Updates From the SHEA Conference: Using EHRs to Find C difficile Earlier, and More

The Society for Healthcare Epidemiology of America (SHEA) 2023 Spring Conference happened last week in Seattle, Washington, and ContagionLive, a sister publication of The American Journal of Managed Care®, covered it. Here is a roundup of some news from the meeting, which was also presented virtually:

Identifying Infections Earlier

A study from the Mayo Clinic investigated whether using an electronic health record (EHR) would reduce the time to diagnose Clostridioides difficile infections (CDI).

C difficile is prevalent in health care facilities and is also a risk in older adults, those who are on antibiotics or proton pump inhibitors, and those who are immunosuppressed. The bacterium is infamous for its ability to cause severe, recurrent, and even fatal infection, and so catching it early is paramount.

Presenter and lead author Brad Krier, MPH, CIC, explained that from August 2021 to September 2022, an EHR report was implemented in a 5-hospital health care system in the Midwest.

The EHR identified patients with 3 or more type 6 or 7 stools (based on the Bristol Stool Form Scale classification) within a 24-hour period. All hospital inpatients who met these criteria and did not have an active order for a C difficile test were included. Patients with a laxative in the previous 48 hours, tube feedings without fever or leukocytosis, or a known cause of diarrhea were excluded.

A total of 25 patients were identified, met inclusion criteria, and underwent C difficile polymerase chain reaction testing. Of the 25, 5 tested positive for CDI (20.0%); these cases were identified before hospital day 4.

Krier noted there were a total of 13 hospital-onset cases of CDI in the health care system during the study period, for a standard infection ratio of 0.346. If the cases detected by the EHR report had not been identified before hospital day 3, the standard infection ratio could have been 38.5% higher at 0.482.

The difference between the actual and potential standard infection ratios was not statistically significant, but the study authors recommended continued data collection to increase statistical power. “Next steps include incorporating a CDI risk score based on patient risk factors and automated notifications to expand coverage,” they wrote.

The investigators concluded that the early identification report helped obtain timely CDI diagnoses, likely limiting the spread of CDI and lowering the standard infection ratio by 38.4%.

New Updates in Infection Control Guidance

Also at the meeting, SHEA said it published its Strategies to Prevent Clostridioides difficile Infections in Acute Care Hospitals: 2022 Update in the journal Infection Control & Hospital Epidemiology.

“C difficile is an urgent health threat, and hospitals need system-wide commitment to stop it,” said lead author Larry K. Kociolek, MD, vice president of System Preparedness, Prevention, and Response at Lurie’s Children’s Hospital of Chicago and a member of SHEA. “Because the use of antibiotics is strongly associated with C difficile infections, antimicrobial stewardship—an approach to making sure these drugs are prescribed and used appropriately—is a strong first-line defense.”

Although health care–associated C difficile cases have leveled off in recent years, community-associated C difficile cases have risen, increasing the risk to hospitalized patients and enhancing the need for quick and accurate diagnosis.

The updated guidance emphasizes assessment of the adequacy of room cleaning and addresses procedures for cleaning equipment and the environment of patients with C difficile. The authors also address the need for timely alerts when patients are newly diagnosed; data reporting; education of environmental services personnel, administrators, patients and families; and additional steps hospitals can take if C difficile incidence remains high after implementing essential practices.

SHEA recruited subject matter experts in CDI prevention to lead the panel of members representing the Compendium partnering organizations including the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, as well as the CDC.

This compendium is a multiyear, collaborative guidance-writing effort by over 100 experts from around the world, and updates the 2014 Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals.