Inappropriate Testing for Clostridioides difficile in Long-Term Care: Implications Highlight the Need for an Algorithm

Authors

  • Katie Vivian Patient Safety Authority
  • Rebecca Jones Patient Safety Authority

DOI:

https://doi.org/10.33940/bedside/2019.9.7

Keywords:

C. diff, long-term care,, test, diarrhea, stool, algorithm, treatment, diagnosis

Abstract

This article provides clear guidance related to appropriate testing for Clostridioides difficile (C. diff) and identifies the negative implications of inappropriate testing, repeat testing, and testing for cure. Residents of long-term care (LTC) facilities are at increased risk for developing C. diff. Complications can arise if a resident does not have an active C. diff infection (colonization) and has a positive C. diff laboratory test result. The authors share a fictional bedside story illustrating the negative consequences that can result from inappropriate C. diff testing, and present an algorithm that promotes mindful application of testing, which may result in cost savings and prevent adverse resident outcomes.

References

Centers for Disease Control and Prevention (CDC). Nearly half a million Americans suffered from Clostridium difficile infections in a single year. 2017 Mar.

Centers for Disease Control and Prevention (CDC). What is C. diff? 2018 Dec.

Jump R, Donskey C. Clostridium difficile in the long-term care facility: prevention and management. Curr Geriatr Rep. 2015 Mar.

Jandhyala S, Talukdar R, Subramanyam C, Vuyyuru H, Sasikala M, Nageshwar Reddy D. Role of the normal gut microbiota. World J Gastroen- tero. 2015 Aug. 21(29): 8787–8803.

Block M, Henderson C, Arocha D, Reed M, Foster J, Melaku T, Croft C, Cont. 2018; 33(2):111–116.

Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilcox MH. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Cont Hosp Ep. 2010 May; 31(5).

McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, Dubberke ER, Garey KW, Gould CV, Kelly C, Loo V, Shaklee Sammons J, Sandora TJ, Wilcox MH. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 March 19; 66(7).

Centers for Disease Control and Prevention (CDC). Transmission-based precautions. Retrieved 2019 Feb 27.

Sprague E, Reynolds S, Brindley P. Patient isolation precautions: are they worth it? Can Respir J. 2015 Oct; 2016(5352625): 1–5.

Morgan D, Diekema D, Sepkowitz K. Perencevich E. Adverse outcomes associated with contact precautions: a review of the literature. Am J Infect Control. 2009 Mar 37(2):85–93.

Furuno J, Krein S, Lansing B, Mody L. Health care worker opinions on use of isolation precautions in long-term care facilities. Am J Infect Con- trol. 2012 Apr; 403:263–266.

Prasad N, Labaze G, Kopacz J, Chwa S, Platis D, Pan C, Russo D, LaBom- bardi V, Osorio G, Pollack S, Kreiswirth B, Chen L, Urban C, Segal-Maurer S. Asymptomatic rectal colonization with carbapenem-resistant Enterobacteriaceae and Clostridium difficile among residents of a long-term care facility in New York City. Am J Infect Control. 2016; 44(5), 525–532.

Parada J, Wright D, Suarez-Ponce S, Trulis E, Linchangco P, Abuihmoud A, Pua H, Green M, Hedlund H, Smith K R, Harrington, A. Lab steward- ship for Clostridium difficile testing improves appropriate testing while decreases unnecessary testing and saves laboratory resources while dramatically helping to reduce C. diff standardized infection ratios. Open Forum Infect Dis. 2018 Nov.

Duncan R, Eyre-Kelly J, Cartagena J, Gawlick M, Delacy R, Villanueva A. Reducing inappropriate hospital-acquired Clostridium difficile diagnoses. Open Forum Infect Dis. 2018 Nov.

C.diff image

Published

2019-09-16

How to Cite

Vivian, K., & Jones, R. . (2019). Inappropriate Testing for Clostridioides difficile in Long-Term Care: Implications Highlight the Need for an Algorithm. Patient Safety, 1(1), 52–57. https://doi.org/10.33940/bedside/2019.9.7

Issue

Section

Original Research and Articles
Bookmark and Share

Most read articles by the same author(s)

1 2 3 > >>