Case Western Reserve University/MetroHealth Medical Center Cleveland, OH
Venkata Sunkesula, MD, MS1, Sirisha Kundrapu, MD, MS1, Gul Madison, MD2; 1Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH; 2Mercy Catholic Medical Center, Philadelphia, PA
Introduction: Clostridium difficile is the most common cause of healthcare-associated diarrhea in developed countries. Despite the current rapid C. difficile infection (CDI) testing methods, studies have shown that delays in CDI diagnosis still exist due to various factors. Identification and intervention of modifiable factors contributing to delays could possibly lead to early initiation of appropriate infection control measures and treatment. Our objective is to identify the factors causing the delays at various levels from the time of CDI test order to results. Methods: We conducted a 6-month retrospective study followed by a 3-month prospective interventional study at Mercy Philadelphia Hospital. Chart review was performed to evaluate the time from CDI test orders to stool specimens collection. Interviews were conducted on CDI patients and a subset of nurses and physicians to identify the reasons for delays in diagnosis. A 3-month intervention was performed to address the delays. This included an Electronic medical record (EMR) alert to notify infection control staff and educating nurses and physicians focusing on the importance of timely CDI testing for initiation of treatment. Results: CDI test orders on 140 patients with 80 in the pre- and 60 post-intervention periods were reviewed. No significant difference in patient characteristics and demographics was noted between the 2 groups. The mean time from the test order to test result was significantly lower after the intervention period compared to the pre-intervention period 2 hours vs. 19 hours (P < 0.0001). Discussion: Factors affecting the time from test order to specimen collection accounted for most of the delays. Education of the health care workers at all levels on prompt isolation of suspected CDI patients and the importance of expedited testing significantly reduced the delays in diagnosis. This may reduce the overuse of empirical CDI therapy, reduce delays in initiation of appropriate therapy and finally, decrease C. difficile transmission with timely isolation.
Disclosures: Venkata Sunkesula indicated no relevant financial relationships. Sirisha Kundrapu indicated no relevant financial relationships. Gul Madison indicated no relevant financial relationships.