Preventable Patient Harm: a Multidisciplinary, Bundled Approach to Reducing Clostridium difficile Infections While Using a Glutamate Dehydrogenase/Toxin Immunochromatographic Assay/Nucleic Acid Amplification Test Diagnostic Algorithm.

Autor:	Schultz K; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA katherine.schultz@unchealth.unc.edu., Sickbert-Bennett E; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Marx A; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Weber DJ; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.; Division of Adult Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA., DiBiase LM; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Campbell-Bright S; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.; Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA., Bode LE; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Baker M; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Belhorn T; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Buchanan M; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Goldbach S; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Harden J; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Hoke E; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Huenniger B; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Juliano JJ; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.; Division of Adult Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA., Langston M; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Ritchie H; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Rutala WA; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Smith J; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Summerlin-Long S; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Teal L; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA., Gilligan P; University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.; Clinical Microbiology-Immunology Laboratories, UNC Health Care, Chapel Hill, North Carolina, USA.; Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Jazyk:	angličtina
Zdroj:	Journal of clinical microbiology [J Clin Microbiol] 2018 Aug 27; Vol. 56 (9). Date of Electronic Publication: 2018 Aug 27 (Print Publication: 2018).
DOI:	10.1128/JCM.00625-18
Abstrakt:	Health care facility-onset Clostridium difficile infections (HO-CDI) are an important national problem, causing increased morbidity and mortality. HO-CDI is an important metric for the Center for Medicare and Medicaid Service's (CMS) performance measures. Hospitals that fall into the worst-performing quartile in preventing hospital-acquired infections, including HO-CDI, may lose millions of dollars in reimbursement. Under pressure to reduce CDI and without a clear optimal method for C. difficile detection, health care facilities are questioning how best to use highly sensitive nucleic acid amplification tests (NAATs) to aid in the diagnosis of CDI. Our institution has used a two-step glutamate dehydrogenase (GDH)/toxin immunochromatographic assay/NAAT algorithm since 2009. In 2016, our institution set an organizational goal to reduce our CDI rates by 10% by July 2017. We achieved a statistically significant reduction of 42.7% in our HO-CDI rate by forming a multidisciplinary group to implement and monitor eight key categories of infection prevention interventions over a period of 13 months. Notably, we achieved this reduction without modifying our laboratory algorithm. Significant reductions in CDI rates can be achieved without altering sensitive laboratory testing methods. (Copyright © 2018 American Society for Microbiology.)
Databáze:	MEDLINE
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