Three stages of laboratory stewardship in improving appropriate Clostridioides difficile testing in a community-based setting
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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 β₯3 loose or liquid stools over 24Β 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, 0.42β0.79). Changing to the reverse testing algorithm reduced reported HO-CDI rate by (95%) (cIRR: 0.05; 95% CI; 0.01β0.40).Conclusions:Staged interventions aimed at improving diagnostic stewardship were effective in overall reducing CDI testing in a community healthcare system.
π C. difficile tests/1,000 PD dropped from 20.53 to 6.92; HO-CDI cases/10,000 PD fell from 9.80 to 0.20. Interventions led to 28%-95% reductions in testing rates.
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22.03.2025 02:30 β π 2 π 1 π¬ 1 π 0
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Alt: Taylor Swift doing a chefβs kiss sign
Itβs cool that folks can reinvent themselves during the #IDSky migration
Some have been surprised to find plum handles unclaimed eg @iddoc.bsky.social
But the best transformation
πβ‘οΈπ¦ is @MaggieMonogue to @tazoswift.bsky.social
23.11.2024 16:07 β π 42 π 5 π¬ 3 π 1
Let me introduce you to my brand of ADHDβ¦
20.11.2024 22:50 β π 0 π 0 π¬ 0 π 0
Lets get to the important things - when writing, do you listen to music, podcasts, or nothing? #IDSky #MedSky #cdiff #microsky
20.11.2024 17:08 β π 9 π 0 π¬ 9 π 0
And just like that, we have our first #idjclub article #idsky
20.11.2024 15:07 β π 98 π 21 π¬ 4 π 1
Iβll join in the fun
16.11.2024 18:42 β π 1 π 0 π¬ 0 π 0
Ah, so we are just going to the journal model of grants
14.11.2024 23:08 β π 1 π 0 π¬ 0 π 0
An honest question for my fellow US researchers. Funding has been drying up for years, but how much worse do we think it will be in the next 2-3 years? Asking for a friend⦠#IDSky #MedSky
14.11.2024 22:34 β π 1 π 0 π¬ 1 π 0
Hello BlueSky and #IDSky community! I am making the jump here and excited to see how we can build better here. I am Professor of Medicine in Infectious Diseases at Emory Univ, a Transplant ID clinician, a viral immunology and antiviral researcher, and a dad of two girls. Cheers!
14.11.2024 12:19 β π 43 π 6 π¬ 2 π 0
Oh I wasnβt refuting your point. Just like providing context for people on ggplot.
Also I have spent more time reformatting ggplot figures in illustrator than I care to admitβ¦
12.11.2024 15:24 β π 1 π 0 π¬ 1 π 0
One of the big things for hospital follow up is early recognition of symptoms. Anecdotally, people ended up being re-hospitalized because diarrhea has gone on for days in a patient population that cannot tolerate large volume shifts. More study is needed to figure out when the follow up is needed
11.11.2024 00:06 β π 1 π 0 π¬ 0 π 0
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ALT: a woman wearing blindfolds and a red jacket is walking through a forest .
As we try to βοΈ I.D. community activity on #IDsky, please donβt forget to add details in your profile/bio.
Nothing is less « attractiveΒ Β» than a blank profil/bio. And personally, I donβt follow blindly
10.11.2024 20:37 β π 21 π 4 π¬ 4 π 0
Nothing to extreme. Just remember they are not trying to purposely trick you and bad questions will likely get thrown out
10.11.2024 17:49 β π 1 π 0 π¬ 0 π 0
Hello #IDSky and #MedSky. Seems like I may stick around this time. For an introduction to those following. I am an ID physician with an unhealthy obsession with C. difficile.
Iβm always game to talk about the clinical, epidemiological, and wet lab aspects of C diff. I talk about HIV after a drink.
10.11.2024 16:10 β π 17 π 0 π¬ 1 π 0
I think the more interesting question is would a company move forward with clindamycin if it came to market today? If not, why are we still using it
10.11.2024 02:03 β π 4 π 0 π¬ 1 π 0
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Alt: Kevin Costner from field of dreams is standing in a corn field at sunset . Text says βif you build it, they will comeβ
Good news:
Our community is growing!
The IDSky Starter Pack has exceeded the max 150 accounts, so Iβve started on another (pls share here and the other place, and LMK if I missed you)
IDSky starter pack 1 go.bsky.app/LnAQjdq
IDSky starter pack 2 go.bsky.app/JNfSvQT
08.11.2024 06:08 β π 186 π 76 π¬ 31 π 9
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