This article is more than 5 years old. Information may no longer be current.
Physicians, nurses often disagree on when to test for C. difficile
Click Here to Manage Email Alerts
Significant differences existed between the risk factors that doctors and nurses considered most important before testing for Clostridium difficile, according to a study published in the American Journal of Infection Control.
“Clostridium difficile infection [CDI] is the primary infectious cause of health care-associated diarrhea,” Nasia Safdar, MD, PhD, department of medicine, University of Wisconsin Medical School, and colleagues wrote. “The incidence of hospital-acquired CDI is increasing and patients diagnosed with CDI incur greater costs, require increased length of stay, and have higher mortality rates.
“We undertook a survey to better understand the factors that prompt diagnostic testing for CDI in nurses and physicians, who may have differing perceptions of what constitutes high CDI risk.”
The study at William S. Middleton Veterans Affairs Hospital in Madison, Wisconsin, included 40 resident and attending physicians and 13 registered nurses. They completed surveys that asked them to rank (1-5 scale, 5 being the highest) various risk factors prior to testing for C. difficile.
The doctors and nurses agreed on the perceived importance of several factors, including: gender (doctors: 1.4; 95% CI, 1.2-1.6 vs. nurses: 1.3; 95% CI, 0.9-1.7;) and being aged older than 65 years (2.9; 95% CI, 2.5-3.3 vs. 2.3; 95% CI, 1.6-3.1), which were deemed as mild to moderate factors. They also agreed on more significant risk factors such as if the patient currently was assigned a high-risk antibiotic (4.9; 95% CI, 4.7-5 vs. 4.9; 95% CI, 4.8-5) or if they previously had a CDI (4.7; 95% CI, 4.5-4.8 vs. 4.4; 95% CI, 4-4.7), the researchers wrote.
The doctors and nurses, however, disagreed on the importance of other risk factors, including current status in the ICU (4; 95% CI, 3.7-4.2 vs. 2.6; 95% CI, 1.8-3.4), whether the patient reported abnormal stool odor (2.8; 95% CI, 2.4-3.2 vs. 4; 95% CI, 3.5-4.5), and whether the patient currently had a fever of 102°F or higher (4.2; 95% CI, 4-4.5 vs. 2.9; 95% CI, 2.3-3.5), according to Safdar and colleagues.
“Given recent data suggesting asymptomatic carriage of C. difficile ranges from 10% to 52%, inappropriate CDI testing increases the risk of inappropriate and unnecessary CDI therapy,” the researchers wrote. “Although there is significant overlap in well-described CDI risk factors that prompt nurses and physicians to order CDI laboratory testing, physicians ranked more clinically complex risk factors higher compared with nurses, whereas nurses ranked stool characteristics higher compared with physicians.” – by David Jwanier
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts