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.
Keywords: ATA, appropriate testing algorithm; CDC, Centers for Disease Control and Prevention; CDI, Clostridioides difficile infection; CMS, Centers for Medicare & Medicaid Services; COVID, coronavirus disease; HAI, health care–associated infection; HCFO, health care facility–onset; IDSA, Infectious Diseases Society of America; IPAC, infection prevention and control; PCR, polymerase chain reaction; QI, quality improvement; SIR, standardized infection ratio.
© 2021 The Authors.