C. diff Infection Program Increases Compliance With Protocols
Infection Control and Hospital Epidemiology.
Cleveland VA Medical Center, which includes a 215-bed hospital and a 265-bed long-term care facility, initiated a CDI stewardship program in March 2012. The program included five elements:
1. Physician education on CDI diagnostic testing and treatment recommendations.
2. A CDI order menu with recommendations in the electronic medical record system.
3. CDI stewardship team notification of all positive C. difficile test results by the microbiology laboratory.
4. Review of EMRs by CDI stewardship team, including team recommendations or feedback of CDI management.
5. Medical record review of a sample of patients prescribed empirical CDI therapy, and feedback on physicians' adherence to prescribing empirical therapy only for suspected severe or recurrent CDI.
In addition, in May 2012, lab testing for CDI was changed from using an enzyme immunoassay for glutamate dehydrogenase as an initial screen and a commercial polymerase chain reaction assay for confirmation of positive results to just the PCR assay. This change was part of a concurrent initiative to reduce delays in C. diff testing, according to the study.
Compared with the baseline period October 2011 to February 2012, management of CDI improved in both the early intervention period, from April to September 2012, and the late intervention period, from December 2012 to April 2013. Specifically, there were reductions in the time from test order to positive test result; the time from positive result to order for treatment; the proportions of CDI patients receiving metronidazole for severe CDI and receiving a dose or duration of therapy nonadherent to practice guidelines; and the proportion of patients with suspected mild to moderate CDI receiving empirical therapy.
In addition, five patients had positive C. diff test results that were not acted on during baseline, but none in the follow-up periods.
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