title: Environmental transmission of Clostridium difficile: association between hospital room size and C. difficile Infection.
abstract: OBJECTIVE
  To evaluate the association between hospital room square footage and acquisition of nosocomial Clostridium 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 on the basis of 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 for every 50 ft² increase, 3.00; 95% CI, 1.75-5.16; P<.001). Other factors associated with an increased risk of CDI were location in a single room (odds ratio, 3.43; 95% CI, 1.31-9.05; P=.01), malignant tumor (4.56; 1.82-11.4; P=.001), and receipt of cefepime (2.48; 1.06-5.82; P=.04) or immunosuppressants (6.90; 2.07-23.0; P=.002) within the previous 30 days.
  
  
  CONCLUSIONS
  Greater room square footage increased the risk of acquisition of CDI in the hospital setting, likely owing 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.
authors: 1Center for Public Health Initiatives,University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Justine
authors: J
authors: Jou
authors: 6Department of Medicine,New York University,New York,New York.
authors: John
authors: J
authors: Ebrahim
authors: 1Center for Public Health Initiatives,University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Frances S
authors: FS
authors: Shofer
authors: 3Division of Infectious Diseases,Department of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Keith W
authors: KW
authors: Hamilton
authors: 3Division of Infectious Diseases,Department of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors: John
authors: J
authors: Stern
authors: 3Division of Infectious Diseases,Department of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Jennifer H
authors: JH
authors: Han
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016360:Clostridioides difficile; D003428:Cross Infection / Q000209:etiology / Q000635:transmission*; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology / Q000635:transmission*; D005260:Female; D006749:Hospital Design and Construction / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D012307:Risk Factors
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