1069. A Comparison Between National Healthcare Safety Network (NHSN) Laboratory-Identified (LabID) Event Reporting Module versus Standard Surveillance for Clostridium difficile Infection
Session: Poster Abstract Session: Surveillance of HAIs: Evaluating National Strategy
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • LabIDcdiffIDSA2013mjd_FINALCOPY.pdf (374.5 kB)
  • Background: Clostridium difficile infection (CDI) is now the most important pathogen in the healthcare setting. The NHSN now requires reporting of CDI using the new LabID method, but little is known about how it compares to standard definitions.

    Methods: Three months of prospective CDI data from 10 community hospitals in the Southeastern US were analyzed using the NHSN LabID definitions and standard surveillance definitions.  CDI cases could be designated as community acquired (CA), community onset – healthcare facility associated (CO-HCFA), hospital onset – healthcare facility associated (HO-HCFA), or indeterminate.  Recurrent cases were determined based on documentation of prior positive CDI tests.

    Results: A total of 191 cases of CDI were identified during 126,798 patient days (pt-d). 

     

    New LabID Definition

    Traditional Infection Surveillance

    CA

    CO-HCFA

    HO-HCFA

    Totals

    CA

    60

    0

    5

    65 (34%)

    CO-HCFA

    0

    36

    13

    49 (26%)

    HO-HCFA

    3

    0

    44

    47 (25%)

    Indeterminate

    30

    0

    0

    30 (16%)

    Totals

    93 (49%)

    36 (19%)

    62 (32%)

    191

    There were 51 (27%) cases categorized different by the two surveillance methods. The majority of the discordant were related to indeterminate definition on infection surveillance. HO- rate was 32% higher for LabID than standard surveillance (4.9 vs 3.7 per 10,000 pt-d,). The 18 LabID HO- cases classified as CO- or CA- by standard surveillance were due to diarrheal symptoms present on admission. More recurrent cases were identified by standard surveillance than LabID (N=20 vs. 1, respectively) due to knowledge of previous positive tests from outside laboratories.

    Conclusion: LabID surveillance techniques led to differences in CDI onset type categorization compared to standard surveillance definitions, largely due to delayed diagnostic testing when symptoms were present on admission. LabID misclassification will occur if clinicians do not send prompt CDI tests upon hospital admission. This led to notable differences in HO-HCFA rates: approximately a third in our study. LabID misclassification will occur if clinicians do not send prompt CDI tests upon hospital admission. This finding is important to note when interpreting longitudinal trends for hospitals that switch to LabID surveillance only.

    Michael J. Durkin, MD1, Deverick J. Anderson, MD, MPH2, Sarah S. Lewis, MD1, Luke F. Chen, MBBS, MPH, CIC, FRACP1, Arthur Baker, MD1, Kristen V. Dicks, MD1, Daniel J. Sexton, MD, FIDSA1 and Rebekah W. Moehring, MD, MPH3, (1)Duke University Medical Center, Durham, NC, (2)Duke Infection Control Outreach Network, Duke University Medical Center, Durham, NC, (3)Division of Infectious Diseases, Duke University Medical Center, Durham, NC

    Disclosures:

    M. J. Durkin, None

    D. J. Anderson, None

    S. S. Lewis, None

    L. F. Chen, None

    A. Baker, None

    K. V. Dicks, None

    D. J. Sexton, None

    R. W. Moehring, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.