Clostridium difficile (C. difficile) Laboratory Practice

Appendix M5
Clostridium difficile (C. difficile) Laboratory Practice Survey
INTRODUCTION
Form Approved
OMB No. 0920-XXXX
Exp. Date xx/xx/20xx
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 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
[email protected].
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 (0920XXXX).

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 Microbiology Issues Update
Microbe, ASM's monthly news magazine
Other (please specify)

* 5. CLIA #:

* 6. Did you already complete this survey?
Yes

If answered "Yes", respondents have completed survey.

No

7. Date:
MM
12/05/2015

DD

/

YYYY

/

Clostridium difficile (C. difficile) Laboratory Practice Survey
DEMOGRAPHICS

* 8. Which of the following best describes your laboratory setting? (Select the best choice.)
University hospital/Academic medical center
City/County/State Hospital
Military/VA Hospital
Other type of hospital that is not listed above
Independent laboratory
Public Health Department,non-hospital
Physician office/ambulatory care laboratory
Other (please specify)

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

* 10. How many pathologists or other physicians are in your laboratory? (Do not include residents,
fellows or trainees/medical students.)

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

Clostridium difficile (C. difficile) Laboratory Practice Survey
DEMOGRAPHICS
* 12. My institution is
hospital based.
non-hospital based.

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

Clostridium difficile (C. difficile) Laboratory Practice Survey
DEMOGRAPHICS
* 14. How many hospital beds does the microbiology section serve?
>500 beds
101-500 beds
50-100 beds
<50 beds
Only have outpatients

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

Clostridium difficile (C. difficile) Laboratory Practice Survey
DEMOGRAPHICS
* 16. Are any of your laboratory staff currently members of the American Society for Microbiology
(ASM)?
Yes
No

If answered "No" or "Do not know",
respondents skip to question 18.

Do not know

Clostridium difficile (C. difficile) Laboratory Practice Survey
DEMOGRAPHICS

* 17. Do any of those members subscribe to (select all that apply)--

ASM's ClinMicroNet listserv
ASM's DivCNet listserv
No, do not subscribe
Do not know

* 18. Does the microbiology laboratory have a doctoral-level clinical scientist or consultant?
Yes

If answered "No", respondents skip to question 20.

No

Clostridium difficile (C. difficile) Laboratory Practice Survey
DEMOGRAPHICS
* 19. What is their board certification? (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)
Ph.D., other board certified
Ph.D., non-board certified
ABP (American Board of Pathology) Sub-boarded in Medical Microbiology
ABIM (American Board of Internal Medicine) Sub-boarded in Infectious Disease
M.D./D.O.
Do not know
Other (please specify)

Clostridium difficile (C. difficile) Laboratory Practice Survey
CURRENT PRACTICE
* 20. Do you test for C. difficile?
Yes

If answered "No", respondents have completed

No

the survey.

Clostridium difficile (C. difficile) Laboratory Practice Survey
CURRENT PRACTICE
* 21. Do you use more than one testing strategy depending on your patient population/clinical
setting?
Yes
No

Clostridium difficile (C. difficile) Laboratory Practice Survey
CURRENT PRACTICE
* 22. Which population(s)/clinical setting(s) do you have more than one testing strategy?

Clostridium difficile (C. difficile) Laboratory Practice Survey
CURRENT PRACTICE
For the following two questions, the abbreviations stand for -NAAT: Nucleic Acid Amplification Test
GDH: Glutamate Dehydrogenase
EIA: Enzyme Immunoassay

* 23. Which of the following is your primary testing strategy?
NAAT as a stand alone test
NAAT as a component of a multiplex assay
EIA alone
Culture
Toxigenic culture
GDH --> EIA
GDH --> EIA --> NAAT
GDH + EIA --> NAAT
GDH --> NAAT
EIA --> NAAT
NAAT --> EIA for toxin production
Other (please specify)

* 24. Which of the following is your secondary testing strategy?
NAAT as a stand alone test
NAAT as a component of a multiplex assay
EIA alone
Culture
Toxigenic culture
GDH --> EIA
GDH --> EIA --> NAAT
GDH + EIA --> NAAT
GDH --> NAAT
EIA --> NAAT
NAAT --> EIA for toxin
Do not have a secondary testing strategy
Other (please specify)

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

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

* 26. What is your average turn-around-time for the first result in your algorithm?

* 27. What is your average turn-around-time for the second result in your algorithm? (Enter N/A if a
second test is not performed.)

* 28. Do you know what percent of your tests are positive?
Yes

If answered "No", respondents skip to question 30.

No

Clostridium difficile (C. difficile) Laboratory Practice Survey
CURRENT PRACTICE
* 29. What is the approximate percent?

* 30. Do any of your clients perform fecal transplants?
Yes
No