Reducing Transmission of Multi-Drug Resistant Organisms in Procedural Areas

Abstract

for testing. Liquid or soft stool specimens taking the shape of container were accepted for testing, otherwise specimen was rejected. One stool specimen was considered adequate for testing because of the high sensitivity (98.79%) and specificity (90.82%) of the assay. Repeat testing was allowed if PCR was indeterminate, or if patient had a relapse of diarrhea or diarrhea continued after 14 days of therapy. If PCR assay was negative, repeat testing was allowed after 5 days. The assay was performed by the laboratory twice a day, seven days a week. We observed the number of specimens submitted for Cepheid testing, rejected specimens, and percentage of positive tests for four months after the reduction initiative. Results: Pre-Cepheid testing was observed for four months during which 840 specimens were submitted and 107 were rejected (12.7%). After introduction of Cepheid testing and hospital-wide policy implementation, 133 specimens tested positive (18.2 %) compared with 9.0% Pre-Cepheid policy. Only 10.6% of specimens were repeatedly tested. Lessons Learned: A change in C difficile testing to the Cepheid Xpert C difficile assay along with a new hospital-wide policy governing appropriate testing of specimens resulted in a higher percentage of positive tests vs. our standard C difficile toxin testing of three daily consecutive specimens. A multidisciplinary team or Team Charter drove the initiative and partnered to ensure adequate testing using the Cepheid PCR system as well as treatment of C difficile. Education must be presented multiple times in multiple ways to further limit submission of inappropriate specimens. Our study did not look at whether or not the 24 hour turnaround time of the Cepheid PCR test decreased utilization of anti-C difficile therapy, but this would be an exciting area for future study.