1. C. Difficile Surveillance Quality Improvement Initiative Baystate 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 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

4. 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.