Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-05T05:42:31.821Z Has data issue: false hasContentIssue false
  • English
  • Français

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 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

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 

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

REFERENCES

1. Reveles, KR, Lee, GC, Boyd, NK, Frei, CR. The rise in Clostridium difficile infection incidence among hospitalized adults in the United States: 2001–2010. Am J Infect Control 2014;42:1028–1032.CrossRefGoogle ScholarPubMed
2. Criteria and standards for VA community living centers (CLC). Veterans Health Administration website. http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1736. Published August 8, 2008. Accessed July 20, 2015.Google Scholar
3. Evans, ME, Simbartl, LA, Kralovic, SM, Jain, R, Roselle, GA. Clostridium difficile infections in Veterans Health Administration acute care facilities. Infect Control Hosp Epidemiol 2014;35:1037–1042.Google Scholar
4. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.Google Scholar
5. Jain, R, Kralovic, SM, Evans, ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:1419–1430.Google Scholar
6. Laffan, AM, Bellantoni, MF, Greenough, WB 3rd, Zenilman, JM. Burden of Clostridium difficile-associated diarrhea in a long-term care facility. J Am Geriatr Soc 2006;54:1068–1073.CrossRefGoogle ScholarPubMed
7. Dubberke, ER, Reske, KA, Olsen, MA, et al. Evaluation of Clostridium difficile-associated disease pressure as a risk factor for C. difficile-associated disease. Arch Intern Med 2007;167:1092–1097.Google Scholar
8. Campbell, RJ, Giljahn, L, Machesky, K, et al. Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infect Control Hosp Epidemiol 2009, 30:526–533.Google Scholar
9. Pennsylvania Patient Safety Authority. Clostridium difficile infections in nursing homes. Pa Patient Saf Advis 2010;7(Suppl 1):10–15.Google Scholar
10. Eyre, DW, Cule, ML, Wilson, DJ, et al. Diverse sources of C. difficile infection identified on whole-genome sequencing. N Engl J Med. 2013;369:1195–1205.CrossRefGoogle ScholarPubMed
11. 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
12. Mylotte, JM, Russell, S, Sackett, B, Vallone, M, Antalek, M. Surveillance for Clostridium difficile infection in nursing homes. J Am Geriatr Soc 2013;61:122–125.Google Scholar
13. Guerrero, DM, Nerandzic, MM, Jury, LA, Chang, S, Jump, RL, Donskey, CJ. Clostridium difficile infection in a Department of Veterans Affairs long-term care facility. Infect Control Hosp Epidemiol 2011;32:513–515.Google Scholar
14. National Healthcare Safety Network long-term care facility component of the multidrug-resistant organism and Clostridium difficile infection (MDRO/CDI) module. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/LTC/LTCF-LabID-Event-Protocol_current.pdf Published January 2015. Accessed October 27, 2015.Google Scholar
15. Directive 2010-006, Methicillin-resistant Staphylococcus aureus (MRSA) prevention initiative. Veterans Health Administration website. http://www.va.gov/vhapublications/ViewPublication.asp ?pub_ID=2163. Published February 3, 2010. Accessed July 25, 2015.Google Scholar
16. Perencevich, EN. Editorial commentary: deconstructing the Veterans Affairs MRSA prevention bundle. Clin Infect Dis 2012;54:1621–1623.CrossRefGoogle ScholarPubMed
17. Directive 2011-007, Required hand hygiene practices. Veterans Health Administration website. http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2367. Published February 16, 2011. Accessed July 25, 2015.Google Scholar
18. Novak-Weekley, SM, Marlowe, EM, Miller, JM, et al. Clostridium difficile testing in the clinical laboratory by use of multiple testing algorithms. J Clin Microbiol 2010;48:889–893.Google Scholar
19. Longtin, Y, Trottier, S, Brochu, G, et al. Impact of the type of diagnostic assay on Clostridium difficile infection and complication rates in a mandatory reporting program. Clin Infect Dis 2013;56:67–73.Google Scholar
20. Moehring, RW, Lofgren, ET, Anderson, DJ. Impact of change to molecular testing for Clostridium difficile infection on healthcare facility-associated incidence rates. Infect Control Hosp Epidemiol 2013;34:1055–1061.Google Scholar
21. Harris-Kojetin, L, Sengupta, M, Park-Lee, E, Valverde, R. Long-term care services in the United States: 2013 overview. National Center for Health Statistics. Vital Health Stat 2013:1–107.Google Scholar
22. Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.Google Scholar
23. Miller, BA, Chen, LF, Sexton, DJ, Anderson, DJ. Comparison of the burdens of hospital-onset, healthcare facility-associated Clostridium difficile infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals. Infect Control Hosp Epidemiol 2011;32:387–390.Google Scholar
24. Centers for Disease Control and Prevention. Vital signs: preventing. Clostridium difficile infections. MMWR 2012;61:157–162.Google Scholar
25. Evans, CT, Safdar, N. Current trends in the epidemiology and outcomes of Clostridium difficile infection. Clin Infect Dis 2015;60(Suppl 2):S66–S71.Google Scholar
26. Chopra, T, Goldstein, EJ. Clostridium difficile infection in long-term care facilities: a call to action for antimicrobial stewardship. Clin Infect Dis 2015;60(Suppl 2):S72–S6.Google Scholar
27. Lee, BY, Bartsch, SM, Wong, KF, et al. The importance of nursing homes in the spread of methicillin-resistant Staphylococcus aureus (MRSA) among hospitals. Med Care 2013;51:205–215.Google Scholar
28. Slayton, RB, Toth, D, Lee, BY, et al. Vital signs: estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities—United States. MMWR Morb Mortal Wkly Rep 2015;64:826–831.Google Scholar