Three stages of laboratory stewardship in improving appropriate Clostridioides difficile testing in a community-based setting.

Antimicrobial stewardship & healthcare epidemiology : ASHE Pub Date : 2025-03-19 eCollection Date: 2025-01-01 DOI:10.1017/ash.2025.55

Michael S Wang, Gretchen Zimmerman, Theres Klein, Bethany Stibbe, Monica Rykse, Samuel Ballard, Naveen Vijayam, Joe Brown, Khateeb Raza, Shannon Beckman, Andrew M Skinner

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Abstract

Objective: Assess the efficacy of staged interventions aimed to reduce inappropriate Clostridioides difficile testing and hospital-onset C. difficile infection (HO-CDI) rates.

Design: Interrupted time series.

Setting: Community-based.

Methods/interventions: National Healthcare Safety Network (NHSN) C. difficile metrics from January 2019 to November 2022 were analyzed after three interventions at a community-based healthcare system. Interventions included: (1) an electronic medical record (EMR) based hard stop requiring confirming ≥3 loose or liquid stools over 24 h, (2) an infectious diseases (ID) review and approval of testing >3 days of hospital admission, and (3) an infection control practitioner (ICP) reviews combined with switching to a reverse two-tiered clinical testing algorithm.

Results: After all interventions, the number of C. difficile tests per 1,000 patient-days (PD) and HO-CDI cases per 10,000 PD decreased from 20.53 to 6.92 and 9.80 to 0.20, respectively. The EMR hard stop resulted in a (28%) reduction in the CDI testing rate (adjusted incidence rate ratio ((aIRR): 0.72; 95% confidence interval [CI], 0.53 to 0.96)) and ID review resulted in a (42%) reduction in the CDI testing rate (aIRR: 0.58; 95% CI, 0.42-0.79). Changing to the reverse testing algorithm reduced reported HO-CDI rate by (95%) (cIRR: 0.05; 95% CI; 0.01-0.40).

Conclusions: Staged interventions aimed at improving diagnostic stewardship were effective in overall reducing CDI testing in a community healthcare system.

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在社区环境中改进适当艰难梭菌检测的实验室管理的三个阶段。

目标：评估分阶段干预措施的效果，以减少不适当的艰难梭菌检测和医院发病艰难梭菌感染率（HO-CDI）：评估旨在减少不适当的艰难梭菌检测和艰难梭菌医院感染率（HO-CDI）的分阶段干预措施的效果：设计：中断时间序列：方法/干预措施在社区医疗保健系统进行了三次干预后，对国家医疗保健安全网络（NHSN）从 2019 年 1 月至 2022 年 11 月的艰难梭菌指标进行了分析。干预措施包括(1) 基于电子病历（EMR）的硬性停止要求确认24小时内≥3次稀便或液便，(2) 入院3天以上的传染病（ID）审查和批准检测，(3) 感染控制从业人员（ICP）审查，结合切换到反向两级临床检测算法：结果：采取所有干预措施后，每千个患者日艰难梭菌检测次数和每万个患者日艰难梭菌感染病例数分别从 20.53 例降至 6.92 例和 9.80 例降至 0.20 例。EMR 硬停机导致 CDI 检测率下降了 28%（调整后发病率比（aIRR）：0.72；95% 置信区间）：0.72；95% 置信区间 [CI]，0.53 至 0.96）），而 ID 复查则使 CDI 检测率降低了（42%）（调整后发病率比（aIRR）：0.58；95% 置信区间 [CI]，0.42-0.79）。改用反向检测算法后，HO-CDI报告率降低了（95%）（cIRR：0.05；95% CI；0.01-0.40）：结论：旨在改善诊断管理的分阶段干预措施能有效减少社区医疗系统中的 CDI 检测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Antimicrobial stewardship & healthcare epidemiology : ASHE

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