Methods: We invited all 34 hospitals and 76 skilled nursing facilities (SNF) in OC to participate from June 2015-June 2016. Participants received onsite infection control and antimicrobial stewardship assessments, trainings, and an interfacility transfer communication improvement initiative. We used an interrupted time-series design and segmented regression analysis to evaluate monthly hospital-onset (HO) and community-onset (CO) CDI rates for acute care hospitals (ACH) reporting HAI data to CDPH via the National Healthcare Safety Network. The baseline period included 17 months (01/2014-06/2015) and the collaborative period 28 months (09/2015-12/2017). All OC acute care hospitals were included in the CO-CDI model to account for direct and indirect effects of the collaborative. We included only participating ACH in the HO-CDI model. For informal comparisons, we assessed changes in CO-CDI for ACH in three San Francisco Bay Area counties and HO-CDI rates in non-participant OC acute care hospitals.
Results: Collaborative participants comprised 15 ACH, three long-term acute care hospitals, one children’s hospital, and 20 SNF; all but two SNF received an onsite assessment. Unadjusted, baseline pooled mean HO-CDI rates were 8.5 cases per 10,000 patient days for participant ACH, and CO-CDI rates were 4.9 cases per 1,000 admissions in OC acute care hospitals. During the collaborative period, HO-CDI rates in OC participant ACH decreased 2% per month (incidence rate ratio [IRR]: 0.98, 95%CI: 0.96, 0.99; p < 0.001). HO-CDI rates among OC non-participant ACH (N=10) did not change during the same timeframe (IRR: 0.99, 0.96, 1.02; p=0.37). During the collaborative period, Orange County CO-CDI rates also declined 2% per month (IRR: 0.98, 0.97, 0.99; p < 0.001); no changes in CO-CDI were observed among ACH (N=27) in the comparison counties (IRR: 1.00, 0.99, 1.01; p=0.78).
Conclusion: Our analysis of acute care hospitals in Orange County provides evidence that coordinated, regional multifacility initiatives can reduce CDI incidence.
M. Zahn, None
S. H. Yi, None
E. Epson, None