Session: Poster Abstract Session: Clostridium difficile: Outcomes, Testing, Prevention
Background: Although the negative predictive value of Clostridium difficile enzyme immunoassays (CD-EIA) is >97%, repeat orders are frequent. We evaluated the effect of an intervention limiting repeat CD-EIA testing on test utilization and clinical outcomes.
Methods: A hard-stop alert was placed in the computerized physician order entry (CPOE) system denying CD-EIA requests within 96 hours of a previous negative test. If the patient met clinical criteria for high suspicion for C. difficile infection, clinicians could request a repeat test by calling the lab medicine resident and a paper requisition. Education was performed pre-intervention (washout period; excluded from analyses). Testing patterns and clinical outcomes in the 3 months pre- and post-intervention were compared. Univariate logistic regression and chi square analyses were performed.
Results: The mean number of assays per admit and the number of admissions with assays ordered <96 hours apart decreased significantly post-intervention; the time between assays increased significantly (Table 1, Figure 1). Among patients with ≥1 CD-EIA, there were no significant negative outcomes post-intervention compared to the pre-intervention period (Table 2).
Conclusion: A CPOE system intervention to reduce repeat CD-EIA after an initial negative result within 96 hours resulted in a significant reduction in the number of repeat tests. The intervention did not appear to have a negative effect on patient outcomes.
Table 1. CD-EIAs 3 months pre- and post-intervention
Variable | Pre-intervention n (%) | Post-intervention n (%) | p |
Total number of EIAs | 1525 | 1203 |
|
Positive | 93 (6) | 86 (7) | 0.27 |
Number of admissions with ≥1 CD-EIA | 1146 | 986 |
|
Number of assays per admit (mean [range]) | 1.42 (1–14) | 1.25 (1–6) | <0.01 |
Days between 1st and 2nd EIAs (mean [range]) | 7.6 (0–64) | 9.5 (<1–41) | <0.01 |
Admissions with EIAs <96 hours apart | 124 (11) | 15 (2) | <0.01 |
Table 2. Clinical outcomes 3 months pre- and post-intervention
Variable | Pre-intervention n(%) | Post-intervention n(%) | OR (95% CI) | p |
Discharge location |
|
|
|
|
Home | 708 (62) | 639 (65) | Ref |
|
Healthcare facility | 304 (27) | 226 (23) | 0.8 (0.7–1.0) | 0.06 |
Died/hospice | 127 (11) | 111 (11) | 1.0 (0.7–1.3) | 0.82 |
Unknown | 7 (1) | 3 (<1) | 0.5 (0.1–1.8) | 0.28 |
Died within 30 days of EIA | 161 (14) | 108 (11) | 0.8 (0.6–1.0) | 0.04 |
Disclosures:
J. H. Kwon,
None
T. Hink, None
R. Jackups Jr., None
C. A. D. Burnham, None
E. R. Dubberke, Rebiotix Inc.: Investigator and Scientific Advisor , Consulting fee and Research support
Merck: Consultant and Investigator , Consulting fee and Research support
Sanofi Pasteur: Consultant and Grant Investigator , Consulting fee and Grant recipient
Summitt: Consultant , Consulting fee
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