scholarly journals Varying Rates of Clostridium Difficile-Associated Diarrhea at Prevention Epicenter Hospitals

2005 ◽  
Vol 26 (8) ◽  
pp. 676-679 ◽  
Author(s):  
SeJean Sohn ◽  
Michael Climo ◽  
Daniel Diekema ◽  
Victoria Fraser ◽  
Loreen Herwaldt ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
The United States ◽  
Case Definition ◽  
Specific Information ◽  
Case Definitions ◽  
Data Set ◽  
Tertiary Care Centers ◽  
Healthcare Associated

AbstractBackground:Clostridium difficile-associated diarrhea (CDAD) causes substantial healthcare-associated morbidity. Unlike other common healthcare-associated pathogens, little comparative information is available about CDAD rates in hospitalized patients.Objectives:To determine CDAD rates per 10,000 patient-days and per 1,000 hospital admissions at 7 geographically diverse tertiary-care centers from 2000 to 2003, and to survey participating centers on methods of CDAD surveillance and case definition.Methods:Each center provided specific information for the study period, including case numbers, patient-days, and hospital characteristics. Case definitions and laboratory diagnoses of healthcare-associated CDAD were determined by each institution. Within institutions, case definitions remained consistent during the study period.Results:Overall, mean annual case rates of CDAD were 12.1 per 10,000 patient-days (range, 3.1 to 25.1) and 7.4 per 1,000 hospital admissions (range, 3.1 to 13.1). No significant increases were observed in CDAD case rates during the 4-year interval, either at individual centers or in the Prevention Epicenter hospitals as a whole. Prevention Epicenter hospitals differed in their CDAD case definitions. Different case definitions used by the hospitals applied to a fixed data set resulted in a 30% difference in rates. No associations were identified between diagnostic test or case definition used and the relative rate of CDAD at a specific medical center.Conclusions:Rates of CDAD vary widely at tertiary-care centers across the United States. No significant increases in case rates were identified. The varying clinical and laboratory approaches to diagnosis complicated comparisons between hospitals. To facilitate benchmarking and comparisons between institutions, we recommend development of a more standardized case definition.

scholarly journals A Multicenter Study of Clostridium difficile Infection—Related Colectomy, 2000—2006

2012 ◽  
Vol 33 (5) ◽  
pp. 470-476 ◽  
Author(s):  
Amelia M. Kasper ◽  
Humaa A. Nyazee ◽  
Deborah S. Yokoe ◽  
Jeanmarie Mayer ◽  
Julie E. Mangino ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Tertiary Care ◽  
Healthcare Facility ◽  
The United States ◽  
Healthcare Facilities ◽  
Tertiary Care Centers ◽  
Design And Methods ◽  
Study Hospital ◽  
Community Onset ◽  
Over Time

Objective.To assess Clostridium difficile infection (CDI)-related colectomy rates by CDI surveillance definitions and over time at multiple healthcare facilities.Setting.Five university-affiliated acute care hospitals in the United States.Design and Methods.Cases of CDI and patients who underwent colectomy from July 2000 through June 2006 were identified from 5 US tertiary care centers. Monthly CDI-related colectomy rates were calculated as the number of CDI-related colectomies per 1,000 CDI cases, and cases were categorized according to recommended surveillance definitions. Logistic regression was performed to evaluate risk factors for CDI-related colectomy.Results.In total, 8,569 cases of CDI were identified, and 75 patients underwent CDI-related colectomy. The overall colectomy rate was 8.7 per 1,000 CDI cases. The CDI-related colectomy rate ranged from 0 to 23 per 1,000 CDI episodes across hospitals. The colectomy rate for healthcare-facility-onset CDI was 4.3 per 1,000 CDI cases, and that for community-onset CDI was 16.5 per 1,000 CDI cases (P < .05). There were significantly more CDI-related colectomies at hospitals B and C (P < .05).Conclusions.The overall CDI-related colectomy rate was low, and there was no significant change in the CDI-related colectomy rate over time. Onset of disease outside the study hospital was an independent risk factor for colectomy.

