C. Difficile Surveillance Quality Improvement Initiative Baystate Health System Anne Zawacki RN MPH CIC

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

System Pros & Cons Data-mining Detailed surveillance 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

Inpatient with positive C. difficile result Is the onset of symptoms >48˚ after admission? No Yes Yes Did the patient have a positive test in the previous 8 weeks? No 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) Dc’d from >1 HCF 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 No Yes Community Acquired 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.