Assessment of public health notification thresholds for Clostridioides difficile in acute-care hospitals—Colorado and Tennessee, 2018

2021 ◽  
pp. 1-6
Author(s):  
Meghana P. Parikh ◽  
Ariella P. Dale ◽  
Wendy M. Bamberg ◽  
Marion A. Kainer
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Descriptive Analysis ◽  
Acute Care Hospitals ◽  
Rapid Identification ◽  
High Burden ◽  
Public Health Agencies ◽  
Clostridioides Difficile ◽  
Unit Unit ◽  
Alert Threshold

Abstract Objectives: We aimed to identify a threshold number of Clostridioides difficile infections (CDI) for acute-care hospitals (ACHs) to notify public health agencies of outbreaks and we aimed to determine whether thresholds can be used with existing surveillance strategies to further infection reduction goals. Design: Descriptive analysis of laboratory-identified CDI reported to the National Healthcare Safety Network by Colorado and Tennessee ACH inpatient units in 2018. Methods: Threshold levels of ≥2, ≥3, and ≥4 CDI events per calendar month per unit (unit month) were assessed to identify units that would trigger facility reporting to public health. Values meeting thresholds were defined as alerts. Recurrent alerts were defined as alerts from units meeting the threshold ≥2 times within 12 months. The presence of alerts was compared to the number of excess infections to identify high-burden facilities. Results: At an alert threshold of ≥2 CDI events per unit month, 204 alerts occurred among 43 Colorado ACHs and 290 among 78 Tennessee ACHs. At a threshold of ≥3, there were 59 and 61 alerts, and at a threshold of ≥4, there were 17 and 10 alerts in Colorado and Tennessee, respectively. In both Colorado and Tennessee, at a threshold of ≥3 nearly 50% of alerts were recurrent, and facilities with at least one alert in 2018 accounted for ∼85% of the statewide excess infections. Conclusions: An alert threshold of ≥3 CDI events per unit month is feasible for rapid identification of outbreaks in ACHs. This threshold can facilitate earlier assessments and interventions in high-burden facilities.

scholarly journals Assessment of Potential Clostridioides difficile Public Health Notification Thresholds in Acute-Care Hospitals

2020 ◽  
Vol 41 (S1) ◽  
pp. s132-s132
Author(s):  
Ariella Dale ◽  
Meghana Parikh ◽  
Wendy Bamberg ◽  
Marion Kainer
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
The United States ◽  
Health Departments ◽  
Healthcare Facilities ◽  
Public Health Departments ◽  
Threshold Levels ◽  
Clostridioides Difficile ◽  
Alert Threshold

Background:Clostridioides difficile remains a pervasive issue throughout healthcare facilities in the United States. Currently, no national guidelines exist for healthcare facilities to notify public health about suspected C. difficile transmission. Identification of a threshold for public health notification is needed to improve efforts to target prevention in facilities and to contain the spread of C. difficile.Methods: We analyzed C. difficile data reported by acute-care hospitals (ACHs) during October 2017–September 2018 via the CDC NHSN in Colorado and Tennessee. Threshold levels of ≥2, ≥3, and ≥4 C. difficile infections per calendar month per unit were assessed to identify ACH units that would trigger facility reporting to public health. Values meeting thresholds were defined as “alerts.” Facilities were further stratified by size and medical teaching status. Recurrent alerts were defined as meeting the threshold at least twice within 12 months. Presence and recurrence of facility alerts were compared to facility-specific standardized infection ratios (SIRs) and cumulative attributable differences (CADs). Results: Of 105 ACHs in Tennessee and 50 in Colorado, 46 in Tennessee (44%) and 28 in Colorado (56%) had alerts with a threshold of ≥2 cases per calendar month per unit; 20 in Tennessee (19%) and 19 in Colorado (38%) had ≥3 cases per calendar month per unit; and 7 in Tennessee (7%) and 10 in Colorado (20%) had ≥4 cases per calendar month per unit. Most alerts with each threshold were in facilities with ≥400 beds and in major teaching hospitals. Using a threshold of ≥2, 64% of Tennessee and 79% of Colorado alerts were associated with recurrent alerting units. Using an alert threshold of ≥3, 85% of Tennessee facilities (17 of 20) and 75% of Colorado facilities (15 of 20) with the highest CAD values had at least 1 alert. Using state-based CAD values, 79% of the CAD value for Tennessee (356 of 449) and 91% of the CAD value for Colorado (309 of 340) were attributable to facilities with at least 1 alert. Facilities above a threshold of ≥3 had a pooled SIR of 0.92 in Tennessee (range, 0.46–7.94) and 1.07 in Colorado (range, 0.74–1.74). Conclusions: Using alert threshold levels identified ACHs with higher levels of C. difficile. Recurrent alerts account for a substantial proportion of the total alerts in ACHs, even as thresholds increased. Alerts were strongly correlated with high CAD values. Because NHSN C. difficile data are not available to public health departments until several months after cases are identified, public health departments should consider working with ACHs to implement a threshold model for public health notification, enabling earlier intervention than those prompted by SIR and CAD calculations.Disclosures: NoneFunding: None

