Study shows hospital policy allowing nurses to initiate C. difficile testing could reduce infection spread and associated morbidity

Arlington, Va., May 11, 2023 – According to a new study published in the American Journal of Infection Control (AJIC), allowing bedside nurses to order testing for C. difficile independently has reduced the time required to receive test results compared to requiring physician approval. The study suggests that this change in testing policy could help reduce the risk of additional patient infections and the resulting financial burden on hospitals.

C. difficile infection (CDI) can cause mild to severe symptoms ranging from diarrhea to life-threatening inflammation of the colon. CDI is a major cause of healthcare-associated infections (HAIs) in the United States, resulting in many deaths and high healthcare costs annually. Despite efforts to prevent the infection, CDI remains one of the most common HAIs. Early detection, isolation and contact precautions, environmental cleaning, and appropriate antibiotic treatment can greatly reduce the impact of the infection.

Ashley Bartlett, MD, lead author of the study and affiliated with Fargo VA Healthcare System, North Dakota, commented that given the impact of CDI on both the hospital and patient, it is important to improve approaches to prevent and spread this infection in the clinical environment. The results of the study suggest that allowing bedside nurses with the necessary training to order C. diff testing based on patient symptoms could be a useful strategy in achieving this goal.

The infectious disease and nursing staff at a single site in the Veterans Affairs (VA) Healthcare System in Fargo, ND, implemented a policy change that permitted nurses to independently order stool samples for new patients exhibiting symptoms of CDI, instead of requiring an electronic signature from a physician. The effectiveness of the new policy was evaluated by researchers, who compared the frequency of test orders, time to obtain results, number of positive and negative tests, and time taken to initiate treatment for positive C. difficile tests over a period of 44 months before and 59 months after the policy change.

  Results show:

• After the policy change, there were a relatively even proportion of physicians and nurses ordering the stool PCR labs (51.1% vs 48.9%, respectively).
• The percent of positive and negative tests results before and after the policy change was relatively unaffected (13.9% vs. 11.5% respectively), suggesting that allowing nursing staff to order stool samples does not lead to increased unnecessary laboratory resource use or financial burden to the hospital.
• Following the policy change, the average difference in time to obtain the test result after the PCR lab order was statistically significant before, versus after, the policy change (mean [sd]; 2.1 (1.3) vs. 1.3 (0.7) hours; p<0.1).
• The average difference in time to obtain the test result after the PCR lab order between nurses and physicians was also statistically significant after the change (mean [sd]; 1.2 (0.7) vs. 1.3 (0.7) hours; p=.02).
• There was no significant difference in time to initiate treatment before and after the policy change (1.7 hours vs. 1.7 hours). The authors suggest this was because the process of notifying physicians to initiate antibiotic treatment did not change – nurses did not receive test results directly, nor could they order antibiotics.

Patricia Jackson, RN, BSN, MA, CIC, FAPIC, the 2023 president of the Association for Professionals in Infection Control and Epidemiology (APIC), stated that practical strategies are necessary to alleviate the significant burden of C. difficile infections. She highlighted this study as one such strategy that healthcare facilities should consider to hasten the appropriate testing for C. difficile, expedite implementation of proper treatment, and infection control measures.

About APIC

Founded in 1972, the Association for Professionals in Infection Control and Epidemiology (APIC) is the leading association for infection preventionists and epidemiologists. With more than 15,000 members, APIC advances the science and practice of infection prevention and control. APIC carries out its mission through research, advocacy, and patient safety; education, credentialing, and certification; and fostering development of the infection prevention and control workforce of the future. Together with our members and partners, we are working toward a safer world through the prevention of infection. Join us and learn more at apic.org.

About AJIC

As the official peer-reviewed journal of APIC, The American Journal of Infection Control (AJIC) is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. Published by Elsevier, AJIC also publishes infection control guidelines from APIC and the CDC. AJIC is included in Index Medicus and CINAHL. Visit AJIC at ajicjournal.org.