ArticleInfection control and hospital epidemiology2021
Using diagnostic stewardship to reduce rates, healthcare expenditures and accurately identify cases of hospital-onset
Article in Infection control and hospital epidemiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 19 citations in OpenAlex.
- Diagnosis ofJournal of medical microbiology · 2024Review
- Diagnostic stewardship in infectious diseases: a scoping review.Journal of medical microbiology · 2024Article
- Diagnostic stewardship to improve patient outcomes and healthcare-associated infection (HAI) metrics.Infection control and hospital epidemiology · 2024Article
- Impact of mandatory nucleic acid amplification test (NAAT) testing approval on hospital-onsetInfection control and hospital epidemiology · 2024Article
- Diagnostic stewardship to limit repeat plasma cytomegalovirus viral load testing.BMC infectious diseases · 2023Article
- Trends in facility-level rates ofInfection control and hospital epidemiology · 2023Article
- Role of diagnostic stewardship in reducing healthcare-facility-onsetAntimicrobial stewardship & healthcare epidemiology : ASHE · 2023Article
- Assessment of Federal Value-Based Incentive Programs and In-Hospital Clostridioides difficile Infection Rates.JAMA network open · 2021Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveLack of judicious testing can result in the incorrect diagnosis of Clostridioides difficile infection (CDI), unnecessary CDI treatment, increased costs and falsely augmented hospital-acquired infection (HAI) rates. We evaluated facility-wide interventions used at the VA San Diego Healthcare System (VASDHS) to reduce healthcare-onset, healthcare-facility-associated CDI (HO-HCFA CDI), including the use of diagnostic stewardship with test ordering criteria.
designWe conducted a retrospective study to assess the effectiveness of measures implemented to reduce the rate of HO-HCFA CDI at the VASDHS from fiscal year (FY)2015 to FY2018.
interventionsMeasures executed in a stepwise fashion included a hand hygiene initiative, prompt isolation of CDI patients, enhanced terminal room cleaning, reduction of fluoroquinolone and proton-pump inhibitor use, laboratory rejection of solid stool samples, and lastly diagnostic stewardship with C. difficile toxin B gene nucleic acid amplification testing (NAAT) criteria instituted in FY2018.
resultsFrom FY2015 to FY2018, 127 cases of HO-HCFA CDI were identified. All rate-reducing initiatives resulted in decreased HO-HCFA cases (from 44 to 13; P ≤ .05). However, the number of HO-HCFA cases (34 to 13; P ≤ .05), potential false-positive testing associated with colonization and laxative use (from 11 to 4), hospital days (from 596 to 332), CDI-related hospitalization costs (from $2,780,681 to $1,534,190) and treatment cost (from $7,158 vs $1,476) decreased substantially following the introduction of diagnostic stewardship with test criteria from FY2017 to FY2018.
conclusionsInitiatives to decrease risk for CDI and diagnostic stewardship of C. difficile stool NAAT significantly reduced HO-HCFA CDI rates, detection of potential false-positives associated with laxative use, and lowered healthcare costs. Diagnostic stewardship itself had the most dramatic impact on outcomes observed and served as an effective tool in reducing HO-HCFA CDI rates.
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