Appropriate Patient Selection Leads to Improvement in Healthcare Facility-Onset C. diff Rates

Abstract

BACKGROUND Healthcare facility-onset Clostridium difficile infections (HO CDI) are potentially preventable events associated with increased cost, morbidity, and mortality in adult patients. Struggling with a high HO CDI rate, our facility identified appropriate patient selection for testing as an improvement opportunity. Careful patient selection for C. diff testing is vital to improve the sensitivity and specificity of HO CDI diagnosis. METHODS A dyad approach was developed to improve CDI testing practices. A rule was built into the electronic medical record that automatically cancelled C. diff orders if the sample was not ?collected within 24?hours of order. A C. diff Ticket-to-Lab (TTL) form with an accompanying testing algorithm was developed to guide clinicians through determining whether or not a patient should be tested for C. diff based on clinical criteria. All C. diff tests were required to have a TTL form filled out before submission to the laboratory. RESULTS Cancellation of outdated results reduced the average amount of C. diff tests performed monthly by 40%. After implementation of TTL, our HO CDI standardized infection ratio (SIR) dropped by 42% from 1.29 during the baseline period to 0.552 post intervention (p-value 0.0094, 95% confidence interval 0.209, 0.821). CONCLUSIONS A combination of electronic and manual tools can be used to assist providers in identifying patients with clinical criteria that warrants C. diff testing. Improving patient selection for C. diff testing is an effective strategy to reduce HO CDI. Detection of C. diff colonization is prevented along with unnecessary antibiotic use, prolonged length of stay and hospital penalties associated with falsely inflated HO CDI rates.