Clostridium difficile Infections in Veterans Health Administration Acute Care Facilities

2014 ◽  
Vol 35 (8) ◽  
pp. 1037-1042 ◽  
Author(s):  
Martin E. Evans ◽  
Loretta A. Simbartl ◽  
Stephen M. Kralovic ◽  
Rajiv Jain ◽  
Gary A. Roselle
Keyword(s):  
Clostridium Difficile ◽  
Acute Care ◽  
Hospital Admissions ◽  
Healthcare Facility ◽  
Resistant Organism ◽  
Veterans Health ◽  
Health Administration ◽  
Case Rate ◽  
Community Onset ◽  
Admission Prevalence

ObjectiveAn initiative was implemented in July 2012 to decrease Clostridium difficile infections (CDIs) in Veterans Affairs (VA) acute care medical centers nationwide. This is a report of national baseline CDI data collected from the 21 months before implementation of the initiative.MethodsPersonnel at each of 132 data-reporting sites entered monthly retrospective CDI case data from October 2010 through June 2012 into a central database using case definitions similar to those of the National Healthcare Safety Network multidrug-resistant organism/CDI module.ResultsThere were 958,387 hospital admissions, 5,286,841 patient-days, and 9,642 CDI cases reported during the 21-month analysis period. The pooled CDI admission prevalence rate (including recurrent cases) was 0.66 cases per 100 admissions. The nonduplicate/nonrecurrent community-onset not-healthcare-facility-associated (CO-notHCFA) case rate was 0.35 cases per 100 admissions, and the community-onset healthcare facility–associated (CO-HCFA) case rate was 0.14 cases per 100 admissions. Hospital-onset healthcare facility–associated (HO-HCFA), clinically confirmed HO-HCFA (CC-HO-HCFA), and CO-HCFA rates were 9.32, 8.40, and 2.56 cases per 10,000 patient-days, respectively. There were significant decreases in admission prevalence (P = .0006, Poisson regression), HO-HCFA (P = .003), and CC-HO-HCFA (P = .004) rates after adjusting for type of diagnostic test. CO-HCFA and CO-notHCFA rates per 100 admissions also trended downward (P = .07 and .10, respectively).ConclusionsVA acute care medical facility CDI rates were higher than those reported in other healthcare systems, but unlike rates in other venues, they were decreasing or trending downward. Despite these downward trends, there is still a substantial burden of CDI in the system supporting the need for efforts to decrease rates further.

Complications of Hospital-Onset Healthcare Facility–Associated Clostridium difficile Infections Among Veterans

2016 ◽  
Vol 37 (6) ◽  
pp. 717-719 ◽  
Author(s):  
Martin E. Evans ◽  
Stephen M. Kralovic ◽  
Loretta A. Simbartl ◽  
Judith L. Whitlock ◽  
Rajiv Jain ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clostridium Difficile ◽  
Acute Care ◽  
Healthcare Facility ◽  
Veterans Health Administration ◽  
Infect Control Hosp ◽  
Veterans Health ◽  
Health Administration ◽  
Infection Diagnosis

Complications within 30 days of a clinically confirmed hospital-onset Clostridium difficile infection diagnosis from July 1, 2012, through June 30, 2015, in 127 acute care Veterans Health Administration facilities were evaluated. Pooled rates for attributable intensive care unit admissions, colectomies, and deaths were 2.7%, 0.5%, and 0.4%, respectively.Infect Control Hosp Epidemiol 2016;37:717–719

scholarly journals Shift to community-onset Clostridium difficile infection in the national Veterans Health Administration, 2003-2014

2018 ◽  
Vol 46 (4) ◽  
pp. 431-435 ◽  
Author(s):  
Kelly R. Reveles ◽  
Mary Jo V. Pugh ◽  
Kenneth A. Lawson ◽  
Eric M. Mortensen ◽  
Jim M. Koeller ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Community Onset

scholarly journals Effect of copper-impregnated linens on multidrug-resistant organism acquisition and Clostridium difficile infection at a long-term acute-care hospital

2018 ◽  
Vol 39 (11) ◽  
pp. 1384-1386 ◽  
Author(s):  
Gregory R. Madden ◽  
Brenda E. Heon ◽  
Costi D. Sifri
Keyword(s):  
Clostridium Difficile ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Healthcare Facility ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Care Hospital ◽  
Healthcare Settings ◽  
Effect Of Copper

AbstractCopper-impregnated surfaces and linens have been shown to reduce infections and multidrug-resistant organism (MDRO) acquisition in healthcare settings. However, retrospective analyses of copper linen deployment at a 40-bed long-term acute-care hospital demonstrated no significant reduction in incidences of healthcare facility-onset Clostridium difficile infection or MDRO acquisition.

