C Difficile Alerts May Increase Incidence, Or at Least Detection

The use of best practice alerts for Clostridium difficile infection seemed to increase the overall incidence and prevalence but also was associated with a decline in health care onset infection, according to a recent study.

Researchers from Mercy Hospital in Arkansas studied the pre- and post-intervention period in relation to the incidence and prevalence of C difficile infection. The team primarily aimed to understand the health care onset infection incidence rate and proportion. Investigators gathered data about admission count, patient-days, C difficile prevalence, and incidence rates for 24 months pre-intervention and 24 months post-intervention.

The use of best practice alerts for C difficile infection was developed in electronic medical records in July 2016. When the system identifies patients at high risk for infection onset, an alert is triggered for health care workers to order isolation and stool studies. The best practice alert system uses factors like previous history of C difficile infection, admission to a healthcare facility in the previous 90 days, and antibiotic use in the previous 90 days as ways to analyze patient risk for infection.

The system was tested in a Mercy facility and then rolled out to the Mercy system nationwide. Other alerts also indicated when providers should reduce antibiotics and order probiotics, the study authors explained.

Before the alert system was implemented, there were 327 inpatient incident C difficile infection cases in 24 months, the researchers reported. That same period saw 30,424 patient admissions. In the first 6 months after the alert program was initialized, there were 130 inpatient incident C difficile infection cases among 9345 admissions, the researchers reported.

Investigators wrote that the rise in incidence and prevalence rates for C difficile infection could be attributed to improved detection using the alert system. Some of the areas of improvement they suggested were compliance with hand hygiene, isolation precautions, antibiotics stewardship, isolating high-risk patients on admission, and raising staff awareness of environmental services. Additionally, they said public and patient awareness of C difficile is a “crucial step” for infection control and prevention.

The team plans to further analyze patient demographic and clinical characteristics for the full 24-month, post-intervention results of the study.

“This study highlights the importance of electronic medical records and best practice alerts utilization as useful tools to enhance our understanding and management of diseases,” the study authors concluded. “Previous studies have utilized electronic medical records and best practice alerts to risk stratify healthcare onset C difficile infection, [to] predict the risk for that infection based on risk score, and to help with providing more standardized management… Final analysis with full sample size is essential to provide a better picture about the long-term effect.”

The study, “Evaluating the efficacy of best practice alerts to improve Clostridium difficile early detection in hospital settings: A 6-month interim analysis of the 2-year prospective study,” was published in the Avicenna Journal of Medicine.