Cancelling uncollected Clostridioides difficile sample tests in French hospitals did not result in a reduction in healthcare-associated infections according to new research.¹

A team, led by Madeline L. Berg, MPH, Department of Infection Prevention and Control, UPMC Presbyterian/Shadyside, assessed the impact of a 24-hour autocancellation of uncollected Clostridioides difficile samples in reducing reported healthcare-associated infections.

“Clostridioides difficile is a priority healthcare-associated pathogen, but testing for C. difficile poorly distinguishes colonized patients from those with an active infection,” the authors wrote. “As many as 4%–15% of hospitalized patients may be asymptomatically colonized with C. difficile, and it is estimated that C. difficile colonization is 5–10 times more common than symptomatic C. difficile colitis.”

The Study

In the quality-improvement, before-and-after implementation study, the investigators examined C difficile sample data from 17 hospitals in Pennsylvania. Any tests not collected within 24 hours were deemed automatically canceled through the electronic health record.

The intervention took place at 2 facilities between November 2021 and July 2022 and 15 additional facilities between April 2022 and July 2022. The team looked at various quality measures including the percentage of orders canceled, C difficile healthcare-associated infection rate, percent of positivity of completed tests, and potential adverse outcomes of canceled or delayed testing.

The Samples

There were 6101 orders included in the study, 17.9% (n = 1090) of which were automatically canceled after not being collected for 24 hours during the intervention periods.

The results show the reported C difficile healthcare-acquired infections rates per 10,000 patient days did not significantly change. The rates were 8.07 in the 6-month preintervention period and 8.77 in the intervention period for facilities A and B combined (incidence rate ratio [IRR], 1.09; 95% confidence interval [CI], 0.88-1.34; P = .43).

There were also 5.23 healthcare-associated infections per 10,000 patient days in the 6-month preintervention period and 5.33 in the intervention period for the remaining 15 facilities combined (IRR, 1.02; 95% CI, 0.79–1.32; P = .87).

From the preintervention to the intervention periods, the percent positivity rates of completed tests increased by 1.1% for the first 2 facilities and by 1.4% for the remaining 15 facilities.

There were no adverse outcomes found in the study.

“The 24-hour autocancellation of uncollected C. difficile orders reduced testing but did not result in reported HAI reduction,” the authors wrote.

References:

Berg, M., Baxter, C., Ayres, A., Chung, A., Slaughter, J., Bilderback, A., . . . Snyder, G. (2023). The impact of autocancellation of uncollected Clostridioides difficile specimens after 24 hours on reported healthcare-associated infections: A quality improvement intervention. Infection Control & Hospital Epidemiology, 1-6. doi:10.1017/ice.2023.117