A study presented at the Society for Healthcare Epidemiology of America (SHEA) conference evaluated adherence to laxative administration guidelines before CDI testing in Veteran Affairs (VA) hospitals and explored associated demographic and contextual factors.
Clostridioides difficile
(Adobe Stock 260659307 by gaetan)
This story first appeared on our sister brand, Contagion®Live.
Clostridioides difficile infection (CDI) remains a major health care challenge, causing around 500,000 infections and 30,000 deaths each year in the US. Despite guidelines that recommend against testing for CDI shortly after laxative use to avoid misdiagnoses, this practice is often ignored.
The results reveal significant adherence issues in an analysis of 7,326 tests for 4,888 patients at VA Medical Centers in Illinois, Wisconsin, and Michigan. Most of the patients tested were White (61.8%) and male (95.6%), with an average age of 70. Notably, about 59% of the tests were conducted within 48 hours of laxative use. Black and Hispanic patients were less likely to undergo guideline-noncompliant testing compared to White patients. Tests from rural facilities, long-term care units, and intensive care units showed higher non-adherent testing. Tests not following guidelines more frequently resulted in adverse outcomes.
This pattern aligns with results from non-VA studies, showing widespread non-compliance with CDI testing guidelines, particularly in settings such as ICUs and long-term care facilities. The noted racial disparities in testing practices suggest a potential area for improving guideline adherence.
This retrospective cohort study focused on adults admitted to VA Medical Centers from January 2019 to December 2022 who underwent CDI testing. The tests used were Toxin B gene Polymerase Chain Reaction or Toxin Enzyme Immunoassay. Data on laxative use, demographics, admission details, and comorbidities were extracted from the VA Corporate Data Warehouse. Testing that did not adhere to guidelines was defined as a CDI test ordered within 48 hours following laxative use. Factors influencing nonadherent testing were analyzed using clustered binomial logistic regression, and statistical analyses were conducted using SAS 9.4.
Further research is needed to explore the implications of inappropriate testing, which include unnecessary treatments and increased health care costs. Diagnostic stewardship should be prioritized to enhance compliance with CDI testing guidelines across VA hospitals.
Reference
Geneva Wilson, PhD. High Prevalence of Laxative Use Among Those Tested for Clostridioides difficile Infection in VA Hospitals. Poster #94 was presented at SHEA 2024. April 16-19, 2024. Houston, TX.
Stay prepared and protected with Infection Control Today's newsletter, delivering essential updates, best practices, and expert insights for infection preventionists.
Reducing Hidden Risks: Why Sharps Injuries Still Go Unreported
July 18th 2025Despite being a well-known occupational hazard, sharps injuries continue to occur in health care facilities and are often underreported, underestimated, and inadequately addressed. A recent interview with sharps safety advocate Amanda Heitman, BSN, RN, CNOR, a perioperative educational consultant, reveals why change is overdue and what new tools and guidance can help.
New Study Explores Oral Vancomycin to Prevent C difficile Recurrence, But Questions Remain
July 17th 2025A new clinical trial explores the use of low-dose oral vancomycin to prevent Clostridioides difficile recurrence in high-risk patients taking antibiotics. While the data suggest a possible benefit, the findings stop short of statistical significance and raise red flags about vancomycin-resistant Enterococcus (VRE), underscoring the delicate balance between prevention and antimicrobial stewardship.
What Lies Beneath: Why Borescopes Are Essential for Verifying Surgical Instrument Cleanliness
July 16th 2025Despite their smooth, polished exteriors, surgical instruments often harbor dangerous contaminants deep inside their lumens. At the HSPA25 and APIC25 conferences, Cori L. Ofstead, MSPH, and her colleagues revealed why borescopes are an indispensable tool for sterile processing teams, offering the only reliable way to verify internal cleanliness and improve sterile processing effectiveness to prevent patient harm.
The Next Frontier in Infection Control: AI-Driven Operating Rooms
Published: July 15th 2025 | Updated: July 15th 2025Discover how AI-powered sensors, smart surveillance, and advanced analytics are revolutionizing infection prevention in the OR. Herman DeBoard, PhD, discusses how these technologies safeguard sterile fields, reduce SSIs, and help hospitals balance operational efficiency with patient safety.
Targeting Uncertainty: Why Pregnancy May Be the Best Time to Build Vaccine Confidence
July 15th 2025New national survey data reveal high uncertainty among pregnant individuals—especially first-time parents—about vaccinating their future children, underscoring the value of proactive engagement to strengthen infection prevention.
Reducing Hidden Risks: Why Sharps Injuries Still Go Unreported
July 18th 2025Despite being a well-known occupational hazard, sharps injuries continue to occur in health care facilities and are often underreported, underestimated, and inadequately addressed. A recent interview with sharps safety advocate Amanda Heitman, BSN, RN, CNOR, a perioperative educational consultant, reveals why change is overdue and what new tools and guidance can help.
New Study Explores Oral Vancomycin to Prevent C difficile Recurrence, But Questions Remain
July 17th 2025A new clinical trial explores the use of low-dose oral vancomycin to prevent Clostridioides difficile recurrence in high-risk patients taking antibiotics. While the data suggest a possible benefit, the findings stop short of statistical significance and raise red flags about vancomycin-resistant Enterococcus (VRE), underscoring the delicate balance between prevention and antimicrobial stewardship.
What Lies Beneath: Why Borescopes Are Essential for Verifying Surgical Instrument Cleanliness
July 16th 2025Despite their smooth, polished exteriors, surgical instruments often harbor dangerous contaminants deep inside their lumens. At the HSPA25 and APIC25 conferences, Cori L. Ofstead, MSPH, and her colleagues revealed why borescopes are an indispensable tool for sterile processing teams, offering the only reliable way to verify internal cleanliness and improve sterile processing effectiveness to prevent patient harm.
The Next Frontier in Infection Control: AI-Driven Operating Rooms
Published: July 15th 2025 | Updated: July 15th 2025Discover how AI-powered sensors, smart surveillance, and advanced analytics are revolutionizing infection prevention in the OR. Herman DeBoard, PhD, discusses how these technologies safeguard sterile fields, reduce SSIs, and help hospitals balance operational efficiency with patient safety.
Targeting Uncertainty: Why Pregnancy May Be the Best Time to Build Vaccine Confidence
July 15th 2025New national survey data reveal high uncertainty among pregnant individuals—especially first-time parents—about vaccinating their future children, underscoring the value of proactive engagement to strengthen infection prevention.
2 Commerce Drive
Cranbury, NJ 08512