ITS 94 - Employing Proactive Surveillance Using an Electronic Health Record-based Screening Technology for Clostridioides difficile to Mitigate Healthcare-associated Infections

Background: Despite increasing prevalence of Clostridioides difficile in the healthcare settings and the community; delays in testing hinder prompt diagnosis and initiation of appropriate infection prevention strategies, leading to adverse patient outcomes and potential transmission. While nurse-driven protocols have improved testing speed compared to physician-dependent processes; further measures are needed for rapid identification and management of this critical pathogen.

Methods: An electronic health record-based screening system identified patients at high risk for Clostridioides difficile infection within the first three days of admission. This intervention was implemented across all patients in a 463-bed acute care facility with 2,400 monthly average admissions for 14 months. Baseline period was 14 months prior to intervention. Segmented regression analysis was employed to compare the incidence of community-onset Clostridioides difficile infection pre and post intervention. For Healthcare-associated Clostridioides difficile infection, standardized infection ratio was analyzed using the National Healthcare Safety Network Statistics Calculator.

Results: Segmented regression analysis of the 28-month community-onset Clostridioides difficile infection data pre and post intervention revealed a β2 coefficient of 1.09 (standard error: 0.29, p-value < 0.001). The Standardized Infection Ratio for the healthcare-associated Clostridioides difficile infection pre-intervention was at 0.803 (p-value: 0.1687, 95% Confidence Interval: 0.576, 1.1091) and post-intervention was at 0.400 (p-value: 0.0000, 95% Confidence Interval: 0.260, 0.591). Comparing the two Standardized Infection Ratio the relative ratio was 0.498 (p-value: 0.0077, 95% CI: 0.293, 0.834) and the relative change was -50.187 (p-value: 0.0077, 95% Confidence Interval: -70.7, -16.6).

Conclusions: Findings show significant increase in the trend of community-onset Clostridioides difficile infection following implementation of the intervention suggesting early identification. Consequently, the healthcare-associated Clostridioides difficile infection showed a statistically significant reduction post implementation. This decline may be attributed to the prompt diagnosis and implementation of appropriate infection prevention strategies upon patient admission, facilitated by the intervention.