Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-25T19:58:06.731Z Has data issue: false hasContentIssue false
  • English
  • Français

The use of laboratory-identified event surveillance to classify adverse outcomes due to Clostridioides difficile infection in Canadian long-term care facilities

Published online by Cambridge University Press:  23 November 2020

Ye Shen Open the ORCID record for Ye Shen [Opens in a new window] ,
Jennifer Ellison ,
Jenine Leal ,
Kathryn R. Bush ,
A. Uma Chandran ,
Sumana Fathima  and
John M. Conly
Ye Shen*
Affiliation:
Infection Prevention and Control, Alberta Health Services, Alberta, Canada
Jennifer Ellison
Affiliation:
Infection Prevention and Control, Alberta Health Services, Alberta, Canada
Jenine Leal
Affiliation:
Infection Prevention and Control, Alberta Health Services, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
Kathryn R. Bush
Affiliation:
Infection Prevention and Control, Alberta Health Services, Alberta, Canada
A. Uma Chandran
Affiliation:
Infection Prevention and Control, Alberta Health Services, Alberta, Canada Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
Sumana Fathima
Affiliation:
Analytics and Performance Reporting Branch, Alberta Ministry of Health, Edmonton, Alberta, Canada
John M. Conly
Affiliation:
Infection Prevention and Control, Alberta Health Services, Alberta, Canada Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada Department of Pathology and Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
*
Author for correspondence: Ye Shen, E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Adverse outcomes following Clostridioides difficile infection (CDI) are not often reported for long-term care facility (LTCF) residents. We focused on the adverse outcomes due to CDI identified in Alberta LTCFs.

Methods:

All positive Clostridioides difficile stool specimens identified by laboratory-identified (LabID) event surveillance in Alberta from 2011 to 2018, along with Alberta Continuing Care Information System, were used to define CDI in Alberta LTCFs. CDI cases were classified as long-term care onset, hospital onset, and community onset. Laboratory records were linked to provincial databases to analyze acute-care admissions and mortality within 30-day post CDI. Age, sex, case classification, episode, and operator type, were investigated using logistic regression.

Results:

Overall, 902 CDI cases were identified in 762 LTCF residents. Of all CDI events, 860 (95.3%) were long-term care onset, 38 (4.2%) were hospital onset, and 4 (0.4%) were community onset. The CDI rate was 2.0 of 100,000 resident days. In total, 157 residents (20.6%) had 30-day all-cause mortality, 126 CDI cases (14.0%) had 30-day all-cause acute-care admissions. The 30-day all-cause mortality rate was significantly higher in residents aged >80 versus ≤80 years (24.9 vs 12.3 per 100 residents; P < .05). Residents aged >80 years, with hospital-onset CDI, and those staying in private or voluntary LTCFs were more likely to have 30-day all-cause acute-care admissions.

Conclusions:

