Indicator Definition

Transcription

1 Hospital Acquired Clostridium difficile Infection (CDI) Rate Full data definition sign-off completed. Name of Measure Name of Measure (short) Domain Type of Measure Business Context Rationale Hospital Acquired Clostridium difficile Infection rate: - all new CDI cases that develop while the person is in an acute care hospital in Alberta: incident cases per 10,000 patient-days Hospital Acquired Clostridium difficile infection rate The incidence of newly reported cases of Clostridium difficile infection (CDI) acquired by patients in acute care hospitals in Alberta: incident cases per 10,000 patient-days Health Services Delivery Dimensions: Safety Outcome Measure CDI is reported to the Health Protection Branch at Alberta Health as well as to the provincial Infection Prevention and Control (IPC) Surveillance Committee and the Provincial IPC Committee. Province-wide CDI reporting was identified as a major Infection Prevention and Control indicator for Accreditation in All individuals with a CDI are monitored and placed on additional isolation precautions while in hospital until their diarrhea resolves. Alberta Health Services (AHS) and Covenant Health (CH) has chosen to focus on 2 CDI measures: 1) The Hospital-acquired CDI rate which reflects acquisition and/or development of CDI in hospital, 2) Total CDI cases which reflects the burden of CDI in hospitals, because it also includes severe community-acquired disease requiring hospitalization. Notes for Interpretation Organizational Strategy Benchmark Comparisons The use of these two measures for CDI was approved by the Provincial Infection Prevention and Control Surveillance Committee (December 2011) and the provincial IPC Committee (January 2012) as the most valid and reliable measures of Clostridium difficile infections in AHS/CH hospitals. Hospital-acquired CDI Rate all newly reported cases of CDI that developed while a patient was in an acute care hospital. The patient must be admitted for longer than 72 hours before case can be classified as hospital-acquired. Develop strategy for achieving compliance with Alberta Health IPC Standards. National or International comparisons available: The CNISP rate does not include cases admitted to alternate level of care wards, transitional care wards and psychiatry ward/units within acute care facilities; however, these cases are included in AHS/CH surveillance since they cannot be excluded from the denominator provided. It is expected that these are subtle differences and that the CNISP rate is equivalent to the AHS/CH rate for HA-CDI. In Alberta, CDI cases are uncommon on these units. The AHS/CH hospital-acquired CDI rates can be compared with rate from the Canadian Nosocomial Infection Surveillance Program (CNISP). This reflects hospital acquisition. They have a reported a CDI rate of 6.3 cases per 10,000 patient-days for 2010 (CNISP personal communication). Page 1 of 5

2 Cited References: Canadian Nosocomial Infection Surveillance Program (CNISP). Updates on CNISP CDI Activities, 2011 (Power point presentation, available on request from the IPC Surveillance group). CNISP, Clostridium difficile infection (CDI) Surveillance Protocol December 2011 Alberta Health Infection Prevention and Control Standards: Page 2 of 5

3 Technical Specifications Metric Preferred Display Format 99.9 New Cases per 10,000 patient-days. Number of new reported cases of Clostridium difficile infection (CDI) acquired by patients in acute care hospitals in Alberta. Inclusion Criteria for A patient is identified as a CDI case if: Patient has diarrhea laboratory confirmation of a positive toxin for C.difficile (toxin assay, PCR or other testing) Has fever WITH abdominal pain and/or ileus laboratory confirmation of a positive toxin for C.difficile (toxin assay, PCR or other testing) Physician diagnosis based on pseudomembranes on endoscopy (sigmoidoscopy or colonoscopy) or histology/pathology All identified cases require laboratory confirmation of CDI plus the presence of signs and symptoms within AHS/CH. This confirmation is obtained at the reporting site. Primary CDI Infection - Only Primary episodes of CDI are included in the surveillance. first episode of CDI ever experienced, re-infection Exclusion Criteria for Re-infections with CDI Subsequent CDI episode of a hospitalized patient who previously had CDI. A case is re-infected if: the patient meets the criteria for a CDI case the new CDI episode occurs >8 weeks after the first diagnosis date of C.difficile symptoms resolved, and this is a new episode following the first infection, and there have not been intermittent recurrences of symptoms Eight weeks is used as an arbitrary cut-off value used to distinguish between a relapse case from a new episode of CDI. Patients with CDI do not undergo repeated testing until a negative test as a test of cure following treatment. A relapse case from CDI is a patient who has: New symptoms < 8 weeks of the diagnosis date of the previous CDI episode. Symptoms not resolved > 8 weeks of the diagnosis date of the previous CDI episode. Page 3 of 5