scholarly journals Effectiveness of Ultraviolet-C Room Disinfection on Preventing Healthcare-Associated Clostridioides difficile Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s33-s33
Author(s):  
Michihiko Goto ◽  
Erin Balkenende ◽  
Gosia Clore ◽  
Rajeshwari Nair ◽  
Loretta Simbartl ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Incidence Rates ◽  
Positive Test ◽  
Negative Binomial Regression Model ◽  
Test Results ◽  
Clostridioides Difficile ◽  
Ultraviolet C ◽  
Healthcare Associated ◽  
Uv C

Background: Enhanced terminal room cleaning with ultraviolet C (UVC) disinfection has become more commonly used as a strategy to reduce the transmission of important nosocomial pathogens, including Clostridioides difficile, but the real-world effectiveness remains unclear. Objectives: We aimed to assess the association of UVC disinfection during terminal cleaning with the incidence of healthcare-associated C. difficile infection and positive test results for C. difficile within the nationwide Veterans Health Administration (VHA) System. Methods: Using a nationwide survey of VHA system acute-care hospitals, information on UV-C system utilization and date of implementation was obtained. Hospital-level incidence rates of clinically confirmed hospital-onset C. difficile infection (HO-CDI) and positive test results with recent healthcare exposures (both hospital-onset [HO-LabID] and community-onset healthcare-associated [CO-HA-LabID]) at acute-care units between January 2010 and December 2018 were obtained through routine surveillance with bed days of care (BDOC) as the denominator. We analyzed the association of UVC disinfection with incidence rates of HO-CDI, HO-Lab-ID, and CO-HA-LabID using a nonrandomized, stepped-wedge design, using negative binomial regression model with hospital-specific random intercept, the presence or absence of UVC disinfection use for each month, with baseline trend and seasonality as explanatory variables. Results: Among 143 VHA acute-care hospitals, 129 hospitals (90.2%) responded to the survey and were included in the analysis. UVC use was reported from 42 hospitals with various implementation start dates (range, June 2010 through June 2017). We identified 23,021 positive C. difficile test results (HO-Lab ID: 5,014) with 16,213 HO-CDI and 24,083,252 BDOC from the 129 hospitals during the study period. There were declining baseline trends nationwide (mean, −0.6% per month) for HO-CDI. The use of UV-C had no statistically significant association with incidence rates of HO-CDI (incidence rate ratio [IRR], 1.032; 95% CI, 0.963–1.106; P = .65) or incidence rates of healthcare-associated positive C. difficile test results (HO-Lab). Conclusions: In this large quasi-experimental analysis within the VHA System, the enhanced terminal room cleaning with UVC disinfection was not associated with the change in incidence rates of clinically confirmed hospital-onset CDI or positive test results with recent healthcare exposure. Further research is needed to understand reasons for lack of effectiveness, such as understanding barriers to utilization.Funding: NoneDisclosures: None

scholarly journals Public Health Oversight of Interfacility Transfers During a Candida auris Outbreak—Orange County, California, 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s76-s77
Author(s):  
Kathleen O'Donnell ◽  
Ellora Karmarkar ◽  
Brendan R Jackson ◽  
Erin Epson ◽  
Matthew Zahn
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Orange County ◽  
Acute Care Hospitals ◽  
Nursing Facilities ◽  
Candida Auris ◽  
Retrospective Case ◽  
California Department ◽  
Healthcare Facilities ◽  
Contact Precautions

