Diagnostic stewardship helps reduce C. difficile at children’s hospital
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Key takeaways:
- Diagnostic stewardship helped lower the rate of hospital-onset C. difficile by more than 50% at a children’s hospital.
- Stewardship was combined with targeted prevention efforts and a new clinical care pathway.
Diagnostic stewardship, along with targeted prevention efforts and a testing and treatment clinical care pathway, reduced hospital-onset cases of Clostridioides difficile by more than 50% in a children’s hospital, researchers reported.
The CDC has identified C. difficile it as an urgent threat and one of the top drug-resistant pathogens in need of aggressive action. Asymptomatic C. difficile is most common among infants aged between 6 and 12 months.
Examining ways to decrease C. difficile in hospital settings, researchers at Children’s Hospital Colorado conducted a quality improvement study to evaluate strategies aimed at reducing hospital-onset C. difficile infection (HO-CDI) with an aim to reduce HO-CDI, C. difficile detection and stool testing by 20% in 12 months.
“At our institution, the introduction of [gastrointestinal panels, (GIPs)] was associated with increased C. difficile detection, high rates of negative stool results (ie, GIP with no organisms detected), and no change in outcomes for most patients,” the researchers wrote. “Ongoing rising rates of CDI at our institution around the same time were likely, in part, because of increased testing, resulting in increased C. difficile detection and misclassification of colonization as CDI. Additionally, there were concerns regarding potential lapses in infection control practices and variations in treatment, particularly in the oncology unit, which had the highest CDI rates.”
The researchers began by creating teams to suggest strategies for testing and treatment, and for C. difficile prevention. These teams then developed and implemented intervention strategies such as the creation and distribution of an evidence-based clinical pathway for testing and treating C. difficile, deployment of the Bristol school scale to help define diarrhea and address inappropriate testing, redesign of unit scrubs in stations and adding timers and signage, initiation of ultraviolet cleaning of shared spaces and waiting rooms and use of blacklight audits for high-touch surfaces to identify missed areas, among others.
Following the implementation of the quality improvement project from 2018 to 2020, HO-CDI in the hospital decreased by 55%, falling from 11 to 5 cases per 10,000 patient days. Overall C. difficile detection decreased by 44%, from 18 to 10 cases per 10,000 patient days, and overall test use decreased by 29%, from 99 to 70 per 10,000 patient days, according to the researchers.
The hospital’s decrease in stool tests resulted in annual savings of $55,649. Only 2.3% of initially suppressed positive C. difficile results were released, and no patients had adverse events.
“In conclusion, we found that a clinical decision support tool, coupled with education, standardized definition of diarrhea, and targeted prevention efforts, led to significant and sustained reductions in C. difficile detection, infection, and stool test utilization,” the researchers wrote.
References:
CDC. AR threats report. https://www.cdc.gov/DrugResistance/Biggest-Threats.html. Accessed Feb. 22, 2024.
Cotter JM, et al. Pediatrics. 2024;doi:10.1542/peds.2023-061981.
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