Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-23T12:30:31.701Z Has data issue: false hasContentIssue false
  • English
  • Français

Investigating the association of room features with healthcare-facility–onset Clostridioides difficile: An exploratory study

Published online by Cambridge University Press:  02 December 2020

Elisabeth Dowling Root ,
Megan Lindstrom ,
Amy Xie ,
Julie E. Mangino ,
Susan Moffatt-Bruce  and
Courtney Hebert
Elisabeth Dowling Root*
Affiliation:
Department of Geography, The Ohio State University, Columbus, Ohio Division of Epidemiology, The Ohio State University, Columbus, Ohio
Megan Lindstrom
Affiliation:
Department of Geography, The Ohio State University, Columbus, Ohio
Amy Xie
Affiliation:
College of Medicine, The Ohio State University, Columbus, Ohio
Julie E. Mangino
Affiliation:
Department of Internal Medicine, The Ohio State University, Columbus, Ohio
Susan Moffatt-Bruce
Affiliation:
Royal College of Physician and Surgeons of Canada, Ottawa, Ontario, Canada
Courtney Hebert
Affiliation:
Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
*
Author for correspondence: Elisabeth Dowling Root, E-mail: root.145@osu.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate hospital room and patient-level risk factors associated with increased risk of healthcare-facility–onset Clostridioides difficile infection (HO-CDI).

Design:

The study used a retrospective cohort design that included patient data from the institution’s electronic health record, existing surveillance data on HO-CDI, and a walk-through survey of hospital rooms to identify potential room-level risk factors. The primary outcome was HO-CDI diagnosis.

Setting:

A large academic medical center.

Patients and participants:

All adult patients admitted between January 1, 2015, and December 31, 2016 were eligible for inclusion. Prisoners were excluded. Patients who only stayed in rooms that were not surveyed were excluded.

Results:

The hospital room survey collected room-level data on 806 rooms. Included in the study were 17,034 patients without HO-CDI and 251 with HO-CDI nested within 535 unique rooms. In this exploratory study, room-level risk factors associated with the outcome in the multivariate model included wear on furniture and flooring and antibiotic use by the prior room occupant. Hand hygiene devices and fixed in-room computers were associated with reduced odds of a HO-CDI. Differences between hospital buildings were also detected. The only individual patient factors that were associated with increased odds of HO-CDI were antibiotic use and comorbidity score.

Conclusion:

Combining a hospital-room walk-through data collection survey, EHR data, and CDI surveillance data, we were able to develop a model to investigate room and patient-level risks for HO-CDI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 7 , July 2021 , pp. 847 - 852
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care–associated infections. N Engl J Med 2014;370:1198–208.CrossRefGoogle ScholarPubMed
Balsells, E, Shi, T, Leese, C, et al. Global burden of Clostridium difficile infections: a systematic review and meta-analysis. J Global Health 2019;9:010407.CrossRefGoogle ScholarPubMed
McDonald, LC, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018;66:987–994.CrossRefGoogle Scholar
Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States. Atlanta, GA: CDC; 2019.Google Scholar
Jullian-Desayes, I, Landelle, C, Mallaret, M-R, Brun-Buisson, C, Barbut, F. Clostridium difficile contamination of healthcare workers’ hands and its potential contribution to the spread of infection: review of the literature. Am J Infect Control 2017;45:51–58.CrossRefGoogle Scholar
Anderson, DJ, Moehring, RW, Weber, DJ, et al. Effectiveness of targeted enhanced terminal room disinfection on hospital-wide acquisition and infection with multidrug-resistant organisms and Clostridium difficile: a secondary analysis of a multicentre cluster-randomised controlled trial with crossover design (BETR Disinfection). Lancet Infect Dis 2018;18:845–853.CrossRefGoogle Scholar
Kim, K-H, Fekety, R, Batts, DH, et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis 1981;143:42–50.CrossRefGoogle ScholarPubMed
Kaatz, GW, Gitlin, SD, Schaberg, DR, et al. Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol 1988;127:1289–1294.CrossRefGoogle ScholarPubMed
Deshpande, A, Cadnum, JL, Fertelli, D, et al. Are hospital floors an underappreciated reservoir for transmission of healthcare-associated pathogens? Am J Infect Control 2017;45:336–338.CrossRefGoogle Scholar
Liscynesky, C, Hines, LP, Smyer, J, Hanrahan, M, Orellana, RC, Mangino, JE. The effect of ultraviolet light on Clostridium difficile spore recovery versus bleach alone. Infect Control Hosp Epidemiol 2017;38:1116–1117.CrossRefGoogle ScholarPubMed
Curry, SR, Muto, CA, Schlackman, JL, et al. Use of multilocus variable number of tandem repeats analysis genotyping to determine the role of asymptomatic carriers in Clostridium difficile transmission. Clin Infect Dis 2013;57:1094–102.CrossRefGoogle ScholarPubMed
Freedberg, DE, Salmasian, H, Cohen, B, Abrams, JA, Larson, EL. Receipt of antibiotics in hospitalized patients and risk for Clostridium difficile infection in subsequent patients who occupy the same bed. JAMA Intern Med 2016;176:1801.CrossRefGoogle ScholarPubMed
Hebert, C, Root, ED. Repurposing geographic information systems for routine hospital infection control. In: Advances in Health Care Management. Bingley, UK: Emerald; 2019: 61–73.Google Scholar
Jou, J, Ebrahim, J, Shofer, FS, Hamilton, KW, Stern, J, Han, JH. Environmental transmission of Clostridium difficile: association between hospital room size and C. difficile infection. Infect Control Hosp Epidemiol 2015;36:564–568.CrossRefGoogle ScholarPubMed
Wilson, GM, Jackson, VB, Boyken, LD, et al. Bioaerosols generated from toilet flushing in rooms of patients with Clostridioides difficile infection. Infect Control Hosp Epidemiol 2020;41:517–521.CrossRefGoogle ScholarPubMed
Vaisman, A, Jula, M, Wagner, J, Winston, LG. Examining the association between hospital-onset Clostridium difficile infection and multiple-bed room exposure: a case-control study. Infect Control Hosp Epidemiol 2018;39:1068–1073.CrossRefGoogle ScholarPubMed
Durant, DJ. Can patient-reported room cleanliness measures predict hospital-acquired C. difficile infection? A study of acute-care facilities in New York state. Am J Infect Control 2020. https://doi.org/10.1016/j.ajic.2020.08.024.CrossRefGoogle Scholar
McFarland, LV, Mulligan, ME, Kwok, RYY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204–210.CrossRefGoogle ScholarPubMed
Sethi, AK, Al-Nassir, WN, Nerandzic, MM, Bobulsky, GS, Donskey, CJ. Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of C. difficile infection. Infect Control Hosp Epidemiol 2010;31:21–27.CrossRefGoogle ScholarPubMed
Supplementary material: File

Root et al. supplementary material

Root et al. supplementary material

Download Root et al. supplementary material(File)
File 62.5 KB