scholarly journals Enhanced Cleaning and Education to Prevent Transmission of Clostridium difficile in Pediatrics

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S406-S406
Author(s):  
Anoshé Aslam ◽  
Giselle Melendez ◽  
Min Wang ◽  
Frederic Stell ◽  
Paulette Kelly ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Tertiary Care ◽  
Educational Interventions ◽  
Cancer Center ◽  
Phase 2 ◽  
Communication Plan ◽  
Effective Strategies ◽  
Key Stakeholders ◽  
Patient Representatives ◽  
Healthcare Associated

Abstract Background Transmission of healthcare-associated Clostridium difficile infection (HA-CDI) has been shown to occur directly or indirectly through a contaminated environment. At a tertiary-care cancer center, HA-CDI rates were higher for pediatric units than for other general oncology units. To address the problem, a multidisciplinary team, including Infection Control, Nursing, and Environmental Services (EVS), was convened and identified refusals and room clutter as barriers to proper cleaning of rooms on the unit. Aim: The aim of this study seeks to reduce HA-CDI in the inpatient pediatrics setting through environmental and educational interventions. Methods In the first phase of the study from February to April 2016, a baseline assessment of prevalent environmental disinfection practices was made among Nursing, EVS, Physicians, and Patient Representatives. Based on this feedback, the following were implemented during Phase 2, from June through October 2016: 1) Unit-wide disinfection with bleach twice a day including common and high traffic areas; 2) Initiation of a “preferred time for cleaning” program to engage families; 3) Enhanced visitor and family education on PPE use; 4) Creation of a communication plan in case of refusal to clean rooms; and 5) Dedicated use of diaper scales. Results During the first phase of the study, the following barriers to cleaning were identified: 1) High refusal rate as cleaning was perceived as inconvenient by families due to timing; 2) Common perception among EVS staff that multiple requests for cleaning the room may appear intrusive to the families; 3) Excessive clutter in the room; 4) Lack of education regarding PPE use; and 5) Shared equipment for diapers. To overcome these barriers, several interventions as outlined in methods were implemented. In Phase 2, there were 0 cases of HA-CDI identified in pediatric patients starting in July through October, 2016. Conclusion Control of CDI on pediatric units poses unique challenges. Engagement of key stakeholders is essential to identify and meet these challenges and to devise effective strategies that will ultimately lead to reduced hospital-based transmission of CDI. Disclosures All authors: No reported disclosures.

66 The Effect of Transfer on Outcomes in Burns

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S43-S43
Author(s):  
Elizabeth Bruenderman ◽  
Selena The ◽  
Nathan Bodily ◽  
Matthew Bozeman
Keyword(s):  
Tertiary Care ◽  
Total Body Surface Area ◽  
The United States ◽  
Infectious Complications ◽  
Burn Care ◽  
Burn Center ◽  
Total Body ◽  
Tertiary Care Centers ◽  
Inhalation Burn ◽  
Time From Injury

Abstract Introduction Burn care in the United States takes place primarily in tertiary care centers with specialty-focused burn capabilities. Patients are often initially transported to centers without burn capabilities, requiring subsequent transfer to a higher level of care. This study aims to evaluate the effect of this treatment delay on outcomes. Methods Under IRB approval, adult burn patients meeting American Burn Association (ABA) criteria for transfer at a single burn center were retrospectively identified. Cohorts were divided into patients who were initially taken to a non-burn center and subsequently transferred versus patients taken immediately to a burn center. Outcomes between the groups were compared. Results A total of 122 patients were identified, 61 in each cohort. There was no difference between the transfer and direct admit cohorts with respect to median age (52 vs. 46, p = 0.45), percent total body surface area burn (10% vs. 10%, p = 0.08), concomitant injury (0 vs. 4, p = 0.12), or intubation prior to admission (5 vs. 7, p = 0.76). Transfer patients experienced a longer median time from injury to burn center admission than directly admitted patients (1 vs. 8 hours, p &lt; 0.01). Directly admitted patients were more likely to have inhalation burn (18 vs. 4, p &lt; 0.01), require intubation after admission (10 vs. 2, p = 0.03), require an emergent procedure (18 vs. 5, p &lt; 0.01), and develop infectious complications (14 vs. 5, p = 0.04). However, there was no difference between transfers and direct admits in ventilator days (9 vs. 3 days, p = 0.37), number of operations (0 vs. 0, p = 0.16), length of stay (3 vs. 3 days, p = 0.44), or mortality (6 vs. 3, p = 0.50). Conclusions This study suggests that significantly injured, hemodynamically unstable patients were more likely to be immediately identified and taken directly to a burn center. Patients who otherwise met ABA criteria for transfer were not affected by short delays in transfer to definitive burn care. Applicability of Research to Practice Initial triage and evaluation of hemodynamically stable patients at non-burn centers does not negatively impact outcomes in patients who meet ABA criteria for transfer to a burn center.

