Impact of a division-wide bundle on hospitalacquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs

Introduction: Updated international guidelines recommend the use of a two-step algorithm (glutamate dehydrogenase [GDH] or nucleic-acid amplification test [NAAT] plus toxin) rather than NAAT alone for the diagnosis of Clostridioides difficile (formerly Clostridium difficile) infections. The goal of...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Elizabeth Wenqian Wang, Ashlee Weekley, Jennifer McCarty, Hoonmo Koo, Bradley Lembcke, Mayar Al Mohajer
Formato:	article
Lenguaje:	EN
Publicado:	Thieme Medical and Scientific Publishers Pvt. Ltd. 2021
Materias:	c. difficile cost diagnostic stewardship dot testing Medicine R
Acceso en línea:	https://doaj.org/article/e2f083c237d34ff293b3a30319892612
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:e2f083c237d34ff293b3a30319892612
record_format	dspace
spelling	oai:doaj.org-article:e2f083c237d34ff293b3a303198926122021-12-02T17:07:08ZImpact of a division-wide bundle on hospitalacquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs2231-07702249-446410.4103/ajm.ajm_193_19https://doaj.org/article/e2f083c237d34ff293b3a303198926122021-01-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.4103/ajm.ajm_193_19https://doaj.org/toc/2231-0770https://doaj.org/toc/2249-4464Introduction: Updated international guidelines recommend the use of a two-step algorithm (glutamate dehydrogenase [GDH] or nucleic-acid amplification test [NAAT] plus toxin) rather than NAAT alone for the diagnosis of Clostridioides difficile (formerly Clostridium difficile) infections. The goal of our project was to evaluate the impact of a new bundle on the rate of hospital-acquired C. difficile infections (CDIs), hospital-acquired CDI standardized infection ratio (SIR), antibiotic days of therapy (DOT), and financial cost. Materials and Methods: The new bundle was implemented in April 2018. This bundle was implemented across five hospitals in Catholic Health Initiatives (CHI) Texas Division. The bundle included a switch from NAAT to a two-step process (GDH and toxin). We placed the new test in an order panel which included enteric isolation and required indications for C. difficile testing. We used quarterly data pre- and post-intervention to calculate SIR and DOT. Results: In the pre-intervention period, 15.5% of the total 3513 C. difficile NAAT was positive. In the post-intervention period, 5.7% of a total of 2845 GDH and toxin assays was positive for both GDH and toxin (P < 0.0001). SIR, which adjusts for denominator and change in testing methodology, also dropped from 1.02 to 0.43. The estimated cost associated with positive C. difficile cases dropped from 1,932,150 USD to 1,113,800 USD with an estimated yearly cost saving of 794,150 USD. Compliance with enteric isolation improved from 73.1% to 92.5% (P = 0.008). Conclusion: The new testing bundle led to a marked reduction in hospital-acquired CDI and unnecessary treatment, reduction in C. difficile testing, an increase in compliance with enteric isolation, and significant cost savings.Elizabeth Wenqian WangAshlee WeekleyJennifer McCartyHoonmo KooBradley LembckeMayar Al MohajerThieme Medical and Scientific Publishers Pvt. Ltd.articlec. difficilecostdiagnostic stewardshipdottestingMedicineRENAvicenna Journal of Medicine, Vol 11, Iss 01, Pp 27-32 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	c. difficile cost diagnostic stewardship dot testing Medicine R
spellingShingle	c. difficile cost diagnostic stewardship dot testing Medicine R Elizabeth Wenqian Wang Ashlee Weekley Jennifer McCarty Hoonmo Koo Bradley Lembcke Mayar Al Mohajer Impact of a division-wide bundle on hospitalacquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs
description	Introduction: Updated international guidelines recommend the use of a two-step algorithm (glutamate dehydrogenase [GDH] or nucleic-acid amplification test [NAAT] plus toxin) rather than NAAT alone for the diagnosis of Clostridioides difficile (formerly Clostridium difficile) infections. The goal of our project was to evaluate the impact of a new bundle on the rate of hospital-acquired C. difficile infections (CDIs), hospital-acquired CDI standardized infection ratio (SIR), antibiotic days of therapy (DOT), and financial cost. Materials and Methods: The new bundle was implemented in April 2018. This bundle was implemented across five hospitals in Catholic Health Initiatives (CHI) Texas Division. The bundle included a switch from NAAT to a two-step process (GDH and toxin). We placed the new test in an order panel which included enteric isolation and required indications for C. difficile testing. We used quarterly data pre- and post-intervention to calculate SIR and DOT. Results: In the pre-intervention period, 15.5% of the total 3513 C. difficile NAAT was positive. In the post-intervention period, 5.7% of a total of 2845 GDH and toxin assays was positive for both GDH and toxin (P < 0.0001). SIR, which adjusts for denominator and change in testing methodology, also dropped from 1.02 to 0.43. The estimated cost associated with positive C. difficile cases dropped from 1,932,150 USD to 1,113,800 USD with an estimated yearly cost saving of 794,150 USD. Compliance with enteric isolation improved from 73.1% to 92.5% (P = 0.008). Conclusion: The new testing bundle led to a marked reduction in hospital-acquired CDI and unnecessary treatment, reduction in C. difficile testing, an increase in compliance with enteric isolation, and significant cost savings.
format	article
author	Elizabeth Wenqian Wang Ashlee Weekley Jennifer McCarty Hoonmo Koo Bradley Lembcke Mayar Al Mohajer
author_facet	Elizabeth Wenqian Wang Ashlee Weekley Jennifer McCarty Hoonmo Koo Bradley Lembcke Mayar Al Mohajer
author_sort	Elizabeth Wenqian Wang
title	Impact of a division-wide bundle on hospitalacquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs
title_short	Impact of a division-wide bundle on hospitalacquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs
title_full	Impact of a division-wide bundle on hospitalacquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs
title_fullStr	Impact of a division-wide bundle on hospitalacquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs
title_full_unstemmed	Impact of a division-wide bundle on hospitalacquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs
title_sort	impact of a division-wide bundle on hospitalacquired clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs
publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
publishDate	2021
url	https://doaj.org/article/e2f083c237d34ff293b3a30319892612
work_keys_str_mv	AT elizabethwenqianwang impactofadivisionwidebundleonhospitalacquiredclostridioidesdifficilecasesantibioticdaysoftherapytestingappropriatenessandassociatedfinancialcosts AT ashleeweekley impactofadivisionwidebundleonhospitalacquiredclostridioidesdifficilecasesantibioticdaysoftherapytestingappropriatenessandassociatedfinancialcosts AT jennifermccarty impactofadivisionwidebundleonhospitalacquiredclostridioidesdifficilecasesantibioticdaysoftherapytestingappropriatenessandassociatedfinancialcosts AT hoonmokoo impactofadivisionwidebundleonhospitalacquiredclostridioidesdifficilecasesantibioticdaysoftherapytestingappropriatenessandassociatedfinancialcosts AT bradleylembcke impactofadivisionwidebundleonhospitalacquiredclostridioidesdifficilecasesantibioticdaysoftherapytestingappropriatenessandassociatedfinancialcosts AT mayaralmohajer impactofadivisionwidebundleonhospitalacquiredclostridioidesdifficilecasesantibioticdaysoftherapytestingappropriatenessandassociatedfinancialcosts
_version_	1718381588890255360

Impact of a division-wide bundle on hospitalacquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs

Ejemplares similares