Program Schedule

Accuracy of Healthcare Facility-Onset Clostridium difficile Classification

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Concise Statement:

We compared the day of diagnosis of healthcare facility-onset Clostridium difficile with the day of symptom onset to determine the accuracy of our classification.


Clostridium difficile (C. difficile) is a publically reportable infection which contributes to 14,000 deaths yearly in the United States. The National Healthcare Safety Network defines healthcare facility-onset (HO) C. difficile as laboratory-confirmed cases identified on day 4 or greater of admission to a facility. However, HO cases may be misclassified if patients are symptomatic prior to day 4 without laboratory confirmation. Our objective is to determine if community-onset (CO) cases are being misclassified as HO cases.


We reviewed 121 HO cases of C. difficile from January 2013 to December 2013. We compared the day of laboratory diagnosis of C. difficile by PCR with the day of the first documented occurrence of diarrhea, including loose and liquid stools.


Thirty-seven of the 121 HO cases of C. difficile had diarrhea documented prior to day 4, representing 30.58% of our HO cases.

Timing of C. difficile Detection Compared to Onset of Symptoms

Quarter C. difficile detected ≥ day 4 (No. of cases) Onset of diarrhea ≤ 3 days (No. of cases) Opportunity for early detection (% of cases)
Q1 27 7 25.93
Q2 29 9 31.03
Q3 30 6 20
Q4 35 15 42.86
Total 121 37 30.58


Approximately 31% of HO cases of C. difficile had the onset of diarrhea prior to day 4 of hospitalization. The potential exists that these cases could have been classified as CO if specimen collection occurred closer to symptom onset. Timely diagnosis of C. difficile may have implications for reporting accuracy, early intervention, and improved patient outcomes. Future education initiatives for medical and nursing staff should focus on early disease recognition.

Regan Trappler, RN, BSN, MPH, Karen Torres, RN, BSN, CIC, Ian Seemungal, MD, Anita Majette-Cain, RN, BSN and Rohit Modak, MD, MBA, Virginia Hospital Center, Arlington, VA


R. Trappler, None

K. Torres, None

I. Seemungal, None

A. Majette-Cain, None

R. Modak, None

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