Impact of a multipronged approach to reduce the incidence of Clostridioides difficile infections in hospitalized patients

Michael Katzman, Austin C. Cohrs, Patricia E. Hnatuck, Wallace H. Greene, Stephanie M. Reed, Michael A. Ward, Frendy D. Glasser, Matthew F. Loser, Cory M. Hale

Research output: Contribution to journalArticlepeer-review


Background: Effective approaches to reduce Clostridioides difficile infections (CDI) in hospitalized patients are needed. We report data from 3 years preceding and 3 years following interventions that proved successful, with detailed analysis of all cases the first year after implementation. Methods: Interventions included a nursing protocol to identify cases present on admission by asking if the patient had 1 or more liquid stools in the last 24 hours, and a 2-step testing algorithm with samples positive by polymerase chain reaction (PCR) for the C. difficile toxin gene reflexing to an enzyme immunoassay (EIA) for the toxin antigen. Results: Healthcare-associated infections due to CDI fell from ∼160 in each of the preceding 3 years to <65 in each of the subsequent 3 years (P < .001), while the ratio of observed-to-expected hospital-onset cases diminished to ∼0.50 (P < .02). In the first year, 395 samples were PCR(+), but only 118 (29.9%) of these were EIA(+). 55 (46.6%) of the PCR(+)/EIA(+) samples were from hospital day 1 or 2 and classified as present on admission. The mean time from stool collection to report of PCR results was ∼7.5 hours, and the EIA took on average only 68 additional minutes to be reported. Conclusions: The number of incident CDI cases can be dramatically decreased by implementing an admission screening question and a 2-step testing algorithm.

Original languageEnglish (US)
Pages (from-to)668-674
Number of pages7
JournalAmerican journal of infection control
Issue number6
StatePublished - Jun 2023

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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