Diagnostic stewardship for Clostridioides difficile testing in an acute care hospital: A quality improvement intervention
Abstract 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 requ...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2023-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X23001419/type/journal_article |
| _version_ | 1797851727447195648 |
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| author | Madeline L. Berg Ashley M. Ayres David R. Weber Melissa McCullough Victoria D. Crall Casey L. Lewis Abby L. Valek Lizabeth A. Vincent Joseph Penzelik Crystal A. Sasinoski Amanda L. Cheng Claire F. Bradford Elizabeth O. Bell Kimberly M. Edwards Isabella A. Castronova Mya B. Brady Julie Slaughter Louise-Marie Oleksiuk Graham M. Snyder |
| author_facet | Madeline L. Berg Ashley M. Ayres David R. Weber Melissa McCullough Victoria D. Crall Casey L. Lewis Abby L. Valek Lizabeth A. Vincent Joseph Penzelik Crystal A. Sasinoski Amanda L. Cheng Claire F. Bradford Elizabeth O. Bell Kimberly M. Edwards Isabella A. Castronova Mya B. Brady Julie Slaughter Louise-Marie Oleksiuk Graham M. Snyder |
| author_sort | Madeline L. Berg |
| collection | DOAJ |
| description |
Abstract
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.
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| first_indexed | 2024-04-09T19:21:22Z |
| format | Article |
| id | doaj.art-9cd692d3042c422d87f39f95c9a5d18f |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-04-09T19:21:22Z |
| publishDate | 2023-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-9cd692d3042c422d87f39f95c9a5d18f2023-04-05T10:22:13ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2023-01-01310.1017/ash.2023.141Diagnostic stewardship for Clostridioides difficile testing in an acute care hospital: A quality improvement interventionMadeline L. Berg0Ashley M. Ayres1David R. Weber2Melissa McCullough3Victoria D. Crall4Casey L. Lewis5Abby L. Valek6Lizabeth A. Vincent7Joseph Penzelik8Crystal A. Sasinoski9Amanda L. Cheng10Claire F. Bradford11Elizabeth O. Bell12Kimberly M. Edwards13Isabella A. Castronova14Mya B. Brady15Julie Slaughter16Louise-Marie Oleksiuk17Graham M. Snyder18https://orcid.org/0000-0001-5562-8880Department of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDivision of Laboratory Medicine, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Anesthesiology and Perioperative Medicine, UPMC Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Pharmacy, UPMC Presbyterian/Shadyside, Pittsburgh, PennsylvaniaDepartment of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, Pennsylvania Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Abstract 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. https://www.cambridge.org/core/product/identifier/S2732494X23001419/type/journal_article |
| spellingShingle | Madeline L. Berg Ashley M. Ayres David R. Weber Melissa McCullough Victoria D. Crall Casey L. Lewis Abby L. Valek Lizabeth A. Vincent Joseph Penzelik Crystal A. Sasinoski Amanda L. Cheng Claire F. Bradford Elizabeth O. Bell Kimberly M. Edwards Isabella A. Castronova Mya B. Brady Julie Slaughter Louise-Marie Oleksiuk Graham M. Snyder Diagnostic stewardship for Clostridioides difficile testing in an acute care hospital: A quality improvement intervention Antimicrobial Stewardship & Healthcare Epidemiology |
| 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 |
| url | https://www.cambridge.org/core/product/identifier/S2732494X23001419/type/journal_article |
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