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Reduction in Clostridium difficile infection rates following a multifacility prevention initiative in Orange County, California: A controlled interrupted time series evaluation

Published online by Cambridge University Press:  24 May 2019

Kyle R. Rizzo Open the ORCID record for Kyle R. Rizzo [Opens in a new window] ,
Sarah H. Yi Open the ORCID record for Sarah H. Yi [Opens in a new window] ,
Erin P. Garcia ,
Matt Zahn  and
Erin Epson
Kyle R. Rizzo*
Affiliation:
Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
Sarah H. Yi
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Erin P. Garcia
Affiliation:
Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
Matt Zahn
Affiliation:
Orange County Health Care Agency, Santa Ana, California
Erin Epson
Affiliation:
Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
*
Author for correspondence: Kyle R. Rizzo, Email: kyle.rizzo@cdph.ca.gov
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Abstract

Objective:

To evaluate the Orange County Clostridium difficile infection (CDI) prevention collaborative’s effect on rates of CDI in acute-care hospitals (ACHs) in Orange County, California.

Design:

Controlled interrupted time series.

Methods:

We convened a CDI prevention collaborative with healthcare facilities in Orange County to reduce CDI incidence in the region. Collaborative participants received onsite infection control and antimicrobial stewardship assessments, interactive learning and discussion sessions, and an interfacility transfer communication improvement initiative during June 2015–June 2016. We used segmented regression to evaluate changes in monthly hospital-onset (HO) and community-onset (CO) CDI rates for ACHs. The baseline period comprised 17 months (January 2014–June 2015) and the follow-up period comprised 28 months (September 2015–December 2017). All 25 Orange County ACHs were included in the CO-CDI model to account for direct and indirect effects of the collaborative. For comparison, we assessed HO-CDI and CO-CDI rates among 27 ACHs in 3 San Francisco Bay Area counties.

Results:

HO-CDI rates in the 15 participating Orange County ACHs decreased 4% per month (incidence rate ratio [IRR], 0.96; 95% CI, 0.95–0.97; P < .0001) during the follow-up period compared with the baseline period and 3% (IRR, 0.97; 95% CI, 0.95–0.99; P = .002) per month compared to the San Francisco Bay Area nonparticipant ACHs. Orange County CO-CDI rates declined 2% per month (IRR, 0.98; 95% CI, 0.96–1.00; P = .03) between the baseline and follow-up periods. This decline was not statistically different from the San Francisco Bay Area ACHs (IRR, 0.97; 95% CI, 0.95–1.00; P = .09).

Conclusions:

Our analysis of ACHs in Orange County provides evidence that coordinated, regional multifacility initiatives can reduce CDI incidence.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 8 , August 2019 , pp. 872 - 879
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION. Preliminary data from this analysis were presented in a poster at IDWeek 2018 on October 4, 2018. in San Francisco, California.

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