Department of Pediatrics, University of Colorado, Aurora, Colorado.
Children's Hospital Colorado, Aurora, Colorado.
Pediatrics. 2024 Mar 1;153(3). doi: 10.1542/peds.2023-061981.
The introduction of multiplex gastrointestinal panels at our institution resulted in increased Clostridioides difficile (C. difficile) detection and stool test utilization. We aimed to reduce hospital-onset C. difficile infections (HO-CDIs), C. difficile detection, and overall stool testing by 20% within 1 year.
We conducted a quality improvement project from 2018 to 2020 at a large children's hospital. Interventions included development of a C. difficile testing and treatment clinical care pathway, new options for gastrointestinal panel testing with or without C. difficile (results were suppressed if not ordered), clinical decision support tool to restrict testing, and targeted prevention efforts. Outcomes included the rate of HO-CDI (primary), C. difficile detection, and overall stool testing. All measures were evaluated monthly among hospitalized children per 10 000 patient-days (PDs) using statistical process-control charts. For balancing measures, we tracked suppressed C. difficile results that were released during real-time monitoring because of concern for true infection and C. difficile-related adverse events.
HO-CDI decreased by 55%, from 11 to 5 per 10 000 PDs. C. difficile detection decreased by 44%, from 18 to 10 per 10 000 PDs, and overall test utilization decreased by 29%, from 99 to 70 per 10 000 PDs. The decrease in stool tests resulted in annual savings of $55 649. Only 2.3% of initially suppressed positive C. difficile results were released, and no patients had adverse events.
Diagnostic stewardship strategies, coupled with an evidence-based clinical care pathway, can be used to decrease C. difficile and improve overall test utilization.
本机构引入多重胃肠道检测面板后，艰难梭菌（C. difficile）的检出率和粪便检测的应用有所增加。我们的目标是在 1 年内将医院获得性艰难梭菌感染（HO-CDIs）、艰难梭菌的检出率和整体粪便检测率降低 20%。
我们于 2018 年至 2020 年在一家大型儿童医院进行了一项质量改进项目。干预措施包括制定艰难梭菌检测和治疗的临床护理路径，提供包含或不包含艰难梭菌的胃肠道检测面板的新选项（如果未订购，则抑制结果），限制检测的临床决策支持工具，以及有针对性的预防措施。结果包括 HO-CDI 的发生率（主要结果）、艰难梭菌的检出率和整体粪便检测率。所有措施均使用统计过程控制图，每月在每 10000 个患者日（PDs）住院患儿中进行评估。为了平衡措施，我们跟踪了在实时监测期间因担心真正感染和艰难梭菌相关不良事件而释放的抑制性艰难梭菌检测结果。
HO-CDI 从 11 例/10000 PDs 降低至 5 例/10000 PDs，降低了 55%；艰难梭菌的检出率从 18 例/10000 PDs 降低至 10 例/10000 PDs，降低了 44%；整体检测利用率从 99 例/10000 PDs 降低至 70 例/10000 PDs，降低了 29%。粪便检测的减少使年度节省了 55649 美元。最初抑制的阳性艰难梭菌检测结果中仅有 2.3%被释放，且无患者发生不良事件。
诊断管理策略，结合基于证据的临床护理路径，可用于降低艰难梭菌的检出率并改善整体检测利用率。
