Advertisement
Post-Operative Clostridium difficile Infection Among Veterans Health Administration Patients

Post-Operative Clostridium difficile Infection Among Veterans Health Administration Patients

Recent research has shown that Clostridium difficile infection (CDI) is a growing cause of morbidity and mortality in the United States and is associated with longer hospital lengths of stay (LOS) and higher hospital costs. “CDI has also been shown to be a significant complication for surgical patients,” says William Gunnar, MD, JD. Data show that the healthcare–associated burden of CDI is increasing among surgical patients and varies among types of surgery. Among surgical patients, CDI has been linked to longer mechanical ventilation, longer ICU and hospital LOS, and higher mortality. The 134 Veterans Health Administration (VHA) Surgery Programs throughout the U.S. perform an estimated 400,000 surgical procedures each year. In 2007, the VHA modified the established VA Surgical Quality Improvement Program (VASQIP) to begin  collecting 30-day postoperative CDI data from eligible non-cardiac surgical procedures. For a retrospective observational study published in JAMA Surgery, Dr. Gunnar and colleagues documented CDI incidence in the VHA from fiscal year 2010 through 2013 across different surgical procedures. They also identified risk factors associated with CDI and determined the impact of CDI on postoperative mortality, morbidity, and hospital LOS.   Examining New Data Results of the study showed that the postoperative CDI rate was 0.4% per year, unchanged throughout the study period, and varied by the VHA Surgery Program and surgical specialty. The 30-day CDI rates were higher in emergency procedures, operations with greater complexity and higher relative value units, and those with a contaminated or infected wound classification. Patients with postoperative CDI were significantly older, were more frequently hospitalized after surgery (59.9% vs 15.4%), and had longer preoperative hospital LOS (9.1 days vs 1.9...
Making the Case for Early ID Specialist Involvement

Making the Case for Early ID Specialist Involvement

In hospital settings, specialists are often consulted when managing patients with complex conditions, offering evidence-based recommendations on diagnosis and treatment plans. Infectious disease (ID) specialists are typically consulted when patients have one or more infectious conditions that are severe and require intensive monitoring. “ID specialists can assist hospitals in the inpatient setting by recommending appropriate antibiotic choices, duration of therapy, and route of delivery,” says Steven K. Schmitt, MD. “They can also help monitor patients to minimize adverse drug reactions.” Studies indicate that when an ID specialist is involved in patient care and the physician in charge follows ID recommendations, patients are more likely to receive a correct diagnosis. ID specialist involvement has also been associated with shorter lengths of stay (LOS), receipt of more appropriate therapies, fewer complications, and reduced use of antibiotics overall. However, data regarding the impact of ID specialists on hospital LOS and costs have been mixed. Many studies have been constrained by small sample size and chart review methodology, which limits the ability to generalize conclusions. As a result, it has been difficult to draw meaningful conclusions about the value of ID specialty interventions. Robust Data In a study published in Clinical Infectious Diseases, Dr. Schmitt and colleagues sought to generate robust data on the impact of ID consultation on spending and outcomes using a national Medicare claims database. Researchers looked at patients hospitalized with at least one of 11 serious but commonly treated infections. These included bacteremia, Clostridium difficile, central line-associated bloodstream infections, bacterial endocarditis, HIV/opportunistic infections, meningitis, osteomyelitis, prosthetic joint infections, septic arthritis, septic shock, and vascular device infections. Outcomes of a...
A Helpful Guide for CDI Prevention

A Helpful Guide for CDI Prevention

According to the CDC, the mortality rate associated with Clostridium difficile infection (CDI) increased by 400% between 2000 and 2007, due in part to a stronger germ strain. CDI accounts for approximately 14,000 deaths each year in the United States. Current estimates show that the average total cost for a single inpatient CDI is more than $35,000, and the estimated annual cost burden for the healthcare system exceeds $3 billion. “Preventing the transmission of CDI continues to be a serious and difficult challenge in hospitals throughout the U.S.,” says Ruth M. Carrico, PhD, RN, FSHEA, CIC. “The epidemiology of CDI is changing [Figure]. Its presence in hospitals and other health-care settings has caused medical personnel across the entire continuum of care to reevaluate approaches and perspectives to preventing and managing this potentially lethal infection.” A National Action Plan on CDI Prevention The U.S. Department of Health and Human Services released the National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination in 2009. The document, available at www.hhs.gov, provides a roadmap for preventing healthcare-associated infections (HAIs) in acute care hospitals, ambulatory surgical centers, long-term care facilities, and other healthcare settings. CDIs were among the first HAIs specifically targeted in the action plan because rates have been increasing in recent years. The Association for Professionals in Infection Control and Epidemiology (APIC) has been involved in promoting and supporting the elements included in this national plan through development of specific guidance aimed at the healthcare practice level. In 2013, APIC issued an updated implementation guide to help clinicians further protect patients from CDI. The update contains new material and revised content...

Patients With CKD Have Higher Rates of CDI

Patients with chronic kidney disease (CKD) appear to have a higher risk of Clostridium difficile infection (CDI) and hospital-associated morbidity and mortality when compared with patients who do not have CKD. A team of American researchers found that patients with CKD had a CDI rate of 1.49%, compared with a 0.70% rate for those without CKD. Abstract: Mayo Clinic Proceedings, November...
Page 1 of 212
[ HIDE/SHOW ]