Burden of Clostridioides difficile in a State's Long-term Care Facilities

Abstract

BACKGROUND Nearly 500,000 persons in the United States developed a Clostridioides difficile infection (CDI) in 2015 and more than 100,000 of these infections were in residents of long-term care facilities (LTCF). It is difficult to estimate the true burden of CDI in LTCF as reporting is not required. To gain a better understanding of CDI, the state health department (SHD) encourages LTCF to enroll and report CDI data into the National Healthcare Safety Network (NHSN). METHODS The SHD analyzed CDI data reported into NHSN's Long-Term Care Component from March 2017 to October 2018. Descriptive analyses were performed on CDI LabID events which were categorized as community-onset (CO), long-term care onset (LO) and acute care-transfer-long-term care onset (ACT-LO) according to NHSN definitions. CDI rates were also calculated based on the NHSN definitions. RESULTS As of October 2018, 44 out of 320 LTCFs in the state were enrolled in NHSN. The median bed size was 103 (38–444). Between March 2017–October 2018, 29 out of 44 facilities reported 174 CDI LabID events with a range of 1–40. Of the total CDI events, 31 events were CO, 143 were LO and 64 LO events were categorized as ACT-LO. The overall CDI rate was 0.70 per 10,000 resident days. The CDI LO-Incidence rate was 0.52 per 10,000 resident days compared to a rate of 5.05 in acute care hospitals during the same period. CONCLUSIONS 14% of long-term care facilities in the state are reporting CDI data voluntarily into NHSN. These data allow the SHD to better characterize the true burden of CDI statewide. Accurate reporting of infection data is imperative in order to establish a baseline infection rate and guide infection prevention strategies. Based on the variation in the data, the SHD plans to perform external validation of CDI data and education on NHSN definitions.