Sustained reduction in rates of hospital-onset Clostridium difficile infection using an automated electronic health record protocol

Published:November 21, 2017DOI:


      • An automated protocol can help a hospital's efforts to reduce Clostridium difficile rates.
      • Optimizing the timing and appropriateness of C difficile testing is an important step in reducing C difficile rates.
      • Hospital leadership commitment and support in addition to buy-in from nursing and physician groups is essential for the success of infection prevention interventions.


      An automated protocol was designed within our electronic medical record (EMR) to help curb the Clostridium difficile problem at our institution. The protocol will identify patients at high risk for C difficile, improve the timing of testing of patients infected on admission, and enhance the appropriateness of C difficile testing throughout the patient's hospitalization.


      Admitted patients with 2 of the following 3 criteria were labeled as high risk for C difficile: admission to a medical institution in the preceding 90 days, administration of antibiotics in the preceding 90 days, or a history of C difficile. High-risk patients with diarrhea in the first 3 days of admission are identified in the EMR, and prompt testing for C difficile is done. After day 3, if diarrhea develops, a series of questions is presented to help test the appropriate patients for C difficile.


      A statistically significant reduction in rates of hospital-onset C difficile was achieved after implementation of the protocol.


      Implementation of an automated protocol for targeted testing of high-risk patients for C difficile was successful at reducing rates of hospital-onset C difficile by improving timing and appropriateness of testing.

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