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Clostridium difficile Infection (CDI), April 1, 2010― March 31, 2011 

This is the second California Department of Public Health (CDPH) report on Clostridium difficile infections (CDI) and the first using data submitted to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). California is the second state (after New York) to report hospital CDI rates using NHSN data, and the first to do so statewide.

Use of NHSN for reporting CDI allows each case to be categorized by whether the onset of illness occurred in a hospital or in the community. Hospital-related cases are identified as “hospital-onset” or “hospital-associated:”

  • Hospital-onset (HO): Cases in which the positive stool sample for CDI was obtained on day four or later during the hospital stay.
  • Hospital-associated (HA): HO cases plus cases in which a patient who was discharged from the same hospital within the previous four weeks is readmitted to that hospital with a new positive stool sample for CDI during the first three days of the current admission. For HA cases, the CDI could have occurred as a result of the recent hospitalization or could be related to other exposures outside of the hospital.
  • Community onset (CO): Cases in which the positive stool sample for CDI was obtained during the first three days of the patient's hospital admission. These cases are presumed unrelated to the patient’s stay in that hospital.
This report provides a hospital-associated and a hospital-onset CDI rate for each hospital, as both rates may reflect hospital care.

Although reporting CDI data to NHSN allows for accurate classification of CDIs, it does not allow the data to be used to compare hospitals with each other or with a state average. The case mix index, a measure of the average severity of illness of patients, is provided for each hospital.

The data in this report should be used as a hospital baseline and not for comparing hospitals. Bearing in mind their limitations, hospitals and healthcare providers can use these rates to examine their patient safety practices and improve quality of care, as appropriate. The public can use these rates as a starting point to discuss patient safety and quality of care with their healthcare providers.

Please consider the following when viewing this report:
  1. For this reporting period, NHSN did not allow hospitals to report the laboratory methodology used to test for CDI, and tests with different sensitivities affect reported rates.
  2. NHSN does not adjust for differences in the risk for CDI in different hospital patient populations. Laboratory-based reporting also depends on appropriate clinician test ordering and laboratory processing. Data on laboratory methodology will be available in the next reporting period.

Long-term acute care (LTAC) hospitals have longer patient lengths of stay and length of stay is an established risk factor for CDI.  An LTAC hospital is a licensed general acute care hospital (GACH) defined by the Centers for Medicare & Medicaid Services (CMS) as providing care for patients with medically complex conditions requiring an average length of stay for all patients of greater than 25 days. For this reason, we present HO and HA incidence rates for LTAC hospitals separately from the other GACHs.

This report provides information to help hospitals identify measures to address CDI prevention using recommended guidelines from CDC, the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Association for Professionals in Infection Control and Epidemiology (APIC).

The public and consumers can use information in this report to ask their healthcare providers about strategies their hospital uses to prevent CDI, including an antibiotic stewardship program, and actions they can take to ensure their safety in the hospital, including protecting against CDI.

The data in this report are presented in the following tables.  CDI rates are provided for all hospitals that reported at least 10 of 12 months of data for the reporting period. Important explanatory information, including definitions, is available in the full CDI Report, data collected from April 1, 2010 through March 31, 2011  Opens in a new browser window.

  Clostridium difficile Infection (CDI) Tables

April 1, 2010―March 31, 2011 (inclusive)

Table 1.
Months of reporting, cases of Clostridium difficile infection, and patient days reported by California general acute care hospitals that submitted fewer than ten months of data Opens in a new browser window. 
Table 2.
Patient days, patient admissions, and crude rates of hospital onset and hospital associated Clostridium difficile infections reported by California long-term acute care hospitals, restricted to hospitals that reported at least ten months of dataOpens in a new browser window.
Table 3.
Incidence rates of hospital onset and hospital associated Clostridium difficile infections reported by California general acute care hospitals other than long-term acute hospitals, restricted to hospitals that reported at least ten months of dataOpens in a new browser window.

 

To view the full report, which includes an Executive Summary that highlights the report findings and the Methods used in collecting and evaluating data, see Clostridium difficile Infection, April 1, 2010―March 31, 2011Opens in a new browser window.

 

 
 
Last modified on: 1/6/2012 2:39 PM