Increasing Prevalence of Methicillin-Resistant Staphylococcus aureus in the United States

1990 ◽  
Vol 11 (12) ◽  
pp. 639-642 ◽  
Author(s):  
John M. Boyce
Keyword(s):  
United States ◽  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Tertiary Care ◽  
The United States ◽  
University Hospitals ◽  
Methicillin Resistant ◽  
Large Numbers ◽  
Tertiary Care Centers ◽  
Community Teaching

AbstractIn the period 1975 to 1981, methicillin-resistant Staphylococcus aureus (MRSA) emerged as an important nosocomial pathogen in tertiary care centers in the United States. To determine if the prevalence of this organism has continued to increase, a questionnaire was sent to hospital epidemiologists in 360 acute care hospitals. A total of 256 (71%) of the 360 individuals responded. Overall, 97% (246/256) of responding hospitals reported having patients with MRSA in the period 1987 through 1989. Respondents in 217 hospitals provided estimates of the number of cases seen in 1987, 1988 and 1989. The percentage of respondents reporting one or more patients with MRSA increased from 88% in 1987 to 96.3% in 1989 (p = .0008). The percent of respondents reporting large numbers (≥50) of cases per year increased from 18% in 1987 to 32% in 1989 (p = .0006). Increasing frequency of large outbreaks was observed in community, community-teaching, federal, municipal and university hospitals.

scholarly journals Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)

2018 ◽  
Vol 66 (7) ◽  
pp. 987-994 ◽  
Author(s):  
L Clifford McDonald ◽  
Dale N Gerding ◽  
Stuart Johnson ◽  
Johan S Bakken ◽  
Karen C Carroll ◽  
...  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Clostridium Difficile ◽  
Infectious Diseases ◽  
Clostridium Difficile Infection ◽  
The United States ◽  
Healthcare Associated Infection ◽  
Adults And Children ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Abstract A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.

Review of Current Literature on the Economic Burden of Clostridium difficile Infection

2009 ◽  
Vol 30 (1) ◽  
pp. 57-66 ◽  
Author(s):  
Erik R. Dubberke ◽  
Albert I. Wertheimer
Keyword(s):  
Clostridium Difficile ◽  
Economic Burden ◽  
International Classification Of Diseases ◽  
The United States ◽  
Diagnosis Code ◽  
Number Of Patients ◽  
Classification Of Diseases ◽  
Control And Prevention ◽  
Healthcare Associated

Clostridium difficile is well recognized as the most common infectious cause of healthcare-associated diarrhea. Since 2000, this pathogen has demonstrated an increased propensity to cause more frequent and virulent illness that is often refractory to treatment. An analysis by the Centers for Disease Control and Prevention revealed that, in the United States, the number of patients discharged from hospitals who received the International Classification of Diseases, Ninth Revision discharge diagnosis code for C. difficile infection (CDI) more than doubled from 2000 to 2003. Unpublished data indicate that this trend has continued and that more than 250,000 US hospitalizations were associated with CDI in 2005. A previously uncommon hypervirulent strain of C. difficile is thought to contribute, in part, to the dramatic increase in the incidence and severity of the infection. Although the economic impact of the disease is believed to be profound and is expected to increase, data on the costs associated with CDI are scarce. To more completely assess its economic burden, we performed a review of available literature that reported costs associated with the infection.

