C. Difficile Surveillance Quality Improvement Initiative Baystate Health System

1. C. Difficile SurveillanceQuality Improvement InitiativeBaystate Health System Anne Zawacki RN MPH CIC

2. Surveillance Process • Historical surveillance process • # Positive C. diff tests for unique patients/month • Monthly census denominator • Proposed improvement • Data-mining vs. Detailed surveillance • Cases of CDAD

3. System Pros & Cons Data-mining Pros Minimal IP time Cons Cannot consistently evaluate onset or admission symptoms Cannot evaluate patient readmission/transfer locations System limitations Detailed surveillance Pros NIM Line listing Chart review of electronic medical record for onset and admission symptoms Review of admission- discharge- transfer- readmission data More accurate data Cons Labor intensive

4. Inpatient with positive C. difficile result Is the onset of symptoms >48˚ after admission? No Yes Did the patient have a positive test in the previous 8 weeks? No Yes Did the patient have a positive test in the previous 8 weeks? Recurrent (Do not count as new case) Was the pt discharged or transferred from > 1 HCF(s) < 30 days ago with a LOS >48hours? No Yes Yes Dc’d from 1 HCF No/Unknown Dc’d from >1 HCF BMC Associated Recurrent (Do not count as new case) Was the previous admission at BMC? Was the patient discharged or transferred from a HCF >30 days ago? Was the most recent admission at BMC? Yes No/Unknown Was the patient dc’d > 12 weeks ago? Yes No No Yes Community Acquired No Yes BMC Associated HCF (not BMC) Associated Association Indeterminate McDonald, L.C. et al. Recommendations for Surveillance of Clostridium difficile- Associated Disease. Infection Control and Hospital Epidemiology; Feb 2007, Vol.28, No.2.