ITS 97 - Implementing an Electronic Best Practice Advisory to Reinforce Clostridioides difficile Testing

Background: The National Healthcare Safety Network (NHSN) defines a hospital-onset Clostridioides difficile (C. diff) infection as one identified after the third hospital day of a patient’s admission. Conversely, a community-onset C. diff infection is identified during the first three hospital days of patient admission. Our facility identified that in a subset of our hospital-onset C. diff infections, unformed stools were documented in the first three days of patient admission. A best practice advisory (BPA) was developed to reinforce our nurse-driven protocol for C. diff testing and increase adherence to this protocol.

Methods: The electronic medical record system was utilized to build a BPA that would fire if nursing documented an unformed stool during the first three hospital days of a patient’s admission. When this BPA fired, it linked to the C. diff test and isolation order to facilitate easier ordering. For our 800+ bed facility, we evaluated the percentage of hospital-onset C. diff infections with unformed stools during the first three hospital days of admission during a 24 month pre-intervention period and a 24 month post-intervention period. Additionally, we quantified the total C. diff community-onset infections identified during the pre-intervention and post-intervention periods.

Results: The percentage of hospital-onset C. diff infections with unformed stools during the first three hospital days of admission decreased from 41% (n=117) during the pre-intervention period to 32% (n=126) during the post-intervention period. Additionally, the number of community-onset C. diff infections identified increased from 291 during the pre-intervention period to 527 in the post-intervention period.

Conclusions: Implementation of a BPA has decreased the percentage of hospital-onset C. diff infections with unformed stools during the first three hospital days of admission and increased early C. diff testing in our facility. Through utilizing this BPA, our C. diff testing protocol is continually reinforced which will promote adherence to testing guidelines.