C. difficile diarrhea (HO-CDI).

Design

Case-control study.

Setting

San Francisco General Hospital and Trauma Center.

Population

Adult general medical and surgical inpatients.

Methods

Consecutive cases of HO-CDI were identified between January 1, 2010, and December 31, 2015. To investigate the effect of multiple-bed room exposure both at admission and at the time of symptom onset, 2 sets of controls were selected from the general medical/surgical inpatient population using incidence density sampling. Conditional logistic regression was used to estimate the relationship between room assignment (single bed vs multiple beds) and the development of HO-CDI.

Results

In total, 187 cases were identified and matched with 512 and 515 controls for the admission and at-diagnosis analyses, respectively. The adjusted rate ratio (RR) associated with the development HO-CDI associated with multiple-bed room exposure during the 7 and 14 days immediately prior to HO-CDI diagnosis were 1.08 (95% confidence interval [CI], 0.93–1.25; P=.31) and 0.96 (95% CI, 0.93–1.18; P=.12), respectively. Furthermore, no significant association was detected in the analysis of the first 7 and 14 days after case admission or among patients with Charlson comorbidity scores ≥4 in either period.

Conclusion

Assignment of patients to multiple-bed rooms on general medical and surgical wards was not associated with an increased risk in the development of HO-CDI. Future investigation should be performed with larger cohorts in multiple sites to more definitively address the question because this issue could have implications for patient room assignment and hospital design.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 9 , September 2018 , pp. 1068 - 1073
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION. This work was previously presented as an abstract at IDWeek 2017 in San Diego, California on October 6, 2017.

Cite this article: Vaisman A, et al. (2018). Examining the association between hospital-onset Clostridium difficile infection and multiple-bed room exposure: a case-control study. Infection Control & Hospital Epidemiology 2018, 39, 1068–1073. doi: 10.1017/ice.2018.163

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