Pilot Test - CDI

Appendix MM4

C. difficile Current Practice Survey

Please read through each survey question with the following elements in mind—

1. Consistency: Question made sense, logical possible responses.

2. Navigation: Easy to move through survey, any technical difficulties.

3. Text: Easy to read.

4. Other: Comments and/or suggestions for how to improve the question (e.g., there was not an answer that fit my laboratory, too few or too many responses).

• If you have no comments on the question, please write “no comment” in the “Other” box.

• If there are more questions fields on the form than you answered, disregard them.

• Keep track of how many minutes it takes you to complete the survey (not the collection form).

Name: ________________________________________________________________

Question	Elements		Specific Observations
21. Do you test for C. difficile? Yes/no
Do you use more than one algorithm depending on your patient population?
Other		More than 1 algorithm, but not dependent on patient population
Which population(s) do you have more than one algorithm? (comment box)
Which of the following is your primary algorithm? NAAT alone GDH --> EIA GDH --> EIA --> NAAT GDH + EIA --> NAAT GDH --> NAAT EIA --> NAAT
Other		NAAT done on indeterminate Ag+1Toxin – or Ag-1Toxin+
Which of the following is your secondary algorithm? NAAT alone GDH --> EIA GDH --> EIA --> NAAT GDH + EIA --> NAAT GDH --> NAAT EIA --> NAAT Not Applicable
Do you perform testing for C. difficile on all shifts? Yes/No
Which shifts do you test? -Day -Evening -Third Shift
Do you know what percent of your tests are positive? Yes/no
Other		No, but data can easily be obtained & calculated from LIS
Do you know what percent of your tests are positive? (comment box)
Other		Could have a multiple choice with several different ranges.
Does your facility perform fecal transplants? Yes/no
Other		When you say “does your facility” -> does that refer to the hospital where the lab is located or all the hospitals that the lab serves? i.e. larger hospital system with a centralized micro lab

How many minutes did it take you to complete the Current Practice survey (not the collection form)? _10 mins, 3 mins, 5 mins, 5 mins, skipped

OVERALL SURVEY EVALUATION	Strongly Disagree	Disagree	Neutral		Agree	Strongly Agree
(Place an “X” to indicate your level of agreement for each statement below).	1	2	3		4	5
12. The survey questions are easy to understand.					3	2
13. I was always able to find an appropriate answer to choose.					3	2
14. The answer choices are clearly written.					3	2
15. There were not enough choices of answers.		2	2			1
16. I always found the answer that fit the circumstances in my laboratory.		1			2	2
17. Overall, the length of the survey was… (circle your answer)
too short	appropriate (5)			too long
18. What did you like best about the survey (strengths, weaknesses)? -It was easy to take and got right to the point -Simple, direct questions
19. Additional thoughts/comments: Easy to navigate & read

1 The first survey question is the “name” field.

2