A Multimodal Intervention to Reduce C. difficile Infections and Stool Testing
The introduction of multiplex gastrointestinal panels at our institution resulted in increased Clostridioides difficile (C. difficile) detection and stool test utilization. We aimed to reduce hospital-onset C. difficile infections (HO-CDIs), C. difficile detection, and overall stool testing by 20% w...
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| Veröffentlicht in: | Pediatrics (Evanston) 2024-03, Vol.153 (3), p.1 |
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| creator | Cotter, Jillian M Stokes, Claire L Tong, Suhong Birkholz, Meghan Child, Jason Cost, Carrye Coughlin, Rebecca Cox, Stephanie Dolan, Susan A Dorris, Kathleen Hazleton, Keith Z Lugo, Virginia Norcross, Mikayla Pearce, Kelly Dominguez, Samuel R |
| description | The introduction of multiplex gastrointestinal panels at our institution resulted in increased Clostridioides difficile (C. difficile) detection and stool test utilization. We aimed to reduce hospital-onset C. difficile infections (HO-CDIs), C. difficile detection, and overall stool testing by 20% within 1 year.
We conducted a quality improvement project from 2018 to 2020 at a large children's hospital. Interventions included development of a C. difficile testing and treatment clinical care pathway, new options for gastrointestinal panel testing with or without C. difficile (results were suppressed if not ordered), clinical decision support tool to restrict testing, and targeted prevention efforts. Outcomes included the rate of HO-CDI (primary), C. difficile detection, and overall stool testing. All measures were evaluated monthly among hospitalized children per 10 000 patient-days (PDs) using statistical process-control charts. For balancing measures, we tracked suppressed C. difficile results that were released during real-time monitoring because of concern for true infection and C. difficile-related adverse events.
HO-CDI decreased by 55%, from 11 to 5 per 10 000 PDs. C. difficile detection decreased by 44%, from 18 to 10 per 10 000 PDs, and overall test utilization decreased by 29%, from 99 to 70 per 10 000 PDs. The decrease in stool tests resulted in annual savings of $55 649. Only 2.3% of initially suppressed positive C. difficile results were released, and no patients had adverse events.
Diagnostic stewardship strategies, coupled with an evidence-based clinical care pathway, can be used to decrease C. difficile and improve overall test utilization. |
| doi_str_mv | 10.1542/peds.2023-061981 |
| format | Article |
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We conducted a quality improvement project from 2018 to 2020 at a large children's hospital. Interventions included development of a C. difficile testing and treatment clinical care pathway, new options for gastrointestinal panel testing with or without C. difficile (results were suppressed if not ordered), clinical decision support tool to restrict testing, and targeted prevention efforts. Outcomes included the rate of HO-CDI (primary), C. difficile detection, and overall stool testing. All measures were evaluated monthly among hospitalized children per 10 000 patient-days (PDs) using statistical process-control charts. For balancing measures, we tracked suppressed C. difficile results that were released during real-time monitoring because of concern for true infection and C. difficile-related adverse events.
HO-CDI decreased by 55%, from 11 to 5 per 10 000 PDs. C. difficile detection decreased by 44%, from 18 to 10 per 10 000 PDs, and overall test utilization decreased by 29%, from 99 to 70 per 10 000 PDs. The decrease in stool tests resulted in annual savings of $55 649. Only 2.3% of initially suppressed positive C. difficile results were released, and no patients had adverse events.
Diagnostic stewardship strategies, coupled with an evidence-based clinical care pathway, can be used to decrease C. difficile and improve overall test utilization.</description><identifier>ISSN: 0031-4005</identifier><identifier>ISSN: 1098-4275</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2023-061981</identifier><identifier>PMID: 38352983</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>Adverse events ; Bacterial infections ; Child ; Child, Hospitalized ; Clostridioides difficile ; Clostridium Infections - diagnosis ; Clostridium Infections - prevention & control ; Critical Pathways ; Digestive system ; Feces ; Hospitals, Pediatric ; Humans ; Patients ; Quality control</subject><ispartof>Pediatrics (Evanston), 2024-03, Vol.153 (3), p.1</ispartof><rights>Copyright © 2024 by the American Academy of Pediatrics.</rights><rights>Copyright American Academy of Pediatrics Mar 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c378t-444154d58b465e0a039fa9b69feb7a8e915f8f860f9e2cf91129c0f448e5bcd53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,782,786,887,27931,27932</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38352983$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cotter, Jillian M</creatorcontrib><creatorcontrib>Stokes, Claire L</creatorcontrib><creatorcontrib>Tong, Suhong</creatorcontrib><creatorcontrib>Birkholz, Meghan</creatorcontrib><creatorcontrib>Child, Jason</creatorcontrib><creatorcontrib>Cost, Carrye</creatorcontrib><creatorcontrib>Coughlin, Rebecca</creatorcontrib><creatorcontrib>Cox, Stephanie</creatorcontrib><creatorcontrib>Dolan, Susan A</creatorcontrib><creatorcontrib>Dorris, Kathleen</creatorcontrib><creatorcontrib>Hazleton, Keith Z</creatorcontrib><creatorcontrib>Lugo, Virginia</creatorcontrib><creatorcontrib>Norcross, Mikayla</creatorcontrib><creatorcontrib>Pearce, Kelly</creatorcontrib><creatorcontrib>Dominguez, Samuel R</creatorcontrib><title>A Multimodal Intervention to Reduce C. difficile Infections and Stool Testing</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>The introduction of multiplex gastrointestinal panels at our institution resulted in increased Clostridioides difficile (C. difficile) detection and stool test utilization. We aimed to reduce hospital-onset C. difficile infections (HO-CDIs), C. difficile detection, and overall stool testing by 20% within 1 year.
