520. Reducing Inappropriate Clostridium difficle Testing by Empowering Nurses

Background Inappropriate testing for Clostridium difficle (CD) can result in over diagnosing, which may lead to overuse of antibiotics, increased length of stay and financial penalties under Center for Medicare and Medicaid’s Value Based Programs. To address unnecessary testing, a nurse-driven algorithm was developed and implemented at a tertiary teaching hospital in Detroit, Michigan. In this study, we evaluate the intervention’s impact on hospital acquired CD infections (HO-CDI) rates. Methods An algorithm for CD testing appropriateness was created by leadership and the Infection Prevention team. The algorithm emphasized that CD testing should not be performed on asymptomatic patients or those receiving laxatives and/or stool softeners. Rates of HO-CDI per 10,000 patient days were compared before and after the intervention and statistical significance was determined by an unpaired t-test. The hospital laboratory used PCR to detect CD throughout the study period. Results Before the algorithm was implemented, our hospital had an average of 8.2 HO-CDI per 10,000 patient days. After the intervention was established, the rate decreased to 4.6 HO-CDI per 10,000 patient days. This represents a statistically significant decrease in HO-CDI (P = 0.037). The rate of community-onset CD cases, defined as infection that are identified between calendar day 1 through 3, did not change significantly during the study (P = 0.65). Conclusion Empowering and educating nurses about CD testing guidelines proved to be an effective tactic to reduce unnecessary CD testing, and in turn, decrease our HO-CDI rates. Disclosures All authors: No reported disclosures.