Major ArticleHealth care worker perceptions toward computerized clinical decision support tools for Clostridium difficile infection reduction: A qualitative study at 2 hospitals
Section snippets
Background
Despite prevention efforts, Clostridium difficile infection (CDI) rates have remained high across the United States, suggesting that new interventions are needed.1 Electronic health record–based computerized clinical decision support (CCDS), a technology that uses patient-specific data to provide relevant pieces of knowledge at the point of care, has been used to optimize infection control and antibiotic stewardship activities.2, 3, 4, 5, 6 However, the use of CCDS specifically for CDI
Materials and methods
We conducted a qualitative study among HCWs at 2 acute care hospitals in Maryland to explore the perceived barriers and facilitators related to the uptake of a CDI reduction bundle.
CDI-related knowledge among HCWs
Of the 34 HCWs (17 from each hospital) who participated in the structured interviews, 11 were nurses, 9 were physicians, 3 were pharmacists, 4 were radiology technicians, and 7 were EVS workers. All EVS workers correctly responded to their CDI knowledge assessment. All interviewed HCWs (EVS excluded) agreed on the association between antibiotics and CDI development (n = 23; 100%); however, the same was not observed for the association between proton-pump inhibitors (PPIs) and CDI (n = 16; 70%).
Discussion
We identified important gaps in CDI-related knowledge and communication between HCWs. HCWs agreed on the potential of the evaluated CCDS tools to improve CDI prevention, control, and diagnosis. They expressed concern regarding a perceived loss of autonomy and clinical judgment, but also conveyed an appreciation for the perceived benefits associated with CCDS tools such as standardization and automation. Previous work on non-CDI CCDS tools confirmed our observations of perceived threats to
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2021, American Journal of Infection ControlCitation Excerpt :Teams included representatives from infection prevention, quality, infectious diseases (ID), pharmacy, microbiology, nursing, environmental services, and informatics. Prior to implementation, in November 2016, we gauged healthcare worker perceptions of proposed interventions through semistructured interviews, and incorporated those into the intervention design and implementation process.8 From January to June 2017, the study team and hospital teams collaborated on the development and implementation of the bundle.
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Funding/support: Supported by the Centers for Disease Control and Prevention through a Broad Agency Announcement (contract no. 200-2016-91943).
Conflicts of interest: N.B. reports grants from Centers for Disease Control and Prevention, during the conduct of the study; S.L. reports grants from Centers for Disease Control and Prevention, during the conduct of the study; D.J.M. reports grants from CDC, NIH, AHRQ, VA HSRD, IDSA, other from ASM, Lown and SHEA for expenses to organize or present at national meetings,other from Springer Inc, outside the submitted work; C.B. reports grants from Centers for Disease Control, during the conduct of the study; G.L.R. reports grants from Centers for Disease Control, during the conduct of the study; J.B. reports grants from Centers for Disease Control, during the conduct of the study; L.M.O reports grants from Centers for Disease Control and Prevention, during the conduct of the study; E.H. reports grants from ALK-ABELLO, outside the submitted work; there are no other conflicts to disclose.