This dataset shows the Center for Disease Control and Prevention National Healthcare Safety Network (NHSN) of hospital onset (HO) Clostridium difficile infections (CDI) reported by California general acute care, long-term acute care and rehabilitation acute care hospitals. CDI cases are classified as HO when the positive stool sample is obtained on day four or later during the hospital stay. Risk factors found to be significant in predicting HO CDI incidence include the type of CDI test used by the hospital, if the hospital is affiliated with a medical school, hospital bed size, and the burden of community-onset CDI in patients admitted to the hospital.
Facility Types: 1) Acute Care Hospitals: Critical access acute care hospital (CAH; defined as certain facilities that participate in Medicare and that are designated by states through a protocol)
2) Rehabilitation (REHABs) acute hospitals are hospitals with inpatient wards for evaluation and restoration of function to patients who have lost function due to acute or chronic pain, musculoskeletal problems, stroke, or catastrophic events resulting in complete or partial paralysis. These hospitals were self-identified through National Healthcare Safety Network (NHSN).
3) Long-term acute care hospitals (LTACs) are defined by the Centers for Medicare and Medicaid Services as providing care to patients with medically complex conditions requiring an average length of stay greater than 25 days.
General Acute Care Hospitals Methods: The HO CDI standardized infection ratios SIR, which adjusts for significant risk factors, is calculated by comparing the number of CDI that occurred (or were observed) in the hospital to the number that would be predicted based on the national referent CDI rate data. Adjusting for these factors provides for a more accurate comparison of hospitals’ infections. Hospitals with NHSN-predicted number of HO CDI cases <1 had no SIRs calculated by NHSN. A SIR was calculated by CDPH if the predicted number of infections was =0.2. The SIR and its comparison are not as accurate as SIRs based on a larger number of predicted infections. For each hospital with a CDI SIR, we performed a statistical analysis to determine if the observed number of infections was significantly different than the predicted number. Based on our statistical analysis we labeled each hospital’s CDI SIR as indicating:
• No Difference - no difference in number of observed and predicted infections,
• Higher - higher or more infections than predicted, or
• Lower - lower or fewer infections than predicted.
The SIRs cannot be compared across hospitals because of "indirect" standardization methodology used in calculating the SIRs.
REHABs and LTACs Methods: The REHAB and LTAC hospital onset (HO) CDI rate is calculated by dividing the number of HO CDI cases by the total inpatient days; the rate is then reported per 10,000 patient days. The rates are not risk adjusted and may reflect factors in the hospital that can affect the occurrence of CDI, such as transmission of the C. difficile bacteria and use of antimicrobials. Differences in rates for hospitals can result from differences in laboratory testing methodology, patient populations, infection and transmission prevention practices, antibiotic utilization, and/or community onset rates of CDI. HO CDI rate in LTAC hospitals is provided separately from the rates in REHABs. Patients in LTAC hospitals have longer lengths of stay, an established risk factor for CDI. Also, specifically for LTAC and REHABs, we include whether a hospital uses the polymerase chain reaction test (PCR) to detect CDI. In this table, hospital rates of CDI for LTAC hospitals have not been adjusted to account for the differences in sensitivity between PCR and other laboratory testing methods; therefore, rates from hospitals using different types of laboratory tests are not comparable.
To link the CDPH facility IDs with those from other Departments, like OSHPD, please reference the "Licensed Facility Cross-Walk" Open Data table at https://data.chhs.ca.gov/dataset/licensed-facility-crosswalk.
Health and Safety Code section 1288.55(a)(1) requires general acute care hospitals to report to the California Department of Public Health (CDPH) all cases of CDI identified in their facilities. The data are submitted by California hospitals to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). For more information on data collection processes and methods, please see the "CDI Technical Notes" of the healthcare-associated infections (HAI) report at: https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/AnnualHAIReports.aspx
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