1541. A Tale of Two Buildings:  Reduction in vancomycin-resistant Enterococcus acquisition and Clostridium difficile infection after moving to a new long-term care facility
Session: Poster Abstract Session: Infections in Non-Acute Healthcare Settings
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Kumar ID Week 2013 - A Tale of Two buildings.pdf (634.1 kB)
  •  Title:  A Tale of Two Buildings:  Reduction in vancomycin-resistant Enterococcus acquisition and Clostridium difficile infection after moving to a new long-term care facility

     

    Authors: Venkata C.K. Sunkesula MD, MS, Sirisha Kundrapu MD, Suresh Ponnada MD, MPH, Annette L. Jencson BSMT(ASCP) CIC, Jennifer Cadnum BS, Abhishek Deshpande MD, PhD Marguerite O' Donnell RN,BSN,CIC, Trina F. Zabarsky NP, , Elizabeth Flannery NP, Lucy A. Jury NP, Dubert M. Guerrero MD and Curtis J. Donskey MD

    Abstract

    Background: There is a growing body of evidence demonstrating that the built environment of healthcare settings plays a key role in facilitating or preventing transmission of healthcare-associated pathogens. In March 2011, the Cleveland VA Medical Center's long-term care facility (LTCF) moved to a new building with several improvements in design (i.e., more private rooms and private bathroom facilities, improved access to hand hygiene and cleaning supplies, more dedicated equipment). We hypothesized that the frequency of acquisition and infection with healthcare-associated pathogens would be significantly reduced in the new building.   

    Methods: We conducted 5-month prospective cohort studies of patients being transferred from the hospital to the LTCF during the year before and after the move. The hospital has a high endemic rate of VRE colonization and does not isolate VRE colonized or infected patients. Rectal swabs for VRE culture were collected at the time of transfer and then weekly for up to 7 weeks. Environmental cultures were also collected from common patient areas including recreational and therapy rooms. Clostridium difficile infection (CDI)  rates were compared in the year before versus after the move.

                                                       Results: For patients with negative rectal cultures at the time of admission, the frequency of acquisition of VRE in the old versus new building was 49% (25/51) versus 10% (7/68), respectively (P <0.001) (Figure).  The incidence of LTCF-associated CDI (cases/10,000 patient days) at the old and new building was 31 and 16, respectively (P = 0.03).

    Conclusion: Our findings are consistent with the hypothesis that improvements in the built environment may contribute to reductions in colonization and infection with healthcare-associated pathogens. 

    Figure. Acquisition of rectal colonization with VRE in Long Term Care Facility

     

    Venkata C.K. Sunkesula, M.D., M.S1,2, Sirisha Kundrapu, M.D.3, Suresh Ponnada, MD, MPH2, Annette Jencson, BSMT(ASCP)SM, CIC1, Jennifer Cadnum, B.S.1, Abhishek Deshpande, M.D., Ph.D.4, Marguerite O'donnell, RN, BSN, CIC1, Trina Zabarsky, RN, CNP3, Elizabeth Flannery, BSN, RN5, Lucy Jury, N.P.1, Dubert Guerrero, MD6 and Curtis J. Donskey, MD2, (1)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (2)Case Western Reserve University, Cleveland, OH, (3)Infectious Diseases, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (4)Infectious Diseases, Case Western Reserve University, Cleveland, OH, (5)Infection Control and Prevention, Infection Control and Prevention, Louis Stokes Clevland VA Medical Center, Cleveland, OH, (6)University of North Dakota School of Medicine and Health Sciences, Fargo, ND

    Disclosures:

    V. C. K. Sunkesula, None

    S. Kundrapu, None

    S. Ponnada, None

    A. Jencson, None

    J. Cadnum, None

    A. Deshpande, None

    M. O'donnell, None

    T. Zabarsky, None

    E. Flannery, None

    L. Jury, None

    D. Guerrero, None

    C. J. Donskey, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.