National Healthcare Safety Network laboratory-identified Clostridium difficile event reporting: A need for diagnostic stewardship

Clare Rock¹, Zoi Pana², Surbhi Leekha³, Polly Trexler⁴, Jennifer Andonian⁴, Avinash Gadala⁴, Karen C Carroll⁵, Lisa L Maragakis⁶; CDC Prevention Epicenters Program

Affiliations

¹ Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD. Electronic address: clare.rock@jhmi.edu.
² Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
⁴ Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD.
⁵ Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD.
⁶ Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD.

PMID: 29305285
PMCID: PMC6734925
DOI: 10.1016/j.ajic.2017.10.011

National Healthcare Safety Network laboratory-identified Clostridium difficile event reporting: A need for diagnostic stewardship

Clare Rock et al. Am J Infect Control. 2018 Apr.

. 2018 Apr;46(4):456-458.

doi: 10.1016/j.ajic.2017.10.011. Epub 2018 Jan 2.

Authors

Clare Rock¹, Zoi Pana², Surbhi Leekha³, Polly Trexler⁴, Jennifer Andonian⁴, Avinash Gadala⁴, Karen C Carroll⁵, Lisa L Maragakis⁶; CDC Prevention Epicenters Program

Affiliations

¹ Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD. Electronic address: clare.rock@jhmi.edu.
² Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
⁴ Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD.
⁵ Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, MD.
⁶ Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD.

PMID: 29305285
PMCID: PMC6734925
DOI: 10.1016/j.ajic.2017.10.011

Abstract

We describe the proportion of health care facility-onset Clostridium difficile infection (HO-CDI) National Healthcare Safety Network laboratory-identified events at our facility that were deemed nontrue HO-CDIs. Reasons included testing in a patient without significant diarrhea or with recent laxative use, or delayed testing. Standardized infection ratios using only true HO-CDI in the numerator were improved compared with publically reported standardized infection ratios. A prioritization matrix identifies which clinical services could benefit most from directed diagnostic stewardship interventions.

Keywords: Facility reimbursement; Facility reputation; Health care-onset infection; Inappropriate testing; Nucleic acid amplification tests.

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Figures

**Figure 1a:**
True HO-CDI Rate vs NHSN LabID HO-CDI Rate

**Figure 1b:**
True HO-CDI SIR vs NHSN LabID HO- CDI Event SIR

See this image and copyright information in PMC

References

1. Medicare Hospital Compare Quality of Care. https://www.medicare.gov/hospitalcompare/search.html. Accessed October 13, 2017.
1. Polage CR, Gyorke CE, Kennedy MA, et al. Overdiagnosis of Clostridium difficile Infection in the Molecular Test Era. JAMA Intern Med. 2015;175:1792–1801. - PMC - PubMed
1. Donskey CJ, Kundrapu S, Deshpande A. Colonization Versus Carriage of Clostridium difficile. Infect Dis Clin North Am. 2015;29:13–28. - PubMed
1. Nerandzic MM, Mullane K, Miller MA, Babakhani F, Donskey CJ. Reduced acquisition and overgrowth of vancomycin-resistant enterococci and Candida species in patients treated with fidaxomicin versus vancomycin for Clostridium difficile infection. Clin Infect Dis Off Publ Infect Dis Soc Am. 2012;55 Suppl 2:S121–126. - PMC - PubMed
1. North F, Varkey P. Use of the prioritization matrix to enhance triage algorithms in clinical decision support software. Am J Med Qual Off J Am Coll Med Qual. 2010;25:468–473. - PubMed

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National Healthcare Safety Network laboratory-identified Clostridium difficile event reporting: A need for diagnostic stewardship

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National Healthcare Safety Network laboratory-identified Clostridium difficile event reporting: A need for diagnostic stewardship

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