Acquisition of Clostridium difficile Colonization and Infection After Transfer From a Veterans Affairs Hospital to an Affiliated Long-Term Care Facility

2017 ◽  
Vol 38 (9) ◽  
pp. 1070-1076 ◽  
Author(s):  
Suresh Ponnada ◽  
Dubert M. Guerrero ◽  
Lucy A. Jury ◽  
Michelle M. Nerandzic ◽  
Jennifer L. Cadnum ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Long Term Care ◽  
Care Facility ◽  
Veterans Affairs ◽  
Term Care ◽  
Long Term Care Facility ◽  
Asymptomatic Patients ◽  
Care Facilities

BACKGROUNDClostridium difficile infection (CDI) and asymptomatic carriage of toxigenic C. difficile are common in long-term care facilities (LTCFs). However, whether C. difficile is frequently acquired in the LTCF versus during acute-care admissions remains unknown.OBJECTIVETo test the hypothesis that LTCF residents often acquire C. difficile colonization and infection in the LTCFDESIGNThis 5-month cohort study was conducted to determine the incidence of acquisition of C. difficile colonization and infection in asymptomatic patients transferred from a Veterans Affairs hospital to an affiliated LTCF.METHODSRectal swabs were cultured for toxigenic C. difficile at the time of transfer to the LTCF and weekly for up to 6 weeks. We calculated the proportion of LTCF-onset CDI cases within 1 month of transfer that occurred in residents colonized on admission versus those with new acquisition in the LTCF.RESULTSOf 110 patients transferred to the LTCF, 12 (11%) were asymptomatically colonized with toxigenic C. difficile upon admission, and 4 of these 12 patients (33%) developed CDI within 1 month, including 3 recurrent and 1 initial CDI episode. Of 82 patients with negative cultures on transfer and at least 1 follow-up culture, 22 (27%) acquired toxigenic C. difficile colonization, and 4 developed CDI within 1 month, including 1 recurrent and 3 initial CDI episodes.CONCLUSIONLTCF residents frequently acquired colonization with toxigenic C. difficile after transfer from the hospital, and 3 of 4 initial CDI cases with onset within 1 month of transfer occurred in residents who acquired colonization in the LTCF.Infect Control Hosp Epidemiol 2017;38:1070–1076

Clostridium difficile Infection in a Department of Veterans Affairs Long-Term Care Facility

2011 ◽  
Vol 32 (5) ◽  
pp. 513-515 ◽  
Author(s):  
Dubert M. Guerrero ◽  
Michelle M. Nerandzic ◽  
Lucy A. Jury ◽  
Shelley Chang ◽  
Robin L. Jump ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Long Term Care ◽  
Medical Center ◽  
Care Facility ◽  
Healthcare Facility ◽  
Veterans Affairs ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

In a Veterans Affairs medical center, 39% of healthcare facility–onset, healthcare facility-associated Clostridium difficile infections had their onset in the affiliated long-term care facility (LTCF). Eighty-five percent of LTCF-onset patients had been transferred from the hospital within the past month. Delays in diagnosis and treatment were common for LTCF-onset patients.

A Regional Outbreak of Clostridium difficile PCR-Ribotype 027 Infections in Southeastern France from a Single Long-Term Care Facility

2016 ◽  
Vol 37 (11) ◽  
pp. 1337-1341 ◽  
Author(s):  
Nadim Cassir ◽  
Jean-Christophe Delarozière ◽  
Gregory Dubourg ◽  
Marion Delord ◽  
Jean-Christophe Lagier ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Long Term Care ◽  
Point Of Care ◽  
Care Facility ◽  
Term Care ◽  
Healthcare Facilities ◽  
Long Term Care Facility ◽  
Care Facilities ◽  
Acute Care Facilities

