S2086 Quality Improvement Project: Optimizing Testing for Clostridioides difficile Infection (CDI) Reducing Healthcare Facility-Onset CDI Events

Introduction: Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infections, contributing to increased morbidity, mortality, and healthcare costs. Inappropriate or delayed testing can lead to underdiagnosis or overdiagnosis, both of which negatively impact patient outcomes and hospital performance metrics. Hospital-onset CDI (HO-CDI) is particularly concerning, as it is closely monitored by the Centers for Medicare and Medicaid Services (CMS) and can result in financial penalties. Methods: Standardized testing criteria: Implemented a C. difficile testing checklist to guide clinical decision-making. The checklist includes criteria such as confirmation of ≥3 liquid stools in 24 hours, no laxative use, and assessment of CDI symptoms and risk factors. Clinical decision Support (CDS): Integrated CDS alerts into the electronic health record (EHR) to guide providers on when to test. Education and training: Conducted multidisciplinary training sessions for nurses, physicians, and lab staff. Real time monitoring and feedback: Infection Control Team reviewed all CDI test orders daily and provided feedback to ordering providers on inappropriate tests. Results: Between 2021 and 2024, the facility observed fluctuations in healthcare facility-onset C. difficile infection (HO-CDI) rates. In 2021, there were 23 infections (rate: 0.275), which increased to 27 infections (rate: 0.312) in 2022. Following the implementation of standardized testing protocols and clinical decision support tools, a notable improvement was observed in 2023, with infections decreasing to 23 (rate: 0.25). However, a slight rebound occurred in 2024, with 24 infections (rate: 0.288). These trends suggest that while interventions were effective in reducing HO-CDI rates initially, sustained and consistent application is essential to maintain improvements. Conclusion: The decline in HO-CDI rates in 2023 suggests that standardized testing protocols, CDS tools, and real-time feedback were effective. However, the slight increase in 2024 highlights the need for sustained efforts. Consistent application of protocols, ongoing education, and provider engagement are essential. External factors like patient acuity and staffing may also influence outcomes. Continued monitoring and adaptation are key to maintaining progress and improving infection control long term.