The prevalence of CDI adverse outcomes is in LTCFs was found to be high using LabID event surveillance. Annual review of CDI adverse outcomes using LabID event can minimize the burden of surveillance and standardize the process across all Alberta LTCFs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 5 , May 2021 , pp. 557 - 564
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Simor, AE. Diagnosis, management, and prevention of Clostridium difficile infection in long-term care facilities: a review. J Am Geriatr Soc 2010;58:1556–1564.CrossRefGoogle ScholarPubMed
Bignardi, GE. Risk factors for Clostridium difficile infection. J Hosp Infect 1998;40:1–15.CrossRefGoogle ScholarPubMed
Kwon, JH, Olsen, MA, Dubberke, ER. The morbidity, mortality, and costs associated with Clostridium difficile infection. Infect Dis Clin N Am 2015;29:123–134.CrossRefGoogle ScholarPubMed
International statistical classification of diseases and related health problems, volume one, tabular list. Canadian Institute for Health Information website. https://www.cihi.ca/sites/default/files/icd_volume_one_2015_en_0.pdf. Published 2015 Accessed February 11, 2020.Google Scholar
Lofgren, ET, Cole, SR, Weber, DJ, Anderson, DJ, Moehring, RW. Hospital-acquired Clostridium difficile infections: estimating all-cause mortality and length of stay. Epidemiology 2014;25:570–575.CrossRefGoogle ScholarPubMed
Feuerstadt, P, Das, R, Brandt, LJ. The evolution of urban C. difficile infection (CDI): CDI in 2009–2011 is less severe and has better outcomes than CDI in 2006–2008. Am J Gastroenterol 2014;109:1265.Google Scholar
Table17-10-0005-01 Population estimates on July 1st, by age and sex. Statistics Canada website. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000501 Published 2020. Accessed February 11, 2020.Google Scholar
Allin, S, Rudoler, D. The Canadian Health Care System, 2015. In: 2015 International Profiles of Health Care Systems. New York: The Commonwealth Fund; 2016: 21–30.Google Scholar
Health services in Alberta. Government of Alberta website. https://web.archive.org/web/20140209041246/http://www.health.alberta.ca/health-services.html. Published 2019. Accessed February 11, 2020.Google Scholar
Duckett, S. Second wave reform in Alberta. Healthcare Manage Forum 2010;23:156–158.CrossRefGoogle ScholarPubMed
Lindeman, C, Leal, J, Rusk, A, et al. Clostridium difficile infection in Alberta’s long-term care facilities. Can J Infect Control 2017;32:87–92.Google Scholar
Pereira, JA, McGeer, A, Tomovici, A, Selmani, A, Chit, A. The clinical burden of Clostridioides difficile in Ontario, Canada. Open Forum Infect Dis 2019;7:1–9.Google ScholarPubMed
Laboratory-identified event surveillance protocol for Clostridioides difficile infection and multidrug resistant organism events for long-term care facilities. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/PDFs/LTC/LTCF-LabID-Event-Protocol_current.pdf. Published 2019. Accessed February 11, 2020.Google Scholar
Government of Alberta. Overview of Administrative Health Datasets. https://open.alberta.ca/dataset/657ed26d-eb2c-4432-b9cb-0ca2158f165d/resource/38f47433-b33d-4d1e-b959-df312e9d9855/download/research-health-datasets.pdf. Published 2017. Accessed February 11, 2020.Google Scholar
Provincial lab-event surveillance of Clostridium difficile infection (CDI) in continuing care (CC) provincial surveillance. Alberta Health Services Infection Prevention & Control website. https://www.albertahealthservices.ca/info/Page15736.aspx. Published 2019. Accessed February 11, 2020.Google Scholar
Hunter, JC, Mu, Y, Dumyati, GK, et al. Burden of nursing home-onset Clostridium difficile infection in the United States: estimates of incidence and patient outcomes. Open Forum Infect Dis 2016;3:1–8.CrossRefGoogle ScholarPubMed
Chopra, T, Awali, RA, Biedron, C, et al. Predictors of Clostridium difficile infection-related mortality among older adults. Am J Infect Control 2016;44:1219–1223.CrossRefGoogle ScholarPubMed
List of publicly funded designated supportive living accommodations and long-term care facilities. Government of Alberta website. https://open.alberta.ca/dataset/7f4fc1ef-779c-4ebb-a557-d7afc405c826/resource/0a431494-4c96-40c6-bc55-0141b3c72e9e/download/cc-list-funded-sla-ltc.pdf. Published 2016. Accessed February 11, 2020.Google Scholar
Leal, J, Ronksley, P, Henderson, EA, Conly, J, Manns, B. Predictors of mortality and length of stay in patients with hospital-acquired Clostridioides difficile infection: a population-based study in Alberta, Canada. J Hosp Infect 2019;103:85–91.CrossRefGoogle ScholarPubMed
Become a continuing care provider or operator. Government of Alberta website. https://www.alberta.ca/become-a-continuing-care-provider-or-operator.aspx. Published 2020. Accessed February 11, 2020.Google Scholar
