Reduction in Health Care Facility–Onset Clostridioides difficile Infection: A Quality Improvement Initiative

• Published in: Mayo Clinic proceedings. Innovations, quality & outcomes quality & outcomes, 2021-12, Vol.5 (6), p.1066-1074
• Main Authors: Zaver, Himesh B., Moktan, Varun P., Harper, Eugene P., Bali, Aman, Nasir, Ayan, Foulks, Carla, Kuhlman, Justin, Green, Max, Algan, Gillian A., Parth, Heather C., Wu-Ballis, Melody, DiCicco, Sandra, Smith, Brenda T., Owen, Ronald N., Mai, Lorraine S., Spiros, Sarah L., Griffis, John, Ramsey Walker, Daphne T., Hata, D. Jane, Oring, Justin M., Powers, Harry R., Bosch, Wendelyn
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2542-4548; 2542-4548
• DOI: 10.1016/j.mayocpiqo.2021.09.004

To reduce health care facility–onset (HCFO) Clostridioides difficile infection (CDI) incidence by improving diagnostic stewardship and reducing the inappropriate testing of C difficile assays. A multidisciplinary team conducted a quality improvement initiative from January 1, 2020, through March 31, 2021. Clostridioides difficile infection and inappropriate testing were identified via electronic health records using predefined criteria related to stool quantity/caliber, confounding medications, and laboratory data. An intervention bundle was designed including (1) provider education, (2) implementation of an appropriate testing algorithm, (3) expert review of C difficile orders, and (4) batch testing of assays to facilitate review and cancellation if inappropriate. Compared with a baseline period from January to September 2020, implementation of our intervention bundle from December 2020 to March 2021 resulted in an 83.6% reduction in inappropriate orders tested and a 41.7% reduction in HCFO CDI incidence. A novel prevention bundle improved C difficile diagnostic stewardship and HCFO CDI incidence by reducing testing of inappropriate orders. Such initiatives targeting HCFO CDI may positively affect patient safety and hospital reimbursement.