A new process for laboratory management of stool Clostridia difficile screening was implemented in August to help ordering practitioners to improve diagnostic accuracy, shorten time to diagnosis, and shorten time to treatment for patients at risk for c. difficile infection. Communication was transmitted to medical staff with screenshots and frequently asked questions to support this change.
Under the new process, all Clostridia difficile PCR positives will automatically trigger (reflex) EIA testing to identify the actual presence of toxin as follows:
- PCR NEGATIVE: Clostridia difficile infection or colonization highly unlikely.
- PCR POSITIVE: EIA toxin test will be performed
- EIA POSITIVE: Clostridia difficile infection highly likely and treatment indicated.
- EIA NEGATIVE: Clostridia difficile infection may or may not be present. May be a Clostridia difficile carrier. Clinical correlation is needed to determine likelihood of infection – consider consultation by infectious disease.
In addition, those ordering C diff screening will be required to respond to questions to validate the need for screening, e.g. the presence of more than 3 loose/watery stools in past 24 hours not on laxatives, and no positive result within the past 30 days.
Epic will respond with computerized decision support via best practice alerts (BPAs) prompting evidence-based selection of patients at risk, based upon answers to the above and other data in Epic:
Consistent with St. Mark’s Hospital policy, all Clostridia difficile PCR positive patients will remain in isolation for the duration of hospital stay regardless of toxin result.
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