Methods: Monthly data entered into the VA Inpatient Evaluation Center from all 127 acute care facilities were analyzed. Standardized Infection Ratios (SIRs) from July 2012-September 2014 were calculated using predicted and observed CDIs from October 2010-June 2012 as baseline. The model for calculating SIRs recommended by CDC/NHSN did not fit VA data well, and an alternate model using VA-specific explanatory variables (CDI diagnostic test type, facility admission prevalence rate, bed size, patient-days, and complexity) was used. CADs were calculated using a SIRgoal= 0.7 and facilities ranked.
Results: Nationwide, there were 1,166,432 admissions, 6,416,696 patient-days, and 5,791 HO-HCFA CDI cases during the 27-month analysis period. Pooled nationwide quarterly SIRs decreased 13% compared to baseline (p=0.02 for overall trend). Forty-two facilities had a pooled annual SIR >1 for the last 12 months of the analysis period. A total of 548 CDIs would need to be prevented to reach a 30% reduction. This would be accomplished by focusing prevention efforts on the 19 facilities with the highest CAD values or 37 facilities with the highest SIR values.
Conclusion: Using the TAP/CAD strategy, prevention efforts can be focused on a subset of facilities with a disproportionate number of CDI cases that, if prevented, could achieve the goal of a 30% reduction. Facilities having SIRs >1 and a large CAD could be matched with those having SIRs ≤1 and small CAD to explore best practices for preventing CDIs.
L. Simbartl, None
G. Roselle, None
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