Examining the impact of clinical features and built environment on risk of hospital onset Clostridioides difficile infection.

Objective: Environmental features of a patient's room depend on the patient's level of acuity and their clinical manifestations upon admission and during their hospital stay. In this study, we wish to apply statistical methodology to explore the association between room features and hospital onset infections caused by Clostridioides difficile (HO-CDI) while accounting for room assignment.

Method: We conducted a nested case-control study using retrospective electronic health record (EHR) data of patients hospitalized at the Ohio State University Wexner Medical Center (OSUWMC) between January 2019 and April 2021. We collected clinical information and combined that with room-based information, collected as surveys. Data were analyzed to assess the association between room factors and HO-CDI.

Results: 2427 patients and 968 unique rooms were included in the study. Results indicated protective effects for rooms with cubical curtains near the patient (OR = 0.705, 95% CI = 0.549-0.906), rooms with separate shower units (OR = 0.674, 95% CI = 0.528-0.860), rooms with wall-mounted toilets (OR = 0.749, 95% CI = 0.592-0.950), rooms with sliding bathroom doors (OR = 0.593, 95% CI = 0.432-0.816), and sliding door knobs (OR = 0.593, 95% CI = 0.431-0.815). Rooms with manual paper towel dispensers had increased odds of HO-CDI (OR = 1.334, 95% CI = 1.053-1.691) compared to those with automatic towel dispensers.

Conclusion: Results suggest possible association between specific room features and HO-CDI, which could be further investigated with techniques like environmental sampling. Moreover, findings from the study offer valuable insights for targeted intervention measures.