1. Maureen Spencer, RN, M.Ed., CIC Infection Control Manager New England Baptist Hospital, Boston, MA

4. New Surveillance Definitions

6. Poster we presented at APIC 2007 showing CDI with room association – 28 patients had been in 42 rooms!

7. FY2008 - NEBH Cases Per New Definitions

9. Enhanced Education Transfers between units on stretchers versus contaminated bed Green tag flagging system for cleaned equipment Dinamap baskets with sanicloths and not allowed in precautions rooms Spatial Separation of precaution cases Bleach wipes for all precaution rooms Enhanced cleaning of equipment

11. Comparison of Rates 2008-2009 FY08 Total HAI 21 Patient Days 28914 Rate/10,000 PtDays 7.3 Hospital Onset 13 Rate/10,000 PtDays 4.5 Comm Onset - HA 8 Rate/10,000 PtDays 2.8 FY09 Total HAI 13 Patient Days 28382 Rate/10,000 PtDays 4.6 Hospital Onset 10 Rate/10,000 PtDays 3.5 Comm Onset - HA 3 Rate/10,000 PtDays 1.1

14. Healthcare Facility Acute Care Hospital Rehabilitation Facility Nursing Home Other Chronic Care A case of C. difficile is defined as a case with the symptom of diarrhea without other known etiology. The stool sample will yield a positive result for laboratory assay for C. difficile toxin A and/or B. For purposes of this collaborative, C. difficile is limited to laboratory confirmed cases. This collaborative will track healthcare facility associated C. difficile C. difficile (CDI) Collaborative Definition

15. C. difficile (CDI) Collaborative Definition A patient classified as having a case of healthcare facility associated C. difficile is defined as a patient who develops diarrhea more than 48 hours after admission OR A patient classified as having any symptoms that develop within 48 hours after discharge to another healthcare facility . OR A patient discharged to home with lab confirmed C.diffIcile within 28 days from the day of discharge and no intervening admissions. . (Day of discharge counts as day 0) Also counts if C.difficile is identified on readmission to your facility. If the time of admission and/ or the time of diarrhea onset and/or the time stool was collected are not available, CDI can be considered to be healthcare facility onset if onset of diarrhea, with a positive stool occurs on or after the third calendar day after the day of admission (which is day zero).

16. EACH PATIENT ONLY COUNTS ONCE Within 8 weeks of index diagnosis C. difficile (CDI) Collaborative Definition A patient readmitted after 8 weeks counts as a new patient /case (E.g. Monday admit, day 4 = Thursday) FACILITY HA-CDI RATE # HA CDI cases / 10,000 Patient Days (exclude NICU days)

18. THE END THANK YOU