New York State Department of Health: Mandatory Reporting of Clostridium difficile via National Healthcare Safety Network LabID Event – Survey to Determine Testing Methods and Policies

Background:

In 2009, the Center for Disease Control (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.

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 1 for results.

 

Table 1: Summary of C. diff Hospital Survey
	Count	Percent
Is C. diff testing outsourced to a laboratory?
Yes	35	19.6
No	144	80.4
Does the lab routinely perform tests on formed stool specimens?
Yes	46	25.7
No	132	73.7
No answer	1	0.6
Does the lab have a rejection policy for duplicate stool specimens?
Yes	106	59.2
No	68	38.0
No answer	5	2.8
What is the primary test method the lab uses to detect C. diff?
Toxin A and B antibody (ELISA or EIA)	146	81.6
PCR	19	10.6
Glutamate dehydrogenase (GDH) or common antigen	5	2.8
Toxin A antibody only (ELISA or EIA)	3	1.7
Cytotoxin (CTX) assay (Toxin B)	2	1.1
Anaerobic microbiology culture	0	0.0
No answer	4	2.2
Is confirmatory test performed for equivocal test results?
Yes	93	52.0
No	78	43.6
No answer	8	4.4
If not currently using a PCR test method, is there consideration for use? (160 facilities)
No	103	64.4
Yes, start date identified	7	4.4
Yes, start date unknown	41	25.6
No answer	9	5.6

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 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.

¹Gerding 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.