Clostridium difficile (CD) Action Team (CDAT): An Intervention to Improve Care for Patients with a Positive CD PCR

BACKGROUND: CD infections (CDI) may be viewed by healthcare workers (HCW) as an unpreventable consequence of antibiotics (abx). The purpose of CDAT was to use patient cases in real time to educate HCW on CD diagnostic, treatment and prevention practices including appropriate abx and proton-pump inhibitors (PPI) use. METHODS: From 7/17/16 to 5/6/17, Johns Hopkins abx stewardship team reviewed positive CD PCRs in inpatient to determine whether they had CDI or colonization (no diarrhea or an alternate cause) and if prevention and management was optimal. Included in this time are 2 surveillance periods (SP) (SP1: 7/17–9/27/16 and SP2: 12/18/16–3/30/17). During SP1, there was no contact with HCW. SP2 followed the intervention, and allowed assessment of sustained practice changes. During the intervention periods (IP) (IP1: 10/9–12/17/16 and IP2: 3/31–5/6/17), teaching points for optimizing care for each case were shared and discussed in person with the HCW team, including prescribers and nursing. Compliance with recommendations at 48 hours was assessed. Chi-square test was used to compare sub-optimal management for each variable in different time periods. RESULTS: We assessed 217 cases in the SPs and 96 cases in the IPs. 75 of 96 cases reviewed in the IPs required intervention. CDAT spoke to 74 teams, which led to a change in the care of patients in 49 cases (65%). Compliance with recommendations were as follows: 1) stop or modify CDI therapy, 53%, (39 cases); 2) stop PPI therapy, 52% (15 cases); 3) stop laxatives, 53% (9 cases); 4) stop or modify non-CDI abx, 46% (16 cases); and 5) improve BM documentation, 58% (11 cases). The Figure shows proportions of patients with suboptimal CD management without (SPs) or before (IPs) CDAT intervention in each period. There were no changes in practice between the SP1 and IP1. Between the SP1 and IP2, significant improvement in BM documentation was seen (P = 0.007). No differences were observed for other variables, although there was a trend towards improved CD therapy (P = 0.09). CONCLUSION: Overall, prescribers did not independently change practice as a result of daily contact with CDAT; however, they were responsive to CDAT recommendations. BM documentation, the only nursing intervention, improved significantly. DISCLOSURES: All authors: No reported disclosures.