Journal article Open Access
Brown, Kevin A.;
McGeer, Allison;
Schwartz, Kevin L.;
Diong, Christina;
Etches, Jacob;
Garber, Gary;
Johnstone, Jennie;
Langford, Bradley;
Daneman, Nick
<?xml version='1.0' encoding='UTF-8'?> <record xmlns="http://www.loc.gov/MARC21/slim"> <leader>00000nam##2200000uu#4500</leader> <datafield tag="540" ind1=" " ind2=" "> <subfield code="a">Free for private use; right holder retains other rights, including distribution</subfield> </datafield> <datafield tag="260" ind1=" " ind2=" "> <subfield code="c">2019-11-25</subfield> </datafield> <controlfield tag="005">20200214072052.0</controlfield> <controlfield tag="001">3666980</controlfield> <datafield tag="909" ind1="C" ind2="O"> <subfield code="p">openaire</subfield> <subfield code="o">oai:zenodo.org:3666980</subfield> </datafield> <datafield tag="520" ind1=" " ind2=" "> <subfield code="a">Objective: Interfacility patient movement plays an important role in the dissemination of antimicrobial-resistant organisms throughout healthcare systems. We evaluated how 3 alternative measures of interfacility patient sharing were associated with C. difficile infection incidence in Ontario acute-care facilities. Design: The cohort included adult acute-care facility stays of ≥3 days between April 2003 and March 2016. We measured 3 facility-level metrics of patient sharing: general patient importation, incidence-weighted patient importation, and C. difficile case importation. Each of the 3 patient-sharing metrics were examined against the incidence of C. difficile infection in the facility per 1,000 stays, using Poisson regression models. Results: The analyzed cohort included 6.70 million stays at risk of C. difficile infection across 120 facilities. Over the 13-year period, we included 62,189 new cases of healthcare-associated CDI (incidence, 9.3 per 1,000 stays). After adjustment for facility characteristics, general importation was not strongly associated with C. difficile infection incidence (risk ratio [RR] per doubling, 1.10; 95% confidence interval [CI], 0.97–1.24; proportional change in variance [PCV], −2.0%). Incidence-weighted (RR per doubling, 1.18; 95% CI, 1.06–1.30; PCV, −8.4%) and C. difficile case importation (RR per doubling, 1.43; 95% CI, 1.29–1.58; PCV, −30.1%) were strongly associated with C. difficile infection incidence. Conclusions: In this 13-year study of acute-care facilities in Ontario, interfacility variation in C. difficile infection incidence was associated with importation of patients from other high-incidence acute-care facilities or specifically of patients with a recent history of C. difficile infection. Regional infection control strategies should consider the potential impact of importation of patients at high risk of C. difficile shedding from outside facilities.</subfield> </datafield> <datafield tag="700" ind1=" " ind2=" "> <subfield code="a">McGeer, Allison</subfield> </datafield> <datafield tag="700" ind1=" " ind2=" "> <subfield code="a">Schwartz, Kevin L.</subfield> </datafield> <datafield tag="700" ind1=" " ind2=" "> <subfield code="a">Diong, Christina</subfield> </datafield> <datafield tag="700" ind1=" " ind2=" "> <subfield code="a">Etches, Jacob</subfield> </datafield> <datafield tag="700" ind1=" " ind2=" "> <subfield code="a">Garber, Gary</subfield> </datafield> <datafield tag="700" ind1=" " ind2=" "> <subfield code="a">Johnstone, Jennie</subfield> </datafield> <datafield tag="700" ind1=" " ind2=" "> <subfield code="a">Langford, Bradley</subfield> </datafield> <datafield tag="700" ind1=" " ind2=" "> <subfield code="a">Daneman, Nick</subfield> </datafield> <datafield tag="856" ind1="4" ind2=" "> <subfield code="s">481983</subfield> <subfield code="z">md5:a708cfd43209f7650502fea25cfeffe4</subfield> <subfield code="u">https://zenodo.org/record/3666980/files/article.pdf</subfield> </datafield> <datafield tag="542" ind1=" " ind2=" "> <subfield code="l">open</subfield> </datafield> <datafield tag="980" ind1=" " ind2=" "> <subfield code="a">publication</subfield> <subfield code="b">article</subfield> </datafield> <datafield tag="100" ind1=" " ind2=" "> <subfield code="0">(orcid)0000-0002-1483-2188</subfield> <subfield code="a">Brown, Kevin A.</subfield> </datafield> <datafield tag="024" ind1=" " ind2=" "> <subfield code="a">10.1017/ice.2019.283</subfield> <subfield code="2">doi</subfield> </datafield> <datafield tag="245" ind1=" " ind2=" "> <subfield code="a">Interfacility patient sharing and Clostridioides difficile infection incidence in the Ontario hospital system: A 13-year cohort study</subfield> </datafield> <datafield tag="650" ind1="1" ind2="7"> <subfield code="a">cc-by</subfield> <subfield code="2">opendefinition.org</subfield> </datafield> </record>
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