A targeted assessment for prevention strategy to decrease Clostridioides difficile infections in Veterans Affairs...

Area of Science:

• Infectious Disease Epidemiology
• Healthcare Quality Improvement
• Public Health Interventions

Background:

• Clostridioides difficile infection (CDI) poses a significant challenge in acute-care settings.
• A national guideline for CDI prevention was implemented in 127 Veterans Health Administration (VHA) facilities in 2012.
• A targeted assessment strategy was introduced in 2015 to focus on hospital-onset healthcare-facility-associated CDIs.

Purpose of the Study:

• To evaluate the effectiveness of a targeted assessment strategy for CDI prevention.
• To identify facilities with the highest impact potential for CDI reduction.
• To achieve a nationwide reduction goal of 30% in CDI rates.

Main Methods:

• Standardized Infection Ratios (SIRs) and Cumulative Attributable Differences (CADs) were calculated using national data.
• Facilities were ranked based on CAD values.
• The 10 facilities with the highest CADs received targeted interventions (conference calls or site visits) from January 2016 to September 2019.

Main Results:

• The hospital-onset healthcare-facility-associated CDI rate declined by 56% in the 10 targeted facilities.
• Non-intervention facilities (117) experienced a 44% decline in CDI rates.
• The difference in decline between targeted and non-targeted facilities was statistically significant (P = .03).

Conclusions:

• Targeting facilities with high CAD values is an efficient strategy for CDI reduction.
• Process improvement interventions can effectively decrease CDI rates in large healthcare systems.
• Data-driven targeting enhances the impact of infection prevention efforts.