521. Clostridium difficile Timeout: A Nurse – Driven Protocol to Optimize Testing Stewardship
Session: Poster Abstract Session: Healthcare Epidemiology: Updates in C. difficile
Thursday, October 4, 2018
Room: S Poster Hall
  • IDWeek Poster CDTfinalPDF.pdf (919.3 kB)
  • Background: There remains a challenge in distinguishing colonization versus infection with Clostridium difficile (C. diff) associated diarrhea. At our institution, despite effective antimicrobial stewardship efforts, C. diff tests and positive infections remained high identifying a need for C. diff testing stewardship optimization.

    Methods: This was an IRB approved study on a nursing driven algorithm for Clostridium difficile Timeout (CDT). This included the number and shape of stools and absence of laxatives in the last 24 hours. Control and study groups were identified and a nurse provided C. diff education to the study group. Nursing utilized the CDT algorithm, and the C. diff PCR was sent if criteria were met to optimize testing stewardship. The primary objective was to assess the positive and negative predictive values (PPV and NPV) associated with CDT. A subgroup analysis included total tests and positive tests per patient days between study versus control groups. The secondary objective was HO-CDI/10000 patient-days (PD), and number of tests ordered and tests positive/10000PD pre and post implementation of CDT.

    Results: There were 87 patients who had CDT performed from June 2017-February 2018. There were 72 patients tested for C. diff PCR, and 15 were not tested. Baseline demographics were similar between both groups. Patients in the tested group compared to control were more likely to meet the criteria for >3 loose BMs/day (88% vs 40%, P=0.002) and lack of new start on laxatives (7% vs. 33%, P=0.012). Compared to the control group, there were fewer tests ordered for the study group (130 vs 160 per 10000PD, P=0.10) and similar positive tests results (26 vs 26 per 10000PD). This led to a PPV of 83.7% and a NPV of 20.3%. Overall, the post implementation group had low number of tests ordered (122 vs 158 per 10000PD) and positive tests (22 vs 26 per 10000PD). We noticed a consistent overall decline in HO-CDI/1000PD rates from 2016 vs. 2017 (6.18 vs 2.13 per 10000PD, P=0.13).

    Conclusion: With CDT utilization, there was a decline in total number of C. diff tests ordered. Through this nurse-initiated algorithm, testing stewardship for C. diff was optimized and a PPV and NPV was uncovered. With use of CDT in conjunction with antimicrobial stewardship efforts, there was an overall decline in HO-CDI/10000PD after implementation of this algorithm.

    Cindy Hou, DO, MA, MBA, FACOI1, Nikunj Vyas, PharmD, BCPS2, Lea Ann Kellum, MSN, RN, CCRN, CEN3, Mary Miller, RN, BSN, CIC3, Ann Marie Flory, MSN, RN, NE-BC3 and Shereef Ali, PharmD, BCPS, BCCCP4, (1)Infectious Diseases, Jefferson Health - New Jersey, Cherry Hill, NJ, (2)Pharmacy, Jefferson Health - New Jersey, Stratford, NJ, (3)Nursing, Jefferson Health - New Jersey, Cherry Hill, NJ, (4)Pharmacy, Jefferson Health - New Jersey, Cherry Hill, NJ


    C. Hou, None

    N. Vyas, None

    L. A. Kellum, None

    M. Miller, None

    A. M. Flory, None

    S. Ali, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.