Certain Rooms in Intensive Care Units May Harbor Risk for Clostridioides difficile Infection

Area of Science:

• Infectious Diseases
• Healthcare Epidemiology
• Critical Care Medicine

Background:

• Clostridioides difficile infection (CDI) is a significant healthcare-associated infection.
• Factors influencing CDI transmission include patient, care, and hygiene practices.
• The role of intensive care unit (ICU) room topography and care provider behavior in CDI genesis remains underexplored.

Purpose of the Study:

• To investigate whether specific ICU rooms are disproportionately associated with CDI cases.
• To identify correlations between room features, clinician movement patterns, and CDI incidence.
• To explore the potential impact of ICU room design on CDI acquisition risk.

Main Methods:

• Retrospective analysis of CDI cases in a surgical intensive care unit (SICU) from July 2009 to June 2018.
• Comparison of room features and provider traffic in high-incidence versus low-incidence CDI rooms using video monitoring.
• Analysis of proximity of toilets to other room features and clinician time spent in different room zones.

Main Results:

• High-incidence CDI rooms exhibited closer proximity between toilets and intravenous poles.
• Mobile objects were consistently positioned farther from toilets in high-incidence rooms.
• Nurses spent more time in far/middle zones of high-incidence rooms, suggesting altered movement patterns.

Conclusions:

• Distinct SICU room features, particularly toilet location, interact with bedside clinician behaviors to influence patient CDI acquisition risk.
• CDI risk appears to be an inherent structural aspect of ICU care delivery.
• Deliberate redesign of ICU rooms offers a potential strategy to mitigate patient CDI risk.