Impact of a division-wide bundle on hospital-acquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs
Elizabeth Wenqian Wang1, Ashlee Weekley2, Jennifer McCarty2, Hoonmo Koo2, Bradley Lembcke2, Mayar Al Mohajer3
1 Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
2 Department of Infection Prevention & Control, CHI Baylor St. Luke’s Medical Center, Houston, Texas, USA
3 Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA; Department of Infection Prevention & Control, CHI Baylor St. Luke’s Medical Center, Houston, Texas, USA
Dr. Mayar Al Mohajer
Department of Infectious Diseases, Infection Prevention and Antimicrobial Stewardship, Baylor St. Luke’s Medical Center, Infection Prevention and Control Room P508E, MC-166, 6720 Bertner Avenue, Houston, TX 77030.
Source of Support: None, Conflict of Interest: None
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 Clostridioides difficile (formerly Clostridium difficile) infections. The goal of our project was to evaluate the impact of a new bundle on the rate of hospital-acquired C. difficile 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 C. difficile 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 C. difficile 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 (P < 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 C. difficile 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% (P = 0.008). Conclusion: The new testing bundle led to a marked reduction in hospital-acquired CDI and unnecessary treatment, reduction in C. difficile testing, an increase in compliance with enteric isolation, and significant cost savings.