Background: In February 2019, the Orange County Health Care Agency (OCHCA) identified an outbreak of Candida auris, an emerging fungus that spreads rapidly in healthcare facilities. Patients in long-term acute-care hospitals (LTACHs) and skilled nursing facilities that provide ventilator care (vSNFs) are at highest risk for C. auris colonization. With assistance from the California Department of Public Health and the Centers for Disease Control and Prevention, OCHCA instituted enhanced surveillance, communication, and screening processes for patients colonized with or exposed to C. auris. Method: OCHCA implemented enhanced surveillance by conducting point-prevalence surveys (PPSs) at all 3 LTACHs and all 14 vSNFs in the county. Colonized patients were identified through axilla/groin skin swabbing with C. auris detected by PCR and/or culture. In facilities where >1 C. auris colonized patient was found, PPSs were repeated every 2 weeks to identify ongoing transmission. Retrospective case finding was instituted at 2 LTACHs with a high burden of colonized patients; OCHCA contacted patients discharged after January 1, 2019, and offered C. auris screening. OCHCA tracked the admission or discharge of all colonized patients, and facilities with ongoing transmission were required to report transfers of any patient, regardless of colonization status. OCHCA tracked all patients discharged from facilities with ongoing transmission to ensure that accepting facilities conducted admission surveillance testing of exposed patients and implemented appropriate environmental and contact precautions. Result: From February–October 2019, 192 colonized patients were identified. All 3 LTACHs and 6 of 14 VSNFs had at least 1 C. auris–colonized patient identified on initial PPS, and 2 facilities had ongoing transmission identified on serial PPS. OCHCA followed 96 colonized patients transferred a total of 230 times (an average of 2.4 transfers per patient) (Fig. 1) and 677 exposed patients discharged from facilities with ongoing transmission (Fig. 2). Admission screening of 252 exposed patients on transfer identified 13 (5.2%) C. auris–colonized patients. As of November 1, 2019, these 13 patients were admitted 21 times to a total of 6 acute-care hospitals, 2 LTACHs, and 3 vSNFs. Transferring facilities did not consistently communicate the colonized patient’s status and the requirements for isolation and testing of exposed patients. Conclusion: OCHCA oversight of interfacility transfer, though labor-intensive, improved identification of patients colonized with C. auris and implementation of appropriate environmental and contact precautions, reducing the risk of transmission in receiving healthcare facilities.Funding: NoneDisclosures: None

scholarly journals 785. Association between Prevalence of Laboratory-Identified Clostridioides difficile Infections (CDIs) and CDI Antibiotic Treatment in U.S. Acute Care Hospitals, 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S437-S437
Author(s):  
Kerui Xu ◽  
Andrea L Benin ◽  
Hsiu Wu ◽  
Jonathan R Edwards ◽  
Qunna Li ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Prevalence Rates ◽  
Hospital Level ◽  
First Line ◽  
Oral Vancomycin ◽  
Patient Admissions ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract Background Clostridioides difficile infections (CDIs) are an urgent public health threat, accounting for 223,900 infections and 12,800 deaths in hospitalized patients annually. In early 2018, the Infectious Disease Society of America (IDSA) recommended oral vancomycin or fidaxomicin as the first-line antibiotics for CDIs. To track the uptake of IDSA’s recommendations, we evaluated the association between CDI prevalence and use of first-line antibiotics in hospitals reporting to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN). Methods We matched 2018 hospital-level, NHSN data on laboratory-identified CDIs with NHSN antimicrobial use (AU) data for the same time period. Hospitals that submitted < 6 months of either data type in 2018 were excluded. The association between quarterly hospital-level CDI prevalence rates per 100 patient-admissions and use of CDI antibiotics (oral vancomycin plus fidaxomicin) per 1,000 days-present was evaluated using Pearson’s linear correlation coefficient and using Goodman and Kruskal’s gamma (G) on ordinal quartiles to assess rates of discordant pairs. Results Among the 2735 hospital-level quarters based on 714 hospitals included in the study, CDI prevalence (median: 0.46 per 100 patient-admissions) and CDI antibiotic use (median: 8.85 antibiotic-days per 1,000 days-present) demonstrated only a moderately positive correlation (r = 0.48). Among hospitals in the highest quartile for CDI prevalence, 5.1% were in the lowest quartile for antibiotic use. Among hospitals in the highest quartile for antibiotic use, 5.3% were in the lowest quartile for CDI prevalence, and 54.2% were in the highest quartile for CDI prevalence (G = 0.60; 95% CI: 0.57–0.63). Correlation of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in U.S. acute care hospitals, 2018 Distribution of hospital-level Clostridioides difficile infection (CDI) prevalence rates and oral vancomycin and fidaxomicin use in ordinal quartiles (Q1–Q4) to access rates of discordant pairs Conclusion The moderate correlation and discordant rates suggest that vancomycin and fidaxomicin are less frequently used as primary antibiotics in some hospitals; whereas in others, CDI antibiotic use is occurring in the absence of positive laboratory tests for CDI. To further investigate this discordance, there is a need to assess hospitals’ prescribing and testing practices in an ongoing manner. These findings may be useful to serve as baseline for measuring progress of appropriateness of treatment and testing for CDIs. Disclosures All Authors: No reported disclosures

scholarly journals Social Network Analysis across Healthcare Entities, Orange County, FL, 2016

