Evaluating the Effect of a <i>Clostridium difficile</i> Infection Prevention Initiative in Veterans Health Administration Long-Term Care Facilities

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Clostridioidesdifficile infection rates from 7 facilities that used nucleic acid amplification testing (NAAT) alone for 12 months then switched to NAAT plus toxin enzyme immunoassay (EIA) and reported the latter result for 12 months were compared to 70 facilities that used NAAT alone for all 24 months. There was no significant difference in rates between facility groups over the first 12 months (P = .21, linear regression), but we detected a decrease in rates for the facilities that changed to NAAT+EIA (P < .0001).

Section: Discussionmentioning

confidence: 79%

Effect of testing methods on incidence of Clostridioides difficile infection rates in Veterans’ Affairs medical centers

McCauley¹,

Evans

Simbartl³

et al. 2020

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“…Similar multifacility initiatives focused on preventing CDI have been described elsewhere, but they vary in methodology and results. [19][20][21] However, this study, in line with other multifacility and multicenter initiatives, provides evidence that HAI prevention interventions can be successfully implemented across healthcare systems and settings. [22][23][24] Health departments and networks of healthcare facilities that share patients should consider coordinating similar multifacility approaches to reduce transmission and incidence of CDI and antibiotic-resistant infections in their regions.…”

Section: Discussionmentioning

confidence: 58%

Reduction in Clostridium difficile infection rates following a multifacility prevention initiative in Orange County, California: A controlled interrupted time series evaluation

Rizzo

Garcia

et al. 2019

Objective:To evaluate the Orange County Clostridium difficile infection (CDI) prevention collaborative’s effect on rates of CDI in acute-care hospitals (ACHs) in Orange County, California.Design:Controlled interrupted time series.Methods:We convened a CDI prevention collaborative with healthcare facilities in Orange County to reduce CDI incidence in the region. Collaborative participants received onsite infection control and antimicrobial stewardship assessments, interactive learning and discussion sessions, and an interfacility transfer communication improvement initiative during June 2015–June 2016. We used segmented regression to evaluate changes in monthly hospital-onset (HO) and community-onset (CO) CDI rates for ACHs. The baseline period comprised 17 months (January 2014–June 2015) and the follow-up period comprised 28 months (September 2015–December 2017). All 25 Orange County ACHs were included in the CO-CDI model to account for direct and indirect effects of the collaborative. For comparison, we assessed HO-CDI and CO-CDI rates among 27 ACHs in 3 San Francisco Bay Area counties.Results:HO-CDI rates in the 15 participating Orange County ACHs decreased 4% per month (incidence rate ratio [IRR], 0.96; 95% CI, 0.95–0.97; P < .0001) during the follow-up period compared with the baseline period and 3% (IRR, 0.97; 95% CI, 0.95–0.99; P = .002) per month compared to the San Francisco Bay Area nonparticipant ACHs. Orange County CO-CDI rates declined 2% per month (IRR, 0.98; 95% CI, 0.96–1.00; P = .03) between the baseline and follow-up periods. This decline was not statistically different from the San Francisco Bay Area ACHs (IRR, 0.97; 95% CI, 0.95–1.00; P = .09).Conclusions:Our analysis of ACHs in Orange County provides evidence that coordinated, regional multifacility initiatives can reduce CDI incidence.

“…Previous published reports describe the effectiveness of C. difficile infection prevention initiatives within the VA hospital. 7,21 Although we found that reporting alone did not decrease CDI rates, ASP and infection control are likely important to formulating a comprehensive plan for controlling CDI.…”

Section: Discussionmentioning

confidence: 83%

Temporal trends of inpatient C. difficile infections within the Veterans Health Administration hospitals: An analysis of the effect of molecular testing, time to testing, and mandatory reporting

Sumon

Lesse

Sellick

et al. 2019

Background:Clostridium difficile infection (CDI) is a reportable hospital metric associated with significant healthcare expenditures. The epidemiology of CDI is pivotal to the implementation of preventative measures.Objective:To portray temporal CDI trends in Veterans Health Administration (VA) hospitals.Design:A retrospective analysis of veterans who had stool testing for C. difficile.Setting:VA acute-care hospitals within the continental United States.Methods:Data were mined from the VA’s Corporate Data Warehouse. CDI is reported per 10,000 patient days.Results:From 2006 to 2016, 472,346 patients had C. difficile testing. Overall, decreases in incidence of total CDI (16.81 to 13.66) and hospital-onset healthcare facility-associated (HO-HCFA) CDI (10.87 to 6.41) were observed. Temporal increases in the incidence of total and HO-HCFA CDI were associated with the increased use of molecular testing (P < .0001). Decreased use of fluoroquinolones (P < .0001), clindamycin (P = .0006), and third-generation cephalosporins (P = .0002) correlated with decreased rates of CDI, but VA mandatory reporting did not influence CDI rates (P = .24). The overall crude 30-day mortality of patients with CDI decreased from 2.17 deaths per 10,000 patient days in 2006 to 1.41 in 2016. The frequency of International Classification of Disease, Ninth/Tenth Revision (ICD-9/10) discharge diagnosis for CDI was 73.3%.Conclusion:Molecular testing was associated with increased incidence of CDI. Controlling CDI is likely multifactorial. Although the VA initiative to report cases of hospital-acquired CDI was not significant in our model, the advent of stewardship programs throughout the VA and reductions in the use of third-generation cephalosporins, fluoroquinolones, and clindamycin were significantly associated with reduced rates of CDI.