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

2020 ◽  
Vol 41 (3) ◽  
pp. 302-305
Author(s):  
Gary A. Roselle ◽  
Martin E. Evans ◽  
Loretta A. Simbartl ◽  
Brian P. McCauley ◽  
Karen R. Lipscomb ◽  
...  
Keyword(s):  
Acute Care ◽  
Process Improvement ◽  
Healthcare Facility ◽  
Prevention Strategy ◽  
Veterans Health ◽  
Health Administration ◽  
Conference Calls ◽  
Clostridioides Difficile ◽  
Acute Care Facilities ◽  
A Site

AbstractObjective: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.

Recommendations for Surveillance of Clostridium difficile–Associated Disease

2007 ◽  
Vol 28 (2) ◽  
pp. 140-145 ◽  
Author(s):  
L. Clifford McDonald ◽  
Bruno Coignard ◽  
Erik Dubberke ◽  
Xiaoyan Song ◽  
Teresa Horan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Clostridium Difficile ◽  
Pseudomembranous Colitis ◽  
Ad Hoc ◽  
Toxic Megacolon ◽  
Healthcare Facility ◽  
Case Patient ◽  
Healthcare Settings ◽  
Community Onset ◽  
Laboratory Assay

Background.The epidemiology of Clostridium difficile-associated disease (CDAD) is changing, with evidence of increased incidence and severity. However, the understanding of the magnitude of and reasons for this change is currently hampered by the lack of standardized surveillance methods.Objective and Methods.An ad hoc C. difficile surveillance working group was formed to develop interim surveillance definitions and recommendations based on existing literature and expert opinion that can help to improve CDAD surveillance and prevention efforts.Definitions and Recommendations.A CDAD case patient was defined as a patient with symptoms of diarrhea or toxic megacolon combined with a positive result of a laboratory assay and/or endoscopic or histopathologic evidence of pseudomembranous colitis. Recurrent CDAD was defined as repeated episodes within 8 weeks of each other. Severe CDAD was defined by CDAD-associated admission to an intensive care unit, colectomy, or death within 30 days after onset. Case patients were categorized by the setting in which C. difficile was likely acquired, to account for recent evidence that suggests that healthcare facility-associated CDAD may have its onset in the community up to 4 weeks after discharge. Tracking of healthcare facility–onset, healthcare facility–associated CDAD is the minimum surveillance required for healthcare settings; tracking of community–onset, healthcare facility–associated CDAD should be performed only in conjunction with tracking of healthcare facility–onset, healthcare facility–associated CDAD. Community–associated CDAD was defined by symptom onset more than 12 weeks after the last discharge from a healthcare facility. Rates of both healthcare facility–onset, healthcare facility–associated CDAD and community–onset, healthcare facility–associated CDAD should be expressed as case patients per 10,000 patient–days; rates of community-associated CDAD should be expressed as case patients per 100,000 person-years.

scholarly journals Automated Nationwide Benchmarking Dashboard for Antimicrobial Stewardship Programs within the Veterans’ Health Administration

2021 ◽  
Vol 1 (S1) ◽  
pp. s23-s24
Author(s):  
Michihiko Goto ◽  
Eli Perencevich ◽  
Alexandre Marra ◽  
Bruce Alexander ◽  
Brice Beck ◽  
...  
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Risk Adjustment ◽  
Long Term Care ◽  
Antimicrobial Use ◽  
Veterans Health ◽  
Health Administration ◽  
Term Care ◽  
Patient Level

