Department of Public Health, National Health Service Leicestershire County and Rutland, Glenfield, Leicestershire, United Kingdom.
Infect Control Hosp Epidemiol. 2013 Oct;34(10):1062-9. doi: 10.1086/673156. Epub 2013 Aug 23.
An emergent strain (ribotype 027) of Clostridium difficile infection (CDI) has been implicated in epidemics worldwide. Organizational factors such as bed occupancy have been associated with an increased incidence of CDI; however, the data are sparse, and the association has not been widely demonstrated. We investigated the association of bed occupancy and CDI within a large hospital organization in the United Kingdom.
To establish whether bed occupancy rates are a significant risk factor for CDI in the general ward setting.
A retrospective cohort study was carried out on data from 2006 to 2008. Univariate and multivariate Cox regression modeling was used to examine the strength and significance of the associations. Variables included patient characteristics, antibiotic policy exposure, case mix, and bed occupancy rates.
A total of 1,589 cases of hospital-acquired CDI were diagnosed (1.7% of admissions), with an overall infection rate of 2.16 per 1,000 patient-days. Median bed occupancy was 93.3% (interquartile range, 83.3%-100%) Univariate and multivariate analyses showed positive and statistically significant associations. In the adjusted model, patients on wards with occupancy rates of 80%-89.9% had rates of CDI that were 56% higher (hazard ratio, 1.56 [95% confidence interval, 1.18-2.04]; P < .001) compared with baseline (0%-69.9% occupancy). CDI rates were 55% higher for patients on wards with maximal bed occupancy (100%).
There is strong evidence of an association between high bed occupancy and CDI. Without effective interventions at high levels of bed occupancy, the economic benefits sought from reducing bed numbers may be negated by the increased risk of CDI.
一种新型的艰难梭菌感染（CDI）菌株（核糖体型 027）已被认为与全球范围内的疫情有关。床位占用等组织因素与 CDI 的发病率增加有关；然而，数据很少，并且这种关联尚未得到广泛证明。我们在英国的一家大型医院组织中调查了床位占用与 CDI 的关系。
确定床位占用率是否是普通病房环境中 CDI 的重要危险因素。
我们对 2006 年至 2008 年的数据进行了回顾性队列研究。使用单变量和多变量 Cox 回归模型来检查关联的强度和显著性。变量包括患者特征、抗生素政策暴露、病例组合和床位占用率。
共诊断出 1589 例医院获得性 CDI（占入院人数的 1.7%），总感染率为每 1000 患者日 2.16 例。中位床位占用率为 93.3%（四分位间距，83.3%-100%）。单变量和多变量分析显示出阳性和统计学显著的关联。在调整后的模型中，床位占用率为 80%-89.9%的患者的 CDI 发生率比基线（0%-69.9%床位占用率）高 56%（危险比，1.56[95%置信区间，1.18-2.04]；P<.001）。床位占用率为 100%的病房患者的 CDI 发生率高 55%。
有强有力的证据表明高床位占用率与 CDI 之间存在关联。如果在高床位占用率水平上没有有效的干预措施，那么减少床位数量所带来的经济效益可能会被 CDI 风险增加所抵消。
