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
Hauptverfasser: 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
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container_end_page
container_issue 3
container_start_page 1
container_title Pediatrics (Evanston)
container_volume 153
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
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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. 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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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