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© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America. This work is licensed under the Creative Commons Attribution License https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

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 ≥3 loose or liquid stools over 24 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, 0.42–0.79). Changing to the reverse testing algorithm reduced reported HO-CDI rate by (95%) (cIRR: 0.05; 95% CI; 0.01–0.40).

Conclusions:

Staged interventions aimed at improving diagnostic stewardship were effective in overall reducing CDI testing in a community healthcare system.

Details

Title
Three stages of laboratory stewardship in improving appropriate Clostridioides difficile testing in a community-based setting
Author
Wang, Michael S 1   VIAFID ORCID Logo  ; Zimmerman, Gretchen 2 ; Klein, Theresa 2 ; Stibbe, Bethany 2 ; Rykse, Monica 2 ; Ballard, Samuel 3 ; Vijayam, Naveen 3 ; Brown, Joe 2 ; Raza, Khateeb 3 ; Beckman, Shannon 2 ; Skinner, Andrew M 4   VIAFID ORCID Logo 

 Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA; Department of Medicine, Corewell Health Southwest, Saint Joseph, MI, USA; Department of Medicine, Central Michigan University School of Medicine, Saginaw, MI, USA 
 Department of Medicine, Corewell Health Southwest, Saint Joseph, MI, USA 
 Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA; Department of Medicine, Corewell Health Southwest, Saint Joseph, MI, USA 
 Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, USA; Research and Infectious Diseases Section, George E. Wahlen VA Medical Center, Salt Lake City, UT, USA 
Section
Original Article
Publication year
2025
Publication date
2025
Publisher
Cambridge University Press
e-ISSN
2732494X
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3178425245
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America. This work is licensed under the Creative Commons Attribution License https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.