Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative

Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative

Objective: To reduce health care facility–onset (HCFO) Clostridioides difficile infection (CDI) incidence by improving diagnostic stewardship and reducing the inappropriate testing of C difficile assays. Patients and Methods: A multidisciplinary team conducted a quality improvement initiative from J...

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Autores principales: Himesh B. Zaver, MD, Varun P. Moktan, MD, Eugene P. Harper, MD, Aman Bali, MD, Ayan Nasir, MD, Carla Foulks, MD, Justin Kuhlman, MD, Max Green, MD, Gillian A. Algan, BS, Heather C. Parth, MPH, Melody Wu-Ballis, BS, Sandra DiCicco, BS, Brenda T. Smith, BS, Ronald N. Owen, BS, Lorraine S. Mai, BS, Sarah L. Spiros, BS, John Griffis, BS, Daphne T. Ramsey Walker, BS, D. Jane Hata, PhD, Justin M. Oring, DO, Harry R. Powers, MD, Wendelyn Bosch, MD
Formato: article
Lenguaje:EN
Publicado: Elsevier 2021
Materias:
Medicine (General)
R5-920
Acceso en línea:https://doaj.org/article/0803db8cd6264022a6cab137fe652613
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Sumario:Objective: To reduce health care facility–onset (HCFO) Clostridioides difficile infection (CDI) incidence by improving diagnostic stewardship and reducing the inappropriate testing of C difficile assays. Patients and Methods: A multidisciplinary team conducted a quality improvement initiative from January 1, 2020, through March 31, 2021. Clostridioides difficile infection and inappropriate testing were identified via electronic health records using predefined criteria related to stool quantity/caliber, confounding medications, and laboratory data. An intervention bundle was designed including (1) provider education, (2) implementation of an appropriate testing algorithm, (3) expert review of C difficile orders, and (4) batch testing of assays to facilitate review and cancellation if inappropriate. Results: Compared with a baseline period from January to September 2020, implementation of our intervention bundle from December 2020 to March 2021 resulted in an 83.6% reduction in inappropriate orders tested and a 41.7% reduction in HCFO CDI incidence. Conclusion: A novel prevention bundle improved C difficile diagnostic stewardship and HCFO CDI incidence by reducing testing of inappropriate orders. Such initiatives targeting HCFO CDI may positively affect patient safety and hospital reimbursement.

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