infection CDI has become the most common cause of healthcare associated infections in the United States The Centers for Disease Control and Prevention CDC classified C difficile as an immediate public health threat that requires urgent and aggressive action ID: 783364
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100350736s
Clostridium difficile infection (CDI) has become the most common cause of health-care associated infections in the United States.The Centers for Disease Control and Prevention (CDC) classified C. difficile as an immediate public health threat that requires urgent and aggressive action and causes nearly 500,000 infections each year in the United States, attributing to about 29,000 deaths.To truly understand the burden of CDI and implement proper prevention programs there has to be an effective surveillance system in place to capture valid data. In 2015, the South Carolina Department of Health and Environmental Control made CDI a laboratory reportable condition.
Background
Objective
Methods
Results
Overall, CHESS was found to be a very flexible and stable system with high acceptability. Improving the simplicity of the system would have a positive effect on the other attributes and result in an overall improvement of the surveillance system.
To evaluate CDI surveillance in South Carolina and identify gaps in the surveillance system.
An Evaluation of Clostridium difficile Surveillance in South Carolina, 2015
Colleen Roberts, MPH1,2, Dana Giurgiutiu, PhD, MPH2, Claire Youngblood, MA21CDC/CSTE Applied Epidemiology Fellowship, 2South Carolina Department of Health and Environmental Control, Division of Acute Disease Epidemiology
74.8% of lab reports were received by public health within the requested time frame of three days following a positive C.difficile lab test result (Table 2). The incidence rate of C. difficile was higher in females compared to males and was highest in those aged 65 and older (Table 3).
During the study period, 2887 CDI lab reports were submitted to CHESS.Facilities can submit a CDI lab report via: (i) Electronic Laboratory Reporting (ELR), (ii) manual data entry by external user, or (iii) mailed disease report cards.Completeness of the six demographic variables ranged from 79.7-99.9% compared to a range of 60-100% completeness for the six lab-related variables (Table 1).
Analysis was done on CDI lab reports submitted into the Carolinas Healthcare Electronic Surveillance System (CHESS) from January 1st 2015 through June 30th 2015. The methods of this evaluation were based on the Updated Guidelines for Evaluating Public Health Surveillance Systems published by the CDC. The CHESS attributes assessed were simplicity, flexibility, stability, acceptability, data quality, timeliness, and representativeness.
This study/report was supported in part by an appointment to the Applied Epidemiology Fellowship Program Administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 1U38OT000143-03
CHESS
can accommodate the addition of new conditions with minimum time and resources. The stability of CHESS is marked by its infrequent unplanned outages. CHESS has high user acceptability as overall data quality was high and there was consistency with the number of lab reports submitted each month. CHESS scored high in these three attributes; however, areas of improvement were also identified. The different submission routes create a complex surveillance system and this complexity also influences the attributes of data quality and timeliness.The fact that the data is limited to 6 months and that data comparisons could not be made as this was the first year of CDI data collection are the limitations of this study.This evaluation established the baseline CDI numbers in SC and informed recommendations as SC transitions to a new electronic surveillance system .
Results
Discussion
Table 1. Percent Completeness of Selected Data Fields in Clostridium difficile lab reports submitted to CHESS (N=2887), SC, Jan-June, 2015Demographic VariablesNo. Missing% CompletePatient Last Name199.9Patient First Name199.9Patient DOB799.8Patient Current Gender999.7Patient State of Residence2399.2Patient County of Residence58579.7Lab-related VariablesNo. Missing% CompleteDate of Specimen Collection3198.9Date Received by Public Health0100.0Date of Lab Test26590.8Specimen Source 7297.5Ordering Facility 114260.4Reporting Facility 0100.0
Table 3. Incidence of Clostridium difficile Infections by Demographic Characteristics, SC, January-June, 2015Demographic CharacteristicsSouth Carolina CHESS 2015No. of CasesRate per 100,000*All Cases288762.42Gender Female177774.8 Male110148.93Age Group 1-17 yr13112.12 18-44 yr 37122.22 45-64 yr74259.68 ≥65 yr 1616255.75*The South Carolina population is based on the 2010 U.S. Census
Table 2. Assessment of Timeliness of Clostridium difficile Lab Reports by Method of Submission to CHESS, SC, January-June, 2015Lab Reports Submitted by ELR (N=1529)Lab Reports Entered by DADE via Disease Report Cards (N=994)Lab Reports Manually Entered by External Users (N=364)Date of Lab Test to Date Received by Public HealthNo. of Lab Reports (N=1499)Percent of Lab Reports Mean DaysNo. of Lab Reports (N=942)Percent of LabReports Mean DaysNo. of Lab Reports (N=181)Percent of Lab Reports Mean Days0-3 Days140793.90.3238140.41.617395.61.14-7 Days644.34.929231.05.284.44.98-11 Days161.18.712913.78.900N/A12+ Days120.724.214014.925.300N/A
Conclusions
Acknowledgements