25652311

PMC4402219

Background

The hospital environment is important in the transmission of Clostridium difficile, with C. difficile frequently contaminating environmental surfaces. Our objective was to evaluate the association between hospital room square footage and acquisition of nosocomial C. difficile infection (CDI).

Methods

A case-control study was conducted at a university hospital during the calendar year of 2011. Case patients were adult inpatients with nosocomial CDI. Control patients were hospitalized patients without CDI, and were randomly selected and matched to cases in a 2:1 ratio based on hospital length of stay in 3-day strata. A multivariate model was developed using conditional logistic regression to evaluate risk factors for nosocomial CDI.

Results

A total of 75 case patients and 150 control patients were included. On multivariate analyses, greater square footage of the hospital room was associated with a significantly increased risk of acquiring CDI (odds ratio [OR] for every 50 ft2, 3.00; 95% confidence interval [CI], 1.75-5.16; P<0.001). Other factors associated with an increased risk of CDI were location in a single room (OR, 3.43; 95% CI, 1.31-9.05; P=0.01), malignancy (OR, 4.56; 95% CI, 1.82-11.4; P=0.001), and receipt of cefepime (OR, 2.48; 95% CI, 1.06-5.82; P=0.04) or immunosuppressants (OR, 6.90; CI, 2.07-23.0; P=0.002) within the previous 30 days.

Conclusions

Greater room square footage increased the risk of acquisition of CDI in the hospital setting, likely due to increased environmental contamination and/or difficulty in effective disinfection. Future studies are needed to determine feasible and effective cleaning protocols based on patient and room characteristics.

CDC Public Access

K01 AI103028/AI/NIAID NIH HHS/United States
K01-AI103028/AI/NIAID NIH HHS/United States
U54-CK000163/CK/NCEZID CDC HHS/United States