Surveillance for Clostridium Difficile Infection in Nursing Homes

Objectives To define the time of onset of Clostridium difficile infection (CDI) in the community nursing home setting. Design Retrospective. Setting Four community nursing homes. Participants Residents with incident CDI identified from infection control surveillance records. Measurements Cases were divided into two groups depending on the time of onset of infection: within 30 days of admission after hospitalization or more than 30 days after admission to a nursing home after hospitalization. Results Of 75 incident CDI cases, 52 (69%) developed within 30 days of admission and 23 (31%) more than 30 days after admission. Of the 52 cases that developed within 30 days, 68% were in residents admitted for subacute care. The mean number of days +/- standard deviation to CDI was 10.5 +/- 2.5 in those who developed infection within 30 days; 75% of these cases developed within 15 days of admission. Conclusions The majority of CDI in the study nursing homes developed within 30 days of admission; this group may be analogous to community-onset, hospital-associated CDI as defined in the Centers for Disease Control and Prevention (CDC) surveillance definitions. Therefore, the proposed CDC surveillance definitions may overestimate the incidence of nursing home-associated CDI.