This report on Clostridium difficile (C. difficile) infections (CDI) in California general acute care hospitals is the fourth by the California Department of Public Health (CDPH) and the third using information submitted by California hospitals to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). Data were reported from January 1, 2012 through December 31, 2012. The data presented in this report are based on laboratory identification of CDI cases. Each case is categorized by whether illness onset occurred in a hospital or in the community. Hospital-related cases of CDI are identified as “hospital-onset” or “hospital-associated.” Hospital-onset (HO) cases are those for which the positive stool sample for CDI was obtained on day four or later during the hospital stay. Hospital-associated (HA) cases are 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.
New in this report, for general acute care hospitals (other than long-term and rehabilitation acute care hospitals), we provide the NHSN hospital-onset (HO) CDI standardized infection ratio (SIR), which adjusts for significant risk factors. Risk factors found to be significant in predicting HO CDI incidence include the type of CDI test used by the hospital, if the hospital is affiliated with a medical school, hospital bed size, and the burden of community-onset CDI in patients admitted to the hospital. Adjusting for these factors provides for a more accurate comparison of hospitals’ infections.
Currently, there are no risk-adjusted SIRs for long-term acute care (LTAC) and rehabilitation hospitals, thus we report the HO and HA CDI rates and whether a hospital uses the polymerase chain reaction test (PCR) to detect CDI, as in previous report. The sensitivity of the PCR test, i.e. the ability of the test to detect C. difficile when present, can be as much as two times greater than other laboratory methods. Rates for LTAC and rehabilitation hospitals that use PCR have not been adjusted to account for this difference in laboratory test sensitivity.
Definitions, including methods associated with this release are summarized in Technical Notes (see link below).
What’s in key findings? This document summarizes the key findings from this report including introduction, important results, and key public health actions and messages.
The data in this report are presented in the following tables. CDI SIR or incidence rates are provided for all hospitals that reported 12 months of data for the reporting period.
What is in the technical notes? The Technical Notes contain information on the data sources, definitions, quality assurance and control, data presentation and statistical analyses associated with this report.
For more information on Clostridium Difficile Infection (CDI) prevention, see CDI Information