Clostridium difficile (C. diff) is a bacterium that produces toxins that can lead to diarrhea and colitis. Health care-associated C. diff infection (CDI) increases morbidity and mortality of hospitalized patients, prolongs hospital stay, and increases health care costs.1 A multidisciplinary team consisting of hospital administrators, clinicians, and nursing staff held interprofessional meetings to evaluate hospital-acquired infections, including CDI. This collaborative initiative focused on reducing the rate of CDI in an inpatient setting. The team developed measures aimed at mitigating CDI rates. A 24-hour C. diff test auto-cancellation rule was implemented, which allowed laboratory personnel to cancel tests if samples were not received within 24 hours or did not meet criteria for loose stool. In addition, a CDI testing algorithm using current Infectious Diseases Society of America guidelines was created to differentiate community-associated CDI from hospital-associated CDI on admission. Additional interventions included electronic health record (EHR) notifications for ordering, alerting providers of potentially inappropriate C. diff testing in the setting with recent laxative use or retesting within 7 days of a previously negative test. Furthermore, educational sessions will be provided to nursing teams, laboratory personnel, and clinicians to better understand CDI and ordering practices.

There was a downward trend in CDI noted after implementation of the 24-hour auto-cancellation rule. From October to December 2020, there were 12 cases of CDI at University Hospital. The 24-hour auto-cancellation rule went into effect in January 2021. CDI cases decreased to approximately 3 cases per quarter for the first 3 quarters of 2021. We expect to see further decline in positive tests after full implementation of the algorithm, EHR notifications, and staff education measures. This quality improvement project highlights the importance of a multidisciplinary approach to tackle hospital-associated infections.

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