ITS 75 - Know Your Poop - How to Effectively Use Stool Documentation in the Electronic Medical Record (EMR) to Capture Clostridioides difficile Infections Before It's Too Late!

Background: According to the Centers for Disease Control and Prevention (CDC), there were an estimated 223,900 hospitalized patients and 12,800 deaths with an attributable 1 billion dollars in healthcare costs. CDC’s National Healthcare Safety Network System (NHSN) defines hospital acquired Clostridioides difficile (C. diff) as cases that occur after day 3 of admission. Healthcare Infection Control Practices Advisory Committee (HICPAC) guidelines recommend special pathogens such as C. diff sometimes require specialized monitoring and intensified infection control efforts to reduce the likelihood of patient to patient spread. In 2021, we had 52 hospital onset cases identified and 11 community onset cases. We noted 24 of the hospital onset cases could have been captured within the first 3 days of admission.

Methods: A new process was implemented to assist in early identification of C.diff infections. Stool documentation within the Electronic Medical Records (EMR) was utilized to create a daily stool status report distributed to clinical staff twice a day. This report identifies patients with documented Bristol stool type 6 or 7 stool within the first 3 days of admission. It also highlights patients who may have flushed or discarded their stool prior to being observed. Clinical staff use these reports to ensure early collection of stool specimens for C.diff testing.

Results: In the first 2 quarters of 2022, 9 community acquired, and 22 hospital-onset cases were identified. Within 4 months of implementation (July 2022), identification of community acquired doubled (18 cases) and hospital-onset decreased by 46% (12 cases).

Conclusions: Early identification and collection of stool specimens for C. diff testing within the first 3 days of admission allows for a more accurate count of infections which facilitates early treatment and timely isolation. Thereby, decreasing the possibility of patient to patient spread. Subsequently, resulting in accurate facility specific counts of hospital acquired versus community acquired cases.