LAUSR

BACKGROUND Kentucky has the sixth highest rate of healthcare facility-onset Clostridium difficile infections (CDI) in the nation. Testing for the presence of the disease is expensive; therefore, the objective of this project was to develop and evaluate an efficient and financially sound plan for monitoring healthcare facility-onset CDIs in a 393-bed community hospital. METHODS In September 2017, the multidisciplinary infection control team began a concerted effort to combat the incidence of healthcare facility-onset CDIs through staff education, creating better communication channels, and implementation of an algorithm leading to appropriate specimen testing for the presence of the C. difficile toxin among hospital inpatients. Independent samples t-tests were calculated on number and cost of tests performed per month before (2017) and following the intervention (2018). RESULTS Statistically significant differences were found in both numbers of tests performed fiscal year (FY) 2017 (M =216.50, SD =16.418) to FY 2018 (M=138.00, SD=34.107; t (22)=7.18, p=.000, two-tailed) and cost of tests FY 2017 (M=6495.00, SD=492.54) to FY 2018 (M=4140.00, SD=1023.20; t(22)=7.18, p=.000, two-tailed). The magnitude of the differences in the means of tests performed (mean difference = 78.50, 95% CI: 55.84 to 101.16) was large (eta squared=0.701). Cost savings following use of the algorithm were $28,260 for FY 2018; an average of $2355 per month. Additionally, we have ?witnessed a significant decrease in the standardized infection ratio (SIR) for healthcare facility-onset CDI from CY 2015=1.16 to CY 2018=0.39. CONCLUSIONS Study findings reveal the importance of effective communication among healthcare professionals as well as developing an interdisciplinary approach to making decisions in relation to C. difficile testing. At this hospital, interventions tested resulted in an accurate understanding of the number of healthcare facility-onset CDIs. In addition, meaningful cost savings were also achieved.