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Interfacility patient sharing and Clostridioides difficile infection incidence in the Ontario hospital system: A 13-year cohort study

Published online by Cambridge University Press:  25 November 2019

Kevin A. Brown Open the ORCID record for Kevin A. Brown [Opens in a new window] ,
Allison McGeer ,
Kevin L. Schwartz ,
Christina Diong ,
Jacob Etches ,
Gary Garber ,
Jennie Johnstone ,
Bradley Langford  and
Nick Daneman
Kevin A. Brown*
Affiliation:
Public Health Ontario, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
Allison McGeer
Affiliation:
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Mount Sinai Hospital, Toronto, Ontario, Canada
Kevin L. Schwartz
Affiliation:
Public Health Ontario, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada St Joseph’s Health Centre, Toronto, Ontario, Canada
Christina Diong
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Jacob Etches
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Gary Garber
Affiliation:
Public Health Ontario, Toronto, Ontario, Canada Ottawa Research Institute, Ottawa, Ontario, Canada
Jennie Johnstone
Affiliation:
Public Health Ontario, Toronto, Ontario, Canada Mount Sinai Hospital, Toronto, Ontario, Canada
Bradley Langford
Affiliation:
Public Health Ontario, Toronto, Ontario, Canada
Nick Daneman
Affiliation:
Public Health Ontario, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Division of Infectious Diseases, Sunnybrook Research Institute, Toronto, Ontario, Canada Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
*
Author for correspondence: Kevin Antoine Brown, Email: kevin.brown@utoronto.ca
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Abstract

Objective:

Interfacility patient movement plays an important role in the dissemination of antimicrobial-resistant organisms throughout healthcare systems. We evaluated how 3 alternative measures of interfacility patient sharing were associated with C. difficile infection incidence in Ontario acute-care facilities.

Design:

The cohort included adult acute-care facility stays of ≥3 days between April 2003 and March 2016. We measured 3 facility-level metrics of patient sharing: general patient importation, incidence-weighted patient importation, and C. difficile case importation. Each of the 3 patient-sharing metrics were examined against the incidence of C. difficile infection in the facility per 1,000 stays, using Poisson regression models.

Results:

The analyzed cohort included 6.70 million stays at risk of C. difficile infection across 120 facilities. Over the 13-year period, we included 62,189 new cases of healthcare-associated CDI (incidence, 9.3 per 1,000 stays). After adjustment for facility characteristics, general importation was not strongly associated with C. difficile infection incidence (risk ratio [RR] per doubling, 1.10; 95% confidence interval [CI], 0.97–1.24; proportional change in variance [PCV], −2.0%). Incidence-weighted (RR per doubling, 1.18; 95% CI, 1.06–1.30; PCV, −8.4%) and C. difficile case importation (RR per doubling, 1.43; 95% CI, 1.29–1.58; PCV, −30.1%) were strongly associated with C. difficile infection incidence.

Conclusions:

In this 13-year study of acute-care facilities in Ontario, interfacility variation in C. difficile infection incidence was associated with importation of patients from other high-incidence acute-care facilities or specifically of patients with a recent history of C. difficile infection. Regional infection control strategies should consider the potential impact of importation of patients at high risk of C. difficile shedding from outside facilities.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 2 , February 2020 , pp. 154 - 160
Copyright
© 2019 Crown Copyright.

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