Mandatory ID approval associated with improved C. difficile testing
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Key takeaways:
- The appropriateness of hospital-onset C. difficile testing increased with mandatory ID approval.
- Mandatory ID approval was also associated with an increase in rates of positive test results.
An intervention requiring that infectious diseases approve testing for Clostridioides difficile infection increased the appropriateness of testing for hospital-onset C. difficile and lowered the positive testing rate by more than 50%.
“Many institutions have noted that C. difficile polymerase chain reaction testing can often be inappropriate, leading to overdiagnosis of [C. difficile infection (CDI)],” Michael Lin, MD, MPH, associate professor of internal medicine at Rush University Medical Center, told Healio.
“We assessed whether a mandatory infectious disease (ID) specialist approval process would improve appropriateness of testing and lead to reduction in hospital onset C. difficile infection rates,” he said.
Lin and colleagues performed a retrospective study, that compared hospital-onset CDI (HO-CDI) rates during three time periods between March 1, 2012, and Dec. 31, 2019 — baseline 1 (no decision support), baseline 2 (computer decision support) and the intervention period (mandatory ID specialist approval for all C. difficile testing on hospital day 4 or later).
Throughout the study, the researchers evaluated CDI across 331,180 admissions and 1,172,015 patient-days and learned that, overall, the appropriateness of HO-CDI testing increased with each time period, with the mandatory ID approval intervention period being associated with the highest rate of appropriate testing.
During the intervention period, an average of one HO-CDI test approval request was observed daily, with adherence to obtaining ID approval by ordering providers being 85%. The researchers analyzed the first 608 requests for testing approval over an 18-month period, during which 493 (81%) test requests were approved.
Reasons for not getting approval included prior laxative receipt within 48 hours (43%), not meeting criteria for diarrhea (38%) and clinical syndrome not suggestive of CDI (12%).
According to the study, the intervention period was also associated with a lower unadjusted HO-CDI rate compared with either baseline period. Specifically, researchers found that HO-CDI testing decreased by 60% between the baseline and intervention, along with an increase in test positivity rate — 11.2% in baseline 1, 13.4% in baseline 2, and 16.2% in the intervention period.
“Infectious disease specialists can play a key role in diagnostic stewardship, highlighting their value to health care organizations,” Lin said.
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