Can C difficile Infection Be Spread Via Hospital Beds?

Conference | <b>Society for Healthcare Epidemiology of America (SHEA) Spring Conference</b>

A patient has a higher risk of infection of C difficile in a hospital bed that previously held a patient who also had C difficile.

Residing in a hospital bed that contained a previous occupant with [Clostridioides] difficile is a risk factor for developing hospital-acquired C. difficile.This is the key finding of a study lead by Lucy Witt, MD, titled “Impact of Exposure to Potentially Contaminated Hospital Beds on Risk of Hospital-onset C. difficile Infection,” which was presented at the Society for Healthcare Epidemiology of America (SHEA) Spring conference, held April 12-14 in Colorado Springs, Colorado. The investigators concluded that “Hospital epidemiologists, infection control personnel, and environmental services staff should consider this association when developing CDI risk mitigation strategies.” Witt spoke with Infection Control Today® about the key findings of the study, what surprised the investigators about the results, and what future research is planned on this topic.

ICT® has covered this topic previously here, here, and here.

Infection Control Today® (ICT®): Please give a brief summary of the key findings and why they are important?

Lucy Witt, MD: I think most people reading this probably are aware about [Clostridioides]difficile and are aware that it is a spore-forming bacteria that lasts on surfaces for a long time. So what we were looking at was whether the bed itself might be a reason that people get [Clostridioides]difficile when they are in the hospital. We specifically looked at the risk of someone getting hospital onset C difficile, if someone who had been in the same bed within the last 90 days, also had C difficile. And what we found is that, yes, if you were in a [hospital] bed, and someone in the last 90 days who had been in that bed had C difficile, you are at a higher risk of getting C difficile even when we controlled for known associated confounders, such as age, having a higher comorbidity score, having received antibiotics, or having received a proton pump inhibitor.

ICT®: That's terrifying.

LW: Yes, it is. We're hopeful that this will guide further evaluations into investigating what part of the bed might be transmitting the C. difficile. Do we need to make bigger changes to mattresses? Is it the bed rails? Hopefully [by answering these questions], we can give ourselves targets for intervention that will improve our care of patients and reduce the amount of C. difficile that gets transmitted in hospitals.

ICT®: What is the practical application for the key findings for infection preventionists from this study?

LW: Some of the key findings would be to make sure that your beds and mattresses are being utilized properly, that they are being maintained to the manufacturer standards and being cleaned and disinfected in the way they should be, and investigating what your hospital can do to make that equipment more resistant to C. difficile spores. We are planning on doing further analysis, looking at whether the room itself is a risk factor. Because we know that C. difficile lies not just on the bed, but also on light switches, on the other furniture, in the sink, and on the personnel. We want to help people identify where the problems lie. And then once we know where they lie, we can help come up with solutions to treat the infection, the spores that remain there after an infected patient stays in a room.

ICT®: What results surprised you from this study?

LW: The surprise was probably that we found that age was not a risk factor for [Clostridioides] difficile, which is a little bit of a controversial finding. Some studies have suggested that age is just a marker of illness severity, not necessarily that age itself confers a risk for C. difficile. I think the reason we found that in this study is that one of the hospitals we evaluated includes a large cohort of solid organ transplant and stem cell transplant patients. We're talking about a younger but quite ill cohort at high risk for C. difficile. That is probably the reason we did not find age associated with [Clostridioides] difficile, but that was not something we were expecting.

ICT®: What future research do you have planned, or do you foresee coming out of this particular study?

LW: I think that it would be great to get samples from the surfaces contaminated and prove that a contaminated surface can lead to subsequent infections. We are using interesting bed tracking technology, but we didn't sample the beds themselves to ensure that there were C difficile spores on them. I think getting the actual samples and confirming that where the spores live will be helpful, again to target interventions that can keep our patients safer.

ICT®: Do you have anything else that you would like to add about your study?

LW: I think that I hope that this study serves as an interesting jumping off point for manufacturers of both disinfecting solutions and a lot of the new touch-free disinfecting devices that they can work [and] partner with the infection control community and the hospital epidemiologists that are at our institutions who come up with devices and products that can help us clean our surfaces better, or prevent spores from sticking on to the surfaces of the equipment that we are using every day.