Background In 2009, the Centers for Disease Control and Prevention (CDC) introduced a module in the...
1
Background In 2009, the Centers for Disease Control and Prevention (CDC) introduced a module in the National Healthcare Safety Network (NHSN) allowing reporting of Clostridium difficile (C. diff). Beginning July 1, 2009, New York State (NYS) began using the LabID Event reporting function to report facility-wide C. diff at all NYS hospitals as part of the mandatory public reporting law. Data collected in 2009 will be used as pilot data and will not be reported to the public by hospital. Objective Collect baseline data regarding laboratory testing policies and testing methods used by NYS facilities to diagnose C. diff. Methods In May 2010, an on-line Survey Monkey tool was developed and sent to 179 NYS facilities reporting C. diff LabID Events to assess testing policies and methods. All surveys were completed within one month. Results 179 (100%) hospitals responded to the survey. See Table for results. Conclusions The vast majority (80%) of NYS facilities perform their own C. diff tests; the most common testing method (82%) is Toxin A and B antibody (ELISA or EIA). Only 19 (11%) facilities are using PCR technology as their primary testing method; an additional 7 (4%) facilities will begin using PCR, and 41 (23%) facilities are considering its use. Despite evidence against testing formed stool or duplicate specimens 1 , many laboratories do not have policies rejecting these specimens (26% and 38%, respectively). NYS will continue to survey facilities on a yearly basis to monitor changes in testing methods and policies. It will be important to monitor these factors and their association with infection rates. Abstract Results Out of 179 (100% response rate) hospitals: ● 144 (80.4%) perform their own C. diff tests vs. outsourcing to an external laboratory (35, 19.6%); ● 146 (83.4%) use Toxin A and B antibody (ELISA or EIA) as their primary test method; 19 (10.9%) use PCR; 10 (5.7%) use a different method; 4 hospitals did not respond; ● Of the 151 hospitals not currently using PCR as their primary test method, 48 (31.8%) are considering its use. However, only 7 (14.6%) have identified a start date for PCR use; ● 132 (74.2%) do not routinely perform tests on formed stool specimens; ● Positive results from formed stools are supposed to be excluded for NHSN and NYS reporting purposes; ● 106 (60.9%) have a rejection policy for duplicate stool specimens; and ● 93 (54.4%) perform a confirmatory test for an equivocal test result; ● 76 (81.7%) repeat primary testing method; 11 (11.8%) perform PCR; 6 (6.5%) use other method. Reference 1 Gerding DN, Johnson S, Peterson LR, Mulligan ME, Silva J Jr. Clostridium difficile- associated diarrhea and colitis. Infect Control Hosp Epidemiol. 1995;16(8):459-477. Conclusio ns NYS will continue to survey facilities on a yearly basis to monitor changes in testing methods and policies. It will be important to monitor these factors and their association with infection rates. In future surveys, NYS will also consider including questions regarding C. difficile prevention policies and practices in order to assess best practices across the state. Overall, by May 2010, very few facilities had made the switch to PCR testing for C. difficile detection. As facilities make the switch to the more sensitive PCR testing method, NYS must ensure that facilities are fairly compared in the annual public report. Changing testing methods may also make it more difficult to assess trends within a facility. Despite evidence against testing formed stool or duplicate specimens 1 , many laboratories do not have policies rejecting these specimens; for those facilities with rejection policies, it is unclear if these policies are enforced. This may adversely affect the accuracy of rates reported at these facilities. Currently, there is no systematic method in place to verify the accuracy of information collected in the survey; this is a consideration for future surveys and on-site hospital audits. No financial disclosures. Kathleen A. Gase, MPH, CIC, KuangNan Xiong, BS, Johanna B. Lee, MPH, MA, Valerie Haley, MS, Boldt Tserenpuntsag, DrPH, Diana Doughty, RN, MBA, CIC, CPHQ, Peggy Hazamy, RN, BSN, CIC, Rachel Stricof, MPH, CIC, Marie Tsivitis, MPH, CIC, Victor Tucci, MPH, CIC, ASCP, Carole Van Antwerpen, RN, BSN, CIC New York State Department of Health: Mandatory Reporting of Clostridium difficile via NHSN LabID Event – Survey to Determine Testing Methods and Laboratory Policies New York State Dept. of Health, HAI Reporting Program Table: Summary of C. diff Hospital Survey 2010 N=179 Number Perce nt Is C. diff testing outsourced to an external laboratory? Yes 35 19.6 No 144 80.4 Does the lab routinely perform tests on formed stool specimens? (No answer = 1) Yes 46 25.8 No 132 74.2 Does the lab have a rejection policy for duplicate stool specimens? (No answer = 5) Yes 106 60.9 No 68 39.1 What is the primary test method the lab uses to detect C. diff? (No answer = 4) Toxin A and B antibody (ELISA or EIA) 146 83.4 PCR 19 10.9 Glutamate dehydrogenase (GDH) or common antigen 5 2.9 Toxin A antibody only (ELISA or EIA) 3 1.7 Cytotoxin (CXT) assay (Toxin B) 2 1.1 Anaerobic microbiology culture 0 0.0 Is confirmatory test performed for equivocal test results? (No answer = 8) Yes 93 54.4 Repeat primary test 76 81.7 PCR 11 11.8 GDH or common antigen 4 4.3 Tissue culture 2 2.2 No 78 45.6 If not currently using a PCR test method, is there consideration for use? (No answer = 9) n=160 No 103 68.2 Yes, start date identified 7 4.6 Yes, start date unknown 41 27.2 Note: The 2007-2009 New York State Hospital-Acquired Infection Reports can be found at: www.nyhealth.gov/nysdoh/hospital/reports/hospital_acquired_infect ions . Methods ● In May 2010, an on-line Survey Monkey tool was developed and sent to all 179 NYS facilities reporting C. diff LabID Events to assess testing policies and methods. ● All surveys were completed within one month. ● To ensure 100% response rate, facilities were notified via e-mail and phone calls if they had not completed the survey. ● All information was captured via self-report by the facilities. ● There was no formal validation of this information by NYSDOH.
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Transcript of Background In 2009, the Centers for Disease Control and Prevention (CDC) introduced a module in the...
BackgroundIn 2009, the Centers for Disease Control and Prevention (CDC) introduced a module in the National Healthcare Safety Network (NHSN) allowing reporting of Clostridium difficile (C. diff). Beginning July 1, 2009, New York State (NYS) began using the LabID Event reporting function to report facility-wide C. diff at all NYS hospitals as part of the mandatory public reporting law. Data collected in 2009 will be used as pilot data and will not be reported to the public by hospital.
ObjectiveCollect baseline data regarding laboratory testing policies and testing methods used by NYS facilities to diagnose C. diff.
MethodsIn May 2010, an on-line Survey Monkey tool was developed and sent to 179 NYS facilities reporting C. diff LabID Events to assess testing policies and methods. All surveys were completed within one month.
Results179 (100%) hospitals responded to the survey. See Table for results.
ConclusionsThe vast majority (80%) of NYS facilities perform their own C. diff tests; the most common testing method (82%) is Toxin A and B antibody (ELISA or EIA). Only 19 (11%) facilities are using PCR technology as their primary testing method; an additional 7 (4%) facilities will begin using PCR, and 41 (23%) facilities are considering its use. Despite evidence against testing formed stool or duplicate specimens1, many laboratories do not have policies rejecting these specimens (26% and 38%, respectively). NYS will continue to survey facilities on a yearly basis to monitor changes in testing methods and policies. It will be important to monitor these factors and their association with infection rates.
Abstract ResultsOut of 179 (100% response rate) hospitals: ● 144 (80.4%) perform their own C. diff tests vs. outsourcing to an external laboratory (35, 19.6%);
● 146 (83.4%) use Toxin A and B antibody (ELISA or EIA) as their primary test method; 19 (10.9%) use PCR; 10 (5.7%) use a different method; 4 hospitals did not respond; ● Of the 151 hospitals not currently using PCR as their primary test method, 48 (31.8%) are considering its use. However, only 7 (14.6%) have identified a start date for PCR use;
● 132 (74.2%) do not routinely perform tests on formed stool specimens; ● Positive results from formed stools are supposed to be excluded for NHSN and NYS reporting purposes;
● 106 (60.9%) have a rejection policy for duplicate stool specimens; and
● 93 (54.4%) perform a confirmatory test for an equivocal test result; ● 76 (81.7%) repeat primary testing method; 11 (11.8%) perform PCR; 6 (6.5%) use other method.
