521. Clostridium difficile Timeout: A Nurse-Driven Protocol to Optimize Testing Stewardship

BACKGROUND: There remains a challenge in distinguishing colonization vs. infection with Clostridium difficile associated diarrhea. At our institution, despite effective antimicrobial stewardship efforts, C. difficile tests and positive infections remained high identifying a need for C. difficile testing stewardship optimization. METHODS: This was an IRB approved study on a nursing driven algorithm for C. difficile Timeout (CDT). This included the number and shape of stools and absence of laxatives in the last 24 hours. Control and study groups were identified and a nurse provided C. difficile education to the study group. Nursing utilized the CDT algorithm, and the C. difficile PCR was sent if criteria were met to optimize testing stewardship. The primary objective was to assess the positive and negative predictive values (PPV and NPV) associated with CDT. A subgroup analysis included total tests and positive tests per patient days between study vs. control groups. The secondary objective was HO-CDI/10,000 patient-days (PD), and number of tests ordered and tests positive/10,000PD pre- and post-implementation of CDT. RESULTS: There were 87 patients who had CDT performed from June 2017 to February 2018. There were 72 patients tested for C. difficile PCR, and 15 were not tested. Baseline demographics were similar between both groups. Patients in the tested group compared with control were more likely to meet the criteria for >3 loose BMs/day (88% vs. 40%, P = 0.002) and lack of new start on laxatives (7% vs. 33%, P = 0.012). Compared with the control group, there were fewer tests ordered for the study group (130 vs. 160 per 10,000PD, P = 0.10) and similar positive tests results (26 vs. 26 per 10,000PD). This led to a PPV of 83.7% and an NPV of 20.3%. Overall, the postimplementation group had low number of tests ordered (122 vs. 158 per 10,000PD) and positive tests (22 vs. 26 per 10,000PD). We noticed a consistent overall decline in HO-CDI/1,000PD rates from 2016 vs. 2017 (6.18 vs. 2.13 per 10,000PD, P = 0.13). CONCLUSION: With CDT utilization, there was a decline in total number of C. difficile tests ordered. Through this nurse-initiated algorithm, testing stewardship for C. difficile was optimized and a PPV and an NPV was uncovered. With the use of CDT in conjunction with antimicrobial stewardship efforts, there was an overall decline in HO-CDI/10,000PD after implementation of this algorithm. DISCLOSURES: All authors: No reported disclosures.