1373. Shared Hoppers: A novel risk factor for the transmission of Clostridium difficile
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • TSICU_CDIFF_FINAL092513.pdf (356.6 kB)
  • Background:

    Previous studies have demonstrated that a prior hospital room occupant or roommate with a multi-drug resistant organism is a risk factor for acquisition. We observed a cluster of cases in spring 2010, occurring among trauma-surgical intensive care unit (TSICU) patients. Cases shared a rimless, flushable basin (hopper), situated between private and double rooms, with a patient infected with C. difficile.  We postulated that hoppers contributed to transmission of C. difficile spores through contamination of healthcare workers and the shared environment.


    We conducted a case-control study to identify risk factors for C. difficile acquisition in our TSICU between December 15, 2010 to December 14, 2011. Cases were defined as those with new onset diarrhea and a positive PCR test for C. difficile toxin B at least 36 hours from TSICU admission. Controls also had a TSICU stay of at least 36 hours and negative  C.difficile PCR for at least 30 days after discharge from the TSICU. Approximately three concurrent controls were randomly selected within one week of admission for each case.  Persons with a known history of prior C. difficile infection were excluded. Demographics, laboratory data, clinical data, and outcomes were abstracted from the electronic medical record.


    Twenty-six patients with hospital-acquired C. difficile infection were identified and 73 controls selected. Study group (n=99) demographics were a mean age of 50.7 years (SD ± 20.9), 61 male (61.6%), and 78 (78.8%) Caucasian.  On bivariate analysis, cases were more likely than controls to have had trauma (OR=3.9 [1.3,11.3]), surgery (OR=16.5 [2.1,128.4]), facial fractures (OR=4.1 [1.1,14.8]), prior room occupant/roommate with C.difficile (OR=3.6 [1.2,11.0]), and shared hopper (OR=5.0 [1.6,15.3]). Longer length of stay, cephalosporin use, H2 blocker use, open abdomen, tube feedings, and mechanical ventilation were also associated with C. difficile infection.


    Environmental predictors of C. difficile in this study included a shared hopper and prior or current room occupant with a C. difficile- infected patient. While the potential for transmission of infectious agents by toilet aerosolization of droplets is documented, this study suggests a novel mode of C. difficile transmission by shared hoppers. These findings have implications for hospital design.

    Julie A. Choudhuri, RN MSPH1, Jeannie D. Chan, PharmD, MPH2, Matthew J. Hafermann, PharmD3, Charlotte Fulton, RN MHA1, Elizabeth Melius, RN MN MPH1, Astrid B. Schreuder, PhD4, Elizabeth Mcnamara, RN MN1, Ronald Pergamit, MPA1, John B. Lynch, MD MPH1 and Timothy H. Dellit, MD1, (1)Infection Control, Harborview Medical Center, Seattle, WA, (2)Pharmacy, Harborview Medical Center, Seattle, WA, (3)Pharmacy, University of Washington, Seattle, WA, (4)Quality Improvement, Harborview Medical Center, Seattle, WA


    J. A. Choudhuri, None

    J. D. Chan, None

    M. J. Hafermann, None

    C. Fulton, None

    E. Melius, None

    A. B. Schreuder, None

    E. Mcnamara, None

    R. Pergamit, None

    J. B. Lynch, None

    T. H. Dellit, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.