Reducing Inappropriate C difficile Testing: A Diagnostic Stewardship Success Story

A recent study published in the American Journal of Infection Control (AJIC) describes the outcome of a new approach to testing for Clostridioides difficile based on diagnostic stewardship principles. At Memorial Healthcare System in Hollywood, Florida, updated guidelines for ordering C difficile tests led to a 20% reduction in inappropriate testing, ultimately helping to prevent patient overtreatment.

To learn more, Infection Control Today^® (ICT^®) spoke with Rachel Guran, MPH, BSN, RN, CIC, FAPIC, director of epidemiology and infection prevention at Memorial Healthcare System and an author of the study, “Impact of an electronic smart order-set for diagnostic stewardship of C difficile infection (CDI) in a community healthcare system in South Florida.”

In this interview, Guran explains why the study was done, what the principles of diagnostic stewardship are, and how they were applied in this study to revise C difficile testing guidelines.

Clostridioides difficile

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“Diagnostic stewardship is definitely a journey that many health care systems have been on for a while just like our partners in pharmacy and antimicrobial stewardship, we focus on with lab to partner to make sure that patients have the right test for the right reasons at the right time, for the right outcomes,” Guran said. “There are many benefits to diagnostic stewardship from the tests are able to better perform if they're used for what they're indicated for. So better results, more accurate results, cost savings, better for the patient that we're not doing unnecessary tests on them. This was a multidisciplinary effort to try to increase our diagnostic stewardship efforts at Memorial.”

ICT asked what insights Guran and her fellow investigators learned from investigating this trend and how future guidelines might address this issue. “By focusing the study on patients who were symptomatic, as that was the appropriate indication for C difficile. So we did find those patients once that algorithm was it, the education from the algorithm was in place, and then that electronic order stopped the inappropriate ordering. Patients who did not have signs and symptoms [or] patients who [recently] had laxatives. That is what we saw a decrease in, and that's exactly the goal we were going for…our NHSN rates have been amazing, and we saw a huge decrease in the amount of reportable C difficile.

Check out the rest of the interview to find out how to use this study to improve your facility’s unnecessary treatment of C difficile.