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528. Lab Stewardship for Clostridium difficile Testing Improves Appropriate Testing While Decreases Unnecessary Testing and Saves Laboratory Resources While Dramatically Helping to Reduce C diff Standardized Infection Ratios (SIR)
BACKGROUND: Unnecessary testing for Clostridium difficile infection (CDI) can be both wasteful and contra productive—retesting the same positive patient after transfer to a new nursing unit will only to confirm the patient has CDI (already known) and likely be classified as a new case of hospital-on...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255454/ http://dx.doi.org/10.1093/ofid/ofy210.537 |
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author | Parada, Jorge P Wright, Dominique Suarez-Ponce, Sylvia Trulis, Elaine Linchangco, Purisima Abuihmoud, Ayat Pua, Herminia Green, Melissa Hedlund, Heather Smith, Kevin R Harrington, Amanda |
author_facet | Parada, Jorge P Wright, Dominique Suarez-Ponce, Sylvia Trulis, Elaine Linchangco, Purisima Abuihmoud, Ayat Pua, Herminia Green, Melissa Hedlund, Heather Smith, Kevin R Harrington, Amanda |
author_sort | Parada, Jorge P |
collection | PubMed |
description | BACKGROUND: Unnecessary testing for Clostridium difficile infection (CDI) can be both wasteful and contra productive—retesting the same positive patient after transfer to a new nursing unit will only to confirm the patient has CDI (already known) and likely be classified as a new case of hospital-onset (HO) CDI. Yet, it is also important to recognize community-onset (CO) CDI in hospital, not only because it prevents late recognition of CO CDI as being classified as an HO event, will also to afford appropriate contact precautions and therapeutic measures are instituted in a timely fashion. Laboratory stewardship (LS) can be helpful in improving appropriateness of C. difficile testing. METHODS: We developed 2 CDI testing algorithms. One focused on hospital days 1–3, the other for all C. difficile testing after hospital day 3 (AHD3). The LS quality improvement (QI) project was rolled out in 2 stages. During the first 6 months we focused on improving early detection of CO-CDI, while during the next 6 months a mandatory review of all C. difficile testing orders AHD3 was conducted by a 10 person team. Testing that concurred with the algorithm was approved. Nonapproval was communicated to the care teams. Appeals could be made on a case-by-case basis to the medical director of infection control. Validation audits of nonapproved cases were performed to determine whether testing algorithms were sound. RESULTS: CO-CDI detection steadily increased over the yearlong LS QI period (average of 6 cases/week at start vs. 12 cases/week at year’s end). During the 6 months of the AHD3 mandatory order review 678 C. difficile orders were placed, 428 (63.1%) were approved, 250 (36.9%) were rejected. Reduced use of laboratory resources is estimated to have saved $14,950. LS and frequent communication with care teams contributed better recognition of CO-CDI, decreased inappropriate repeat testing, avoidance of diagnosing colonized patients as HO-CDI and was associated with a significantly drop our CDI SIR (Figure 1). CONCLUSION: An algorithm-based guideline for a 2-step LS QI program focused on reviews of all C. difficile orders AFHD3 as well as improving early detection of CO-CDI and was associated with better laboratory resource utilization and markedly decreased C. difficile SIR. Efforts are currently underway to automate much of the review process. [Image: see text] DISCLOSURES: J. P. Parada, Merck: Speaker’s Bureau, Speaker honorarium. A. Harrington, Biofire: Grant Investigator and Scientific Advisor, Consulting fee, Research grant and Speaker honorarium. Cepheid: Grant Investigator and Speaker’s Bureau, Research grant. |
format | Online Article Text |
id | pubmed-6255454 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-62554542018-11-28 528. Lab Stewardship for Clostridium difficile Testing Improves Appropriate Testing While Decreases Unnecessary Testing and Saves Laboratory Resources While Dramatically Helping to Reduce C diff Standardized Infection Ratios (SIR) Parada, Jorge P Wright, Dominique Suarez-Ponce, Sylvia Trulis, Elaine Linchangco, Purisima Abuihmoud, Ayat Pua, Herminia Green, Melissa Hedlund, Heather Smith, Kevin R Harrington, Amanda Open Forum Infect Dis Abstracts BACKGROUND: Unnecessary testing for Clostridium difficile infection (CDI) can be both wasteful and contra productive—retesting the same positive patient after transfer to a new nursing unit will only to confirm the