Diagnostic stewardship method to C. diff reduces pointless testing

A brand new research printed at this time within the American Journal of An infection Management (AJIC) describes the result of a brand new method to testing for Clostridioides difficile (C. diff), guided by the ideas of diagnostic stewardship. At Memorial Well being care System in Hollywood, Fla., revised guidelines for when C. diff assessments might be ordered helped to cut back inappropriate testing by 20%, which in flip can assist rein within the overtreatment of sufferers.

C. diff is a typical and doubtlessly harmful gastrointestinal pathogen, usually linked to well being care-associated infections and the overuse of antibiotics. Whereas early analysis may be useful in making certain that sufferers obtain the precise therapy, inappropriate testing could establish sufferers who’re harmlessly colonized with the micro organism relatively than affected by an acute an infection. Tips from infectious illness organizations suggest focused testing for sufferers demonstrating clear signs related to C. diff, relatively than broader testing for all sufferers with gastrointestinal signs, to keep away from pointless therapy.

On this research, clinicians from Memorial Well being care System developed and carried out new pointers to assist scale back inappropriate testing for C. diff, and monitored outcomes throughout the affected person inhabitants for 9 months to judge the method. These outcomes have been in comparison with testing carried out within the yr previous the brand new ordering pointers. The research stories outcomes from 224 grownup sufferers, 118 examined primarily based on the brand new methodology and 106 from earlier than the rules have been carried out.

The brand new ordering method concerned two units of guidelines: one for sufferers admitted throughout the final 72 hours, for whom C. diff testing might be ordered with out restriction for any affected person who lately had no less than three free or unformed stools, and the opposite for sufferers who had been within the hospital for 4 days or extra. For the latter group, C. diff testing couldn’t be ordered for sufferers who had been given laxatives inside 48 hours, who had been handled for C. diff 14 to 24 days prior, or who had examined optimistic for C. diff inside 14 days. Sufferers who had been examined for C. diff up to now 4 days, even when they acquired a adverse outcome, have been additionally not eligible for a new check.

For high-risk sufferers, reminiscent of those that have been immunocompromised or had lately undergone gastrointestinal surgical procedure, C. diff assessments might be given even when different eligibility pointers weren’t met. The brand new system was built-in with the hospital’s digital well being information to make sure consistency and documentation, and academic sources have been distributed to workers members.

Clinicians discovered a 20.1% discount in C. diff check orders deemed inappropriate below the brand new system in comparison with the yr previous to implementation, from 31.1% of assessments earlier than the brand new pointers to only 11% with them. Testing was outlined as inappropriate when sufferers didn’t have sufficient incidence of diarrhea reported or when there was latest laxative use with out different indicators of an infection.

“The objective of diagnostic stewardship is to make use of the precise check for the precise affected person on the proper time, and meaning we should use assessments appropriately and judiciously to make sure they supply outcomes that may assist information affected person care,” mentioned Rachel Guran, MPH, BSN, RN, CIC, FAPIC, director of epidemiology and an infection prevention at Memorial Well being care System and an creator of the research. “We’re more than happy that our new pointers for C. diff testing led to a transparent lower in inappropriate check ordering, which has advantages for decreasing pointless therapy and related well being care prices.”

Further particulars from the research embody:

• Following the adoption of new pointers, clinicians noticed a rise in 30-day readmission charges for sufferers within the research. An investigation famous a better proportion of sufferers with latest gastrointestinal surgical procedure within the post-intervention group in comparison with the pre-intervention group, and it was these sufferers who have been extra prone to be readmitted. Charges of readmission at 60 days remained larger for the post-intervention group, however the distinction was now not statistically important.
• Variations in 30-day and 60-day mortality throughout the 2 teams weren’t thought of statistically important.
• Regardless of the ordering restrictions for sufferers who had taken laxatives within the earlier 48 hours, there was no important distinction in publicity to laxatives within the teams of sufferers studied earlier than and after the brand new ordering system was put in place.

“Diagnostic stewardship is a crucial part in an infection prevention and management efforts,” mentioned Tania Bubb, Ph.D., RN, CIC, FAPIC, 2024 APIC president. “This research highlights the significance of evidence-based pointers for making certain acceptable use of testing and therapy in sufferers who could have C. diff infections.”

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Affiliation for Professionals in An infection Management