Background: Our goal was to reduce the rate of hospital-onset (HO) C. difficile (CD) by prompt testing in patients with diarrhea on hospital day (HD) 1-3 using a nurse-driven testing protocol (NTP) with PCR and improve identification of disease after HD 3 using a combined toxin/antigen assay (TAA).
Methods: An automated best practice advisory/NTP was developed in Epic, triggered by documentation of diarrhea during HD 1-3, to facilitate prompt stool collection, testing and initiation of contact precautions. Education was provided. The NTP was fully implemented at 2 community-teaching hospitals mid-February 2016. The TAA was adopted 7/27/16 for testing after HD 3.
Results: In 2016, the standardized infection ratio (SIR) at Cambridge and Everett was 0.43 (p=0.009) and 0.5 (p=0.017), respectively, reflecting a 48-61% decrease from 2015. There was a 14-28% improvement in identifying cases as community-onset. The TAA led to a further decline in HO-CD by 10-61%. Refer to the graph for quarterly SIRs before and after implementation. Despite a 26% increase in testing volume, costs are less with the current strategy.
Conclusion: Prompt identification of CD improves care and prevents inflation of HO-CD. This strategy has enhanced our efforts to reduce our SIR (observed/expected cases) and resulted in a substantial incentive payment for CHA.
L. A. Bruno-Murtha,
C. Alexandre, None
R. Mahmood, None