Impact of a C. difficile infection (CDI) reduction bundle and its components on CDI diagnosis and prevention

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https://www.sciencedirect.com/science/article/pii/S0196655320309664

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https://doi.org/10.1016/j.ajic.2020.10.020
 http://hdl.handle.net/11603/28221

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2021-02-25

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journal articles
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Blanco, Natalia, et al. "Impact of a C. difficile infection (CDI) reduction bundle and its components on CDI diagnosis and prevention." American Journal of Infection Control 49, no. 3 (March 2021): 319-326. https://doi.org/10.1016/j.ajic.2020.10.020.

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This work was written as part of one of the author's official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law.
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Abstract

Background - Published bundles to reduce Clostridioides difficile Infection (CDI) frequently lack information on compliance with individual elements. We piloted a computerized clinical decision support-based intervention bundle and conducted detailed evaluation of several intervention-related measures. Methods - A quasi-experimental study of a bundled intervention was performed at 2 acute care community hospitals in Maryland. The bundle had five components: (1) timely placement in enteric precautions, (2) appropriate CDI testing, (3) reducing proton-pump inhibitor (PPI) use, (4) reducing high-CDI risk antibiotic use, and (5) optimizing use of a sporicidal agent for environmental cleaning. Chi-square and Kruskal-Wallis tests were used to compare measure differences. An interrupted time series analysis was used to evaluate impact on hospital-onset (HO)-CDI. Results - Placement of CDI suspects in enteric precautions before test results did not change. Only hospital B decreased the frequency of CDI testing and reduced inappropriate testing related to laxative use. Both hospitals reduced the use of PPI and high-risk antibiotics. A 75% decrease in HO-CDI immediately postimplementation was observed for hospital B only. Conclusion - A CDI reduction bundle showed variable impact on relevant measures. Hospital-specific differential uptake of bundle elements may explain differences in effectiveness, and emphasizes the importance of measuring processes and intermediate outcomes.