Sustained reduction in rates of hospital-onset Clostridium difficile infection using an automated electronic health record protocol.

BACKGROUND

An automated protocol was designed within our electronic medical record (EMR) to help curb the Clostridium difficile problem at our institution. The protocol will identify patients at high risk for C difficile, improve the timing of testing of patients infected on admission, and enhance the appropriateness of C difficile testing throughout the patient's hospitalization.

METHODS

Admitted patients with 2 of the following 3 criteria were labeled as high risk for C difficile: admission to a medical institution in the preceding 90 days, administration of antibiotics in the preceding 90 days, or a history of C difficile. High-risk patients with diarrhea in the first 3 days of admission are identified in the EMR, and prompt testing for C difficile is done. After day 3, if diarrhea develops, a series of questions is presented to help test the appropriate patients for C difficile.

RESULTS

A statistically significant reduction in rates of hospital-onset C difficile was achieved after implementation of the protocol.

CONCLUSIONS

Implementation of an automated protocol for targeted testing of high-risk patients for C difficile was successful at reducing rates of hospital-onset C difficile by improving timing and appropriateness of testing.