A novel approach to correcting attribution of Clostridioides difficile in a healthcare setting

Abstract

Objective: To describe a novel attribution metric estimating the causal source location of healthcare-associated Clostridioides difficile and compare it with the current US National Healthcare Safety Network (NHSN) surveillance reporting standard.

Design: Quality improvement study.

Setting: Two acute care facilities.

Methods: A novel attribution metric assigned days of attribution to locations where patients were located for 14 days before and the day of their C. difficile diagnosis. We correlated the NHSN-assigned unit attribution with the novel attribution measure and compared the proportion of attribution assigned to inpatient units.

Results: During a 30-month period, there were 727 NHSN C. difficile healthcare-associated infections (HAIs) and 409 non-HAIs; the novel metric attributed 17,034 days. The correlation coefficients for NHSN and novel attributions among non-ICU units were 0.79 (95% CI, 0.76-0.82) and 0.74 (95% CI, 0.70-0.78) and among ICU units were 0.70 (95% CI, 0.63-0.76) and 0.69 (95% CI, 0.60-0.77) at facilities A and B, respectively. The distribution of difference in percent attribution showed higher inpatient unit attribution using NHSN measure than the novel attribution metric: 38% of ICU units and 15% of non-ICU units in facility A, and 20% of ICU units and 25% of non-ICU units in facility B had a median difference >0; no inpatient units showed a greater attribution using the novel attribution metric.

Conclusion: The novel attribution metric shifts attribution from inpatient units to other settings and correlates modestly with NHSN methodology of attribution. If validated, the attribution metric may more accurately target C. difficile reduction efforts.

Figure 1.

Representative heat map of the Clostridioides difficile conventional attribution metric in an acute care facility.

Figure 2.

Frequency of the monthly Clostridioides difficile infections attributed to intensive care units and non-intensive care units at two study facilities, comparing conventional and novel attribution metrics.

Figure 3.

Distribution of the difference in attribution of Clostridioides difficile disease when using a novel attribution metric versus a conventional attribution metric, among inpatient intensive care and non-intensive care units.

Figure 4.

Frequency of the quarterly Clostridioides difficile infections attributed to intensive care units and non-intensive care units at two study facilities, comparing conventional and novel attribution metrics.