by Heather Dubendris, MSPH, North Carolina Department of Health and Human Services
In early 2015, the North Carolina Division of Public Health (NC DPH) Healthcare-Associated Infection (HAI) Prevention Program initiated a consultative, non-regulatory validation of central line-associated bloodstream infection (CLABSI) and C. difficile infection (CDI) data reported through the National Healthcare Safety Network (NHSN). The purpose of this validation is to help hospitals improve the identification and reporting of CLABSI and CDI. This validation is ongoing; aggregate results will be made available upon completion of validation activities. In addition to quality assurance, validation also presents important opportunities to identify and address any areas for improvement. One immediate area of improvement that we have identified is the failure to report community onset CDI events (CO CDI) through NHSN. CO CDI events do not appear in the total count of CDI attributed to your facility. However, these events are used to assess the burden of CDI within your community and are one factor used to risk-adjust the standardized infection ratio (SIR) for your facility. If you do not report CO CDI, your facility’s risk adjustment will not be accurate.
Please note that this is not a change in reporting requirements, but applies only to those units facilities are currently required to report from FACWIDEIN (which includes all inpatient locations and as of 2015 also requires facilities to include location specific reporting for Emergency Departments and 24-hour observation locations). Facilities do not need to report positive CDIs that come from outside of their inpatient, ED and observation units.
The 2015 NHSN definition of laboratory identified (LabID) CDI is provided below for reference. Additional information is available here.
CDI-positive laboratory assay: A positive laboratory test result for C. difficile toxin A and/or B, (includes molecular assays [PCR] and/or toxin assays) tested on an unformed stool specimen (must conform to the container) OR A toxin-producing C. difficile organism detected by culture or other laboratory means performed on an unformed stool sample (must conform to the container).
CDI Data Analysis: Based on data provided on the LabID Event form, each event will be categorized by NHSN to populate different measures. By classifying positive cultures obtained on day 1 (admission date), day 2, and day 3 of admission as CO LabID Events and positive cultures obtained on or after day 4 as HO LabID Events. All HO LabID Events will have occurred more than 48 hours after admission.