Wang Michael S, Zimmerman Gretchen, Klein Theres, Stibbe Bethany, Rykse Monica, Ballard Samuel, Vijayam Naveen, Brown Joe, Raza Khateeb, Beckman Shannon, Skinner Andrew M
Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA.
Department of Medicine, Corewell Health Southwest, Saint Joseph, MI, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Mar 19;5(1):e81. doi: 10.1017/ash.2025.55. eCollection 2025.
Assess the efficacy of staged interventions aimed to reduce inappropriate testing and hospital-onset infection (HO-CDI) rates.
Interrupted time series.
Community-based.
METHODS/INTERVENTIONS: National Healthcare Safety Network (NHSN) metrics from January 2019 to November 2022 were analyzed after three interventions at a community-based healthcare system. Interventions included: (1) an electronic medical record (EMR) based hard stop requiring confirming ≥3 loose or liquid stools over 24 h, (2) an infectious diseases (ID) review and approval of testing >3 days of hospital admission, and (3) an infection control practitioner (ICP) reviews combined with switching to a reverse two-tiered clinical testing algorithm.
After all interventions, the number of tests per 1,000 patient-days (PD) and HO-CDI cases per 10,000 PD decreased from 20.53 to 6.92 and 9.80 to 0.20, respectively. The EMR hard stop resulted in a (28%) reduction in the CDI testing rate (adjusted incidence rate ratio ((aIRR): 0.72; 95% confidence interval [CI], 0.53 to 0.96)) and ID review resulted in a (42%) reduction in the CDI testing rate (aIRR: 0.58; 95% CI, 0.42-0.79). Changing to the reverse testing algorithm reduced reported HO-CDI rate by (95%) (cIRR: 0.05; 95% CI; 0.01-0.40).
Staged interventions aimed at improving diagnostic stewardship were effective in overall reducing CDI testing in a community healthcare system.
评估旨在降低不适当检测和医院获得性感染（HO-CDI）发生率的分阶段干预措施的效果。
中断时间序列。
基于社区。
方法/干预措施：对一个基于社区的医疗系统进行三次干预后，分析了2019年1月至2022年11月期间的国家医疗安全网络（NHSN）指标。干预措施包括：（1）基于电子病历（EMR）的硬停止，要求确认24小时内有≥3次稀便或水样便；（2）传染病（ID）对入院3天以上的检测进行审查和批准；（3）感染控制从业者（ICP）进行审查，并改为反向两级临床检测算法。
所有干预措施实施后，每1000患者日（PD）的检测次数和每10000 PD的HO-CDI病例数分别从20.53降至6.92和9.80降至0.20。EMR硬停止使CDI检测率降低了（28%）（调整发病率比（aIRR）：0.72；95%置信区间[CI]，0.53至0.96），ID审查使CDI检测率降低了（42%）（aIRR：0.58；95% CI，0.42 - 0.79）。改为反向检测算法使报告的HO-CDI率降低了（95%）（cIRR：0.05；95% CI；0.01 - 0.40）。
旨在改善诊断管理的分阶段干预措施在总体上有效降低了社区医疗系统中的CDI检测。
