Impact of a division-wide bundle on cases, antibiotic days of therapy, testing appropriateness, and associated financial costs.

INTRODUCTION

Updated international guidelines recommend the use of a two-step algorithm (glutamate dehydrogenase [GDH] or nucleic-acid amplification test [NAAT] plus toxin) rather than NAAT alone for the diagnosis of (formerly ) infections. The goal of our project was to evaluate the impact of a new bundle on the rate of hospital-acquired infections (CDIs), hospital-acquired CDI standardized infection ratio (SIR), antibiotic days of therapy (DOT), and financial cost.

MATERIALS AND METHODS

The new bundle was implemented in April 2018. This bundle was implemented across five hospitals in Catholic Health Initiatives (CHI) Texas Division. The bundle included a switch from NAAT to a two-step process (GDH and toxin). We placed the new test in an order panel which included enteric isolation and required indications for testing. We used quarterly data pre- and post-intervention to calculate SIR and DOT.

RESULTS

In the pre-intervention period, 15.5% of the total 3513 NAAT was positive. In the post-intervention period, 5.7% of a total of 2845 GDH and toxin assays was positive for both GDH and toxin ( < 0.0001). SIR, which adjusts for denominator and change in testing methodology, also dropped from 1.02 to 0.43. The estimated cost associated with positive cases dropped from 1,932,150 USD to 1,113,800 USD with an estimated yearly cost saving of 794,150 USD. Compliance with enteric isolation improved from 73.1% to 92.5% ( = 0.008).

CONCLUSION

The new testing bundle led to a marked reduction in hospital-acquired CDI and unnecessary treatment, reduction in testing, an increase in compliance with enteric isolation, and significant cost savings.