Infection Control & Hospital Epidemiology (2018), 39, 1484–1486 doi:10.1017/ice.2018.241
Concise Communication
Immediate impact of healthcare-facility–onset Clostridium difficile laboratory-identified events reporting methodology change on standardized infection ratios
Carlos E. Figueroa Castro MD1, Louis Palen MPH, BSN, CIC2, Carrie Johnson RN, BSN, CIC3, Mary Beth Graham MD1, David Letzer MD3, Nathan Ledeboer PhD, D(ABMM)4, Blake Buchan PhD, D(ABMM)4, Timothy Block MT (ASCP)6, Heather Seliger MB (ASCP)CM2, Siddhartha Singh MD,
MS5, Elizabeth Behrens RN, MS6, Susan Huerta PhD, RN6 and L. Silvia Munoz-Price MD, PhD1 1Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, 2Infection Prevention and Control Department, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin, 3Infection Prevention and Control Department, Community Hospital Division, Milwaukee, Wisconsin, 4Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, 5Division of Hospital Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin and 6Froedtert Health System, Milwaukee, Wisconsin.
Abstract
In 2018, the Clostridium difficile LabID event methodology changed so that hospitals doing 2-step tests, nucleic acid amplification test (NAAT) plus enzyme immunofluorescence assay (EIA), had their adjustment modified to EIA-based tests, and only positive final tests (eg, EIA) were counted in the numerator. We report the immediate impact of this methodological change at 3 Milwaukee hospitals.
(Received 17 May 2018; accepted 19 August 2018; electronically published October 23, 2018)
Clostridium difficile infections are the most frequent hospital- acquired infection in the United States.1 For several years, the largest hospital in our health system (hospital A) experienced higher-than-expected numbers of healthcare-facility–onset C. difficile laboratory identified events (HO-CDI LabID), per the National Healthcare Safety Network (NHSN), with standardized infection ratios (SIRs) consistently above 1.0. These infections occurred despite several interventions, including heightened environmental disinfection with sporicidal agents, an ultraviolet automatic disinfection system, antimicrobial stewardship, and hand hygiene campaigns. Until recently, our 3 hospitals used the nucleic acid amplification test (NAAT) as the sole clinical test for C. difficile infections; however, in February 2017, we instituted an enzyme immunofluorescence assay (EIA) after any NAAT- positive result. Given that the NHSN reporting definition for HO-CDI LabID events was based solely on NAAT-positive results, our SIRs remained unchanged after implementation of reflex EIA. On January 1, 2018, NHSN changed the reporting methodology for institutions performing a 2-step test (ie, NAAT with reflex EIA). Instead of all NAAT-positive tests, only NAAT- positive/EIA-positive tests were included in the new LabID
Author for correspondence: L. Silvia Munoz-Price, MD, PhD, 8701 Watertown Plank Road, Milwaukee, WI 53226. E-mail:
smunozprice@mcw.edu
Cite this article: Figueroa Castro CE et al. (2018). Immediate impact of healthcare-
facility–onset Clostridium difficile laboratory-identified events reporting methodology change on standardized infection ratios. Infection Control & Hospital Epidemiology 2018, 39, 1484–1486. doi: 10.1017/ice.2018.241
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
definition.2 We describe the immediate impact of these NHSN methodology changes in the number of HO-CDI LabID events observed, the number of predicted events, and the final impact on C. difficile SIRs across our health system during the first 2 quarters of 2018.
Methods
The Froedtert Health System comprises 3 hospitals in the greater Milwaukee area: hospital A is a 565-bed urban inpatient teaching affiliated facility, hospital B is a 206-bed hospital in a suburban area (which as of January 1, 2018, switched its reporting category from community nonteaching affiliated to community teaching-affiliated), and hospital C is a 70-bed facility in a rural area 33 miles from downtown Milwaukee. In hospital A, 110 of 565 beds (19.5%) are allocated to hematology- oncology patients and solid-organ transplant recipients. The definition of HO-CDI LabID events and the respective metho- dology changes were obtained directly from NHSN. The number of predicted HO-CDI LabID events, monthly patient days, and quarterly SIRs were downloaded from the NHSN database. No new C. difficile interventions were implemented in either hospital during 2018.
Clostridium difficile clinical tests
Unformed stool samples underwent NAAT C. difficile testing using hospital specific methodologies in accordance with the
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124
