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Impact of a Nurse Testing Guide on the Accuracy of Clostridium Difficile Location Onset Classification

      Background: The use of healthcare facility-onset Clostridium difficile infection (CDI) data in financial incentive and penalty programs has made the timely identification and testing of CDI patients essential for appropriate classification within the National Healthcare Safety Network (NHSN). NHSN classifies location onset based on specimen collection date; community-onset (CO) on admission day one, two, or three, and healthcare facility-onset (HO) on day four or later. Delay in the identification and testing of potential CDI patients can cause CO-CDI to be misclassified as HO-CDI. To improve the screening process and reduce time to testing one four-campus regional health system implemented a Clostridium difficile nurse testing guide. The guide outlined criteria for testing as three or more watery or loose stools not related to laxatives and allowed nurses to collect a specimen and send for testing without a provider order.
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