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Clostridium difficile Toolkit Evaluation
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1.
First Name:
(Required.)
*
2.
Email:
(Required.)
*
3.
Zip Code:
(Required.)
4.
Are you field-testing this toolkit on behalf of the Prevention Strategies Subcommittee?
Yes
No
5.
Which format of the toolkit are you using?
Website/Internet links
Physical booklet
PDF version
6.
Which of the following facilities do you represent?
Emergency medicine
Indian Health Service
Acute care hospital
Long-term acute care hospital (LTACH)
Longterm care/Skilled Nursing Facility
Critical Access Hospitals
Hospice
Outpatient Treatment Center
Physician Office/ Urgent care centers
Assisted Living Facility
Ambulatory Surgery Center
Hospice
Dialysis
Behavioral health centers
Correctional facilities
Other (please specify)
7.
Do you perform routine or active surveillance on Clostridium difficile infections?
Yes
No
Do not know
Not applicable
8.
Do you isolate patients with Clostridium difficile infections?
Yes
No
Do not know
Not applicable
9.
Do you have ready access to a computer?
Yes
No
10.
Are you a member of APIC?
Yes
No
11.
What specifically can be done to make the toolkit more user friendly?
12.
Do you have suggestions for future toolkits?