Interrupted Time-Series Analysis of the Impact of Clostridium difficile Infection Control Interventions at Emory Healthcare. Public
Chaturvedi, Anusha (Spring 2019)
Published
Abstract
Background: Clostridium difficile Infection (CDI) is one of the leading causes of healthcare associated infections in the USA. Due to the risk factors and colonization associated with this infection, judicious utilization of testing for C.difficile is necessary for prevention of both Hospital onset- (HO) and Community onset- (CO) CDI.
Methods: This was an interrupted time-series analysis intended to assess the impact of three C.difficle control initiatives on hospital onset C.difficile infection at Emory Healthcare. The study included 32 months (January 2016 - August 2018) of data from four healthcare facilities. The population under study consisted on patients who were hospitalized and had suspected C.difficile diarrhea. The interventions consisted of laxative alert, C.diffile testing algorithm education and cancellation of testing orders at 48 hours. Laxative alert was the primary intervention to be tested as it was rolled out at the same time point across Emory Healthcare.
Results: The cumulative incidence of HO- and CO-CDI at Emory Healthcare was 0.81 per 1,000 patient-days and 0.07 cases per 100 admissions, respectively. The testing rate for C.difficile was 6.55 tests per 1,000 patient-days and 0.33 tests per 100 admissions for HO- and CO- CDI, respectively. Over the entire study period, there was a statistically significant downward trend in testing rates and CDI incidence at almost all metrics and facilities. Immediately after the laxative alert intervention was rolled out, there was a statistically significant reduction in the incidence of HO-CDI by -0.44 cases per 1,000 patient-days at Emory University Hospital [rate ratio (RR): 0.64; 95% CI: 0.54, 0.77].
Conclusion: This study shows that there was a reduction in the incidence of HO-CDI following the laxative alert. Testing the impact of multifaceted control interventions is an important step towards the prevention of CDI.
Table of Contents
1. Background and Literature Review......................................................................................1
2. Methods.............................................................................................................................................6
3. Results.............................................................................................................................................10
4. Discussion......................................................................................................................................14
5. Public Health Implications......................................................................................................17
6. References.....................................................................................................................................18
7. Tables...............................................................................................................................................26
8. Figures.............................................................................................................................................31
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