Decreasing Unnecessary Clostridium Difficle Testing in the Acute Care Setting

Abstract

Purpose: The purpose of this project was to reduce the incidence of unnecessary testing of Clostridium (C.) difficile negative diagnoses in the hospital through a retrospective chart review. Assessment of the current algorithm and findings of those with the signs and symptoms for being at risk were identified. Background: Evaluating each patient and his/her risk for C. difficile is important to provide patient-centered care. Three elements to consider when deciding whether a patient should be tested for C. difficile include 1) host-related factors, 2) pharmacologic factors, and 3) clinical factors. Host factors include age and comorbidities. Pharmacological factors include exposure to antibiotics and the use of proton pump inhibitors. Clinical factors include longer lengths of stays and abdominal surgery increase the risk of exposure to C. difficile. Methods: The primary investigator (PI) received approval from the infection prevention team and research council at HonorHealth Scottsdale Shea to retrospectively analyze medical records to identify the signs and symptoms triggering C. difficile testing, testing outcomes, as well as if C. difficile testing adhered to the criteria specified in the existing C. difficile testing algorithm. Results: The major findings from this DNP project showed that C. difficile testing is ordered on patients who do not meet the criteria, even with the implementation of the C. difficile testing algorithm. A chart review of 75 patients tested for C. difficile over 6 months, 12 (16%) did not meet the criteria to test. It is unclear why C. difficile testing was performed in patients who did not meet the testing criteria. The most common symptoms for C. difficile testing were diarrhea and abdominal pain, while most common risk factors were being aged greater than 65. Of the 63 patients who met the criteria to test for C. difficile, only 4 (6%) testing positive for C. difficile and met the criteria to test. Conclusion: There are practice gaps in following the C. difficile testing algorithm. In this project, 12 patients did not meet the criteria for C. difficile testing. This would cost $5,520 to $11,040 over a 2–4-day period to manage these patients who do not have CDIs. Due to a high rate of negative testing, further quality improvement projects or research are necessary to better understand if these testings were warranted and further improve the specificity of the risk factors in the current C. difficile testing algorithm.