520. Reducing Inappropriate Clostridium difficle Testing by Empowering Nurses
Session: Poster Abstract Session: Healthcare Epidemiology: Updates in C. difficile
Thursday, October 4, 2018
Room: S Poster Hall
  • RN Driven Algorithm HO CDI.pdf (369.8 kB)
  • Background:

    Inappropriate testing for Clostridium difficle (CD) can result in over diagnosing, which may lead to overuse of antibiotics, increased length of stay and financial penalties under Center for Medicare and Medicaid’s Value Based Programs. To address unnecessary testing, a nurse driven algorithm was developed and implemented at a tertiary teaching hospital in Detroit, Michigan.  In this study, we evaluate the intervention’s impact on hospital acquired CD infections (HO-CDI) rates.


    An algorithm for CD testing appropriateness was created by leadership and the Infection Prevention team.  The algorithm emphasized that CD testing should not be performed on asymptomatic patients or those receiving laxatives and/or stool softeners.  Rates of HO-CDI per 10,000 patient days were compared before and after the intervention and statistical significance was determined by an unpaired t-test.  The hospital laboratory used PCR to detect CD throughout the study period.


    Before the algorithm was implemented, our hospital had an average of 8.2 HO-CDI per 10,000 patient days.  After the intervention was established, the rate decreased to 4.6 HO-CDI per 10,000 patient days. This represents a statistically significant decrease in HO-CDI (p=0.037). The rate of community onset CD cases, defined as infection that are identified between calendar day 1 through 3, did not change significantly during the study (p=0.65).


    Empowering and educating nurses about CD testing guidelines proved to be an effective tactic to reduce unnecessary CD testing, and in turn, decrease our HO-CDI rates.

    Jennifer LeRose, MPH1, Amar Krishna, MD2, Suganya Chandramohan, MD2, Michelle Bartholomew, BS1, Margaret Turner, M.Ed., CIC, RN3, Nancy Baran, MS, CIC4, Thomas Chevalier, RN, BSN, CIC4, Judy Moshos, MT (ASCP), CIC5, Samyah Mogalli, MHSA, MT(ASCP)3, Lynn Semproch, MPH, CIC6 and Teena Chopra, MD, MPH2, (1)Quality and Safety, Detroit Medical Center, Detroit, MI, (2)Division of Infection Control and Hospital Epidemiology, Detroit Medical Center, Detroit, MI, (3)Detroit Medical Center, Detroit, MI, (4)Infection Prevention and Hospital Epidemiology, Detroit Medical Center, Detroit, MI, (5)Detroit Medical Center/Wayne State University, Detroit, MI, (6)Epidemiologist, Children's Hospital of Michigan/Detroit Medical Center, Detroit, MI


    J. LeRose, None

    A. Krishna, None

    S. Chandramohan, None

    M. Bartholomew, None

    M. Turner, None

    N. Baran, None

    T. Chevalier, None

    J. Moshos, None

    S. Mogalli, None

    L. Semproch, None

    T. Chopra, 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.