Natalia Blanco1, Gwen L Robinson2, Emily L Heil3, Rebecca Perlmutter4, Lucy E Wilson4, Clayton H Brown5, Mojdeh S Heavner6, Gita Nadimpalli2, Daniel Lemkin7, Daniel J Morgan8, Surbhi Leekha2. 1. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD. Electronic address: nblanco@som.umaryland.edu. 2. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD. 3. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD. 4. Emerging Infections Program, Maryland Department of Health, Baltimore, MD. 5. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD. 6. Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD. 7. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD. 8. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; VA Maryland Healthcare System, Baltimore, MD.
Abstract
BACKGROUND: Published bundles to reduce Clostridioides difficile Infection (CDI) frequently lack information on compliance with individual elements. We piloted a computerized clinical decision support-based intervention bundle and conducted detailed evaluation of several intervention-related measures. METHODS: A quasi-experimental study of a bundled intervention was performed at 2 acute care community hospitals in Maryland. The bundle had five components: (1) timely placement in enteric precautions, (2) appropriate CDI testing, (3) reducing proton-pump inhibitor (PPI) use, (4) reducing high-CDI risk antibiotic use, and (5) optimizing use of a sporicidal agent for environmental cleaning. Chi-square and Kruskal-Wallis tests were used to compare measure differences. An interrupted time series analysis was used to evaluate impact on hospital-onset (HO)-CDI. RESULTS: Placement of CDI suspects in enteric precautions before test results did not change. Only hospital B decreased the frequency of CDI testing and reduced inappropriate testing related to laxative use. Both hospitals reduced the use of PPI and high-risk antibiotics. A 75% decrease in HO-CDI immediately postimplementation was observed for hospital B only. CONCLUSION: A CDI reduction bundle showed variable impact on relevant measures. Hospital-specific differential uptake of bundle elements may explain differences in effectiveness, and emphasizes the importance of measuring processes and intermediate outcomes.
BACKGROUND: Published bundles to reduce Clostridioides difficile Infection (CDI) frequently lack information on compliance with individual elements. We piloted a computerized clinical decision support-based intervention bundle and conducted detailed evaluation of several intervention-related measures. METHODS: A quasi-experimental study of a bundled intervention was performed at 2 acute care community hospitals in Maryland. The bundle had five components: (1) timely placement in enteric precautions, (2) appropriate CDI testing, (3) reducing proton-pump inhibitor (PPI) use, (4) reducing high-CDI risk antibiotic use, and (5) optimizing use of a sporicidal agent for environmental cleaning. Chi-square and Kruskal-Wallis tests were used to compare measure differences. An interrupted time series analysis was used to evaluate impact on hospital-onset (HO)-CDI. RESULTS: Placement of CDI suspects in enteric precautions before test results did not change. Only hospital B decreased the frequency of CDI testing and reduced inappropriate testing related to laxative use. Both hospitals reduced the use of PPI and high-risk antibiotics. A 75% decrease in HO-CDI immediately postimplementation was observed for hospital B only. CONCLUSION: A CDI reduction bundle showed variable impact on relevant measures. Hospital-specific differential uptake of bundle elements may explain differences in effectiveness, and emphasizes the importance of measuring processes and intermediate outcomes.
Authors: Clare Rock; Rebecca Perlmutter; David Blythe; Jacqueline Bork; Kimberly Claeys; Sara E Cosgrove; Kate Dzintars; Valeria Fabre; Anthony D Harris; Emily Heil; Yea-Jen Hsu; Sara Keller; Lisa L Maragakis; Aaron M Milstone; Daniel J Morgan; Prashila Dullabh; Petry S Ubri; Christina Rotondo; Richard Brooks; Surbhi Leekha Journal: BMJ Qual Saf Date: 2021-12-09 Impact factor: 7.035