A targeted assessment for prevention strategy to decrease Clostridioides difficile infections in Veterans Affairs acute-care medical centers

Abstract

Objective:A guideline for the prevention of Clostridioides difficile infection (CDI) in 127 Veterans Health Administration acute-care facilities was implemented in July 2012. Beginning in 2015, a targeted assessment for prevention strategy was used to evaluate facilities for hospital-onset healthcare-facility–associated CDIs to focus prevention efforts where they might have the most impact in reaching a reduction goal of 30% nationwide.Methods:We calculated standardized infection ratios (SIRs) and cumulative attributable differences (CADs) using a national data baseline. Facilities were ranked by CAD, and those with the 10 highest CAD values were targeted for periodic conference calls or a site visit from January 2016–September 2019.Results:The hospital-onset healthcare-facility–associated CDI rate in the 10 facilities with the highest CADs declined 56% during the process improvement period, compared to a 44% decline in the 117 nonintervention facilities (P = .03).Conclusion:Process improvement interventions targeting facilities ranked by CAD values may be an efficient strategy for decreasing CDI rates in a large healthcare system.

Effectiveness of national and subnational interventions for prevention and control of health-care-associated infections in acute hospitals in high-income and upper-middle-income counties: a systematic review update

“…Most were conducted in USA (n=25). [12][13][14]17,19,20,[22][23][24][25][26][27][29][30][31][34][35][36][37]39,40,42,[44][45][46] The remaining studies derived from England (n=2), 11,33 Taiwan (n=2), 16,21 Australia (n=1), 28 Brazil (n=1), 15 Germany (n=1), 18 Israel (n=1), 38 Italy (n=1), 43 New Zealand (n=1), 32 and Republic of Ireland (n=1). 41 Study designs included 21 ITS, 12,14,[17][18][19][20][21]24,[29][30][31][32][33][34]…”

“…41 Study designs included 21 ITS, 12,14,[17][18][19][20][21]24,[29][30][31][32][33][34][37][38][39][40][41]43,44 nine CBAs, 13,16,22,23,25,28,35,45,46 four cluster-randomised trials (CRTs), 15,26,27,42 and two NRTs. 11,36 Interventions were categorised according to the type of intervention, including care bundles, 16,39 care bundles with implementation strategies, [11][12][13]18,21,26,31,43,46 IPC programmes 14,15,17,…”

“…In 16 studies the interventions were various IPC programmes, including quality improvement projects, 14,15,17,20,29,30,32,[34][35][36]40,42 hand hygiene programmes, 28,41 appointment of infection control task force, 38 and an intervention consisting of five campaigns involving hand hygiene promotion, a clean hospital environment, care for catheter devices, MRSA screening and ventilated patient care recommendations. 33 Six ITS 14,29,33,34,40,41 and two CRTs 15,42 investigated the effect of an IPC programmes on BSI rates amongst ICU, 15,29,40,42 or acute hospital patients.…”

“…Two studies, including a NRT 36 and another STRIVE ITS 17 focused on the effect of IPC quality improvement programmes in preventing Clostridioides difficile infections (CDI) amongst acute hospital patients. Roselle et al 36 observed a significant reduction in CDI rates after the implementation in both intervention and comparison hospitals compared to the baseline period. Similarly, a statistically significant decrease in CDI incidence was found in Dubberke et al 17 following the intervention compared to baseline.…”

Association between Clostridioides difficile infection testing results and decision to treat

“…Clostridioides difficile infection (CDI) rates in Department of Veterans Affairs (VA) acute-care facilities have decreased nationwide by 37% in the 7 years since the implementation of a VA CDI control guideline in 2012. 1 For much of that time, the diagnosis was made using a compatible clinical illness and a positive nucleic acid amplification test (NAAT). This test has a sensitivity of ˜96%, but because it detects bacterial DNA, it may be positive in stool containing toxin-producing bacteria, bacteria carrying the nonexpressed toxin gene, or DNA left behind by dead bacteria.…”