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Related Concept Videos

Healthcare Associated Infections II: Preventive Measures01:22

Healthcare Associated Infections II: Preventive Measures

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Essential infection prevention measures are based on the knowledge of the infection chain, the modes of transmission in healthcare settings, and the use of the best practices in all healthcare settings. Compulsory public reporting of healthcare-associated infection rates is needed to allow individuals and the community to make informed choices regarding selecting a healthcare facility.
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
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A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
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Reduction in testing and change in testing algorithm associated with decrease in number of nosocomial Clostridioides

Paul P Cook1, Suzy Nichols1, Michael Coogan2

  • 1Division of Infectious Diseases, Department of Medicine, Brody School of Medicine at East Carolina University, Greenville, NC.

American Journal of Infection Control
|February 12, 2020
PubMed
Summary
This summary is machine-generated.

Implementing a best practice advisory (BPA) and changing the Clostridioides difficile testing algorithm reduced nosocomial C. difficile infections (nCDI). The BPA decreased testing, while a new algorithm using cell cytotoxicity assay (CCA) significantly lowered nCDI rates.

Keywords:
C. difficileCell cytotoxicity assayNucleoside amplification assay testing

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Area of Science:

  • Infectious Diseases
  • Hospital Epidemiology
  • Clinical Microbiology

Background:

  • Nosocomial Clostridioides difficile infection (CDI) remains a significant healthcare challenge.
  • Inappropriate diagnostic testing contributes to the spread and management difficulties of CDI.
  • Optimizing diagnostic algorithms is crucial for effective CDI control.

Purpose of the Study:

  • To assess the impact of a best practice advisory (BPA) on C. difficile testing rates.
  • To evaluate the effect of modifying the CDI testing algorithm on nosocomial CDI (nCDI) incidence.
  • To determine the combined effect of these interventions on CDI diagnosis.

Main Methods:

  • Retrospective analysis of adult patients with CDI from July 2017 to September 2019.
  • Implementation of an electronic health record BPA to discourage CDI testing in patients on laxatives.
  • Shift in diagnostic strategy from nucleic acid amplification testing (NAAT) to cell cytotoxicity assay (CCA) for specific specimen types.

Main Results:

  • The BPA led to a 14% decrease in monthly C. difficile tests ordered (P=.0001).
  • Nosocomial CDI rates showed a 16.5% decrease post-BPA implementation (P=.33).
  • Substitution of CCA for NAAT resulted in a 50% reduction in nCDI rates (P<.0001).

Conclusions:

  • A BPA effectively reduced inappropriate C. difficile testing.
  • Modifying the diagnostic algorithm by replacing NAAT with CCA significantly decreased nCDI rates.
  • Combined interventions offer a successful strategy for reducing nosocomial CDI.