Implementing Hard Stops in the Electronic Record to Decrease Hospital Acquired C-Diff Infections

Abstract

<h3>Background</h3> Background: Clostridioides difficile is the leading cause of health care- associated infections. C diff infection data are publicly reported and value- based purchasing can impact a hospital's financial reimbursement if these goals are not met. After experiencing increases in C-diff rates at our organization, testing procedures and patient selection were reviewed. The purpose of our work was to decrease hospital acquired C-diff rates by 30 % by mid-December 2019 through implementing the Centers for Disease Control and Prevention recommendations and Society for Healthcare Epidemiology of America (SHEA) practice guidelines. <h3>Methods</h3> Methods: All adult patients that C diff testing ordered were compared to recommendations by CDC and SHEA. We implemented the following changes to align with the recommendations: isolation at time of suspicion of C diff, daily review of all specimens ordered, automatic cancellation of specimen after 24 hours if not sent, bleach disinfection twice a day on all C diff patients, education of all staff that are involved in patient care, and electronic hard stops for all laxative use and inappropriate testing <h3>Results</h3> Results: These interventions resulted in significant improvement in C-diff rates, and several process measures. C-diff rates decreased from 9.33 per month during the first quarter of calendar year 2019 to an average of 6.8 infections per month during the fourth quarter. All patients with diarrhea on admission began having testing within 48 hours of admission to identify infection and decreased day 4 testing. These processes also eliminated testing with patients receiving laxatives within 48 hours. <h3>Conclusions</h3> Conclusion: Results of this project demonstrate how aligning testing practices with CDC and SHEA guidelines and electronic hard stops can effectively decrease hospital-acquired C-Diff rates. It is recommended organizations adopt standardized practices for testing and utilize available technology to eliminate inappropriate testing and unnecessary treatment.