QAPI 136 - Improving Bone Marrow Transplant Patient Outcomes by Implementing a Clostridioides Difficile Screening Protocol

Background: Clostridioides difficile (C.difficile) is the most common healthcare-associated infection in the United States due to its ease of transmission via contaminated surfaces, touch, or undetected colonized patients. Due to multiple risk factors, Bone Marrow Transplant (BMT) patients are more susceptible to these infections. One study had shown that screening this type of patient population for C.difficile colonization at admission may reduce the rate of healthcare-associated C.difficile infections (CDI) by up to 56%. In 2021, our BMT unit noted a significant increase in CDI where our rate was 4.03 per 1000 patient days. In 2022, our CDI rate was 2.47 per 1000 patient days. Due to these increased C.difficile infection rates in the BMT population, we sought to utilize this method and determine whether or not implementing this screening would decrease our C.difficile infection rates.

Methods: Upon admission, a stool sample is collected from each BMT patient, marked to ensure it is not rejected by the laboratory, and is sent to the lab for two-step testing. Polymerase chain reaction test (PCR) is the first test, and reflexes to a toxin assay if the PCR result is positive. Patients who tested PCR positive were placed into isolation immediately and prescribed a prophylactic regimen of oral Vancomycin regardless of toxin status.

Results: Over the course of a calendar year, 354 BMT admission tests were ordered. 49 tests (14%) were C.difficile PCR positive, 15 (4%) of those testing positive for toxin production, and 22 (6%) were cancelled. The 2023 data showed our CDI rate was 0.77 per 1000 patient days, which is a 33% reduction from 2022.

Conclusions: The implementation of a C.difficile screening test helped reduce our CDI rate, allowed us to isolate patients appropriately, and provided guidance to physicians when deciding if prophylactic treatment was deemed necessary.