4 Data Source(s) for Refresh Rate of Inclusion Criteria for Exclusion Criteria for Data Source(s) for Refresh Rate of Technical Notes Calculation Relationship to Other Indicators Level of Reporting Frequency of Reporting Limitations Diagnostic Laboratories Patient Charts/kardex Electronic Health Records Pharmacy records Patient symptoms and laboratory results typically define a case. The use of pharmacy and other health records help to classify the cases as hospital or community acquired. Quarterly Number of patient-days in acute care hospitals in Alberta All patient-days This is hospital admissions information systems via Alberta Health Services Data Repository for Reporting (AHSDRR) Quarterly The methodology is based on the Surveillance of Clostridium difficile infection (CDI) Surveillance Protocol December (Total Number of new hospital-acquired Clostridium difficile infections identified / number of patient-days) * 10,000 Total Clostridium difficile infections: all new cases of Clostridium difficile infection (CDI) diagnosed in hospital, regardless of where it was acquired. Provincial, Zone, Site Annually, Quarterly The definitions and methodology used for CDI surveillance are standardized to those used by the Canadian Nosocomial Infection Surveillance Program (CNISP). Capture is close to 100% because patients must have a positive toxin test/culture to be classified as having CDI. All toxin/culture positive cases for Clostridium difficile occurring in hospital are investigated to determine if the patient has signs and symptoms of CDI. Each case is assessed by an Infection Control Practitioner as they occur and those patients with signs and symptoms of CDI are placed on additional isolation precautions. All positive culture reports are either printed in the IPC office or are available through the site laboratory systems. The validity and reliability of the data presented are very high. Cases are reviewed and submitted from the individual site Infection Prevention and Control (IPC) Programs within 15 days after the end of the 30 day outcome observation period to IPC Surveillance. Data are reviewed, validated and compiled by the IPC Surveillance Team. Reports are approved by the provincial IPC Surveillance Committee and the Provincial Infection Prevention and Control Committee prior to publication. Only cases of CDI for which no laboratory specimen was collected would be missed. Standard practice is to collect and submit specimens on any patients who have unexplained diarrhea. Page 4 of 5

5 Document Version History Version Version Date Summary of Changes 1.0 May 18, 2010 Final version for initial use. 1.1 May 27, 2010 Transfer to final approved version. 1.2 June 7, 2010 Waiting for discussion and approval by Province-wide Surveillance Committee on June 24, August 10, 2011 Update based on ARO Surveillance Protocol - ARO June 2010.pdf. 1.4 August 11, 2011 Add documentation lead contact information. 1.5 October 18, 2011 Revised to reflect implementation of definitions and reporting 1.6 October 19, 2011 Revisions and questions. 1.7 October 24, 2011 Revisions in response to questions 1.8 January 24, 2012 Remove field definitions, formatting. 1.9 July 6, 2012 Updated signatories, naming convention. Updated Domain to reflect current Performance Measurement Framework. Target removed from Rationale. 2.0 July 13, 2012 Changes made, comments/questions inserted as part of quality review 2.1 July 27, 2012 Updated Business Context, Data source for numerator, data steward for numerator 2.2 August 2, 2012 Revisions made to document 2.3 August 9, 2012 Additional minor revisions upon review by Alberta Health 2.4 August 28, 2012 Updated denominator source acronym. 2.5 August 28, 2012 Tracked changes removed 3.0 August 28, 2012 Version ready for signoff 3.1 Full data definition signoff completed. Page 5 of 5