2431. When More is Less – Recognizing More Community-onset Clostridium difficile Infections Helps to Dramatically Lower C diff Standardized Infection Ratio (SIR)

Abstract

BackgroundIt is essential to recognize the true burden of community-onset (CO) Clostridium difficile infection (CDI) in hospital, not only because it prevents late recognition of CO CDI as being classified as a hospital-onset (HO) event, but also to assure appropriate contact precautions and therapeutic measures are deployed in a timely fashion. We recognized that our timely diagnosis of CO-CDI was suboptimal and sought to improve early recognition of CO-CDI.MethodsWe developed an automated daily report for all patients during their first 3 days of hospitalization who had loose stools documented in the nursing flow sheets and no stool sample sent to the lab. This report was automatically pushed out to the unit nurse managers, as well as reviewed by the infection preventionists (IP). Nurse managers alerted staff to acquire a stool sample to send to the lab. If stool testing still was not sent at the time of IP review of these symptomatic cases, then the IP called the nurse caring for the patient to encourage that a stool sample be sent ASAP and before the third hospital day was completed.ResultsWe increased early appropriate stool testing for patients with documented loose stools during the first 3 days of hospitalization. Improved early diagnosis and better lab stewardship was associated with a marked increase in CO-CDI (15.6/month in 2015 vs 58.7/month in the last year), as well as a decrease in HO-CDI (22.8/month in 2015 vs 7.4/month last year) (Figure 1). In turn, we saw a remarkable drop in our CDI SIR (2 year pre-intervention SIR = 1.49 vs post-intervention SIR for the last 1.5 years = 0.41) (Figure 2).ConclusionAfter several years of our CDI SIR remaining stubbornly around 1.5, we developed a system of enhanced recognition of patients who had loose stools early in their hospitalization. This aided in better recognition of CDI present on admission, substantially increasing our detection of CO-CDI. We also noted decreases in HO-CDI, presumably secondary to no longer diagnosing patients later in their hospitalization as HO-CDI cases who actually had been admitted with CO-CDI. Better early recognition and isolation of patients with CDI also helped to decrease inadvertent C. difficile transmission in hospital, contributing to decreases in HO-CDI. In turn, we noted a remarkable decrease in our CDI SIR. Disclosures All authors: No reported disclosures.