969. Evaluating Veterans Affairs (VA) Acute Care Facilities for Clostridium difficile Infections (CDIs) Using a Targeted Assessment for Prevention (TAP) Strategy
Session: Poster Abstract Session: Clostridium difficile Infections: Treatment and Prevention
Friday, October 9, 2015
Room: Poster Hall
Background: A guideline for the prevention of Clostridium difficile infection (CDI) in Veterans Affairs (VA) acute care facilities was implemented nationwide in July 2012.  A targeted assessment for prevention (TAP) strategy was developed using cumulative attributable differences (CAD) to evaluate facilities for hospital-onset healthcare facility-associated (HO-HCFA) CDIs to focus prevention efforts where they may have the most impact in reaching a reduction goal of 30% nationwide. 

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.

Martin Evans, MD, FIDSA, FSHEA1,2,3, Stephen Kralovic, MD, MPH, FSHEA4,5,6, Loretta Simbartl, MS4 and Gary Roselle, MD, FIDSA4,5,6, (1)Veterans Health Administration, MRSA/MDRO Prevention Office, National Infectious Diseases Service, Patient Care Services, Veterans Affairs Central Office, Lexington, KY, (2)Lexington Veterans Affairs Medical Center, Lexington, KY, (3)Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, (4)National Infectious Diseases Service, Patient Care Services, Veterans Affairs Central Office, Cincinnati, OH, (5)Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, (6)Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH


M. Evans, None

S. Kralovic, None

L. Simbartl, None

G. Roselle, None

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