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Clostridium difficile Infections in Veterans Health Administration Long-Term Care Facilities

Published online by Cambridge University Press:  21 December 2015

Jeffrey S. Reeves ,
Martin E. Evans ,
Loretta A. Simbartl ,
Stephen M. Kralovic ,
Allison A. Kelly ,
Rajiv Jain  and
Gary A. Roselle
Jeffrey S. Reeves*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky Lexington Veterans Affairs Medical Center, Lexington, Kentucky
Martin E. Evans
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky Lexington Veterans Affairs Medical Center, Lexington, Kentucky Veterans Health Administration, MRSA/MDRO Prevention Office, National Infectious Diseases Service, Patient Care Services, Veterans Affairs Central Office, Washington, DC
Loretta A. Simbartl
Affiliation:
National Infectious Diseases Service, Patient Care Services, Veterans Affairs Central Office, Washington, DC
Stephen M. Kralovic
Affiliation:
National Infectious Diseases Service, Patient Care Services, Veterans Affairs Central Office, Washington, DC Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
Allison A. Kelly
Affiliation:
National Infectious Diseases Service, Patient Care Services, Veterans Affairs Central Office, Washington, DC Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
Rajiv Jain
Affiliation:
Patient Care Services, Veterans Affairs Central Office, Washington, DC
Gary A. Roselle
Affiliation:
National Infectious Diseases Service, Patient Care Services, Veterans Affairs Central Office, Washington, DC Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
*
Address correspondence to Jeffrey S. Reeves, MD, 740 South Limestone, K512, Lexington, KY 40536 (js.reeves@uky.edu).
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Abstract

OBJECTIVE

A nationwide initiative was implemented in February 2014 to decrease Clostridium difficile infections (CDI) in Veterans Affairs (VA) long-term care facilities. We report a baseline of national CDI data collected during the 2 years before the Initiative.

METHODS

Personnel at each of 122 reporting sites entered monthly retrospective CDI case data from February 2012 through January 2014 into a national database using case definitions similar to those used in the National Healthcare Safety Network Multidrug-Resistant Organism/CDI module. The data were evaluated using Poisson regression models to examine infection occurrences over time while accounting for admission prevalence and type of diagnostic test.

RESULTS

During the 24-month analysis period, there were 100,800 admissions, 6,976,121 resident days, and 1,558 CDI cases. The pooled CDI admission prevalence rate (including recurrent cases) was 0.38 per 100 admissions, and the pooled nonduplicate/nonrecurrent community-onset rate was 0.17 per 100 admissions. The pooled long-term care facility–onset rate and the clinically confirmed (ie, diarrhea or evidence of pseudomembranous colitis) long-term care facility–onset rate were 1.98 and 1.78 per 10,000 resident days, respectively. Accounting for diagnostic test type, the long-term care facility–onset rate declined significantly (P=.05), but the clinically confirmed long-term care facility–onset rate did not.

CONCLUSIONS

VA long-term care facility CDI rates were comparable to those in recent reports from other long-term care facilities. The significant decline in the long-term care facility-onset rate but not in the clinically confirmed long-term care facility–onset rate may have been due to less testing of asymptomatic patients. Efforts to decrease CDI rates in long-term care facilities are necessary as part of a coordinated approach to decrease healthcare-associated infections.

Infect. Control Hosp. Epidemiol. 2016;37(3):295–300

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 3 , March 2016 , pp. 295 - 300
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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