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Multifacility Prevention Initiative Reduces Monthly CDI Rates by 4%
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A multifacility collaborative initiative implemented among acute-care hospitals in Orange County, California, resulted in a statistically significant 4% monthly decrease in hospital-onset Clostridioides difficile infection, or CDI, and a statistically significant 2% decrease in community-onset CDI, researchers reported in Infection Control & Hospital Epidemiology.
“The results from this study show a reduction in C. difficile infections following a public health-coordinated effort to strengthen prevention practices in hospitals and skilled nursing facilities in a large county,” Kyle R. Rizzo, MPH, from the California Department of Public Health’s Healthcare-Associated Infections Program, told Infectious Disease News. “Infectious disease doctors with responsibilities for health care epidemiology and infection prevention should consider coordinating their CDI prevention efforts with their local health departments and regional health care facility referral networks.”
A previous study found that the CDI cases in California could be reduced by 13% if contamination from hospital transfers were eliminated.
Rizzo and colleagues invited all 34 hospitals and 76 skilled nursing homes in Orange County to participate in their controlled interrupted time series evaluation. According to the study, 56% of the hospitals and 26% of the skilled nursing homes participated.
The baseline period, before the initiative was implemented, lasted 17 months from January 2014 to June 2015. The follow-up period occurred between September 2015 and December 2017, lasting 28 months. According to the study, participating health care facilities received onsite infection control and antimicrobial stewardship assessments, interactive learning and discussion sessions and an interfacility communication improvement initiative. The researchers also assessed CDI rates among 27 acute-care hospitals in three San Francisco Bay Area counties for comparison.
Among the participating facilities, hospital-onset CDI rates decreased 4% per month during the follow-up period compared with the baseline period (incidence rate ratio [IRR] = 0.96; 95% CI, 0.95-0.97). Moreover, when the researchers compared Orange County facilities with the nonparticipant hospitals in the San Francisco Bay Area, they observed a 3% decrease in monthly rates of hospital-onset CDI (IRR = 0.97; 95% CI, 0.95-0.99).
Between the baseline and follow-up periods, community-onset CDI rates declined 2% in Orange County. However, Rizzo and colleagues noted that this decline was not statistically different from decreases seen from the San Francisco Bay Area (IRR = 0.97; 95% CI, 0.95-1).
“The results from this study suggest that monitoring adherence to infection prevention measures and implementing antibiotic stewardship interventions in a network of health care facilities can accelerate regional CDI prevention,” Rizzo said. “Hospitals building relationships with other health care facilities with which they regularly share patients improves interfacility communication and ensures all interconnected facilities engage in CDI prevention efforts.” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.
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