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- Title
Reduction of C. difficile standardized infection ratio by limiting testing in patients with low probability of infection.
- Authors
Block, Morgan; Henderson, Chris; Arocha, Doramarie; Reed, Mary-Grace; Foster, James; Melaku, Tsedey; Croft, Carol; Trivedi, Julie; Lee, Francesca
- Abstract
Background: Clostridium difficile is a spore-forming, anaerobic gram-positive bacillus that is a major cause of healthcare-associated infections. C. difficile can be transmitted from symptomatic individuals as well as from asymptomatic carriers, however, compliance with recommended precautions can minimize the risk of transmission. Testing of patients with a low probability of C. difficile Infection (CDI), based on the presence or absence of risk factors and symptoms, can result in the identification of asymptomatic carriers. This can lead to 1) the unnecessary institution of contact isolation; 2) unnecessary administration of antibiotics for the treatment of C. difficile; and 3) an increased length of stay, all of which contribute towards increased healthcare-related expenditures on an individual and system wide level. In order to reduce the amount of unnecessary testing and subsequent treatment of patients colonized, but not infected with C. difficile, a "C. diff SWAT team" was created. Methods: Starting January 2015, all orders for C. difficile toxin B gene (PCR) at Clements University Hospital (CUH) placed or collected while in an inpatient location were considered. CUH is a 460-bed acute care hospital associated with the University of Texas Southwestern Medical School. The following measures were monitored using individual-moving range control charts (XmR): Outcomes measures: (1) National Healthcare Safety Network (NHSN) C. difficile hospital-onset standardized infection ratio (SIR) and (2) inpatient facility C. difficile healthcare facility-onset incidence rate per 10,000 patient days. Process measures: (1) percentage of C. difficile testing ordered when laxatives were given within the prior 48 hours, (2) percentage of C. difficile samples ordered on day 1-3 but collected on hospital day 4 or greater, and (3) percentage of samples collected greater than 24 hours after the order was placed. Balances measures: Total community-onset C. difficile. Results: Both the process measures and the NHSN C. difficile hospital onset rate per 10,000 days demonstrate statistically significant shifts on the control charts. Overall, the SIR in 2015 quarter Q1-Q3 was 1.20 (107/89.38), and from initiation of the project through 2017 Q2, the SIR is 0.87 (151/174.28) (p = 0.011). Conclusion: With the aid of clinical decision support (CDS) and clinical education, the project team was able to successfully hardwire C. difficile testing and diagnosis best practice guidelines into the diagnostic pathway and significantly reduce the C. difficile SIR and subsequent burden of treatment.
- Subjects
INFECTIOUS disease transmission; CLOSTRIDIUM diseases; CROSS infection; MEDICAL needs assessment; MEDICAL protocols; MEDICAL screening; PATHOLOGICAL laboratories; DATA analysis software; DIAGNOSIS; DISEASE risk factors
- Publication
Canadian Journal of Infection Control / Revue Canadienne de Prévention des Infections, 2018, Vol 33, Issue 2, p111
- ISSN
1183-5702
- Publication type
Article