Table 13-10-0710-01: deaths and mortality rates, by age group. Statistics Canada website. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310071001. Published 2019. Accessed February 11, 2020.Google Scholar
Collins, CE, Ayturk, MD, Anderson, FA, Santry, HP. Predictors and outcomes of readmission for Clostridium difficile in a national sample of medicare beneficiaries. J Gastroint Surg 2015;19:88–99.CrossRefGoogle Scholar
Gravel, D, Miller, M, Simor, A, et al. Healthcare-associated Clostridium difficile infection in adults admitted to acute-care hospitals in Canada: a Canadian Nosocomial Infection Surveillance Program Study. Clin Infect Dis 2009;48:568–576.CrossRefGoogle Scholar
Kalseth, J, Theisen, OM. Trends in place of death: The role of demographic and epidemiological shifts in end-of-life care policy. Palliat Med 2017;31:964–974.CrossRefGoogle ScholarPubMed
Motiwala, SS, Croxford, R, Guerriere, DN, Coyte, PC. Predictors of place of death for seniors in Ontario: a population-based cohort analysis. Can J Aging 2006;25:363–371.CrossRefGoogle ScholarPubMed
Ahearn, DJ, Jackson, TB, McIlmoyle, J, Weatherburn, AJ. Improving end of life care for nursing home residents: an analysis of hospital mortality and readmission rates. Postgrad Med J 2010;86:131–135.CrossRefGoogle ScholarPubMed
Kim, JH, Toy, D, Muder, RR. Clostridium difficile infection in a long-term care facility: hospital-associated illness compared with long-term care-associated illness. Infect Control Hosp Epidemiol 2011;32:656–660.CrossRefGoogle Scholar
Pedersen, MK, Meyer, G, Uhrenfeldt, L. Risk factors for acute-care hospital readmission in older persons in Western countries: a systematic review. JBI Database Systc Revs Implement Rept 2017;15:454–485.CrossRefGoogle ScholarPubMed
Kirsebom, M, Hedström, M, Wadensten, B, Pöder, U. The frequency of and reasons for acute hospital transfers of older nursing home residents. Arch Gerontol Geriatr 2014;58:115–120.CrossRefGoogle ScholarPubMed
Sheitoyan-Pesant, C, Abou Chakra, CN, Pépin, J, Marcil-Héguy, A, Nault, V, Valiquette, L. Clinical and healthcare burden of multiple recurrences of Clostridium difficile infection. Clin Infect Dis 2015;62:574–580.CrossRefGoogle ScholarPubMed
Appaneal, HJ, Caffrey, AR, Beganovic, M, Avramovic, S, LaPlante, KL. Predictors of mortality among a national cohort of veterans with recurrent Clostridium difficile infection. Open Forum Infect Dis 2018;5:ofy175. doi: 10.1093/ofid/ofy175.CrossRefGoogle ScholarPubMed
Reveles, KR, Lawson, KA, Mortensen, EM, et al. National epidemiology of initial and recurrent Clostridium difficile infection in the Veterans’ Health Administration from 2003 to 2014. PloS One 2017;12:e0189227. doi: 10.1371/journal.pone.0189227.CrossRefGoogle Scholar
Ziakas, PD, Zacharioudakis, IM, Zervou, FN, Grigoras, C, Pliakos, EE, Mylonakis, E. Asymptomatic carriers of toxigenic C. difficile in long-term care facilities: a meta-analysis of prevalence and risk factors. PloS One 2015;10:e0117195.CrossRefGoogle Scholar
Gase, KA, Haley, VB, Xiong, K, Van Antwerpen, C, Stricof, RL. Comparison of 2 Clostridium difficile surveillance methods National Healthcare Safely Network’s laboratory-identified event reporting module versus clinical infection surveillance. Infect Control Hosp Epidemiol 2013;34:284–290.CrossRefGoogle Scholar
Durkin, MJ, Baker, AW, Dicks, KV, et al. A comparison between National Healthcare Safety Network laboratory-identified event reporting versus traditional surveillance for Clostridium difficile infection. Infect Control Hosp Epidemiol 2015;36:125–131.CrossRefGoogle ScholarPubMed
McDonald, LC, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infection Disease Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018;6:e1–e48.CrossRefGoogle Scholar
Smith, PW, Bennett, G, Bradley, S, et al. SHEA/APIC guideline: infection prevention and control in the long-term care facility. Infect Control Hosp Epidemiol 2008;29:785–814.CrossRefGoogle ScholarPubMed
Simor, AE, Bradley, SF, Strausbaugh, LJ, Crossley, K, Nicolle, LE, and the SHEA Long-Term–Care Committee. Clostridium difficile in long-term–care facilities for the elderly. Infect Control Hosp Epidemiol 2002;23:696–703.CrossRefGoogle ScholarPubMed
Olsen, MA, Stwalley, D, Demont, C, Dubberke, ER. Clostridium difficile infection increases acute and chronic morbidity and mortality. Infect Control Hosp Epidemiol 2019;40:65–71.CrossRefGoogle ScholarPubMed
Pawar, D, Tsay, R, Nelson, DS, et al. Burden of Clostridium difficile infection in long-term care facilities in Monroe County, New York. Infect Control Hosp Epidemiol 2012;33:1107–1112.CrossRefGoogle ScholarPubMed