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Dynamic Duos and Where to Find Them: Infection Prevention and Infectious Disease Pharmacist Collaboration to Prevent Clostridium Difficile Infections

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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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