We conducted a quality improvement project from 2018 to 2020 at a large children's hospital. Interventions included development of a C. difficile testing and treatment clinical care pathway, new options for gastrointestinal panel testing with or without C. difficile (results were suppressed if not ordered), clinical decision support tool to restrict testing, and targeted prevention efforts. Outcomes included the rate of HO-CDI (primary), C. difficile detection, and overall stool testing. All measures were evaluated monthly among hospitalized children per 10 000 patient-days (PDs) using statistical process-control charts. For balancing measures, we tracked suppressed C. difficile results that were released during real-time monitoring because of concern for true infection and C. difficile-related adverse events.
HO-CDI decreased by 55%, from 11 to 5 per 10 000 PDs. C. difficile detection decreased by 44%, from 18 to 10 per 10 000 PDs, and overall test utilization decreased by 29%, from 99 to 70 per 10 000 PDs. The decrease in stool tests resulted in annual savings of $55 649. Only 2.3% of initially suppressed positive C. difficile results were released, and no patients had adverse events.
Diagnostic stewardship strategies, coupled with an evidence-based clinical care pathway, can be used to decrease C. difficile and improve overall test utilization.</description><subject>Adverse events</subject><subject>Bacterial infections</subject><subject>Child</subject><subject>Child, Hospitalized</subject><subject>Clostridioides difficile</subject><subject>Clostridium Infections - diagnosis</subject><subject>Clostridium Infections - prevention & control</subject><subject>Critical Pathways</subject><subject>Digestive system</subject><subject>Feces</subject><subject>Hospitals, Pediatric</subject><subject>Humans</subject><subject>Patients</subject><subject>Quality control</subject><issn>0031-4005</issn><issn>1098-4275</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc9LHDEYhkNRdGt776kEvHiZ9cuvmeQksmgVFMHac8hkvtjI7GSdzAj975tlVWxPOeT5Xt6Xh5BvDJZMSX66wS4vOXBRQc2MZp_IgoHRleSN2iMLAMEqCaAOyeecnwBAqoYfkEOhheJGiwW5Pae3cz_FdepcT6-HCccXHKaYBjoleo_d7JGulrSLIUQfeyxMQL8FMnVDR39OKfX0AfMUh8cvZD-4PuPX1_eI_Lq8eFhdVTd3P65X5zeVF42eKillqd8p3cpaITgQJjjT1iZg2ziNhqmgg64hGOQ-GMa48RCk1Kha3ylxRM52uZu5XWPnS-PR9XYzxrUb_9jkov33Z4i_7WN6sYyJGqDWJeHkNWFMz3Npb9cxe-x7N2Cas-WG14ozA6agx_-hT2keh7KvUGWPFg1rCgU7yo8p5xHDexsGdivLbmXZrSy7k1VOvn9c8X7wZkf8BatokGc</recordid><startdate>20240301</startdate><enddate>20240301</enddate><creator>Cotter, Jillian M</creator><creator>Stokes, Claire L</creator><creator>Tong, Suhong</creator><creator>Birkholz, Meghan</creator><creator>Child, Jason</creator><creator>Cost, Carrye</creator><creator>Coughlin, Rebecca</creator><creator>Cox, Stephanie</creator><creator>Dolan, Susan A</creator><creator>Dorris, Kathleen</creator><creator>Hazleton, Keith Z</creator><creator>Lugo, Virginia</creator><creator>Norcross, Mikayla</creator><creator>Pearce, Kelly</creator><creator>Dominguez, Samuel R</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240301</creationdate><title>A Multimodal Intervention to Reduce C. difficile Infections and Stool Testing</title><author>Cotter, Jillian M ; Stokes, Claire L ; Tong, Suhong ; Birkholz, Meghan ; Child, Jason ; Cost, Carrye ; Coughlin, Rebecca ; Cox, Stephanie ; Dolan, Susan A ; Dorris, Kathleen ; Hazleton, Keith Z ; Lugo, Virginia ; Norcross, Mikayla ; Pearce, Kelly ; Dominguez, Samuel R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c378t-444154d58b465e0a039fa9b69feb7a8e915f8f860f9e2cf91129c0f448e5bcd53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adverse events</topic><topic>Bacterial infections</topic><topic>Child</topic><topic>Child, Hospitalized</topic><topic>Clostridioides difficile</topic><topic>Clostridium Infections - diagnosis</topic><topic>Clostridium Infections - prevention & control</topic><topic>Critical Pathways</topic><topic>Digestive