Form 0920-1096 Clostridium difficile (C. difficile) Laboratory Practice

2018 Clostridium difficile (C. difficile) Laboratory Practice Survey
INTRODUCTION

Form Approved
OMB No. 0920-1096
Exp. Date 01/31/2019
Purpose of the Survey: This survey is being performed for the Centers for Disease Control and Prevention
(CDC) and the American Society for Microbiology (ASM) to understand laboratories' current microbiological
practices related to improving diagnosis and management of patients with Clostridium difficile (C. difficile)
infection. This survey will take approximately 20 minutes to complete.
Security Information: All information collected in this survey will be kept in a secure manner. We ask you to
include your CLIA number to ensure that only one response/paired response per laboratory is recorded.
We also ask you to include your email address to follow-up if needed. Your CLIA number and email
address will not be stored in a database and they will not be linked to your survey responses. Your IP
address will NOT be retained.
Participation is voluntary; you are free to withdraw from this survey at any time. If at any point you do not
want to continue, you can simply leave this website. If you do not click on the “done" button at the end of
the survey, your answers and participation will not be recorded.
Asterisks (*): Questions marked with an asterisk require an answer before you can proceed to the next
question.
How the findings will be used: The results from the survey will be compiled and shared in aggregate as a
learning tool, presented at professional conferences, and potentially published in a professional journal in
the field of laboratory science.
Contact Information: If you have concerns or questions about this survey please address them to
clinmicro@asmusa.org.
Agreement: By beginning the survey, you acknowledge that you have read this information and agree to
participate in this survey, with the knowledge that you are free to withdraw your participation at any time
without penalty.
Public reporting burden of this collection of information is estimated to average 20 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. An agency may not conduct or
sponsor, and a person is not required to respond to a collection of information unless it displays a currently
valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to CDC/ATSDR Information
Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (09201096).

Thank you for taking the time to complete this CDC and ASM survey. Your feedback is important for
guiding CDC and ASM in their efforts to understand current laboratory C. difficile practice. The survey
should take approximately 20 minutes of your time. All answers will remain completely anonymous.

* 1. Position/Title of Person Completing Survey:

* 2. Email address:

* 3. Laboratory Name:

* 4. How did you learn about this survey?
Laboratory Response Network Request
ClinMicroNet
DivCNet
Clinical and Public Health Microbiology Newsletter
Microcosm, ASM's monthly news magazine
Laboratory Outreach Communication System (LOCS)
Other (please specify)

* 5. Were you aware of the ASM-CDC published guideline "A Laboratory Medicine Best Practices
Systematic Review and Meta-Analysis for the Laboratory Diagnosis of Clostridium difficile" before
receiving this survey?
Yes
No

* 6. CLIA #

* 7. Did someone from your laboratory complete the initial C. difficile survey in 2016?
Yes
No
Do not know

8. Today's date:

12/05/2015

MM/DD/YYYY

2018 Clostridium difficile (C. difficile) Laboratory Practice Survey
DEMOGRAPHICS

* 9. Which of the following best describes your laboratory setting? (Select the best choice.)

University Hospital
Academic/Teaching Medical Center (includes association with a medical school and residency training program)
City/County/State Hospital
Military/VA Hospital
Community Hospital/Health System (non-federal, short term general hospital)
Specialty Hospitals (e.g., women's, eye, heart, orthopaedic)
Other type of hospital that is not listed above
Independent Laboratory/Reference Laboratory
Public Health Department, non-hospital
Physician Office/Ambulatory Care Laboratory
Other (please specify)

* 10. How would you characterize your institution?
For profit
Non-profit

11. How many pathologists or other physicians provide direct oversight in your laboratory? (Do not
include residents, fellows or trainees/medical students.)

* 12. Is your laboratory located in an institution that provides direct patient care?
Yes
No

* 13. My institution is
hospital based.
non-hospital based.

Skip logic: if non-hospital based, skip to question 15.

2018 Clostridium difficile (C. difficile) Laboratory Practice Survey
DEMOGRAPHICS

* 14. How many hospital beds does the microbiology section serve?
>1,000 beds
501-1,000 beds
101-500 beds
50-100 beds
<50 beds
Only have outpatients

2018 Clostridium difficile (C. difficile) Laboratory Practice Survey

* 15. What kind of patient population is at your institution? (Select all that apply.)
Inpatient
Outpatient
Other (please specify)

* 16. What agency accredits your institution? (Select all that apply.)
AABB
American Association for Laboratory Accreditation
American Osteopathic Association/Healthcare Facilities Accreditation Program (AOA/HFAP)
American Society for Histocompatibility and Immunogenetics
COLA
College of American Pathology
Joint Commission
Do not know

* 17. What is your laboratory's zip code?

* 18. Are any of your laboratory staff currently members of the American Society for Microbiology
(ASM)?
Yes
No
Do not know

* 19. Does the microbiology laboratory have a doctoral-level (e.g. Ph.D., M.D., D.O., etc) clinical
scientist or consultant?
Yes
No
Do not know

Skip logic: if no, skip to question 21.

