Category: Professional Posters
Purpose: A community hospital identified a larger than anticipated increase in hospital-acquired Clostridioides difficile infections (CDI) after changing testing methods from glutamate dehydrogenase plus toxin A and B enzyme immunoassays to polymerase chain reaction (PCR). Infection Prevention and Antimicrobial Stewardship Committees determined that there was an opportunity to improve which patients were tested for Clostridioides difficile (C. difficile) to avoid unnecessary testing and ensure treatment of active infection instead of colonization. The purpose of this project was to determine if changing how prescribers ordered C. difficile tests impacted the number of hospital-acquired CDIs.
Methods: Three interventions were performed to improve prescriber ordering of C. difficile tests. Prescribers were no longer allowed to provide a verbal order for a C. difficile test. The C. difficile PCR test was required to be ordered by the prescriber in the electronic medical record (EMR). No repeat testing of C. difficile within seven days was permitted, and if ordering was attempted, an educational pop-up message alerted the prescriber with an explanation about unnecessary testing. EMR clinical decision support within the laboratory ordering module for C. difficile was built to guide the prescriber to appropriately assess the patient and need for CDI testing. To determine the impact of the interventions on CDIs, all hospital-acquired CDIs were retrospectively reviewed for each month one year prior to interventions (May 2017 through April 2018) and one year post interventions (May 2018 through April 2019). Hospital-acquired CDI was defined by the Centers for Disease Control and Prevention’s National Healthcare Safety Network. No patients with hospital-acquired CDI were excluded from review. Statistical analysis for the change in the number of hospital-acquired CDIs was evaluated through a paired t test. Data are expressed as means with 95 percent confidence intervals.
Results: The total number of hospital-acquired CDIs in both intervention periods was 101 with 67 prior to intervention and 34 after intervention. The mean hospital-acquired CDIs for each month decreased from 5.58 pre-intervention to 2.83 post-intervention (95 percent CI, 1.47 to 4.03, P less than 0.001).
Conclusion: Implementation of prescriber ordering changes for C. difficile tests led to a decrease in hospital-acquired CDIs.