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Zaver HB, Moktan VP, Harper EP, Bali A, Nasir A, Foulks C, Kuhlman J, Green M, Algan GA, Parth HC, Wu-Ballis M, DiCicco S, Smith BT, Owen RN, Mai LS, Spiros SL, Griffis J, Ramsey Walker DT, Hata DJ, Oring JM, Powers HR, Bosch W. Reduction in Health Care Facility-Onset Clostridioides difficile Infection: A Quality Improvement Initiative. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1066-1074. [PMID: 34820598 PMCID: PMC8599925 DOI: 10.1016/j.mayocpiqo.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective 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. Patients and Methods 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. Results 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. Conclusion 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.
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Key Words
- ATA, appropriate testing algorithm
- CDC, Centers for Disease Control and Prevention
- CDI, Clostridioides difficile infection
- CMS, Centers for Medicare & Medicaid Services
- COVID, coronavirus disease
- HAI, health care–associated infection
- HCFO, health care facility–onset
- IDSA, Infectious Diseases Society of America
- IPAC, infection prevention and control
- PCR, polymerase chain reaction
- QI, quality improvement
- SIR, standardized infection ratio
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Affiliation(s)
- Himesh B Zaver
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Varun P Moktan
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Eugene P Harper
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Aman Bali
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Ayan Nasir
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Carla Foulks
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Justin Kuhlman
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Max Green
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Gillian A Algan
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | - Heather C Parth
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | | | - Sandra DiCicco
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | - Brenda T Smith
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | - Ronald N Owen
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | - Lorraine S Mai
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | - Sarah L Spiros
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL
| | - John Griffis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
| | | | - D Jane Hata
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
| | - Justin M Oring
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL.,Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL
| | - Harry R Powers
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL.,Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL
| | - Wendelyn Bosch
- Infection Prevention and Control, Mayo Clinic, Jacksonville, FL.,Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL
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