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

Clare Rock; Zoi Pana; Surbhi Leekha; Polly Trexler; Jennifer Andonian; Avinash Gadala; Karen C Carroll; Lisa L Maragakis; CDC Prevention Epicenters Program

doi:10.1016/j.ajic.2017.10.011

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

Am J Infect Control. 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.

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.

MeSH terms

Anti-Bacterial Agents / administration & dosage*
Anti-Bacterial Agents / therapeutic use*
Clinical Laboratory Information Systems*
Clostridioides difficile
Clostridium Infections / epidemiology*
Clostridium Infections / prevention & control*
Disease Notification
Drug Utilization*
Health Facilities*
Humans
Public Health Surveillance / methods
United States / epidemiology

Substances

Anti-Bacterial Agents

Abstract

MeSH terms

Substances

Grants and funding