2097. Reducing Unnecessary Clostridium difficile Testing in a Community Teaching Hospital
Session: Poster Abstract Session: Clostridium difficile: Outcomes, Testing, Prevention
Saturday, October 29, 2016
Room: Poster Hall
Background:

Clostridium difficile (C. difficile) is implicated in 500,000 healthcare-acquired infections and 29,000 deaths in the U.S. each year[1]. Despite its prevalence, laboratory testing for C. difficile is often unwarranted. Our study evaluates the efficacy of an educational presentation in conjunction with a streamlined electronic order screen in reducing the frequency of inappropriate C. difficile testing.



[1] CDC. Nearly Half a Million Americans Suffered from Clostridium Difficile Infections in a Single Year. 25 Feb. 2015.

Methods:

This is a combined retrospective/prospective cohort study evaluating the efficacy of an intervention to reduce unnecessary C. difficile testing. First, the C. difficile DNA probe test order screen was updated to require the ordering physician to choose from a list of indications. Listed indications included those supported by guidelines published by the Society for Healthcare Epidemiology in America (SHEA) and the Infectious Diseases Society of America (IDSA) as well as those unsupported by guidelines. No distinction was made between the two groups. Two months later, a brief educational presentation was made to house staff on the SHEA/IDSA guidelines in conjunction with a further update to the C. difficile order screen that now distinguishes between guideline supported and non-guideline supported indications.

Results:

During part one of the intervention, 277 C. difficile tests were ordered (3.90 per day) of which 80 (1.13 per day) were based on non-guideline supported indications, including leukocytosis without diarrhea, fever of unknown origin, and test of cure. During part two of the intervention, 116 C. difficile tests were ordered (3.41 per day) of which 33 (0.97 per day) were based on non-guideline supported indications.

Conclusion:

Despite the wide availability of evidence-based guidelines, unwarranted C. difficile testing persists in the hospitalized setting. We have demonstrated that an intervention of negligible cost and complexity can help reduce unnecessary C. difficile testing. In light of the more than $14,000/year spent on unnecessary C. difficile testing in our institution, this intervention may help lower healthcare costs and reduce the burden of unnecessary downstream testing and procedures.

Uri Goldberg, MD1, Alok Gupta, MD2, Virginie Auguste, MD2, Jorge Donado, MD2, Vincent Peyko, Pharm.D2, Angela Belfer, RN2, Pwint Htwe, MD3 and Rajat Mukherji, MD2, (1)Internal Medicine, Kingsbrook Jewish Medical Center, Brooklyn, NY, (2)Kingsbrook Jewish Medical Center, Brooklyn, NY, (3)Infectious diseases, Maimonides medical center, brooklyn, NY

Disclosures:

U. Goldberg, None

A. Gupta, None

V. Auguste, None

J. Donado, None

V. Peyko, None

A. Belfer, None

P. Htwe, None

R. Mukherji, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.