patient has CDI (already known) and likely be classified as a new case of hospital-onset (HO) CDI. Yet, it is also important to recognize community-onset (CO) CDI in hospital, not only because it prevents late recognition of CO CDI as being classified as an HO event, will also to afford appropriate contact precautions and therapeutic measures are instituted in a timely fashion. Laboratory stewardship (LS) can be helpful in improving appropriateness of C. difficile testing. METHODS: We developed 2 CDI testing algorithms. One focused on hospital days 1–3, the other for all C. difficile testing after hospital day 3 (AHD3). The LS quality improvement (QI) project was rolled out in 2 stages. During the first 6 months we focused on improving early detection of CO-CDI, while during the next 6 months a mandatory review of all C. difficile testing orders AHD3 was conducted by a 10 person team. Testing that concurred with the algorithm was approved. Nonapproval was communicated to the care teams. Appeals could be made on a case-by-case basis to the medical director of infection control. Validation audits of nonapproved cases were performed to determine whether testing algorithms were sound. RESULTS: CO-CDI detection steadily increased over the yearlong LS QI period (average of 6 cases/week at start vs. 12 cases/week at year’s end). During the 6 months of the AHD3 mandatory order review 678 C. difficile orders were placed, 428 (63.1%) were approved, 250 (36.9%) were rejected. Reduced use of laboratory resources is estimated to have saved $14,950. LS and frequent communication with care teams contributed better recognition of CO-CDI, decreased inappropriate repeat testing, avoidance of diagnosing colonized patients as HO-CDI and was associated with a significantly drop our CDI SIR (Figure 1). CONCLUSION: An algorithm-based guideline for a 2-step LS QI program focused on reviews of all C. difficile orders AFHD3 as well as improving early detection of CO-CDI and was associated with better laboratory resource utilization and markedly decreased C. difficile SIR. Efforts are currently underway to automate much of the review process. [Image: see text] DISCLOSURES: J. P. Parada, Merck: Speaker’s Bureau, Speaker honorarium. A. Harrington, Biofire: Grant Investigator and Scientific Advisor, Consulting fee, Research grant and Speaker honorarium. Cepheid: Grant Investigator and Speaker’s Bureau, Research grant. Oxford University Press 2018-11-26 /pmc/articles/PMC6255454/ http://dx.doi.org/10.1093/ofid/ofy210.537 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Parada, Jorge P Wright, Dominique Suarez-Ponce, Sylvia Trulis, Elaine Linchangco, Purisima Abuihmoud, Ayat Pua, Herminia Green, Melissa Hedlund, Heather Smith, Kevin R Harrington, Amanda 528. Lab Stewardship for Clostridium difficile Testing Improves Appropriate Testing While Decreases Unnecessary Testing and Saves Laboratory Resources While Dramatically Helping to Reduce C diff Standardized Infection Ratios (SIR) |
title | 528. Lab Stewardship for Clostridium difficile Testing Improves Appropriate Testing While Decreases Unnecessary Testing and Saves Laboratory Resources While Dramatically Helping to Reduce C diff Standardized Infection Ratios (SIR) |
title_full | 528. Lab Stewardship for Clostridium difficile Testing Improves Appropriate Testing While Decreases Unnecessary Testing and Saves Laboratory Resources While Dramatically Helping to Reduce C diff Standardized Infection Ratios (SIR) |
title_fullStr | 528. Lab Stewardship for Clostridium difficile Testing Improves Appropriate Testing While Decreases Unnecessary Testing and Saves Laboratory Resources While Dramatically Helping to Reduce C diff Standardized Infection Ratios (SIR) |
title_full_unstemmed | 528. Lab Stewardship for Clostridium difficile Testing Improves Appropriate Testing While Decreases Unnecessary Testing and Saves Laboratory Resources While Dramatically Helping to Reduce C diff Standardized Infection Ratios (SIR) |
title_short | 528. Lab Stewardship for Clostridium difficile Testing Improves Appropriate Testing While Decreases Unnecessary Testing and Saves Laboratory Resources While Dramatically Helping to Reduce C diff Standardized Infection Ratios (SIR) |
title_sort | 528. lab stewardship for clostridium difficile testing improves appropriate testing while decreases unnecessary testing and saves laboratory resources while dramatically helping to reduce c diff standardized infection ratios (sir) |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255454/ http://dx.doi.org/10.1093/ofid/ofy210.537 |
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