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Background
Healthcare associated Clostridium difficile infections (HAI CDI) can be challenging
to prevent in acute care hospitals. Innovative strategies, beyond the basics of prevention,
are needed in small community hospitals with limited resources to further reduce the
number of infections. CDI Stewardship in a 158-bed community hospital mediated by
Infection Prevention (IP) and Infectious Disease Pharmacist (IDP) evaluates the appropriateness
of CDI testing in real time.
Methods
Beginning January 2018 IP and IDP conducted nursing rounds to evaluate inpatients
with CDI test orders for clinical symptoms as well as medications or nutrition factors
that may cause loose stools. On the spot education on CDI symptoms and other causes
of diarrhea was provided to nurses and clinicians. After patient assessment a recommendation
to continue or stop testing was made to the ordering provider. We then compared the
incidence of HAI CDI and the number of CDI orders in 2017 and 2019.
Results
Comparing data in the pre-intervention period of 2017 and post-intervention period
of 2019 we identified a 25% reduction in orders for CDI (340 vs 255), and a 25% increase
in the proportion of canceled orders (28% vs 35%). A corresponding decrease in the
number of HAI CDI pre vs post-intervention occurred (18 vs 9 cases, p>0.05). We also
noted an increase in the number of consultations sought by nursing staff to review
CDI testing appropriateness.
Conclusions
Though not statistically significant, real-time CDI Stewardship intervention by IP
and IDP reduced the number of HAI CDI by 50% in our hospital. Increased awareness
among clinical staff of the need to assess patient clinical symptoms, medications
and nutrition to ensure appropriate identification of HAI CDI contributed to the reduction
in unnecessary orders. With minimal resources in a community setting, CDI Stewardship
is a feasible intervention in the prevention of CDI and other antimicrobial resistant
infections.
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Copyright
© 2020 Published by Elsevier Inc.
