1365. A Clostridium difficile Infection (CDI) Stewardship Initiative Decreases Inappropriate CDI Testing and Reduces Delays in Diagnosis
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Timely and appropriate diagnostic testing for Clostridium difficile Infection (CDI) is necessary to guide treatment and infection control decision making. We tested whether a CDI Stewardship Initiative would decrease inappropriate CDI testing and reduce delays in diagnosis.

Methods: We implemented a CDI stewardship initiative that included education and monitoring and feedback to nurses and physicians regarding indications for CDI testing and efforts to reduce delays in testing, including ward-level monitoring and feedback on timing and appropriateness of CDI testing, identification of ward nurse champions, and printouts each shift showing pending CDI tests on each ward. For a 3-month period before and 6-month period after the intervention, we compared the timing from CDI test order to completion of results and the proportions of inappropriate CDI tests (defined as testing ordered in the absence of diarrhea or other signs and symptoms consistent with CDI). 

Results: In comparison to the pre-intervention period, there were significant reductions in the proportion of patients with CDI tests completed that were inappropriate (48/130, 42% versus 82/305, 27%; P =0.0002) and in the average time from test order to test result (1.8 days to 0.8 days; P <0.01).

Conclusion: A CDI Stewardship Initiative resulted in a decrease in inappropriate CDI testing and reduced delays in diagnosis. A significant proportion of delays in diagnosis are attributable to inappropriate testing.

Lucy Jury, N.P.1, Brett Sitzlar, B.S.2, Myreen E. Tomas, MD3, Sirisha Kundrapu, M.D.2, Sudha Nagalingam, MD2 and Curtis J. Donskey, MD4, (1)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (2)Infectious Diseases, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (3)Infectious Disease, University Hospitals Case Medical Center, Ceveland, OH, (4)Infectious Diseases, Case Western Reserve University, Cleveland, OH


L. Jury, None

B. Sitzlar, None

M. E. Tomas, None

S. Kundrapu, None

S. Nagalingam, None

C. J. Donskey, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.