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2446. Longitudinal Results and Cost Savings Using a Bundle of C. difficile Infection Prevention Strategies in a Long-Term Care Facility

BACKGROUND: Long-term care patients are at high risk of C. difficile infections (CDI) due to advanced age, high comorbid illness burden, and frequent antibiotic use. Primary infection prevention of CDI is challenging and not frequently studied. Following a period of high CDI incidence, the Long-Term...

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Autores principales: Olson, Bridget A, Butera, Michael L, Ship, Noam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810569/
http://dx.doi.org/10.1093/ofid/ofz360.2124
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author Olson, Bridget A
Butera, Michael L
Ship, Noam
author_facet Olson, Bridget A
Butera, Michael L
Ship, Noam
author_sort Olson, Bridget A
collection PubMed
description BACKGROUND: Long-term care patients are at high risk of C. difficile infections (CDI) due to advanced age, high comorbid illness burden, and frequent antibiotic use. Primary infection prevention of CDI is challenging and not frequently studied. Following a period of high CDI incidence, the Long-Term Care facility at Sharp Coronado Hospital implemented a bundle of strategies. METHODS: Patient census, the incidence of CDI (primary and recurrent cases), transfers to acute care and length-of-stay were collected from Jul 2008 through December 2018. In the first phase, 2010, a bundle of CDI prevention strategies was initiated, including an Antimicrobial Stewardship Program (ASP), reduction of acid suppression, and L. acidophilus and S. boulardii probiotics with antibiotic use. From 2012, there was further refinement of the ASP and the probiotic was changed to capsules of a 3-species combination of Lactobacillus acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2, 100 Billion CFU daily. In October 2016, a protocol was put in place delegating authority to pharmacists to add probiotics to all antibiotic courses. The average CDI rates were calculated and compared for each time period. The net cost of CDI was calculated from the number of CDI cases, hospital length-of-stay and probiotic purchases. RESULTS: The incidence of facility-onset CDI cases decreased significantly with each policy change from 7.6 cases/10,000 patient-days (2008–09), to 2.8 (2010–11, p = 0.028), to 0.91 (2012-Q3 2016, p = 0.0015) and to the present incidence 0.24 (Q4 2016–2018, p = 0.048). The annual cost of facility-onset CDI was $214k initially. The annual cost, including the purchase of probiotic, decreased to $161k with introduction of the bundle, to $57k in switching probiotics, and to $18k with initiation of a probiotic policy. CONCLUSION: Implementing a bundle of concurrent infection prevention strategies resulted in a significant reduction in CDI incidence. Refinements to the bundle led to significant reductions in CDI incidence, along with switching the type of probiotic, and delegating ordering authority to pharmacists to ensure probiotic compliance. Cumulatively, there was a 95% decrease in CDI incidence at the Long-Term Care facility and meaningful cost savings with each refinement. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68105692019-10-28 2446. Longitudinal Results and Cost Savings Using a Bundle of C. difficile Infection Prevention Strategies in a Long-Term Care Facility Olson, Bridget A Butera, Michael L Ship, Noam Open Forum Infect Dis Abstracts BACKGROUND: Long-term care patients are at high risk of C. difficile infections (CDI) due to advanced age, high comorbid illness burden, and frequent antibiotic use. Primary infection prevention of CDI is challenging and not frequently studied. Following a period of high CDI incidence, the Long-Term Care facility at Sharp Coronado Hospital implemented a bundle of strategies. METHODS: Patient census, the incidence of CDI (primary and recurrent cases), transfers to acute care and length-of-stay were collected from Jul 2008 through December 2018. In the first phase, 2010, a bundle of CDI prevention strategies was initiated, including an Antimicrobial Stewardship Program (ASP), reduction of acid suppression, and L. acidophilus and S. boulardii probiotics with antibiotic use. From 2012, there was further refinement of the ASP and the probiotic was changed to capsules of a 3-species combination of Lactobacillus acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2, 100 Billion CFU daily. In October 2016, a protocol was put in place delegating authority to pharmacists to add probiotics to all antibiotic courses. The average CDI rates were calculated and compared for each time period. The net cost of CDI was calculated from the number of CDI cases, hospital length-of-stay and probiotic purchases. RESULTS: The incidence of facility-onset CDI cases decreased significantly with each policy change from 7.6 cases/10,000 patient-days (2008–09), to 2.8 (2010–11, p = 0.028), to 0.91 (2012-Q3 2016, p = 0.0015) and to the present incidence 0.24 (Q4 2016–2018, p = 0.048). The annual cost of facility-onset CDI was $214k initially. The annual cost, including the purchase of probiotic, decreased to $161k with introduction of the bundle, to $57k in switching probiotics, and to $18k with initiation of a probiotic policy. CONCLUSION: Implementing a bundle of concurrent infection prevention strategies resulted in a significant reduction in CDI incidence. Refinements to the bundle led to significant reductions in CDI incidence, along with switching the type of probiotic, and delegating ordering authority to pharmacists to ensure probiotic compliance. Cumulatively, there was a 95% decrease in CDI incidence at the Long-Term Care facility and meaningful cost savings with each refinement. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6810569/ http://dx.doi.org/10.1093/ofid/ofz360.2124 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Olson, Bridget A
Butera, Michael L
Ship, Noam
2446. Longitudinal Results and Cost Savings Using a Bundle of C. difficile Infection Prevention Strategies in a Long-Term Care Facility
title 2446. Longitudinal Results and Cost Savings Using a Bundle of C. difficile Infection Prevention Strategies in a Long-Term Care Facility
title_full 2446. Longitudinal Results and Cost Savings Using a Bundle of C. difficile Infection Prevention Strategies in a Long-Term Care Facility
title_fullStr 2446. Longitudinal Results and Cost Savings Using a Bundle of C. difficile Infection Prevention Strategies in a Long-Term Care Facility
title_full_unstemmed 2446. Longitudinal Results and Cost Savings Using a Bundle of C. difficile Infection Prevention Strategies in a Long-Term Care Facility
title_short 2446. Longitudinal Results and Cost Savings Using a Bundle of C. difficile Infection Prevention Strategies in a Long-Term Care Facility
title_sort 2446. longitudinal results and cost savings using a bundle of c. difficile infection prevention strategies in a long-term care facility
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810569/
http://dx.doi.org/10.1093/ofid/ofz360.2124
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