title: Clostridium difficile infections in Veterans Health Administration acute care facilities.
abstract: OBJECTIVE
  An initiative was implemented in July 2012 to decrease Clostridium difficile infections (CDIs) in Veterans Affairs (VA) acute care medical centers nationwide. This is a report of national baseline CDI data collected from the 21 months before implementation of the initiative.
  
  
  METHODS
  Personnel at each of 132 data-reporting sites entered monthly retrospective CDI case data from October 2010 through June 2012 into a central database using case definitions similar to those of the National Healthcare Safety Network multidrug-resistant organism/CDI module.
  
  
  RESULTS
  There were 958,387 hospital admissions, 5,286,841 patient-days, and 9,642 CDI cases reported during the 21-month analysis period. The pooled CDI admission prevalence rate (including recurrent cases) was 0.66 cases per 100 admissions. The nonduplicate/nonrecurrent community-onset not-healthcare-facility-associated (CO-notHCFA) case rate was 0.35 cases per 100 admissions, and the community-onset healthcare facility-associated (CO-HCFA) case rate was 0.14 cases per 100 admissions. Hospital-onset healthcare facility-associated (HO-HCFA), clinically confirmed HO-HCFA (CC-HO-HCFA), and CO-HCFA rates were 9.32, 8.40, and 2.56 cases per 10,000 patient-days, respectively. There were significant decreases in admission prevalence (P = .0006, Poisson regression), HO-HCFA (P = .003), and CC-HO-HCFA (P = .004) rates after adjusting for type of diagnostic test. CO-HCFA and CO-notHCFA rates per 100 admissions also trended downward (P = .07 and .10, respectively).
  
  
  CONCLUSIONS
  VA acute care medical facility CDI rates were higher than those reported in other healthcare systems, but unlike rates in other venues, they were decreasing or trending downward. Despite these downward trends, there is still a substantial burden of CDI in the system supporting the need for efforts to decrease rates further.
authors.affiliation: Veterans Health Administration, Methicillin-Resistant Staphylococcus aureus/Multidrug-Resistant Organism Prevention Office, National Infectious Diseases Service, Patient Care Services, Veterans Affairs Central Office, Lexington, Kentucky; Lexington Veterans Affairs Medical Center, Lexington, Kentucky; and Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky School of Medicine, Lexington, Kentucky.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Evans
authors.forename: Loretta A
authors.initials: LA
authors.lastname: Simbartl
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Kralovic
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jain
authors.forename: Gary A
authors.initials: GA
authors.lastname: Roselle
mesh_terms: D016360:Clostridioides difficile; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D014481:United States / Q000453:epidemiology