926. Clostridium Difficile incidence and severity in transitional Long Term Care Facility Patients with Fecal Management Systems
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall
  • IDSA 2015 green 3.png (1.2 MB)
  • Background: Clostridium difficile is now the most commonly reported pathogen in U.S. healthcare facilities, causing 12% of all hospital acquired infections (HAI). Patients in long-term care facilities (LTCF) contribute significantly, with the carriage rate among residents approaching 50%. Both symptomatic and asymptomatic carriers contribute to new hospital infections. LTCF residents are often placed on Fecal Management Systems (FMS) at the onset of diarrhea. Although research suggests a strong link between admission from LTCFs and increased hospital burden of Clostridium difficile Infection (CDI), little research exists regarding FMS, screening and hospital rates of CDI. This study aims to explore the links between FMS, LTCF admissions, and increased hospital burden of CDI.

    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.

    Catherine Edgell, BS1, Yazan Kherallah, BS2 and Teena Chopra, MD, MPH1, (1)Infectious Diseases, Detroit Medical Center/Wayne State University, Detroit, MI, (2)Wayne State University School of Medicine, Detroit, MI


    C. Edgell, None

    Y. Kherallah, None

    T. Chopra, None

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