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Environmental Transmission of Clostridium difficile: Association Between Hospital Room Size and C. difficile Infection

  • Justine Jou (a1), John Ebrahim (a2), Frances S. Shofer (a1) (a3), Keith W. Hamilton (a4), John Stern (a4) and Jennifer H. Han (a4) (a5) (a6)...



To evaluate the association between hospital room square footage and acquisition of nosocomial Clostridium difficile infection (CDI).


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.


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.


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.

Infect Control Hosp Epidemiol 2015;00(0): 1–5


Corresponding author

Address correspondence to Jennifer H. Han, MD, MSCE, Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 811 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104 (


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