Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-19T08:37:46.480Z Has data issue: false hasContentIssue false
  • English
  • Français

Bed Occupancy Rates and Hospital-Acquired Clostridium difficile Infection: A Cohort Study

Published online by Cambridge University Press:  28 May 2015

Lauren C. Ahyow ,
Paul C. Lambert ,
David R. Jenkins ,
Keith R. Neal  and
Martin Tobin
Lauren C. Ahyow*
Affiliation:
Department of Public Health, National Health Service Leicestershire County and Rutland, Glenfield, Leicestershire, United Kingdom
Paul C. Lambert
Affiliation:
Department of Health Sciences, University of Leicester, Leicester, United Kingdom Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
David R. Jenkins
Affiliation:
Department of Clinical Microbiology, University Hospitals of Leicester National Health Service Trust, Leicester Royal Infirmary, Leicester, United Kingdom
Keith R. Neal
Affiliation:
School of Community Health Sciences, Division of Public Health Sciences, University of Nottingham Medical School, Nottingham, United Kingdom
Martin Tobin
Affiliation:
Department of Health Sciences, University of Leicester, Leicester, United Kingdom Department of Genetics, University of Leicester, Leicester, United Kingdom National Institute for Health Research Leicester, Respiratory Biomedical Research Unit, Leicester, United Kingdom
*
Department of Public Health, National Health Service Leicestershire County and Rutland, County Hall, Glenfield, Leicestershire LE3 8TB, United Kingdom ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

An emergent strain (ribotype 027) of Clostridium difficile infection (CDI) has been implicated in epidemics worldwide. Organizational factors such as bed occupancy have been associated with an increased incidence of CDI; however, the data are sparse, and the association has not been widely demonstrated. We investigated the association of bed occupancy and CDI within a large hospital organization in the United Kingdom.

Objective.

To establish whether bed occupancy rates are a significant risk factor for CDI in the general ward setting.

Methods.

A retrospective cohort study was carried out on data from 2006 to 2008. Univariate and multivariate Cox regression modeling was used to examine the strength and significance of the associations. Variables included patient characteristics, antibiotic policy exposure, case mix, and bed occupancy rates.

Results.

A total of 1,589 cases of hospital-acquired CDI were diagnosed (1.7% of admissions), with an overall infection rate of 2.16 per 1,000 patient-days. Median bed occupancy was 93.3% (interquartile range, 83.3%–100%) Univariate and multivariate analyses showed positive and statistically significant associations. In the adjusted model, patients on wards with occupancy rates of 80%–89.9% had rates of CDI that were 56% higher (hazard ratio, 1.56 [95% confidence interval, 1.18–2.04]; P<.001) compared with baseline (0%–69.9% occupancy). CDI rates were 55% higher for patients on wards with maximal bed occupancy (100%).

Conclusions.

There is strong evidence of an association between high bed occupancy and CDI. Without effective interventions at high levels of bed occupancy, the economic benefits sought from reducing bed numbers may be negated by the increased risk of CDI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 10 , October 2013 , pp. 1062 - 1069
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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

