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Diagnostic stewardship for Clostridioides difficile testing in an acute care hospital: A quality improvement intervention
OBJECTIVE: To evaluate the impact of a diagnostic stewardship intervention on Clostridioides difficile healthcare-associated infections (HAI). DESIGN: Quality improvement study. SETTING: Two urban acute care hospitals. INTERVENTIONS: All inpatient stool testing for C. difficile required review and a...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cambridge University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10127245/ https://www.ncbi.nlm.nih.gov/pubmed/37113206 http://dx.doi.org/10.1017/ash.2023.141 |
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author | Berg, Madeline L. Ayres, Ashley M. Weber, David R. McCullough, Melissa Crall, Victoria D. Lewis, Casey L. Valek, Abby L. Vincent, Lizabeth A. Penzelik, Joseph Sasinoski, Crystal A. Cheng, Amanda L. Bradford, Claire F. Bell, Elizabeth O. Edwards, Kimberly M. Castronova, Isabella A. Brady, Mya B. Slaughter, Julie Oleksiuk, Louise-Marie Snyder, Graham M. |
author_facet | Berg, Madeline L. Ayres, Ashley M. Weber, David R. McCullough, Melissa Crall, Victoria D. Lewis, Casey L. Valek, Abby L. Vincent, Lizabeth A. Penzelik, Joseph Sasinoski, Crystal A. Cheng, Amanda L. Bradford, Claire F. Bell, Elizabeth O. Edwards, Kimberly M. Castronova, Isabella A. Brady, Mya B. Slaughter, Julie Oleksiuk, Louise-Marie Snyder, Graham M. |
author_sort | Berg, Madeline L. |
collection | PubMed |
description | OBJECTIVE: To evaluate the impact of a diagnostic stewardship intervention on Clostridioides difficile healthcare-associated infections (HAI). DESIGN: Quality improvement study. SETTING: Two urban acute care hospitals. INTERVENTIONS: All inpatient stool testing for C. difficile required review and approval prior to specimen processing in the laboratory. An infection preventionist reviewed all orders daily through chart review and conversations with nursing; orders meeting clinical criteria for testing were approved, orders not meeting clinical criteria were discussed with the ordering provider. The proportion of completed tests meeting clinical criteria for testing and the primary outcome of C. difficile HAI were compared before and after the intervention. RESULTS: The frequency of completed C. difficile orders not meeting criteria was lower [146 (7.5%) of 1,958] in the intervention period (January 10, 2022–October 14, 2022) than in the sampled 3-month preintervention period [26 (21.0%) of 124; P < .001]. C. difficile HAI rates were 8.80 per 10,000 patient days prior to the intervention (March 1, 2021–January 9, 2022) and 7.69 per 10,000 patient days during the intervention period (incidence rate ratio, 0.87; 95% confidence interval, 0.73–1.05; P = .13). CONCLUSIONS: A stringent order-approval process reduced clinically nonindicated testing for C. difficile but did not significantly decrease HAIs. |
format | Online Article Text |
id | pubmed-10127245 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Cambridge University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-101272452023-04-26 Diagnostic stewardship for Clostridioides difficile testing in an acute care hospital: A quality improvement intervention Berg, Madeline L. Ayres, Ashley M. Weber, David R. McCullough, Melissa Crall, Victoria D. Lewis, Casey L. Valek, Abby L. Vincent, Lizabeth A. Penzelik, Joseph Sasinoski, Crystal A. Cheng, Amanda L. Bradford, Claire F. Bell, Elizabeth O. Edwards, Kimberly M. Castronova, Isabella A. Brady, Mya B. Slaughter, Julie Oleksiuk, Louise-Marie Snyder, Graham M. Antimicrob Steward Healthc Epidemiol Original Article OBJECTIVE: To evaluate the impact of a diagnostic stewardship intervention on Clostridioides difficile healthcare-associated infections (HAI). DESIGN: Quality improvement study. SETTING: Two urban acute care hospitals. INTERVENTIONS: All inpatient stool testing for C. difficile required review and approval prior to specimen processing in the laboratory. An infection preventionist reviewed all orders daily through chart review and conversations with nursing; orders meeting clinical criteria for testing were approved, orders not meeting clinical criteria were discussed with the ordering provider. The proportion of completed tests meeting clinical criteria for testing and the primary outcome of C. difficile HAI were compared before and after the intervention. RESULTS: The frequency of completed C. difficile orders not meeting criteria was lower [146 (7.5%) of 1,958] in the intervention period (January 10, 2022–October 14, 2022) than in the sampled 3-month preintervention period [26 (21.0%) of 124; P < .001]. C. difficile HAI rates were 8.80 per 10,000 patient days prior to the intervention (March 1, 2021–January 9, 2022) and 7.69 per 10,000 patient days during the intervention period (incidence rate ratio, 0.87; 95% confidence interval, 0.73–1.05; P = .13). CONCLUSIONS: A stringent order-approval process reduced clinically nonindicated testing for C. difficile but did not significantly decrease HAIs. Cambridge University Press 2023-04-05 /pmc/articles/PMC10127245/ /pubmed/37113206 http://dx.doi.org/10.1017/ash.2023.141 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited. |
spellingShingle | Original Article Berg, Madeline L. Ayres, Ashley M. Weber, David R. McCullough, Melissa Crall, Victoria D. Lewis, Casey L. Valek, Abby L. Vincent, Lizabeth A. Penzelik, Joseph Sasinoski, Crystal A. Cheng, Amanda L. Bradford, Claire F. Bell, Elizabeth O. Edwards, Kimberly M. Castronova, Isabella A. Brady, Mya B. Slaughter, Julie Oleksiuk, Louise-Marie Snyder, Graham M. Diagnostic stewardship for Clostridioides difficile testing in an acute care hospital: A quality improvement intervention |
title | Diagnostic stewardship for Clostridioides difficile testing in an acute care hospital: A quality improvement intervention |
title_full | Diagnostic stewardship for Clostridioides difficile testing in an acute care hospital: A quality improvement intervention |
title_fullStr | Diagnostic stewardship for Clostridioides difficile testing in an acute care hospital: A quality improvement intervention |
title_full_unstemmed | Diagnostic stewardship for Clostridioides difficile testing in an acute care hospital: A quality improvement intervention |
title_short | Diagnostic stewardship for Clostridioides difficile testing in an acute care hospital: A quality improvement intervention |
title_sort | diagnostic stewardship for clostridioides difficile testing in an acute care hospital: a quality improvement intervention |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10127245/ https://www.ncbi.nlm.nih.gov/pubmed/37113206 http://dx.doi.org/10.1017/ash.2023.141 |
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