Clostridium difficile Toolkit Evaluation
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1
. First Name:
First Name:
*
2
. Email:
Email:
*
3
. Zip Code:
Zip Code:
4
. Are you field-testing this toolkit on behalf of the Prevention Strategies Subcommittee?
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
Which format of the toolkit are you using?
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
Which of the following facilities do you represent?
Other (please specify)
7
. Do you perform routine or active surveillance on Clostridium difficile infections?
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?
Do you isolate patients with Clostridium difficile infections?
Yes
No
Do not know
Not applicable
9
. Do you have ready access to a computer?
Do you have ready access to a computer?
Yes
No
10
. Are you a member of APIC?
Are you a member of APIC?
Yes
No
11
. What specifically can be done to make the toolkit more user friendly?
What specifically can be done to make the toolkit more user friendly?
12
. Do you have suggestions for future toolkits?
Do you have suggestions for future toolkits?
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