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Danielle Rankin
Keyword(s):  
Public Health ◽  
Social Network ◽  
Social Network Analysis ◽  
Network Analysis ◽  
Disease Control ◽  
Acute Care ◽  
Orange County ◽  
Acute Care Hospitals ◽  
Patient Movement

Objective: To create a baseline social network analysis to assess connectivity of healthcare entities through patient movement in Orange County, Florida.Introduction: In the realm of public health, there has been an increasing trend in exploration of social network analyses (SNAs). SNAs are methodological and theoretical tools that describe the connections of people, partnerships, disease transmission, the interorganizational structure of health systems, the role of social support, and social capital1. The Florida Department of Health in Orange County (DOH-Orange) developed a reproducible baseline social network analysis of patient movement across healthcare entities to gain a county-wide perspective of all actors and influences in our healthcare system. The recognition of the role each healthcare entity contributes to Orange County, Florida can assist DOH-Orange in developing facility-specific implementations such as increased usage of personal protective equipment, environmental assessments, and enhanced surveillance.Methods: DOH-Orange received Centers for Medicare and Medicaid Services data from the Centers for Disease Control and Prevention Division of Health Care Quality Promotion. The dataset contains the frequency of patients transferred across Medicare accepting healthcare entities during 2016. We constructed a directional sociogram using R package statnet version 2016.9, built under R version 3.3.3. Node colors are categorized by the type of healthcare entity represented (e.g., long-term care facilities, acute care hospitals, post-acute care hospitals, and other) and depict the frequency of patients transferred with weighted edges. Node sizes are proportional to the log reduction of the total degree of patients transferred, and are arranged with the Fruchterman-Reingold layout. We calculated standard network indices to assess the magnitude of connectedness across healthcare entities in Orange County, Florida. Additionally, we calculated node-level indices to gain a perspective of the strength of each individual entity.Results: A total of 48 healthcare entities were included in the sociogram, with 44% representing Orange County, Florida. Although the majority of the healthcare entities are located in nearby counties, 90% of patient movement occurred across Orange County entities. The range of patient movement was 1 to 5196 with a median of 15 patients transferred in 2016. The network in Orange County is sparse with a density of 0.05, but the movement of patients across the healthcare entities is predominately symmetric (reciprocity=97%). The sociogram is centralized (degree centrality= 0.70) and contains a vast amount of entities that serve as connectors (betweenness centrality=0.53). The node-level indices identified our acute care hospitals and long term acute care hospitals are the connectors of our county health system.Conclusions: The SNA of patient movement across healthcare entities in Orange County, Florida provides public health with knowledge of the influences entities contribute to the county healthcare system. This will contribute to identifying changes in the network in future research on the transmission risks of specific diseases/conditions, which will enhance prioritization of targeted interventions within healthcare entities. In addition, SNAs can assist in targeting disease control efforts during outbreak investigations and support health communication. A SNA toolkit will be distributed to other local county health departments for reproduction to determine baseline data and integrate county-specific SNAs.

Much to Do about Carbapenem-Resistant Enterobacteriaceae: Why Supplementing Surveillance May Be the Key to Stopping Spread

2014 ◽  
Vol 35 (8) ◽  
pp. 984-986 ◽  
Author(s):  
Christopher D. Pfeiffer ◽  
Zintars G. Beldavs
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Artery Bypass ◽  
Vital Signs ◽  
Surgical Site Infections ◽  
Acute Care Hospitals ◽  
Colon Surgery ◽  
The United States ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

