Methods: Laboratory and Electronic Health Record (EHR) data was collected for all patients with diarrhea admitted to a 77-bed Long Term Acute Care (LTAC) facility in Detroit. Patients were tested for CDI and, if positive, placed in contact isolation. During a twelve-week period starting January, 2015, isolated patients were further stratified by CDI on arrival versus HAI, FMS/no FMS, and severity of CDI.
Results: Twenty patients tested positive for CDI. Of patients admitted with FMS, 100% (4/4) were positive on arrival (POA) vs 44% (7/16) of non-FMS patients POA and 56% non-FMS patients HAI. In addition, all FMS patients were classified as having severe CDI.
Conclusion: Our study indicates a very high incidence of pre-admission severe CDI in LTAC patients with FMS in place, as well as frequent HAI of other patients. Patients with FMS should be placed directly into contact isolation upon admission, tested for CDI and treated empirically for severe CDI while awaiting results to minimize morbidity and mortality as well as HAI. Another important implication is the need for enhanced protocols regarding both FMS and CDI status at the time of admission via greater attention to transitions of care, communication between facility employees, and initiation of hand-washing protocols and sterilization techniques.
T. Chopra, None
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