Evaluation of the microbiology lab addressing physicians regarding Clostridium Difficile testing

Introduction:

Hospital acquired Clostridium Difficile rates have increased in the past decade and through the antibiotic stewardship program at Sacred Heart Hospital, methods have been implemented to make the ordering process of Clostridium Difficile tests more efficient.  

Objectives:

In order to decrease hospital acquired Clostridium Difficile rates, the microbiology lab started calling physicians/nurses when Clostridium Difficile tests are ordered to check for inappropriate testing.

Study Design:

Retrospective cohort study

Methods:

Participants classified as having hospital acquired Clostridium Difficile were included in this study. The ordering process of Clostridium Difficile tests were analyzed based off data collected retrospectively from eligible participants between July 2015 and April 2016. In November 2015, the microbiology lab began calling physicians/nurses when Clostridium Difficile tests were ordered to prevent inappropriate testing. Inappropriate testing was defined as being tested for the Clostridium Difficile toxin when a prokinetic agent was administered within 24 hours before receiving the test. Data was collected before and after the implementation of this process to decrease our hospital acquired Clostridium Difficile rates through eliminating test performance on participants who are colonized with this pathogen instead of having an active infection.

Results:

After 2 months since implementation of this process, inappropriate tests ordered for the Clostridium Difficile toxin in hospital acquired participants has dropped from 58.3% to 33.3%. Data gathered between July and November showed 14/24 inappropriate tests and preliminary data for December and January show 3/9 inappropriate tests ordered thus far. There was an average of 4.8% of Clostridium Difficile cases during the first 5 months. It is predicted to be less than this average over the second 5 month course of this study.

Conclusions:

A decrease is shown in hospital acquired Clostridium Difficile rates due to inappropriate test ordering which should also decrease our overall hospital acquired Clostridium Difficile rates as well.