Development of a Community-onset Clostridioides difficile Detection Tool to Prevent Delayed Identification of Infection

Abstract

<h3>Background</h3> : Clostridioides difficile (Cdiff) identified after hospital day (HD) three are classified as hospital-onset (HO) while those identified prior are community-onset (CO) based on National Healthcare Safety Network definitions. At a Level 1 Trauma Center it was determined that a portion of HO Cdiff cases were likely CO with delayed identification. The objective was to develop an early detection tool to aid in earlier testing of high-risk patients with CO Cdiff. <h3>Methods</h3> : A report was developed to identify a list of patients admitted in previous two days with≥ one loose stool and potential Cdiff risk factors including: number of liquid stools, white blood cell count, temperature, antibiotic exposure, diarrhea at home, and transfer source. Risk factors were weighted, resulting in a daily CO Cdiff risk index for each patient ranging from -2 to +10. Patient with a risk index ≥+1 was escalated to nursing leadership for evaluation and testing. <h3>Results</h3> : Between January 2019 and August 2020, 25% (n = 10) of HO Cdiff cases were identified on HD four through six. In the first two months of report implementation (September - October 2020), 354 patients were admitted with ≥ one loose stool in the first three HD. Over 25% (n = 93) of these patients were given a risk index of ≥+1 and testing were recommended. Testing was performed on 26 patients (28.0%) which resulted in identification of 10 (38.5%) CO Cdiff cases. Reasons for not testing included: patient discharged (n = 14), loose stool ceased (n = 20), did not meet criteria (n = 8), death (n = 1) and no follow up (n = 20). In this time period, no cases of Cdiff were identified between HD four and six. <h3>Conclusions</h3> : Early identification of CO Cdiff has multiple benefits including early isolation, appropriate treatment and reduction of misclassification of HO events.