The 'Multi-step' to Success: Key Points for C. Diff Labid Reduction

Abstract

Background Polymerase Chain Reaction (PCR) testing for Clostridioides difficle (C. diff) does not differentiate colonization versus active disease. This healthcare system sought to implement a multi-step testing platform with PCR and toxin testing to distinguish active C diff infections versus colonization and achieve Laboratory –identified (LabID) rate lower than 4.59/10,000 patient days. Methods The hospital healthcare system C. diff database was queried for tests between 2019-2020. Selected tests were associated with adult inpatient hospitalization and National Safety Network (NHSN) LabID criteria (loose stools, day four of admission). Stool samples collected after January 2020 were tested using C. diff multi-step testing platform. Results Multi-step testing dramatically reduced LabID C diff rates from 4.59 in 2019 to 1.60 in 2020 across the healthcare system. Multi-step testing excluded 78 positive PCR with negative toxin results January-October 2020 from NHSN LabID submission. Conclusions The multi-step testing platform contributes to a systemwide 65% reduction in LabID C. diff cases reported to NHSN by differentiating between colonization and active infection. In turn, this leads to correctly identifying, isolating, and treatment of patients. In addition, identification of appropriate interventions and targeted resource allocation allows healthcare systems to move the needle closer to zero for this healthcare associated infection.