Impact of Mandatory Infectious Disease Specialist Approval on Hospital-Onset Clostridioides difficile Infection Rates...

Area of Science:

• Infectious Diseases
• Hospital Epidemiology
• Clinical Microbiology

Background:

• Inappropriate Clostridioides difficile testing is prevalent in hospitals, potentially leading to overdiagnosis.
• The impact of infectious diseases (ID) specialists on optimizing C. difficile testing protocols remains under-explored.

Purpose of the Study:

• To evaluate the feasibility and impact of an ID specialist-led approval process for C. difficile testing.
• To assess the effect of this intervention on hospital-onset C. difficile infection (HO-CDI) rates.

Main Methods:

• A retrospective study was conducted at a 697-bed academic hospital over 94 months (March 2012-December 2019).
• Hospital-onset C. difficile infection (HO-CDI) rates were compared across three periods: baseline (no decision support), baseline with computer decision support, and intervention with mandatory ID specialist approval for testing on or after hospital day 4.
• A discontinuous growth model was used to analyze HO-CDI rate changes.

Main Results:

• The HO-CDI rate decreased from 10.2 and 10.4 events per 10,000 patient-days during baseline periods to 4.3 events per 10,000 patient-days during the intervention period.
• The intervention demonstrated a statistically significant reduction in HO-CDI rates (P < .001) compared to the baseline periods.
• Provider adherence to the testing approval process was 85%, with a median of one approval request per day during the intervention.

Conclusions:

• An infectious diseases specialist-led C. difficile testing approval process is feasible in a hospital setting.
• This intervention was associated with a greater than 50% reduction in hospital-onset C. difficile infection rates.
• Enforcing appropriate testing through specialist approval effectively reduces HO-CDI incidence.