1. UNMH’s hospital acquired C
UNMH’s hospital acquired C. diff infection rate is above the national average.

2. Our lab’s current testing algorithm reflexes to NAAT-PCR testing on all intermediate C. diff testing results.

3. However, a patient’s C. diff test can be positive if they are an asymptomatic carrier.
Sensitiviy
Specificity
Differentiates non-toxigenic strains from toxigenic
NAAT -PCR
Very Sensitive
Not specific No
EIA Toxins A & B
Less sensitive
Very specific
Yes
EIA GDH
Sensistive

4. Twenty percent of hospitalized patients are asymptomatic carriers of C
Twenty percent of hospitalized patients are asymptomatic carriers of C. diff. Rates are even higher in long term care facilities.

5. Providers must rely on the presence of the clinical syndrome of C
Providers must rely on the presence of the clinical syndrome of C. diff to differentiate between asymptomatic carriers and actively infected individuals. Asymptomatic carriers do NOT require treatment.
>=3 Loose stools in 24 hours
Mucus or occult blood may be present, rarely hematochezia or melena
Abdominal pain and leukocytosis are common
5 to 10% of patients have not been exposed to antibiotics

6. Providers must also consider other causes of diarrhea.

7. The C. diff team hopes to encourage collaboration between nurses and providers to consider all of these factors before ordering a C. diff test.

8. Providers will have hard stops in the EMR to flag inappropriate testing
Senna
Polyethylene glycol 3350
Lactulose
Bisacodyl

9. The hard stop can be overriden through call to pathology if your patient should still be tested urgently (must justify reason)

10. Nurses will be asked to complete a Cdiff appropriateness form
Form completion:
Prior to calling provider to suggest a sample
Prior to sending sample if provider orders
Has patient had diarrhea?
Does patient have symptoms?
Has patient been on laxatives?
Hard stop in place for <24 hours, but provider will be notified if laxative within hours

11. Provider take aways
Cdiff testing can diagnose Cdiff infection AND colonization
Providers should only test when INFECTION is suspected
Hard stops in the EMRs will be rolled out August 1st
Repeat testing within 7d (Tricore also blocking these)
Laxative use within 24h
You can call hot seat pathology resident if you strongly feel that your patient still needs testing (rare)
Nurses may also call you if Cdiff testing ordered on patients without diarrhea, clear syndrome of infection, or laxative use within 48h (not a hard stop)