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Evaluation of Hospital Room Assignment and Acquisition of Clostridium difficile Infection

Published online by Cambridge University Press:  02 January 2015

Megan K. Shaughnessy ,
Renee L. Micielli ,
Daryl D. DePestel ,
Jennifer Arndt ,
Cathy L. Strachan ,
Kathy B. Welch  and
Carol E. Chenoweth
Megan K. Shaughnessy
Affiliation:
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
Renee L. Micielli
Affiliation:
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
Daryl D. DePestel
Affiliation:
Department of Clinical, Social, and Administrative Sciences, University of Michigan College of Pharmacy, and Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, Michigan
Jennifer Arndt
Affiliation:
Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Cathy L. Strachan
Affiliation:
Clinical Information Decision Support Services, University of Michigan Health System, Ann Arbor, Michigan
Kathy B. Welch
Affiliation:
University of Michigan Center for Statistical Consultation and Research, Ann Arbor, Michigan
Carol E. Chenoweth*
Affiliation:
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
*
3119 Taubman Center, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5378 ([email protected])
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Abstract

Background and Objective.

Clostridium difficile spores persist in hospital environments for an extended period. We evaluated whether admission to a room previously occupied by a patient with C. difficile infection (CDI) increased the risk of acquiring CDI.

Design.

Retrospective cohort study.

Setting.

Medical intensive care unit (ICU) at a tertiary care hospital.

Methods.

Patients admitted from January 1, 2005, through June 30, 2006, were evaluated for a diagnosis of CDI 48 hours after ICU admission and within 30 days after ICU discharge. Medical, ICU, and pharmacy records were reviewed for other CDI risk factors. Admitted patients who did develop CDI were compared with admitted patients who did not.

Results.

Among 1,844 patients admitted to the ICU, 134 CDI cases were identified. After exclusions, 1,770 admitted patients remained for analysis. Of the patients who acquired CDI after admission to the ICU, 4.6% had a prior occupant without CDI, whereas 11.0% had a prior occupant with CDI (P = .002). The effect of room on CDI acquisition remained a significant risk factor (P = .008) when Kaplan-Meier curves were used. The prior occupant's CDI status remained significant (P = .01; hazard ratio, 2.35) when controlling for the current patient's age, Acute Physiology and Chronic Health Evaluation III score, exposure to proton pump inhibitors, and antibiotic use.

Conclusions.

A prior room occupant with CDI is a significant risk factor for CDI acquisition, independent of established CDI risk factors. These findings have implications for room placement and hospital design.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 3 , March 2011 , pp. 201 - 206
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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