A nationwide initiative was implemented in February 2014 to decrease Clostridium difficile infections (CDI) in Veterans Affairs (VA) long-term care facilities. This is a report of baseline national CDI data collected from the 24 months prior to implementation of the initiative.
Personnel at each of 122 data reporting units entered monthly retrospective CDI case data from February 2012 through January 2014 into a central database using case definitions similar to those of the NHSN MDRO/CDI module. Case onset was defined as the time a stool was collected for C. difficile testing (LabID Event). A community-onset healthcare facility associated (CO-HCFA) case was defined as a positive LabID Event ≤48h of admission + previous admission ≤28d; CO-notHCFA as a positive LabID Event ≤48h of admission + no previous admission ≤28d; long-term care facility-onset HCFA (LO-HCFA) as a positive LabID Event >48h after admission; and clinically confirmed LO-HCFA (CC-LO-HCFA) as a LO-HCFA case with diarrhea or histopathologic or colonoscopic evidence of pseudomembranous colitis. Poisson regression models were used to examine the change in infections over time.
During the 24-month analysis period, there were 100,800 long-term care facility admissions, 6,976,121 resident-days, and 1,558 CDI cases. The pooled CDI admission prevalence rate (including recurrent cases) was 0.38 cases per 100 admissions. The pooled non-duplicate/non-recurrent CO-notHCFA and CO-HCFA rates were 0.19 ± 0.91 and 0.04 ± 0.38 per 100 admissions, respectively. The LO-HCFA, CC-LO-HCFA, and CO-HCFA rates were 1.98 ± 5.07, 1.78 ± 4.71, and 0.06 ± 0.59 per 10,000 resident-days, respectively. There was a significant decrease in the LO-HCFA (P=0.05, Poisson regression) rate after adjusting for type of diagnostic test. The decreased rate was evident regardless of test type used (enzyme immunoassay vs. nucleic acid amplification test).
VA long-term care facility CDI rates were comparable to those reported in other long-term care facilities in the last decade. The LO-HCFA rates were markedly lower than the hospital-onset HCFA rates previously reported in VA acute care facilities. Efforts to decrease rates further are still necessary given the substantial burden of CDI in the healthcare system.
L. Simbartl, None
S. Kralovic, None
G. Roselle, None
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