1.Wilcox, MH, Eastwood, KA. Evaluation Report. Clostridium difficile Toxin Detection Assays. London: Centre for Evidence-Based Purchasing, 2009.Google Scholar
2.Rupnik, M, Wilcox, MH, Gerding, DN. Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol 2009;7(7):526–536.Google Scholar
3.Freeman, J, Bauer, MP, Baines, SD, et al.The changing epidemiology of Clostridium difficile infections. Clin Microbiol Rev 2010;23(3):529–549.CrossRefGoogle ScholarPubMed
4.Pepin, J, Valiquette, L, Cossette, B. Mortality attributable to nosocomial Clostridium difficile–associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ 2005;173(9):1037–1042.Google Scholar
5.Hookman, P, Barkin, JS. Clostridium difficile associated infection, diarrhea and colitis. World J Gastroenterol 2009;15(13):1554–1580.Google Scholar
6.Rouphael, NG, O'Donnell, JA, Bhatnagar, J, et al.Clostridium difficile–associated diarrhea: an emerging threat to pregnant women. Am J Obstet Gynecol 2008;635:e1–e6.Google Scholar
7.Centers for Disease Control and Prevention. Severe Clostridium difficile–associated disease in populations previously at low risk—four states, 2005. MMWR Morb Mortal Wkly Rep 2005;54:1201–1205.Google Scholar
8.Muto, CA, Pokrywka, M, Shutt, K, et al.A large outbreak of Clostridium difficile–associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005;26(3):273–280.Google Scholar
9.Kuijper, EJ, Coignard, B, Tüll, P; ESCMID Study Group for Clostridium difficile; EU Member States; European Centre for Disease Prevention and Control. Emergence of Clostridium difficile–associated disease in Nort h America and Europe. Clin Microbiol Infect 2006;12:2–18.Google Scholar
10.Office for National Statistics. Deaths involving Clostridium difficile. England and Wales, 1999 and 2001–06. Health Stat Q 2008:52–56.Google Scholar
11.Warny, M, Pepin, J, Fang, A, et al.Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005:1530–1533.Google Scholar
12.McDonald, LC, Killgore, GE, Thompson, A, et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353(23):2433–2441.Google Scholar
13.Pepin, J, Saheb, N, Coulombe, MA, et al.Emergence of fluoro-quinolones as the predominant risk factor for Clostridium difficile–associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41(9):1254–1260.Google Scholar
14.Thomas, C, Stevenson, M, Riley, TV. Antibiotics and hospital-acquired Clostridium difficile–associated diarrhoea: a systematic review. J Antimicrob Chemother 2003;51(6):1339–1350.Google Scholar
15.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile–associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353(23):2442–2449.Google Scholar
16.Kyne, L, Warny, M, Qamar, A, Kelly, CP. Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet 2001;357(9251):189–193.Google Scholar
17.Kyne, L, Sougioultzis, S, McFarland, LV, Kelly, CF. Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea. Infect Control Hosp Epidemiol 2002;23(11):653–659.Google Scholar
18.Linsky, A, Gupta, K, Lawler, EV, Fonda, JR, Hermos, JA. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch Intern Med 2010;170(9):772–778.Google Scholar
19.Griffiths, P, Renz, A, Hughes, J, Rafferty, AM. Impact of organisation and management factors on infection control in hospitals: a scoping review. J Hosp Infect 2009;73(1):1–14.Google Scholar
20.Clements, A, Halton, K, Graves, N, et al.Overcrowding and understaffing in modern health-care systems: key determinants in meticillin-resistant Staphylococcus aureus transmission. Lancet Infect Dis 2008;8(7):427–434.Google Scholar
21.Cunningham, JB, Kernohan, WG, Rush, T. Bed occupancy, turnover intervals and MRSA rates in English hospitals. Br J Nurs 2006;15(12):656–660.Google Scholar
22.Cunningham, JB, Kernohan, WG, Sowney, R. Bed occupancy and turnover interval as determinant factors in MRSA infections in acute settings in Northern Ireland: 1 April 2001 to 31 March 2003. J Hosp Infect 2005;61(3):189–193.Google Scholar
23.Kaier, K, Luft, D, Dettenkofer, M, Kist, M, Frank, U. Correlations between bed occupancy rates and Clostridium difficile infections: a time-series analysis. Epidemiol Infect 2010;139:482–485.Google Scholar
24.Eastwood, K, Patrick, E, Charlett, A, Wilcox, M. Comparison of nine commercially available Clostridium difficile toxin detection assays, a real-time PCR assay for C. difficile tcdB, and a glutamate dehydrogenase detection assay to cytotoxin testing and cytotoxigenic culture methods. J Clin Microbiol 2009;47(10):3211–3217.Google Scholar
25.Department of Health (DH); Health Protection Agency. Clostridium difficile Infection: How to Deal with the Problem. London: DH, 2008.Google Scholar
26.Cohen, SH, Gerding, DN, Johnson, S, et al.Clinical practice guide-lines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31(5):431–455.Google Scholar
27.Department of Health (DH). Saving Lives: High Impact Intervention No 6: Reducing the Risk of Infection from and the Presence of Clostridium difficile. London: DH, 2006.Google Scholar
28.Therneau, TM, Grambsch, PM. Modeling Survival Data: Extending the Cox Model. Statistics for Biology and Health. London: Springer, 2000.Google Scholar
29.Nijssen, S, Bonten, MJM, Franklin, C, Verhoef, J, Hoepelman, AIM, Weinstein, RA. Relative risk of physicians and nurses to transmit pathogens in a medical intensive care unit. Arch Intern Med 2003;163(22):2785–2786.Google Scholar
30.Dancer, SJ. The role of environmental cleaning in the control of hospital-acquired infection. J Hosp Infect 2009;73(4):378–385.Google Scholar
31.Pittet, D, Mourouga, P, Perneger, TV; Members of the Infection Control Program. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130(2):126–130.Google Scholar
32.Allegranzi, B, Pittet, D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 2009;73(4) 305–315.Google Scholar
33.Dancer, SJ. Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis 2008;8(2):101–113.Google Scholar
34.Cooper, BS, Stone, SR, Kibbler, CC, et al.Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modeling. Health Technol Assess 2003;7(39):1–194.Google Scholar
35.Casewell, MW. New threats to the control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 1995;30:465–471.Google Scholar
36.Department of Health (DH). Hospital Organisation, Speciality Mix and MRSA. London: DH, 2007.Google Scholar
37.Borg, MA, Suda, D, Scicluna, E. Time-series analysis of the impact of bed occupancy rates on the incidence of methicillin-resistant Staphylococcus aureus infection in overcrowded general wards. Infect Control Hosp Epidemiol 2008;29(6):496–502.Google Scholar
38.Department of Health (DH). Hospital Activity Statistics. London: DH, 2009.Google Scholar
39.Duckett, S. Australian hospital services: an overview. Aust Health Rev 2002;25:2–18.Google Scholar
40.American Hospital Association (AHA). Annual Survey Data, 2008, for Community Hospitals. Washington, DC: AHA, 2008.Google Scholar
41.Orendi, J. Health-care organisation, hospital-bed occupancy, and MRSA. Lancet 2008;371:1401–1402.Google Scholar
42.Clements, ACA, Magalhaes, RJS, Tatem, AJ, Paterson, DL, Riley, TV. Clostridium difficile PCR ribotype 027: assessing the risks of further worldwide spread. Lancet Infect Dis 2010;10(6):395–404.Google Scholar
43.Kmietowicz, Z. New health secretary warns further NHS efficiency savings may be needed. BMJ 2010;340:c2600.Google Scholar