(See the article by Thaden et al, on pages 978–983.)It is critical to the future of public health to understand the burden of carbapenem-resistant Enterobacteriaceae (CRE) so that we can effectively target efforts to limit potential spread. The Centers for Disease Control and Prevention (CDC) classifies CRE as 1 of 3 “urgent” antibiotic resistance threats to public health because of the high mortality associated with CRE infection and its rapid dissemination in the United States.What is the current burden of CRE disease? We can glean a snapshot of the national epidemiology of CRE from the CDC’s national surveillance. Rapid geographic spread is evident in the CDC’s national map of CRE, which indicates that all but 3 states now have identified CRE. Incidence by facility type, procedure, device, and organism all have considerable variation, providing preliminary indications where future prevention efforts might best be focused. The 2013 CRE Vital Signs states that 3.9% of short-stay acute care hospitals and 17.8% of long-term acute care hospitals have identified cases of CRE infection among those with catheter-associated urinary tract infection (CAUTI) or central line–associated bloodstream infection (CLABSI). The CDC also reported that 10% of Klebsiella species in intensive care unit (ICU) CLABSIs, ICU CAUTIs, and surgical site infections after colon surgery or coronary artery bypass grafting in 2011 were carbapenem resistant. Although CRE have been reported in most states, it is increasingly clear that wide regional variation exists, from regions of hyperendemicity, such as parts of New York City, to regions apparently free of CRE, such as Maine.

scholarly journals (P2-78) Creating Alternate Care Sites and Community-Based Care Centers for the Delivery of Medical Care During Public Health Emergencies

2011 ◽  
Vol 26 (S1) ◽  
pp. s161-s161
Author(s):  
M. Reilly
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Care Center ◽  
Acute Care Hospitals ◽  
Public Health Emergency ◽  
Care Hospital ◽  
Community Based ◽  
Surge Capacity ◽  
Public Health Emergencies ◽  
Concept Of Operations

IntroductionDeveloping alternative systems to deliver emergency health services during a pandemic or public health emergency is essential to preserving the operation of acute care hospitals and the overall health care infrastructure. Alternate care sites or community-based care centers which can serve as areas for primary screening and triage or short-term medical treatment can assist in diverting non-acute patients from hospital emergency departments and manage non-life threatening illnesses in a systematic and efficient manner. Additionally, if planned for correctly these facilities can also be used to decant less critical patients from inpatient wards thereby increasing the surge capacity of acute care hospitals.MethodsA model concept of operations plan for alternate care sites to be used during pandemics and large-scale public health emergencies was developed over a 3 year period, 2007–2010. Subject matter experts were convened and best-practice methods were used to design operational plans, clinical protocols, modified standards of care, and checklists for facilities appropriate to locate such a facility. This model plan was designed to allow the mild to moderately ill patient to be managed in a non-acute care hospital or community-based care setting and then ultimately return to their homes for convalescence, following a public health emergency where regional surge capacity had been exceeded.ResultsOver three years of interagency, comprehensive planning, training and review was conducted to create the model alternate care site/community-based care center concept of operations plan. Accomplishments and milestones included: Creating stakeholders, engaging community partners, site selection, staffing issues, detailed medical protocols and clinical pathways, functional role development, equipment and supplies, site security, media and communications plans, designing training programs and conducting drills and exercises.ConclusionThe key tenets of the concept, planning, operation and demobilization of an alternate care site or community-based care center will be discussed in this session. Participants will learn what has worked based on our planning experience. Lessons learned and best-practices developed in our program will be presented to assist attendees in beginning or continuing the process of creating surge capacity in the out-of-hospital setting, by planning to operate alternate care sites in their local areas.

State Public Health and Long Term Acute Care Hospitals: Collaboration from Prevention Assessment to Infection Prevention Action Plans

2014 ◽  
Vol 42 (6) ◽  
pp. S165
Author(s):  
Vicki Keller ◽  
Sue Chen ◽  
Linda Becker ◽  
Tracy Lanier ◽  
Teresa Nelson ◽  
...  
Keyword(s):  
Public Health ◽  
Acute Care ◽  
Infection Prevention ◽  
Acute Care Hospitals ◽  
Action Plans

scholarly journals Associations of facility-level antibiotic use and hospital-onset Clostridioides difficile infection in US acute-care hospitals, 2012–2018

2021 ◽  
pp. 1-3
Author(s):  
Sophia V. Kazakova ◽  
James Baggs ◽  
Sarah H. Yi ◽  
Sujan C. Reddy ◽  
Kelly M. Hatfield ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Fourth Generation ◽  
Third Generation ◽  
Hospital Level ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Facility Level

Abstract Previously reported associations between hospital-level antibiotic use and hospital-onset Clostridioides difficile infection (HO-CDI) were reexamined using 2012–2018 data from a new cohort of US acute-care hospitals. This analysis revealed significant positive associations between total, third-generation, and fourth-generation cephalosporin, fluoroquinolone, carbapenem, and piperacillin-tazobactam use and HO-CDI rates, confirming previous findings.

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