January 13, 2020
2 min read

Cumulative attributable difference demonstrates efficacy for calculating decrease in C. difficile

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Using the cumulative attributable difference to evaluate implementation of a Clostridioides difficile infection prevention program appears effective for measuring the decrease in infections in a large health care system, according to a study published in Infection Control & Hospital Epidemiology.

“A guideline for the prevention of C. difficile infection in 127 Veterans Health Administration acute-care facilities was implemented in July 2012,” the authors wrote. “Beginning in 2015, a targeted assessment for prevention strategy was used to evaluate facilities for hospital-onset, health care facility-associated C. difficile infections to focus prevention efforts where they might have the most impact in reaching a reduction goal of 30% nationwide.”

The prevention program comprises a four-part strategy that focuses on environmental management, hand hygiene, contact precautions for suspected or confirmed cases of C. difficile infection and “institutional culture change in which infection control becomes everyone’s business,” according to the study authors.

Gary A. Roselle, MD, of the National Infectious Diseases Service and Patient Care Services at the Veterans Affairs Central Office, the Cincinnati Veterans Affairs Medical Center and the division of infectious diseases in the department of internal medicine at the University of Cincinnati College of Medicine, and colleagues identified cases of C. difficile infection with a positive diagnostic laboratory test. Standardized infection ratios and cumulative attributable differences, or CADs, were calculated using a national data baseline. The researchers ranked facilities according to CADs; the facilities with the 10 highest CAD values were selected for intermittent conference calls or a site visit between January 2016 through September 2019.

Nationwide, 4,575,316 admissions, 25,005,923 patient days and 20,048 hospital-onset, health care facility-associated cases of C. difficile infection were recorded during the analysis period of October 2010 to September 2019.

A significant downward trend in hospital-onset, health care facility-associated C. difficile infections was observed in the 127 facilities included in the study. Roselle and colleagues noted a significant decrease (P < .0001) in the rate of hospital-onset, health care facility-associated C. difficile infections nationwide following the implementation of the process improvement program. In the 10 facilities with the highest CAD values, the hospital-onset, health care facility-associated C. difficile infection rates decreased by 56% during the process improvement period compared with a 44% decline in the 117 facilities where the process improvement program was not implemented (P = .03).

“We achieved a statistically significant decline in C. difficile infection rates nationwide coincident with application of the CAD approach to our process improvement program. The decline in C. difficile infection rates in the intervention facilities was significantly greater than that in concurrent, nonintervention facilities,” the authors wrote. “Targeting 10 facilities seemed sufficient, although we may have had more of an impact by targeting additional facilities with high CAD values.” -by Erin T. Welsh

Disclosures: The authors report no relevant financial disclosures.