Reduction in Health Care Facility-Onset Clostridioides difficile Infection: A Quality Improvement Initiative

Area of Science:

• Infectious Diseases
• Healthcare Quality Improvement
• Diagnostic Stewardship

Background:

• Health care facility-onset Clostridioides difficile infection (HCFO CDI) remains a significant challenge.
• Inappropriate diagnostic testing contributes to the incidence of HCFO CDI.
• Improving diagnostic stewardship is crucial for infection control.

Purpose of the Study:

• To decrease HCFO CDI incidence.
• To enhance diagnostic stewardship for Clostridioides difficile testing.
• To reduce inappropriate testing of C. difficile assays.

Main Methods:

• A quality improvement initiative was conducted from January 2020 to March 2021.
• An intervention bundle included provider education, an appropriate testing algorithm, expert order review, and batch testing.
• Electronic health records were used to identify HCFO CDI and inappropriate testing.

Main Results:

• The intervention bundle led to an 83.6% reduction in inappropriate C. difficile orders tested.
• HCFO CDI incidence decreased by 41.7% compared to the baseline period.
• The study demonstrated a significant impact of the intervention on diagnostic practices and infection rates.

Conclusions:

• A novel prevention bundle effectively improved C. difficile diagnostic stewardship.
• The initiative successfully reduced HCFO CDI incidence by curbing inappropriate testing.
• Targeting HCFO CDI through such stewardship programs can enhance patient safety and hospital finances.