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National Healthcare Safety Network laboratory-identified Clostridium difficile event reporting: A need for diagnostic stewardship

Published:January 02, 2018DOI:https://doi.org/10.1016/j.ajic.2017.10.011

      Highlights

      • Healthcare facility-onset Clostridium difficile Laboratory Identification (HO-CDI LabID) events are reported publically and impact facility reputation and reimbursement.
      • At our academic facility, 206 (42%) HO-CDI LabID were “non-true HO-CDI” but positive tests with no significant diarrhea, recent laxative, or delayed testing where diarrhea was present on admission.
      • Facilities' understanding of proportion of HO-CDI that represent inappropriate or delayed tests will help target improvement strategies.
      • Diagnostic stewardship has an important role in ensuring appropriate Clostridium difficile testing.
      We describe the proportion of health care facility-onset Clostridium difficile infection (HO-CDI) National Healthcare Safety Network laboratory-identified events at our facility that were deemed nontrue HO-CDIs. Reasons included testing in a patient without significant diarrhea or with recent laxative use, or delayed testing. Standardized infection ratios using only true HO-CDI in the numerator were improved compared with publically reported standardized infection ratios. A prioritization matrix identifies which clinical services could benefit most from directed diagnostic stewardship interventions.

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