C. difficile infection case counts and rates of community onset-healthcare associated, by Sub ICB Location (SICBL) and year

C. difficile infection in patients with a positive specimen taken on day 2 or less of admission (with day 1 as day of admission), and a prior healthcare interaction at the same Trust within the last 28 days. Including all patients aged 2 years and above, diagnosed by one of the following five methods: 1. Diarrhoeal stools (Bristol Stool types 5-7) where the specimen is C. difficile toxin positive* 2. Toxic megacolon or ileostomy where the specimen is C. difficile toxin positive* 3. Pseudomembranous colitis revealed by lower gastro-intestinal endoscopy or Computed Tomography 4. Colonic histopathology characteristic of C. difficile infection (with or without diarrhoea or toxin detection) on a specimen obtained during endoscopy or colectomy 5. Faecal specimens collected post-mortem where the specimen is C. difficile toxin positive or tissue specimens collected post-mortem where pseudomembranous colitis is revealed or colonic histopathology is characteristic of C. difficile infection Data is available by Sub ICB ([Integrated Care Board]) location. ## Rationale Surveillance of C. difficile laboratory faecal samples in England and Wales was introduced in 1990 as part of the Public Health Laboratory Service’s voluntary monitoring of infectious diseases. Between 1990 and 2004, there was a rise in the number of C. difficile infections, from less than 3,000 in 1990 to more than 45,000 in 2004. Rates of C. difficile infections also rose over this time period in all age groups ≥40 years old. Due to the increasing incidence of C. difficile infections, the mandatory reporting of C. difficile infection in people aged ≥65 years was introduced in England in January 2004. This was a quarterly aggregate data return reported by NHS acute Trusts comprising data on the number of toxin-positive C. difficile faecal samples. Due to the continued rise of C. difficile infections among the population aged ≥65 years, the C. difficile mandatory surveillance scheme was enhanced in April 2007 to be patient-level and to cover all C. difficile infections in patients aged 2 years and over. Prior healthcare interactions were introduced in April 2017 as a means to determine any prior healthcare interactions from the same Trust. A low value is indicative of a low rate of C. difficile community-onset healthcare-associated cases. ## Caveats These data do not provide a basis for decisions on the clinical effectiveness of infection control interventions in individual Trusts: further investigations considering potential confounders would need to be undertaken before this could be done. Nor do these data provide a basis for comparisons between acute Trust or SICBLs. Rate information, using rate calculations as currently defined, is not appropriate for comparison. The counts of infections have not been adjusted to give a standardised rate considering factors such as organisational demographics or case mix. Rate information is of use for comparison of an individual organisation over time. ‘All reported cases’ refers to all toxin-positive results for C. difficile infections that are detected by the Trust whose laboratory processed the specimen. It is important to note that this does not necessarily imply that the infection was acquired there. Confidence intervals for rates are not currently calculated because appropriate methods for comprehensive coverage are being assessed. Cases that the UKHSA’s HCAI Data Capture System attributes to a commissioning hub (such as the national commissioning hub, 13Q, or one of the regional Health & Justice commissioning hubs) are not featured in sub ICB Location dashboards but they do still contribute to the highest spatial level—the England national total. This means the England case total & rates may be slightly higher than the sum of all sub ICB Location cases & rates. IMPORTANT NOTE: CCG calculations for the period between January 2021 and January 2022 have been based on SICBL boundaries. As such, some SICBLs may experience higher or lower rates than expected due to this change. Those SICBLs affected are: Bassetlaw, Glossop, East Leicestershire and Rutland, Lincolnshire, Cambridgeshire and Peterborough, Birmingham and Solihull, Black Country and West Birmingham, and Oundle.