ISR 79 - Early Hospital Onset Clostridioides Difficle: Do Not Wait to Test. Findings from a Systemwide Hospital Chart Review

Background: Clostridioides difficile (C. diff) is the most common cause of diarrhea in a healthcare setting. Patients are at a higher risk of C. diff infection (CDI) if they have been on antibiotics, have a prior history of CDI, have had extended healthcare stays, advanced age, and serious underlying illness. The National Healthcare Safety Network (NSHN) utilizes a simplified algorithm to determine community onset (CO) versus hospital onset (HO) CDI cases via the Laboratory Identification (LABID) Event module.

Methods: Utilizing NHSN LABID definition for CO-CDI and HO-CDI, a multi-state hospital system, extracted CDI cases from January 2022 – June 2023. HO-CDI cases, defined as a positive C. diff stool specimen collected on or after hospital day 4 were evaluated. Early hospital onset cases were defined as HO-CDI cases identified on days 4, 5, and 6 of the patients stay. A subset of patient charts was reviewed further and consisted of specific investigative abstraction questions.

Results: From January 2022 – June 2023, 707 HO-CDI cases were identified for the system. Early HO-CDI accounted for 33% (n=234) of these cases. The subset of charts reviewed (n=78), demonstrated 29% of the patients had arrived with nausea, vomiting, and/or diarrhea, 17% had a prior history of CDI within the past six months, and 28% of the cases lacked documentation of stool frequency, consistency, and other descriptors prior to testing.

Conclusions: Early HO-CDI chart review revealed a delay in testing when the patient arrived with signs and symptoms, including diarrhea and history of CDI. Timely testing of patients with symptoms or history of CDI would accurately capture CO-CDI cases, leading to earlier treatment decisions and faster isolation. Additional focus on stool documentation regarding frequency and consistency may also assist in identifying CO-CDI cases.