title: Development and validation of a Clostridium difficile risk assessment tool.
abstract: The incidence of Clostridium difficile infection has increased rapidly during the past decade, increasing lengths of stays in the hospital, costs, and mortality rates. To address this increased incidence, we performed a retrospective case-control study using known risk factors to develop a tool to determine which patients are at risk for infection. Multivariate analysis generated a combination of risk factors associated with development of infection including prior admission, endoscopy within 30 days, cephalosporin/fluoroquinolone use, length of stay 7 days or longer, age 65 years or older, body mass index less than 25, and albumin level less than 2.7 g/dL. A weighted scoring tool was created that predicted disease with a sensitivity of 86% and a specificity of 44% in the derivation sample, and 92% sensitivity and a specificity of 39% when applied to the validation sample. Application of this 8-item tool by nurses in multiple settings could aid in the determination of patients who are at risk, allowing prophylactic treatment, prompt isolation of patients, restricted antibiotic use, and decreased testing of low-risk patients.
authors.affiliation: Lisa Ann Smith is Critical Care Float Nurse, Allina Health-United Hospital, 333 North Smith Ave, St Paul, MN 55102 (lisa.smith@allina.com). Chi-Keung Chan is Assistant Professor, Department of Counseling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong. Margo Halm is Director Nursing Research, Professional Practice and Magnet, Salem Hospital, Salem, Oregon. Wendolyn Slattery is Medical Director of Infection Control, Allina Medical Clinic, Coon Rapids, Minnesota. Ruth Lindquist is Professor, University of Minnesota School of Nursing, Minneapolis. Kay Savik is Senior Statistician, University of Minnesota School of Nursing, Minneapolis.
authors.forename: Lisa Ann
authors.initials: LA
authors.lastname: Smith
authors.forename: Chi-Keung
authors.initials: CK
authors.lastname: Chan
authors.forename: Margo
authors.initials: M
authors.lastname: Halm
authors.forename: Wendolyn
authors.initials: W
authors.lastname: Slattery
authors.forename: Ruth
authors.initials: R
authors.lastname: Lindquist
authors.forename: Kay
authors.initials: K
authors.lastname: Savik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity