Background Clostridium difficile infections (CDI) are the leading cause of health care-associated diarrhea, and is reported to cause 500,000 patient infections in the United States per year. A target for reducing the number of CDIs have been established by the Centers for Medicare and Medicaid Services (CMS). Boston Medical Center's reported CY2013 Standardized Infection Ration (SIR) for Hospital Onset CDI was 1.573, above the US National Benchmark of 1.
Objectives Reduce the SIR Hospital Onset C. difficile to CMS expected ratio of =1 by June, 2016.
Methods Using Quality Improvement methodologies a multidisciplinary team addressed the appropriateness of CDI PCR testing and increased patient isolation through the use of the electronic medical record. PDSAs included:
The CDI order was modified to include instructions on appropriate test frequency and sample consistency.
Past lab results are displayed within the order as an automated reminder.
A Best Practice Alert “fires” when writing an order if a laxative has been administered within the past 72 hours, recommending that the laxative is discontinued prior to testing
Created a CDI testing and Contact Plus Isolation order panel to reduce the risk of environmental contamination. Negative lab results include instructions to discontinue isolation.
Results Decreased test volume by 39%; reduced inappropriate repeat testing by 80%, 7 day negative and 66%, 30 day positive. Achieved SIR 4 quarter average 0.78, better than national goal.
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