Asymptomatic C. difficile Carriage

With increasing recognition of asymptomatic Clostridium difficile carriers among hospitalized adults, questions have risen regarding whether screening for carriage plays a role in C. difficile infection (CDI) prevention. Although there are no current recommendations regarding testing, management, or benefit of infection control measures for such patients, there are anecdotal reports of practice variation.

The purpose of this survey is to understand current practices addressing asymptomatic C. difficile carriage among adult inpatients.

If you see patients at more than one institution, please respond based on your experience with your primary hospital (the institution at which you spend the most time).

References: Clin Infect Dis 2013; Am J Infect Control 2013; Clin Infect Dis 2014; Infect Control Hosp Epidemiol 2014; JAMA Intern Med 2016; Am J Infect Control 2015.

Name:                                                                       EIN ID: Approximately how many patients with symptomatic C. difficile (CDI) infection have you seen in the past six months? None        1-10        11-25        26-50        >50 What test(s) are used to diagnose symptomatic CDI in your primary hospital? Single test                                                            [Select all that apply]      C. difficile included in a GI panel of multiple pathogens (e.g. Biofire)      Nucleic acid amplification test (NAAT) only, e.g. PCR or LAMP      Enzyme immunoassay (EIA) for toxin only      Combined EIA for glutamate dehydrogenase (GDH) assay and toxin      Toxigenic culture (C. difficile culture followed by detection of toxins) Multi-step algorithm      GDH EIA followed by cell cytotoxicity neutralization assay or toxin EIA (if GDH positive)      GDH EIA followed by NAAT (if GDH positive)      NAAT followed by EIA for toxin (if NAAT positive)      Combined GDH/toxin EIA, followed by NAAT for discrepant results Other, specify:  Not sure Does your primary hospital routinely test any patient populations for asymptomatic carriage of C. difficile?  Yes            No -- STOP HERE and submit survey. Thank you. On what basis are patients selected for asymptomatic carriage screening? Hospital-wide                                                 [Select all that apply] Selected unit(s): ICU(s)     Oncology +/- HCT      Other, specify:  Admission source:   Emergency dept         Long-term care / nursing home Long-term acute care facility          Other, specify:   Previous history of CDI  Other, specify:   Not sure Which specimen types are tested for asymptomatic carriage?     [Select all that apply]  Rectal swab        Perirectal swab        Not sure         Other, specify:  Do any of the following actions occur when asymptomatic carriage of C. difficile is detected?  Gloves required prior to patient contact                    [Select all that apply]  Gowns required prior to patient contact  Requirement for single patient room  Bedside commode or dedicated toilet facilities  Patient cohorting  Enhanced environmental cleaning (e.g. frequency and/or type of disinfectant)  Administration of probiotics  None of the above  Other, specify:   Not sure a. Do patients with asymptomatic carriage receive prophylaxis in your primary hospital (i.e. get started on antibiotics for C. difficile even if not having diarrhea)?  Yes            No            Not sure            It varies, specify how:      b. If yes, which drug(s)? Oral vancomycin Metronidazole Provider's choice, specify:     c. If yes, when? When carriage identified    When other antibiotics started Other:  What actions are taken if an asymptomatic carrier develops diarrhea?     [Select all that apply]  Repeat C. difficile testing  Empiric treatment without repeat testing  Depends on presence of other causes of diarrhea  Other, specify:   Not sure a. Are asymptomatic carriers reported to the National Healthcare Safety Network (NHSN)?  Yes        No        Not sure     b. If yes, WHEN are asymptomatic carriers reported to NHSN?        While asymptomatic        Whenever they become symptomatic             Reporting to NHSN is based on the date of asymptomatic testing             Reporting to NHSN is based on date of diarrhea onset        Not sure Additional comments about this survey or about asymptomatic carriage and testing: