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A targeted assessment for prevention strategy to decrease Clostridioides difficile infections in Veterans Affairs acute-care medical centers

Published online by Cambridge University Press:  03 January 2020

Gary A. Roselle
Affiliation:
National Infectious Diseases Service, Patient Care Services, Veterans Affairs Central Office Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
Martin E. Evans*
Affiliation:
Veterans Health Administration, MRSA/MDRO Prevention Office, National Infectious Diseases Service, Specialty Care Services, Veterans Affairs Central Office Lexington Veterans Affairs Medical Center, Lexington, Kentucky Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky School of Medicine, Lexington, Kentucky
Loretta A. Simbartl
Affiliation:
National Infectious Diseases Service, Patient Care Services, Veterans Affairs Central Office
Brian P. McCauley
Affiliation:
Veterans Health Administration, MRSA/MDRO Prevention Office, National Infectious Diseases Service, Specialty Care Services, Veterans Affairs Central Office
Karen R. Lipscomb
Affiliation:
Veterans Health Administration, MRSA/MDRO Prevention Office, National Infectious Diseases Service, Specialty Care Services, Veterans Affairs Central Office
Marla Clifton
Affiliation:
National Infectious Diseases Service, Patient Care Services, Veterans Affairs Central Office
*
Author for correspondence: Martin E. Evans, E-mail: martin.evans@va.gov

Abstract

Objective:

A guideline for the prevention of Clostridioides difficile infection (CDI) in 127 Veterans Health Administration acute-care facilities was implemented in July 2012. Beginning in 2015, a targeted assessment for prevention strategy was used to evaluate facilities for hospital-onset healthcare-facility–associated CDIs to focus prevention efforts where they might have the most impact in reaching a reduction goal of 30% nationwide.

Methods:

We calculated standardized infection ratios (SIRs) and cumulative attributable differences (CADs) using a national data baseline. Facilities were ranked by CAD, and those with the 10 highest CAD values were targeted for periodic conference calls or a site visit from January 2016–September 2019.

Results:

The hospital-onset healthcare-facility–associated CDI rate in the 10 facilities with the highest CADs declined 56% during the process improvement period, compared to a 44% decline in the 117 nonintervention facilities (P = .03).

Conclusion:

Process improvement interventions targeting facilities ranked by CAD values may be an efficient strategy for decreasing CDI rates in a large healthcare system.

Type
Original Article
Creative Commons
Creative Common License - CCCreative Common License - BY
This work is classified, for copyright purposes, as a work of the U.S. Government and is not subject to copyright protection within the United States.
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

Evans, ME, Kralovic, SM, Simbartl, LA, Jain, R, Roselle, GA.Eight years of decreased methicillin-resistant Staphylococcus aureus healthcare-associated infections associated with a Veterans Affairs prevention initiative. Amer J Infect Control 2017;45:1316.CrossRefGoogle ScholarPubMed
Evans, ME, Kralovic, SM, Simbartl, LA, Jain, R, Roselle, GA.Effect of a Clostridium difficile infection prevention initiative in Veterans Affairs acute-care facilities. Infect Control Hosp Epidemiol 2016;37:720722.CrossRefGoogle ScholarPubMed
Soe, MM, Gould, CV, Pollock, D, Edwards, J.Targeted assessment for prevention of healthcare-associated infections: a new prioritization metric. Infect Control Hosp Epidemiol 2015;36:13791384.CrossRefGoogle ScholarPubMed
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;35:10371042.CrossRefGoogle ScholarPubMed