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Correlation of prevention practices with rates of health care-associated Clostridioides difficile infection

Published online by Cambridge University Press:  29 October 2019

Jackson S. Musuuza
Affiliation:
William S. Middleton Memorial Veterans’ Hospital, Madison, Wisconsin Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Linda McKinley
Affiliation:
William S. Middleton Memorial Veterans’ Hospital, Madison, Wisconsin
Julie A. Keating
Affiliation:
William S. Middleton Memorial Veterans’ Hospital, Madison, Wisconsin
Chidi Obasi
Affiliation:
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Mary Jo Knobloch
Affiliation:
William S. Middleton Memorial Veterans’ Hospital, Madison, Wisconsin Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Christopher Crnich
Affiliation:
William S. Middleton Memorial Veterans’ Hospital, Madison, Wisconsin Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Charlesnika T. Evans
Affiliation:
Veterans’ Affairs (VA) Center of Innovation for Complex Chronic Healthcare, Hines, Illinois Department of Preventive Medicine, Center for Healthcare Studies, Northwestern University, Chicago, Illinois
Martin E. Evans
Affiliation:
Lexington VA Medical Center, Lexington, Kentucky National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, Cincinnati, Ohio
Daniel Livorsi
Affiliation:
Iowa City VA Health Care System, Iowa City, Iowa Department of Internal Medicine, Carver College of Medicine, University of Iowa
Daniel J. Morgan
Affiliation:
VA Maryland Health Care System VA, Baltimore, Maryland
Eli N. Perencevich
Affiliation:
Iowa City VA Health Care System, Iowa City, Iowa Department of Internal Medicine, Carver College of Medicine, University of Iowa
Heather Schacht Reisinger
Affiliation:
Iowa City VA Health Care System, Iowa City, Iowa Department of Internal Medicine, Carver College of Medicine, University of Iowa
Marin L. Schweizer
Affiliation:
Iowa City VA Health Care System, Iowa City, Iowa Department of Internal Medicine, Carver College of Medicine, University of Iowa
Katie J. Suda
Affiliation:
Veterans’ Affairs (VA) Center of Innovation for Complex Chronic Healthcare, Hines, Illinois College of Pharmacy, Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago
Loretta A. Simbartl
Affiliation:
National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, Cincinnati, Ohio
Nasia Safdar*
Affiliation:
William S. Middleton Memorial Veterans’ Hospital, Madison, Wisconsin Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
*
Author for correspondence: Nasia Safdar, Email: ns2@medicine.wisc.edu.

Abstract

Objective:

We examined Clostridioides difficile infection (CDI) prevention practices and their relationship with hospital-onset healthcare facility-associated CDI rates (CDI rates) in Veterans Affairs (VA) acute-care facilities.

Design:

Cross-sectional study.

Methods:

From January 2017 to February 2017, we conducted an electronic survey of CDI prevention practices and hospital characteristics in the VA. We linked survey data with CDI rate data for the period January 2015 to December 2016. We stratified facilities according to whether their overall CDI rate per 10,000 bed days of care was above or below the national VA mean CDI rate. We examined whether specific CDI prevention practices were associated with an increased risk of a CDI rate above the national VA mean CDI rate.

Results:

All 126 facilities responded (100% response rate). Since implementing CDI prevention practices in July 2012, 60 of 123 facilities (49%) reported a decrease in CDI rates; 22 of 123 facilities (18%) reported an increase, and 41 of 123 (33%) reported no change. Facilities reporting an increase in the CDI rate (vs those reporting a decrease) after implementing prevention practices were 2.54 times more likely to have CDI rates that were above the national mean CDI rate. Whether a facility’s CDI rates were above or below the national mean CDI rate was not associated with self-reported cleaning practices, duration of contact precautions, availability of private rooms, or certification of infection preventionists in infection prevention.

Conclusions:

We found considerable variation in CDI rates. We were unable to identify which particular CDI prevention practices (i.e., bundle components) were associated with lower CDI rates.

Type
Original Article
Creative Commons
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
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

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