Reference1Gerding DN, Johnson S, Peterson LR, Mulligan ME, Silva J Jr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol. 1995;16(8):459-477.
Conclusions
NYS will continue to survey facilities on a yearly basis to monitor changes in testing methods and policies. It will be important to monitor these factors and their association with infection rates. In future surveys, NYS will also consider including questions regarding C. difficile prevention policies and practices in order to assess best practices across the state.
Overall, by May 2010, very few facilities had made the switch to PCR testing for C. difficile detection. As facilities make the switch to the more sensitive PCR testing method, NYS must ensure that facilities are fairly compared in the annual public report. Changing testing methods may also make it more difficult to assess trends within a facility.
Despite evidence against testing formed stool or duplicate specimens1, many laboratories do not have policies rejecting these specimens; for those facilities with rejection policies, it is unclear if these policies are enforced. This may adversely affect the accuracy of rates reported at these facilities.
Currently, there is no systematic method in place to verify the accuracy of information collected in the survey; this is a consideration for future surveys and on-site hospital audits.
No financial disclosures.
Kathleen A. Gase, MPH, CIC, KuangNan Xiong, BS, Johanna B. Lee, MPH, MA, Valerie Haley, MS, Boldt Tserenpuntsag, DrPH,Diana Doughty, RN, MBA, CIC, CPHQ, Peggy Hazamy, RN, BSN, CIC, Rachel Stricof, MPH, CIC,Marie Tsivitis, MPH, CIC, Victor Tucci, MPH, CIC, ASCP, Carole Van Antwerpen, RN, BSN, CIC
New York State Department of Health: Mandatory Reporting of Clostridium difficile via NHSN LabID Event – Survey to Determine Testing Methods and Laboratory Policies
New York State Dept. of Health, HAI Reporting Program
Table: Summary of C. diff Hospital Survey 2010 N=179
Number Percent
Is C. diff testing outsourced to an external laboratory?
Yes 35 19.6
No 144 80.4
Does the lab routinely perform tests on formed stool specimens? (No answer = 1)
Yes 46 25.8
No 132 74.2
Does the lab have a rejection policy for duplicate stool specimens? (No answer = 5)
Yes 106 60.9
No 68 39.1
What is the primary test method the lab uses to detect C. diff? (No answer = 4)
Toxin A and B antibody (ELISA or EIA) 146 83.4
PCR 19 10.9
Glutamate dehydrogenase (GDH) or common antigen 5 2.9
Toxin A antibody only (ELISA or EIA) 3 1.7
Cytotoxin (CXT) assay (Toxin B) 2 1.1
Anaerobic microbiology culture 0 0.0
Is confirmatory test performed for equivocal test results? (No answer = 8)
Yes 93 54.4
Repeat primary test 76 81.7
PCR 11 11.8
GDH or common antigen 4 4.3
Tissue culture 2 2.2
No 78 45.6
If not currently using a PCR test method, is there consideration for use? (No answer = 9) n=160
No 103 68.2
Yes, start date identified 7 4.6
Yes, start date unknown 41 27.2
Note: The 2007-2009 New York State Hospital-Acquired Infection Reports can be found at: www.nyhealth.gov/nysdoh/hospital/reports/hospital_acquired_infections.
The 2010 Report is expected to be released September 2011.
Methods● In May 2010, an on-line Survey Monkey tool was developed and sent to all 179 NYS facilities reporting C. diff LabID Events to assess testing policies and methods.
● All surveys were completed within one month. ● To ensure 100% response rate, facilities were notified via e-mail and phone calls if they had not completed the survey.
● All information was captured via self-report by the facilities. ● There was no formal validation of this information by NYSDOH.
