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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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References

1.Bartlett, JG, Gerding, DN. Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis 2008;46(suppl 1): S12–S18.Google Scholar
2.Gerding, DN, Muto, CA, Owens, RC. Measures to control and prevent Clostridium difficile infection. Clin Infect Dis 2008;46(suppl 1):S43–S49.Google Scholar
3.Kyne, L, Hamel, MB, Polavaram, R, Kelly, CRHealth care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002;34:346–353.CrossRefGoogle ScholarPubMed
4.Kim, KH, 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
5.Huang, SS, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:1945–1951.CrossRefGoogle ScholarPubMed
6.Chang, VT, Nelson, K. The role of physical proximity in nosocomial diarrhea. Clin Infect Dis 2000;31:717–722.CrossRefGoogle ScholarPubMed
7.Dubberke, ER, Reske, KA, Olsen, MA, et al.Evaluation of Clostridium difficile-associated disease pressure as a risk factor for C. difficile-associated disease. Arch Intern Med 2007;167:1092–1097.CrossRefGoogle ScholarPubMed
8. WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD index 2011. http://www.whocc.no/atcddd/. Accessed August 15, 2008.Google Scholar
9.Kazakova, SV, Ware, K, Baughman, B, et al.A hospital outbreak of diarrhea due to an emerging epidemic strain of Clostridium difficile. Arch Intern Med 2006;166:2518–2524.CrossRefGoogle Scholar
10.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;26:273–280.Google Scholar
11.Loo, VG, Poirier, L, Miller, MA, et al.A predominately clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–2449.CrossRefGoogle ScholarPubMed
12.Pepin, J, Saheb, N, Coulombe, M, et al.Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41:1254–1260.CrossRefGoogle ScholarPubMed
13.Dubberke, ER, Reske, KA, Yan, Y, Olsen, MA, McDonald, LC, Fraser, VJ. Clostridium difficile-associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis 2007;45:1543–1549.CrossRefGoogle Scholar
14.Owens, RC, Donskey, CJ, Gaynes, RP, Loo, VG, Muto, CA. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis 2008;46(suppl 1):S19–S31.CrossRefGoogle ScholarPubMed
15.McCusker, ME, Harris, AD, Perencevich, E, Roghmann, M. Fluoroquinolone use and Clostridium difficile-associated diarrhea. Emerg Infect Dis 2003;9:730–733.CrossRefGoogle ScholarPubMed
16.Dial, S, Alrasadi, K, Manoukian, C, Huang, A, Menzies, D. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies. CMAJ 2004;17(1):33–38.CrossRefGoogle Scholar
17.Cunningham, R, Dale, B, Undy, B, Gaunt, N. Proton pump inhibitors as a risk factor for Clostridium difficile diarrhea. J Hosp Infect 2003;54:243–245.CrossRefGoogle Scholar
18.Bliss, DZ, Johnson, S, Savik, K, Clabots, CR, Willard, K, Gerding, DN. Acquisition of Clostridium difficile and Clostridium difficile-associated diarrhea in hospitalized patients receiving tube feeding. Ann Intern Med 1998;129:1012–1019.CrossRefGoogle ScholarPubMed
19.American Institute of Architects. Guidelines for Design and Construction of Hospital and Healthcare Facilities. Washington, DC: American Institute of Architects Press, 2006.Google Scholar
20.Polk, RE, Fox, C, Mahoney, A, Letcavage, J, MacDougall, C. Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis 2007;44:664–670.CrossRefGoogle ScholarPubMed
21.Boyce, JM, Havill, NL, Otter, JA, et al.Impact of hydrogen peroxide vapor room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting. Infect Control Hosp Epidemiol 2008;29:723–729.CrossRefGoogle Scholar