OBJECTIVETo describe and analyze a large outbreak of Clostridium difficile 027 (CD-027) infections.METHODSConfirmed CD-027 cases were defined as CD infection plus real-time polymerase chain reaction assay (PCR) positive for CD-027. Clinical and microbiological data on patients with CD-027 infection were collected from January 2013 to December 2015 in the Provence-Alpes-Côte-d’Azur region (southeastern France).RESULTSIn total, 19 healthcare facilities reported 144 CD-027 infections (112 confirmed and 32 probable CD-027 infections) during a 22-month period outbreak. Although the incidence rate per 10,000 bed days was lower in long-term care facilities (LTCFs) than in acute care facilities (0.05 vs 0.14; P<.001), cases occurred mainly in LTCFs, one of which was the probable source of this outbreak. After centralization of CD testing, the rate of confirmed CD-027 cases from LTCFs or residential-care homes increased significantly (69% vs 92%; P<.001). Regarding confirmed CD-027 patients, the sex ratio and the median age were 0.53 and 84.2 years, respectively. The 30-day crude mortality rate was 31%. Most patients (96%) had received antibiotics within 3 months prior to the CD colitis diagnosis. During the study period, the rate of patients with CD-027 (compared with all patients tested in the point-of-care laboratories) decreased significantly (P=.03).CONCLUSIONSA large CD-027 outbreak occurred in southeastern France as a consequence of an initial cluster of cases in a single LTCF. Successful interventions included rapid isolation and testing of residents with potentially infectious diarrhea and cohorting of case patients in a specialized infectious diseases ward to optimize management.Infect Control Hosp Epidemiol 2016;1–5

Clostridium difficile Infections in Veterans Health Administration Long-Term Care Facilities

2015 ◽  
Vol 37 (3) ◽  
pp. 295-300 ◽  
Author(s):  
Jeffrey S. Reeves ◽  
Martin E. Evans ◽  
Loretta A. Simbartl ◽  
Stephen M. Kralovic ◽  
Allison A. Kelly ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Care Facilities ◽  
Onset Rate ◽  
Admission Prevalence

OBJECTIVEA 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.METHODSPersonnel 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.RESULTSDuring 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.CONCLUSIONSVA 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

Evaluating the Effect of a Clostridium difficile Infection Prevention Initiative in Veterans Health Administration Long-Term Care Facilities

2018 ◽  
Vol 39 (3) ◽  
pp. 343-345 ◽  
Author(s):  
Maninder B. Singh ◽  
Martin E. Evans ◽  
Loretta A. Simbartl ◽  
Stephen M. Kralovic ◽  
Gary A. Roselle
Keyword(s):  
Clostridium Difficile ◽  
Infection Prevention ◽  
Long Term Care ◽  
Care Facility ◽  
Veterans Health ◽  
Health Administration ◽  
Term Care ◽  
Long Term Care Facility ◽  
Care Facilities

We evaluated rates of clinically confirmed long-term-care facility-onset Clostridium difficile infections from April 2014 through December 2016 in 132 Veterans Affairs facilities after the implementation of a prevention initiative. The quarterly pooled rate decreased 36.1% from the baseline (P<.0009 for trend) by the end of the analysis period.Infect Control Hosp Epidemiol 2018;39:343–345

scholarly journals FEDERAL POLICY SUPPORTS AND GAPS IN ADDRESSING RACIAL-ETHNIC HEALTH DISPARITIES IN U.S. LONG-TERM CARE FACILITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S161-S161
Author(s):  
Rebecca L Mauldin ◽  
Kathy Lee ◽  
Antwan Williams
Keyword(s):  
Long Term Care ◽  
Federal Policy ◽  
Care Facility ◽  
Well Being ◽  
The United States ◽  
Term Care ◽  
Long Term Care Facility ◽  
Care Facilities

Abstract Older adults from racial and ethnic minority groups face health inequities in long-term care facilities such as nursing homes and assisted living facilities just as they do in the United States as a whole. In spite of federal policy to support minority health and ensure the well-being of long-term care facility residents, disparities persist in residents’ quality of care and quality of life. This poster presents current federal policy in the United States to reduce racial and ethnic health disparities and to support long-term care facility residents’ health and well-being. It includes legislation enacted by the Patient Protection and Affordable Care Act of 2010 (ACA), regulations of the U.S. Department of Health and Human Services (DHHS) for health care facilities receiving Medicare or Medicare funds, and policies of the Long-term Care Ombudsman Program. Recommendations to address threats to or gaps in these policies include monitoring congressional efforts to revise portions of the ACA, revising DHHS requirements for long-term care facilities staff training and oversight, and amending requirements for the Long-term Care Ombudsman Program to mandate collection, analysis, and reporting of resident complaint data by race and ethnicity.

Sign in / Sign up

Export Citation Format

Share Document