Infections due to Clostridium Difficile

2021 ◽  
Author(s):  
Marcia B Goldberg ◽  
Molly Paras ◽  
K.C Coffey
Keyword(s):  
Clostridium Difficile ◽  
Disease Process ◽  
The United States ◽  
Healthcare Associated Infection ◽  
Therapeutic Guidelines ◽  
Common Causes ◽  
Control And Prevention ◽  
Current Infection ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Clostridium difficile is one of the most common causes of healthcare associated infection in the United States. Despite significant attention and resources, national rates increased dramatically between 2000-2011 and have only started to decline in the last five years.. The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) updated their clinical practice guidelines on the diagnosis and management of C. difficile disease in 2017. The recommended changes in therapeutic guidelines, recommendations for pediatric patient populations, and overview of available diagnostics are described herein. Additionally, this review discusses the changing epidemiology, examines the pathophysiology of the disease process, and outlines current infection control and prevention strategies.  This review has 6 figures and 9 tables. Key Words: Clostridium difficile, diarrhea, colitis, antibiotics, spores, nosocomial, hospital

Neonatal Hospital Course and Outcomes of Live-born Infants with Trisomy 18 at Two Tertiary Care Centers in the United States

2016 ◽  
Vol 34 (03) ◽  
pp. 270-275
Author(s):  
Eniko Pivnick ◽  
Kirtikumar Upadhyay ◽  
Ramasubbareddy Dhanireddy ◽  
Ajay Talati ◽  
Narendra Dereddy
Keyword(s):  
United States ◽  
Tertiary Care ◽  
The United States ◽  
Trisomy 18 ◽  
Tertiary Care Centers

scholarly journals Clinical Characteristics and Predictors of Adverse Outcome in Adult and Pediatric Patients With Healthcare-Associated Ventriculitis and Meningitis

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Chanunya Srihawan ◽  
Rodrigo Lopez Castelblanco ◽  
Lucrecia Salazar ◽  
Susan H. Wootton ◽  
Elizabeth Aguilera ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Adverse Outcome ◽  
Vegetative State ◽  
Tertiary Care ◽  
Persistent Vegetative State ◽  
Case Definition ◽  
Neurosurgical Procedures ◽  
Neurological Exam ◽  
Control And Prevention ◽  
Healthcare Associated

Abstract Background.  Healthcare-associated meningitis or ventriculitis is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Methods.  We performed a retrospective study of adults and children with the diagnosis of healthcare-associated meningitis or ventriculitis, as defined by the 2015 Centers of Disease Control and Prevention case definition, at 2 large tertiary care hospitals in Houston, Texas from July 2003 to November 2014. Patients were identified by infection control practitioners and by screening cerebrospinal fluid samples sent to the central laboratory. We collected data on demographics, clinical presentations, laboratory results, imaging studies, treatments, and outcomes. Results.  A total of 215 patients were included (166 adults and 49 children). A positive cerebrospinal fluid culture was seen in 106 (49%) patients, with the majority of the etiologies being Staphylococcus and Gram-negative rods. An adverse clinical outcome was seen in 167 patients (77.7%) and was defined as death in 20 patients (9.3%), persistent vegetative state in 31 patients (14.4%), severe disability in 77 patients (35.8%), or moderate disability in 39 patients (18.1%). On logistic regression analysis, age &gt;45 years (adjusted odds ratio [OR], 6.47; 95% confidence interval [CI], 2.31–18.11; P ≤ .001), abnormal neurological exam (adjusted OR, 3.04; 95% CI, 1.27–7.29; P = .013), and mechanical ventilation (adjusted OR, 5.34; 95% CI, 1.51–18.92; P = .01) were associated with an adverse outcome. Conclusions.  Healthcare-associated meningitis or ventriculitis is associated with significant morbidity and mortality.

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