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

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.

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

Intensive Care Services in the Veterans Health Administration

CHEST Journal ◽  
2007 ◽  
Vol 132 (5) ◽  
pp. 1455-1462 ◽  
Author(s):  
Peter Almenoff ◽  
Anne Sales ◽  
Sharon Rounds ◽  
Michael Miller ◽  
Kelly Schroeder ◽  
...  
Keyword(s):  
Intensive Care ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Care Services

Temporal trends of inpatient C. difficile infections within the Veterans Health Administration hospitals: An analysis of the effect of molecular testing, time to testing, and mandatory reporting

2019 ◽  
Vol 41 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Zarchi E. Sumon ◽  
Alan J. Lesse ◽  
John A. Sellick ◽  
Sheldon Tetewsky ◽  
Kari A. Mergenhagen
Keyword(s):  
Temporal Trends ◽  
Healthcare Facility ◽  
Veterans Health Administration ◽  
Mandatory Reporting ◽  
Molecular Testing ◽  
Testing Time ◽  
Third Generation ◽  
Veterans Health ◽  
Health Administration ◽  
Third Generation Cephalosporins

AbstractBackground:Clostridium difficile infection (CDI) is a reportable hospital metric associated with significant healthcare expenditures. The epidemiology of CDI is pivotal to the implementation of preventative measures.Objective:To portray temporal CDI trends in Veterans Health Administration (VA) hospitals.Design:A retrospective analysis of veterans who had stool testing for C. difficile.Setting:VA acute-care hospitals within the continental United States.Methods:Data were mined from the VA’s Corporate Data Warehouse. CDI is reported per 10,000 patient days.Results:From 2006 to 2016, 472,346 patients had C. difficile testing. Overall, decreases in incidence of total CDI (16.81 to 13.66) and hospital-onset healthcare facility-associated (HO-HCFA) CDI (10.87 to 6.41) were observed. Temporal increases in the incidence of total and HO-HCFA CDI were associated with the increased use of molecular testing (P < .0001). Decreased use of fluoroquinolones (P < .0001), clindamycin (P = .0006), and third-generation cephalosporins (P = .0002) correlated with decreased rates of CDI, but VA mandatory reporting did not influence CDI rates (P = .24). The overall crude 30-day mortality of patients with CDI decreased from 2.17 deaths per 10,000 patient days in 2006 to 1.41 in 2016. The frequency of International Classification of Disease, Ninth/Tenth Revision (ICD-9/10) discharge diagnosis for CDI was 73.3%.Conclusion:Molecular testing was associated with increased incidence of CDI. Controlling CDI is likely multifactorial. Although the VA initiative to report cases of hospital-acquired CDI was not significant in our model, the advent of stewardship programs throughout the VA and reductions in the use of third-generation cephalosporins, fluoroquinolones, and clindamycin were significantly associated with reduced rates of CDI.

Epidemiologic Review of Veterans Health Administration Patients with Isolation of Nontuberculous Mycobacteria after Cardiopulmonary Bypass Procedures

2017 ◽  
Vol 38 (9) ◽  
pp. 1103-1106 ◽  
Author(s):  
Gina Oda ◽  
Russell Ryono ◽  
Cynthia Lucero-Obusan ◽  
Patricia Schirmer ◽  
Hasan Shanawani ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Nontuberculous Mycobacteria ◽  
Veterans Health Administration ◽  
Infect Control Hosp ◽  
Veterans Health ◽  
Health Administration ◽  
Respiratory Isolate

We evaluated the isolation of postoperative nontuberculous mycobacteria (NTM) associated with heater-cooler devices (HCDs) used during cardiopulmonary bypass (CPB) surgery in the Veterans Health Administration from January 1, 2010, to December 31, 2016. In more than 38,000 CPB procedures, NTM was isolated in 111 patients; 1 Mycobacterium chimaera mediastinitis case and 1 respiratory isolate were found.Infect Control Hosp Epidemiol 2017;38:1103–1106

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