Group Name: VHA Center for Antimicrobial Stewardship and Prevention of Antimicrobial Resistance (CASPAR) Background: Antimicrobial stewardship programs (ASPs) are advised to measure antimicrobial consumption as a metric for audit and feedback. However, most ASPs lack the tools necessary for appropriate risk adjustment and standardized data collection, which are critical for peer-program benchmarking. We created a system that automatically extracts antimicrobial use data and patient-level factors for risk-adjustment and a dashboard to present risk-adjusted benchmarking metrics for ASP within the Veterans’ Health Administration (VHA). Methods: We built a system to extract patient-level data for antimicrobial use, procedures, demographics, and comorbidities for acute inpatient and long-term care units at all VHA hospitals utilizing the VHA’s Corporate Data Warehouse (CDW). We built baseline negative binomial regression models to perform risk-adjustments based on patient- and unit-level factors using records dated between October 2016 and September 2018. These models were then leveraged both retrospectively and prospectively to calculate observed-to-expected ratios of antimicrobial use for each hospital and for specific units within each hospital. Data transformation and applications of risk-adjustment models were automatically performed within the CDW database server, followed by monthly scheduled data transfer from the CDW to the Microsoft Power BI server for interactive data visualization. Frontline antimicrobial stewards at 10 VHA hospitals participated in the project as pilot users. Results: Separate baseline risk-adjustment models to predict days of therapy (DOT) for all antibacterial agents were created for acute-care and long-term care units based on 15,941,972 patient days and 3,011,788 DOT between October 2016 and September 2018 at 134 VHA hospitals. Risk adjustment models include month, unit types (eg, intensive care unit [ICU] vs non-ICU for acute care), specialty, age, gender, comorbidities (50 and 30 factors for acute care and long-term care, respectively), and preceding procedures (45 and 24 procedures for acute care and long-term care, respectively). We created additional models for each antimicrobial category based on National Healthcare Safety Network definitions. For each hospital, risk-adjusted benchmarking metrics and a monthly ranking within the VHA system were visualized and presented to end users through the dashboard (an example screenshot in Figure 1). Conclusions: Developing an automated surveillance system for antimicrobial consumption and risk-adjustment benchmarking using an electronic medical record data warehouse is feasible and can potentially provide valuable tools for ASPs, especially at hospitals with no or limited local informatics expertise. Future efforts will evaluate the effectiveness of dashboards in these settings.Funding: NoDisclosures: None

scholarly journals Reduction of Methicillin-ResistantStaphylococcus aureusInfection among Veterans in Atlanta

2013 ◽  
Vol 34 (1) ◽  
pp. 62-68 ◽  
Author(s):  
Edward Stenehjem ◽  
Cortney Stafford ◽  
David Rimland
Keyword(s):  
Active Surveillance ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Healthcare Settings ◽  
Surveillance Cultures ◽  
Mrsa Infection ◽  
The Impact ◽  
Mrsa Colonization ◽  
Community Onset

Objective.Describe local changes in the incidence of community-onset and hospital-onset methicillin-resistantStaphylococcus aureus(MRSA) infection and evaluate the impact of MRSA active surveillance on hospital-onset infection.Design.Observational study using prospectively collected data.Setting.Atlanta Veterans Affairs Medical Center (AVAMC).Patients.All patients seen at the AVAMC over an 8-year period with clinically and microbiologically proven MRSA infection.Methods.All clinical cultures positive for MRSA were prospectively identified, and corresponding clinical data were reviewed. MRSA infections were classified into standard clinical and epidemiologic categories. The Veterans Health Administration implemented the MRSA directive in October 2007, which required active surveillance cultures in acute care settings.Results.The incidence of community-onset MRSA infection peaked in 2007 at 5.45 MRSA infections per 1,000 veterans and decreased to 3.14 infections per 1,000 veterans in 2011 (P< .001 for trend). Clinical and epidemiologic categories of MRSA infections did not change throughout the study period. The prevalence of nasal MRSA colonization among veterans admitted to AVAMC decreased from 15.8% in 2007 to 11.2% in 2011 (P<.001 for trend). The rate of intensive care unit (ICU)-related hospital-onset MRSA infection decreased from October 2005 through March 2007, before the MRSA directive. Rates of ICU-related hospital-onset MRSA infection remained stable after the implementation of active surveillance cultures. No change was observed in rates of non-ICU-related hospital-onset MRSA infection.Conclusions.Our study of the AVAMC population over an 8-year period shows a consistent trend of reduction in the incidence of MRSA infection in both the community and healthcare settings. The etiology of this reduction is most likely multifactorial.

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