The Effect of a Clinical Pathway on Reducing the Rate of Healthcare-Onset Clostridioides difficile

Authors

  • John W. Millard, Pharm.D., BCIDP
  • Yasmine Hussein Agha, M.D.
  • Sachin Srinivasan, M.D.
  • Maha Assi, M.D., MPH

DOI:

https://doi.org/10.17161/kjm.vol13.14762

Keywords:

Healthcare associated infections, Clostridium difficile infection, nosocomial infection

Abstract

Introduction. Stool assays used to diagnose Clostridioides difficile infection (CDI) do not differentiate acute CDI from asymptomatic carriers, which contributes to a falsely elevated rate of healthcare-facility onset (HO) CDI when CD stool assays are inappropriately ordered. The aim of this study was to investigate the rate of HO-CDI before and after implementing a mandatory clinical pathway prior to ordering stool tests when suspecting CDI.

Methods. A single-center retrospective observational study was conducted that spanned 12 months. All patients who developed diarrhea 48 hours after being admitted and whose primary physician requested a CD stool assay were included in the study. The intervention consisted of a mandatory sequence of questions that allowed providers to order a CD stool assay only if clinically indicated.

Results. Differences in HO-CDI rates pre- and post-intervention were analyzed. The HO-CDI rate during the pre-intervention and post-intervention periods were 24.1 and 0.0, respectively (p = 0.023).
Conclusion. A marked reduction of the rate of HO-CDI occurred after implementing a mandatory clinical pathway. Setting up a mandatory pre-testing questionnaire could decrease the misclassification of asymptomatic carriers as HO-CDI and the unnecessary prescription of antibiotics in situations where it is not indicated.

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Published

2020-10-16

Issue

Section

Original Research