A Comparison Between National Healthcare Safety Network Laboratory-Identified Event Reporting versus Traditional Surveillance for Clostridium difficile Infection

Abstract

Objective Hospitals in the National Healthcare Safety Network began reporting laboratory-identified (LabID) Clostridium difficile infection (CDI) events in January 2013. Our study quantified the differences between the LabID and traditional surveillance methods. Design Cohort study. Setting A cohort of 29 community hospitals in the southeastern United States. Methods A period of 6 months (January 1, 2013, to June 30, 2013) of prospectively collected data using both LabID and traditional surveillance definitions were analyzed. CDI events with mismatched surveillance categories between LabID and traditional definitions were identified and characterized further. Hospital-onset CDI (HO-CDI) rates for the entire cohort of hospitals were calculated using each method, then hospital-specific HO-CDI rates and standardized infection ratios (SIRs) were calculated. Hospital rankings based on each CDI surveillance measure were compared. Results A total of 1,252 incident LabID CDI events were identified during 708,551 patient-days; 286 (23%) mismatched CDI events were detected. The overall HO-CDI rate was 6.0 vs 4.4 per 10,000 patient-days for LabID and traditional surveillance, respectively (P < .001); of 29 hospitals, 25 (86%) detected a higher CDI rate using LabID compared with the traditional method. Hospital rank in the cohort differed greatly between surveillance measures. A rank change of at least 5 places occurred in 9 of 28 hospitals (32%) between LabID and traditional CDI surveillance methods, and for SIR. Conclusions LabID surveillance resulted in a higher hospital-onset CDI incidence rate than did traditional surveillance. Hospital-specific rankings varied based on the HO-CDI surveillance measure used. A clear understanding of differences in CDI surveillance measures is important when interpreting national and local CDI data.

The Epidemiology of Clostridium difficile Infection in Japan: A Systematic Review

“…Fewer studies reported overall rates of hospital- and community-acquired CDI. Nevertheless, the current literature suggests that hospital-onset CDI in Japan occurs at an incidence of 0.8–4.7 cases/10,000 patient-days; lower than that reported in Europe for winter 2012–2013 (country range 0.7–28.7/10,000 patient bed-days), and similar to the US for hospital-onset CDI in 2013 (6.0/10,000 patient-days for laboratory-identified CDI and 4.4/10,000 patient-days for traditional surveillance-detected CDI) [ 54 , 55 ]. However, direct comparisons between studies are difficult owing to differences in design, population size and detection methods used.…”

Evaluation of the National Healthcare Safety Network standardized infection ratio risk adjustment for healthcare-facility-onset Clostridioides difficile infection in intensive care, oncology, and hematopoietic cell transplant units in general acute-care hospitals

“…12,[21][22][23] Other studies have pointed out inaccuracies in the LabID classification of CDI events, HO-CDI risk adjustment for C. difficile test method and SIR calculation. 8,[24][25][26][27] Our study adds unique information by demonstrating that failure to adjust for important high-risk patient populations in general acute-care hospitals may lead to falsely elevated SIR results.…”

Clostridium difficile infection as a novel marker for hospital quality, efficiency and other factors associated with prolonged inpatient length of stay

“…Similarly, the variation of di↵erent CDI definitions within the literature is also reflected in surveillance methods used in practice to measure incidence of HA CDI. Research has shown that traditional surveillance methods, which use a 48 hour window to define HA cases, and the laboratory-identified method used by the National Healthcare Safety Network, which uses a 72 hour window, can produce dramatically di↵erent results when ranking hospitals based on their incidence of HA CDI [48]. Therefore, when analyzing and comparing results across studies and hospital surveillance reporting, it is important to pay attention to the various inclusion criteria used when defining di↵erent CDI cases.…”

“…Due to the increasing incidence and growing costs associated with HAIs, many Network also began reporting CDI events [129,48]. Given this increased availability of public information on hospital incidence of HAIs, studies have now begun using hospital incidence rates of HAIs, such as MRSA and CDI, as measures for making hospital-level comparisons [30,151].…”

“…As previously described, CO-HA CDIs are cases that are associated with a hospital stay but do not appear, and are not diagnosed, until after a patient is discharged. Various time windows have been used to identify such cases, including 30, 60 and 90 days along with 4 or 12 weeks following discharge; although, 4 weeks post discharge seems to have become the standard length of time that is now most frequently applied [48]. There is now a large body of evidence that suggests a significant number of CDI cases occur as CO-HA, after a patient has been discharged from a healthcare setting [87,23,40,35].…”