Declining Rates of Clostridium difficile infections (CDI) in Veterans Affairs (VA) Long-term Care Facilities (LTCF)

Abstract

BackgroundClinically-confirmed hospital-onset CDI rates declined 15% in VA acute care facilities after implementation of a CDI Prevention Initiative in July 2012. A similar initiative was launched in VA LTCFs in February 2014. The Initiative featured a four-part bundle emphasizing 1) environmental management, 2) hand hygiene, 3) contact precautions for suspected or documented CDI cases, and 4) and institutional culture change where infection control becomes everyone’s business. This is a report of subsequent CDI rates in VA LTCFs.MethodsMultidrug Resistant Organism prevention coordinators at each of the 132 VA reporting sites entered monthly CDI case data from February 2014 to December 2016 into a central database. A clinically-confirmed (CC) LTCF-onset CDI case was defined as a resident with clinical evidence of illness (i.e. diarrhea or histopathologic or colonoscopic evidence of pseudomembranous colitis) and a non-duplicate, non-recurrent positive diagnostic laboratory test collected ≥48h after admission. Quarterly CDI case rate trends were evaluated using negative binomial regression accounting for admission prevalence and diagnostic test type and compared with rates during a 24-month baseline period before implementation of the LTCF Initiative.ResultsDuring the 35-month analysis period, there were 145,421 admissions, 9,844,927 resident-days, and 1,480 CC-LTCF-onset CDI cases nationwide for a pooled CDI LTCF-onset rate of 1.50/10,000 resident-days. The use of nucleic acid amplification testing (NAAT) increased from 77.8% to 83.5% of facilities during the analysis period. CC-LTCF-onset CDI rates decreased 36% (P < .0001 for trend) (Figure 1).ConclusionAs with acute care, LTCF-onset CDI case rates declined coincident with implementation of an initiative featuring a four-part bundle of interventions.Disclosures All authors: No reported disclosures.