1395. A Veterans Affairs (VA) Initiative to Prevent Healthcare-Associated Clostridium difficile Infections (CDI)
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: An Initiative was implemented in July 2012 in 132 acute care VA reporting sites nationwide in an effort to decrease CDI.  This is a report of baseline data collected in the first 6 months of the program.

Methods: The Initiative was developed with expert input based on IDSA/SHEA recommendations stressing environmental management, infection prevention and control, and laboratory strategies.  Data definitions were analogous to the NHSN MDRO/CDI module.  Case onset was the time a stool was collected for C. difficile testing (LabID Event).  Community-onset healthcare facility associated (CO-HCFA) cases were positive LabID Event ≤48h of admission + previous admission ≤30d; CO-not HCFA were positive LabID Event ≤48h of admission + no previous admission ≤30d; hospital-onset HCFA (HO-HCFA) positive LabID Event >48h after admission; clinically confirmed HO-HCFA (CC HO-HCFA) were HO-HCFA case with diarrhea or histopathologic or colonoscopic evidence of pseudomembranous colitis.  Personnel at each site entered aggregate surveillance and infection control data into a central database each month.

Results: From July – December 2012, there were 264,467 admissions and 1.47 million patient-days in VA acute care facilities nationwide.  Approximately 22% of laboratories used enzyme immunoassay, 64% a molecular test, and 10% a glutamate dehydrogenase-based test for CDI.   CDI admission prevalence was 0.75%.  CDI case rates/10,000 patient-days were CO-not HCFA 6.96; CO-HCFA 2.71; HO-HCFA 8.84; CC HO-HCFA 8.05; combined CO- +HO-HCFA 11.55.  The reported CDI-attributable complication rates/100 CC-HO HCFA cases were colectomies 0.42, ICU admissions 2.70, and deaths 1.18.  Fully 97% of CDI cases were put into Contact Precautions, with signs posted in 96.6%, gowns available in 98%, gloves available in 99%, hand hygiene supplies available in 99.5% of cases. 

Conclusion: A nationwide Initiative for the prevention of CDI in VA acute care facilities has been implemented and baseline data are being collected.

Martin Evans, MD1,2,3, Stephen Kralovic, MD, MPH4, Loretta Simbartl, MS5, Rajiv Jain, MD6 and Gary Roselle, MD4, (1)National Infectious Diseases Service, Department of Veterans Affairs Central Office, Washington, DC, (2)Internal Medicine, University of Kentucky, Lexington, KY, (3)VHA MRSA/MDRO Program, Lexington, KY, (4)National Infectious Diseases Service, Department of Veterans Affairs, Cincinnati, OH, (5)National Infectious Diseases Service, Department of Veterans Affairs, Washington, DC, (6)Department of Veterans Affairs, Veterans Health Administration, Washington, DC

Disclosures:

M. Evans, None

S. Kralovic, None

L. Simbartl, None

R. Jain, None

G. Roselle, None

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