HCF (not BMC) Associated Association Indeterminate Example from Baystate Medical Ctr 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 BMC Associated Recurrent (Do not count as new case) Was the previous admission at BMC? Dc’d from >1 HCF 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.