Evaluating the Relationship between Healthcare Facility Network Characteristics and the Incidence of Clostridium difficile Infection (CDI) in Long Term Care Facilities in the Atlanta area, 2016 Restricted; Files Only

Sefton, Samantha (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/xd07gs767?locale=en
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Abstract

 

Background: Clostridium difficile infection (CDI) is a common healthcare associated infection (HAI) and is known to cause inflammation of the colon, severe diarrhea and occasionally death. Older age, exposure to healthcare facilities (i.e., environmental contamination), and antibiotic receipt are all risk factors for CDI.  Transfer dynamics of patients within healthcare networks incorporate these factors and have also been associated with CDI risk.  We evaluated the relationship between facility level characteristics of long term care facilities (LTCF) in the Atlanta area and the incidence of CDI.  

 

 

 

Methods: We analyzed incident level CDI data from Georgia Emerging Infections Program (EIP).  Incident LTCF-onset (LFTCO) cases are defined as an initial toxin positive test with no previous positive test in the 8 weeks prior.  Centers for Medicare and Medicaid (CMS) cost reports were used to gather facility level characteristics, including bed days, which was used to calculate the CDI incidence facility rate. Negative Binomial Regression was used to evaluate LTCF characteristics associated with facility CDI rates (number of CDI/ 10,000 bed days).  These characteristics include number of admissions, average length of stay, nursing staff ratio, bed size and connectivity metrics.

 

 

 

ResultsThere were 64 facilities included in the analysis, reporting a combined 155 incident CDI cases (facility CDI range: 0 -19 cases). A negative binomial model was created including the variables outdegree (no. of facilities receiving patients from the LTCF), number of admissions into the LTCF, and average length of stay.  CDI rate was found to increase 69% for each unit decrease in average length of stay, holding number of admissions and outdegree constant.

 

 

 

Conclusions Average length of stay is the most significant predictor of CDI rate in LTCF.  The rate of CDI decreases as patients stay in the facility longer.  This is a contrasting finding compared to acute care facilities, indicating that this relationship is unique to LTCF.

 

Table of Contents

 

TABLE OF CONTENTS

 

BACKGROUND.................................................................................... 1

 

METHODS........................................................................................... 4

 

RESULTS............................................................................................. 11

 

DISCUSSION..............................................................................................15

 

References........................................................................................................... 19

 

Tables................................................................................................................... 22

 

Figures................................................................................................................. 28

 

Appendices.......................................................................................................... 30

 

 

 

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