2018 Clostridium difficile (C. difficile) Laboratory Practice Survey

* 20. What is their board certification (e.g. ABP, ABMM, HCLD, BCLD, ABB, etc.)? (Select all that
apply.)
D(ABMM) Diplomate, American Board of Medical Microbiology
D(ABB) Diplomate, American Board of Bioanalysis, HCLD (High Complexity Laboratory Director)
D(ABB) Diplomate, American Board of Bioanalysis, BCLD (Bioanalyst Clinical Laboratory Director)
ABCC – American Board of Clinical Chemistry
ABFT – American Board of Forensic Toxicology (limited to individuals with a doctoral degree)*
ABHI – American Board of Histocompatibility and Immunogenetics
ABIM (American Board of Internal Medicine)
ABMGG – American Board of Medical Genetics and Genomics (formerly known as American Board of Medical
Genetics (ABMG))
D(ABMLI) – American Board of Medical Laboratory Immunology
ABP (American Board of Pathology) boarded in Medical Microbiology
NRCC – National Registry of Certified Chemists (limited to individuals with a doctoral degree)
Do not know
Other (please specify)

2018 Clostridium difficile (C. difficile) Laboratory Practice Survey
CURRENT PRACTICE

* 21. Do you test for C. difficile?
Yes
No

Skip logic: if no, end survey.

2018 Clostridium difficile (C. difficile) Laboratory Practice Survey
CURRENT PRACTICE

* 22. Do you provide instructions (written, verbal or computer) to your healthcare providers against
sending stools for C. difficile testing if the patient is on laxatives?
Yes
No
In the process of making changes based on the ASM-CDC guideline
Do not know

* 23. Do you reject formed stools for C. difficile testing?
Yes
No
In the process of making changes based on the ASM-CDC guideline
Do not know

* 24. Does your laboratory have a policy to reject repeat stool specimens within seven days forC.
difficile testing?
Yes
No
In the process of making changes based on the ASM-CDC guideline
Do not know

* 25. Does your laboratory have a policy to reject stool specimens forC. difficile “test of cure”
testing?
Yes
No
In the process of making changes based on the ASM-CDC guideline
Do not know

* 26. Does your laboratory require a patient to have three liquid stools within 24 hours to be
acceptable for C. difficile testing?
Yes
No
In the process of making changes based on the ASM-CDC guideline
Do not know

* 27. Do you use more than one testing strategy depending on your patient population/clinical
setting?
Yes
No

Skip logic: if no, skip to question 29.

2018 Clostridium difficile (C. difficile) Laboratory Practice Survey
CURRENT PRACTICE

* 28. Which population(s)/clinical setting(s) do you have more than one testing strategy?

2018 Clostridium difficile (C. difficile) Laboratory Practice Survey
CURRENT PRACTICE

For the following two questions, the abbreviations stand for -NAAT: Nucleic Acid Amplification Test (such as PCR, LAMP and other amplification methods)
EIA: Enzyme Immunoassay (including lateral flow)
GDH: Glutamate Dehydrogenase EIA (including lateral flow)
Toxin: Enzyme Immunoassay or lateral flow Assay
--> means followed by. i.e.: Test 1 followed by (-->) Test 2 in a defined algorithm
* 29. Which of the following is your primary testing strategy?
NAAT as a stand alone test
NAAT as a component of a multiplex assay (e.g., BioFire, Cepheid, Luminex, etc.)
Toxin alone
Culture alone
Toxigenic culture
Cell Cytotoxity Neutralization Assay (CCNA)
GDH --> Toxin
GDH + Toxin (together) --> NAAT
GDH --> Toxin --> NAAT
NAAT --> Toxin
Toxin --> NAAT
GDH --> NAAT
Other (please specify)

* 30. Which of the following is your secondary testing strategy?
NAAT as a stand alone test
NAAT as a component of a multiplex assay (e.g., BioFire, Cepheid, Luminex, etc.)
Toxin alone
Culture alone
Toxigenic culture
Cell Cytotoxity Neutralization Assay (CCNA)
GDH --> Toxin
GDH + Toxin (together) --> NAAT
GDH --> Toxin --> NAAT
NAAT --> Toxin
Toxin --> NAAT
GDH --> NAAT
Do not have a secondary testing strategy
Other (please specify)

2018 Clostridium difficile (C. difficile) Laboratory Practice Survey
CURRENT PRACTICE

* 31. Which shifts do you perform testing for C. difficile? (Select all that apply.)
Day
Afternoon/Evening
Late Evening/night

* 32. What is your average turn-around-time for the initial result in your algorithm? (Use whole
numbers to represent hours from 1 hour to 96.)
0

Hours

96

* 33. If you use more than one test in your algorithm, what is your average turn-around-time for the
second result in your algorithm? (Enter "0" into the box on the right if a second test is not
performed.)
0

Hours

96

* 34. If you use more than two tests in your algorithm, what is your average turn-around-time for the
third result in your algorithm? (Enter "0" into the box on the right if a third test is not performed.)
0

Hours

* 35. How many stool specimens do you test annually?
0 - 100
101 - 500
501 - 1,000
1,001 - 5,000
5,001 - 10,000
> 10,000
Do not know

96

* 36. Do you know what percentage of your stool specimens are positive for C. difficile?
Yes
No

Skip logic: if no, skip to question 38.

2018 Clostridium difficile (C. difficile) Laboratory Practice Survey

* 37. What percent of your stool specimens are positivefor C. difficile?
0

50%

100%

2018 Clostridium difficile (C. difficile) Laboratory Practice Survey
CURRENT PRACTICE

* 38. Do any of your clients perform fecal transplants?
Yes
No
Do not know