# Relationship between patient-rated cleanliness and Clostridioides difficile standardized infection ratios in U.S. medicare-certified hospitals

## TL;DR

This study found that patient perceptions of hospital cleanliness are not linked to lower rates of Clostridioides difficile infections.

## Contribution

The study is novel in showing that patient-rated cleanliness does not predict better infection control for CDI in U.S. hospitals.

## Key findings

- Patient-rated cleanliness was not associated with improved Clostridioides difficile infection (CDI) performance.
- Facilities with higher cleanliness ratings were not more likely to have CDI rates below the national average.
- A 1% increase in patient-reported cleanliness was weakly linked to a 4.2% increase in observed CDI cases.

## Abstract

We evaluated whether patient perceptions of cleanliness are associated with objective measures of Clostridioides difficile infection (CDI), as an early indicator of facility-level CDI rates and prevention.

Cross-sectional analysis of Medicare-certified hospitals across the United States.

Data from the CMS Hospital Compare website and U.S. Census Bureau from 2023 were analyzed using multivariate logistic regression models. The primary outcome was C. difficile standardized infection ratios (SIRs) compared to the national average. The primary exposure was patient-rated cleanliness star ratings from the Hospital Consumer Assessment of Healthcare Providers and Systems survey.

The population studied was 3,616 medicare-certified hospitals with an estimated 17,994,034 unique patient admissions. There was no association between better patient-rated cleanliness and improved CDI performance. Facilities with a 5-star cleanliness rating were not more likely to have an SIR less than or equal to the national average compared to those with a lower star rating. For every 1% increase in patients who reported their room and bathroom as always clean, the odds of CDI observed cases being higher than predicted increases by 4.2% (ie, increasing patient-related cleanliness was weakly associated with worse CDI performance).

Patient-rated cleanliness was not associated with improved CDI performance in U.S. national hospital data. Findings were consistent across multiple operationalizations of cleanliness and CDI suggesting patient perceptions of cleanliness are not a strong indicator of CDI control measure performance.