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A Novel Approach to Correcting Attribution of Clostridioides difficile in a Healthcare Setting

Doyle, Hunter Haese (2023) A Novel Approach to Correcting Attribution of Clostridioides difficile in a Healthcare Setting. Master Essay, University of Pittsburgh.

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Background: National Healthcare Safety Network (NHSN) guidelines define a Clostridioides difficile healthcare-associated infection (HAI) as a positive specimen collected on hospital day ≥3; this definition may not accurately reflect where acquisition of the organism or antibiotic “trigger” for development of symptomatic infection occurred. We developed a novel C.difficile attribution measure and compared this to the “conventional” NHSN attribution metric.
Methods: C.difficile events at two acute care facilities (A and B) from 7/2019-12/2021 were analyzed. The attribution metric ascribes one day of attribution to the unit where the patient was located for that day, for each of the 14 days preceding the diagnosis. We correlated the C.difficile NHSN HAI rate with the attribution measure, by inpatient unit-month, stratified by facility and unit types (intensive care unit [ICU] and non-ICU). Both measures were normalized as a percent of the C.difficile attribution for each facility, monthly. We also used the monthly difference in C.difficile percent attribution (NHSN-defined attribution minus novel attribution measure) for each unit to qualitatively assess trends in differences between the measures.
Results: During the 30-month study period, there were 727 NHSN-adjudicated C.difficile HAI events; the novel metric attributed 15,904 days of responsibility. The correlation coefficients for the non-ICU units were 0.80 (95%CI, 0.78-0.83) and 0.74 (95%CI, 0.70-0.78) and for ICU units were 0.76 (95%CI, 0.70-0.81) and 0.70 (95%CI, 0.60-0.77) at facilities A and B, respectively. For all four stratifications (ICU/non-ICU, facility A/B), the distribution of difference in percent attribution showed higher median attribution using NHSN than the novel metric in 21% (12/56) of total units. The remainder of units had a median difference of zero; no units had a difference in medians of <0.
Discussion: The novel C. difficile attribution metric shifts attribution from acute care units to other healthcare and community settings, and correlates modestly with NHSN methodology of attribution. The attribution metric is sufficiently different that if accurate, may provide a better indicator of where to implement C. difficile reduction efforts, which has public health significance as it can lead to a decrease in infections and death due to C. difficile.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Doyle, Hunter HaeseHHD7@pitt.eduHHD7
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairGlynn, Nancy Wepidnwg@pitt.eduNWGUNSPECIFIED
Committee MemberSnyder, Grahamsnydergm3@upmc.eduUNSPECIFIEDUNSPECIFIED
Committee MemberBerg, Madelinemasonml@upmc.eduUNSPECIFIEDUNSPECIFIED
Date: 4 January 2023
Date Type: Completion
Number of Pages: 35
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 04 Jan 2023 14:56
Last Modified: 04 Jan 2023 14:56


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