Evaluating the efficacy of best practice alerts to improve Clostridium difficile early detection in hospital settings: A 6-month interim analysis of the 2-year prospective study

Abstract

Introduction: Clostridium difficile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness with high burden on the health-care system. Design: Observational, retrospective, prospective, pre- and post-intervention study on the incidence and prevalence rates of CDIs. The primary outcome is the healthcare-onset CDIs (HO-CDIs) incidence rate and proportion. Methods: Best practice alerts (BPAs) for CDI were developed in electronic medical records and released on July 13, 2016. When high-risk patients for CDI are identified, BPAs are triggered requiring nurses to order contact isolation and stool studies followed by other subsequent BPAs encouraging providers to de-escalate antibiotics and order probiotics. Data on admission count, patient-days, CDIs categories prevalence, and incidence rates were collected for the 24-month preintervention and will be collected for the 24-month postintervention period. Results: An interim analysis comparing the data from the first 6-month postintervention period with the average 6-month data of the preintervention period showed that short-term BPAs use is associated with significant increase in the overall CDI infection rate (71.47 vs. 38.38, P < 0.0001), incidence rate (53.81 vs. 28.76, P < 0.0001), overall prevalence rate (1.86 vs. 1.32, P = 0.001), and admission prevalence rate (1.10 vs. 0.70, P < 0.0001). Despite the observed overall shift from HO toward CO; no statistically significant difference in the HO-CDI event number and proportion was detected (28 [21.4%] vs. 22 [29.1%], P = 0.094). Conclusion: Short-term BPAs use is associated with significant increase in the overall CDI incidence and prevalence along with a non-statistically significant decline in HO-CDI proportion. Final analysis with full sample size is essential to provide a better picture about the long-term effect.

Keywords

Best practice alert - Clostridium difficile - hospital-acquired infection

Publication History

Article published online:
12 August 2021

• References

• 1 Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR. et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015; 372: 825-34
• 2 Centers for Medicare and Medicaid Services. Fiscal Year (FY) 2016 Results for the CMS Hospital Value-Based Purchasing Program; 2015. Available from: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-26.html. [Last accessed on 2018 Apr 19].
• 3 Centers for Disease Control and Prevention. CDC/NHSN Surveillance Definitions for Specific Types of Infections; 2016. Available from: http://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf. [Last accessed on 2018 Apr 19].
• 4 Gupta A, Khanna S. et al. Community-acquired Clostridium difficile infection: An increasing public health threat. Infect Drug Resist 2014; 7: 63-72
• 5 Zilberberg MD, Tabak YP, Sievert DM, Derby KG, Johannes RS, Sun X. et al. Using electronic health information to risk-stratify rates of Clostridium difficile infection in US hospitals. Infect Control Hosp Epidemiol 2011; 32: 649-55
• 6 Tabak YP, Johannes RS, Sun X, Nunez CM, McDonald LC. Predicting the risk for hospital-onset Clostridium difficile infection (HO-CDI) at the time of inpatient admission: HO-CDI risk score. Infect Control Hosp Epidemiol 2015; 36: 695-701
• 7 Revolinski S. et al. Implementation of a clinical decision support alert for the management of Clostridium difficile infection. Antibiotics (Basel) 2015; 4: 667-74