Kozinski, Rhianna
(2024)
Reviewing Appropriateness of C. difficile Testing and Ordering Practices: An Approach to Reduce Pediatric C. difficile Infections.
Master Essay, University of Pittsburgh.
Abstract
Background: Hospital-acquired infections (HAIs), including Clostridioides difficile (C. difficile) infections, pose significant threats to patient safety, healthcare economics, and public health. C. difficile, a Gram-positive, spore-forming bacillus, can be acquired in both community and hospital settings. Children exhibit higher colonization rates during their first two years of life, with a subsequent decrease to 3-5% in those aged two and older. Accurate identification of C. difficile infections in children is challenging due to these elevated colonization rates during early development.
Methods: Infection preventionists at the University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh (CHP) implemented a surveillance and feedback strategy for C. difficile testing. This involved reviewing all C. difficile orders that could result in an HAI upon lab confirmation of a positive result. Pilot data from the project, gathered between March 15 and July 31, 2023, were compared with data from the same period in 2022, before the project's initiation.
Results: In 2023, out of 99 C. difficile orders, 67 (67.7%) were reviewed by infection preventionists. Following review, 22 orders (32%) were deemed inappropriate and suggested to be canceled, 8 (12%) resulted in positive infections, and 27 (40%) were negative. The proportion of C. difficile orders in 2023 was higher among patients with a recent infection history (31%), compared to zero orders in 2022 among such patients. Additionally, more patients in 2023 had recent antibiotic exposure (95%) within the past seven days compared to 2022 (70%).
Discussion: The project's impact on reducing inappropriate test orders and the significance of accurate HAI diagnosis. Although the results suggest progress, a yearly analysis is recommended to determine sustained improvements. The review of orders not only enhances C. difficile infection confirmation but also contributes to appropriate treatment, reducing unnecessary antibiotic distribution and healthcare costs. The findings underscore the broader implications of C. difficile infections on healthcare systems and the importance of ongoing efforts to mitigate the impact in public health.
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Details
| Item Type: |
Other Thesis, Dissertation, or Long Paper
(Master Essay)
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| Contributors: |
| Contribution | Contributors Name | Email | Pitt Username | ORCID  |
|---|
| Thesis advisor | Haggerty, Catherine | haggertyc@edc.pitt.edu | haggertyc | UNSPECIFIED | | Committee Member | Montoya, Lindsay | lindsay.montoya@chp.edu | UNSPECIFIED | UNSPECIFIED | | Committee Member | Green, Michael | michael.green@chp.edu | UNSPECIFIED | UNSPECIFIED |
|
| Date: |
3 January 2024 |
| Date Type: |
Completion |
| Submission Date: |
14 December 2023 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
36 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Epidemiology |
| Degree: |
MPH - Master of Public Health |
| Thesis Type: |
Master Essay |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Clostridioides difficile, infection prevention, hospital-acquired infections, c. difficile |
| Date Deposited: |
03 Jan 2024 16:57 |
| Last Modified: |
03 Jan 2024 16:57 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/45699 |
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