system</topic><topic>Feces</topic><topic>Hospitals, Pediatric</topic><topic>Humans</topic><topic>Patients</topic><topic>Quality control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cotter, Jillian M</creatorcontrib><creatorcontrib>Stokes, Claire L</creatorcontrib><creatorcontrib>Tong, Suhong</creatorcontrib><creatorcontrib>Birkholz, Meghan</creatorcontrib><creatorcontrib>Child, Jason</creatorcontrib><creatorcontrib>Cost, Carrye</creatorcontrib><creatorcontrib>Coughlin, Rebecca</creatorcontrib><creatorcontrib>Cox, Stephanie</creatorcontrib><creatorcontrib>Dolan, Susan A</creatorcontrib><creatorcontrib>Dorris, Kathleen</creatorcontrib><creatorcontrib>Hazleton, Keith Z</creatorcontrib><creatorcontrib>Lugo, Virginia</creatorcontrib><creatorcontrib>Norcross, Mikayla</creatorcontrib><creatorcontrib>Pearce, Kelly</creatorcontrib><creatorcontrib>Dominguez, Samuel R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cotter, Jillian M</au><au>Stokes, Claire L</au><au>Tong, Suhong</au><au>Birkholz, Meghan</au><au>Child, Jason</au><au>Cost, Carrye</au><au>Coughlin, Rebecca</au><au>Cox, Stephanie</au><au>Dolan, Susan A</au><au>Dorris, Kathleen</au><au>Hazleton, Keith Z</au><au>Lugo, Virginia</au><au>Norcross, Mikayla</au><au>Pearce, Kelly</au><au>Dominguez, Samuel R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Multimodal Intervention to Reduce C. difficile Infections and Stool Testing</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2024-03-01</date><risdate>2024</risdate><volume>153</volume><issue>3</issue><spage>1</spage><pages>1-</pages><issn>0031-4005</issn><issn>1098-4275</issn><eissn>1098-4275</eissn><abstract>The introduction of multiplex gastrointestinal panels at our institution resulted in increased Clostridioides difficile (C. difficile) detection and stool test utilization. We aimed to reduce hospital-onset C. difficile infections (HO-CDIs), C. difficile detection, and overall stool testing by 20% within 1 year.
We conducted a quality improvement project from 2018 to 2020 at a large children's hospital. Interventions included development of a C. difficile testing and treatment clinical care pathway, new options for gastrointestinal panel testing with or without C. difficile (results were suppressed if not ordered), clinical decision support tool to restrict testing, and targeted prevention efforts. Outcomes included the rate of HO-CDI (primary), C. difficile detection, and overall stool testing. All measures were evaluated monthly among hospitalized children per 10 000 patient-days (PDs) using statistical process-control charts. For balancing measures, we tracked suppressed C. difficile results that were released during real-time monitoring because of concern for true infection and C. difficile-related adverse events.
HO-CDI decreased by 55%, from 11 to 5 per 10 000 PDs. C. difficile detection decreased by 44%, from 18 to 10 per 10 000 PDs, and overall test utilization decreased by 29%, from 99 to 70 per 10 000 PDs. The decrease in stool tests resulted in annual savings of $55 649. Only 2.3% of initially suppressed positive C. difficile results were released, and no patients had adverse events.
Diagnostic stewardship strategies, coupled with an evidence-based clinical care pathway, can be used to decrease C. difficile and improve overall test utilization.</abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>38352983</pmid><doi>10.1542/peds.2023-061981</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | Pediatrics (Evanston), 2024-03, Vol.153 (3), p.1 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adverse events Bacterial infections Child Child, Hospitalized Clostridioides difficile Clostridium Infections - diagnosis Clostridium Infections - prevention & control Critical Pathways Digestive system Feces Hospitals, Pediatric Humans Patients Quality control |
| title | A Multimodal Intervention to Reduce C. difficile Infections and Stool Testing |
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