Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.
Department of Information Technology/Analytics for Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York.
Infect Control Hosp Epidemiol. 2023 Feb;44(2):186-190. doi: 10.1017/ice.2022.117. Epub 2022 Jun 15.
To reduce both inappropriate testing for and diagnosis of healthcare-onset (HO) infections (CDIs).
We performed a retrospective analysis of testing from hospitalized children before (October 2017-October 2018) and after (November 2018-October 2020) implementing restrictive computerized provider order entry (CPOE).
Study sites included hospital A (a ∼250-bed freestanding children's hospital) and hospital B (a ∼100-bed children's hospital within a larger hospital) that are part of the same multicampus institution.
In October 2018, we implemented CPOE. No testing was allowed for infants aged ≤12 months, approval of the infectious disease team was required to test children aged 13-23 months, and pathology residents' approval was required to test all patients aged ≥24 months with recent laxative, stool softener, or enema use. Interrupted time series analysis and Mann-Whitney test were used for analysis.
An interrupted time series analysis revealed that from October 2017 to October 2020, the numbers of tests ordered and samples sent significantly decreased in all age groups ( < .05). The monthly median number of HO-CDI cases significantly decreased after implementation of the restrictive CPOE in children aged 13-23 months ( < .001) and all ages combined ( = .003).
Restrictive CPOE for CDI in pediatrics was successfully implemented and sustained. Diagnostic stewardship for CDI is likely cost-saving and could decrease misdiagnosis, unnecessary antibiotic therapy, and overestimation of HO-CDI rates.
减少医疗保健相关性（HO）感染（CDI）的不合理检测和诊断。
我们对实施限制计算机医嘱录入（CPOE）前后（2018 年 11 月至 2020 年 10 月）住院儿童的检测进行了回顾性分析。
研究地点包括医院 A（一家约 250 张床位的独立儿童医院）和医院 B（一家隶属于更大医院的约 100 张床位的儿童医院），它们均属于同一多校区机构。
2018 年 10 月，我们实施了 CPOE。不允许对≤12 个月龄婴儿进行检测，13-23 个月龄儿童的检测需要传染病团队的批准，所有近期使用过泻药、大便软化剂或灌肠的≥24 个月龄患者的检测需要病理住院医师批准。采用中断时间序列分析和 Mann-Whitney 检验进行分析。
中断时间序列分析显示，2017 年 10 月至 2020 年 10 月，所有年龄组的检测数量和送检样本量均显著减少（<0.05）。实施限制 CPOE 后，13-23 个月龄儿童（<0.001）和所有年龄组（=0.003）HO-CDI 病例的每月中位数显著减少。
儿科 CDI 的限制 CPOE 得以成功实施并持续进行。CDI 的诊断管理可能具有成本效益，并可减少误诊、不必要的抗生素治疗和对 HO-CDI 发生率的高估。
