Rhode Island Clostridium difficile infection trends and laboratory ID events ranking.

In January 2013, the Centers for Medicare & Medicaid Services (CMS) began requiring acute-care hospitals to submit any laboratory-identified (“LabID”) Clostridium difficile cases to the Centers for Disease Control and Prevention’s surveillance system, the National Healthcare Safety Network (NHSN).1 By collecting data from acute-care hospitals across the nation, Medicare was able, for the first time, to systematically assess the burden of C. difficile nationwide and to publicly report LabID incidence on Hospital Compare.2 CMS’s requirement to collect C. difficile surveillance data reflects the fact that C. difficile infection (CDI) is a high public health priority—both because of the impact on patients, who suffer diarrhea due to mucosal inflammation and damage3 and because it is the most common healthcare-associated infection (HAI).1,4,5 In 2011, there were 383,498 cases of CDI at hospital discharge in just 36 states with available data.6 The cost of an inpatient CDI is more than $35,000 and estimates of annual medical costs exceed $3 billion nationally.1 The recent inclusion of CDI LabID data in Hospital Compare provides an opportunity to assess Rhode Island’s performance. The objectives of this analysis were to: (1) describe RI’s longitudinal trends in CDI using available historical data, and (2) compare RI’s performance to neighboring states and the nation, using the newly-available LabID events data.