Using Stool Documentation in the Electronic Medical Record to Capture Clostridioides difficile Infections

Hospital-acquired Clostridioides difficile infections pose a significant challenge in health care settings worldwide. C difficile is a bacterium that can cause severe gastrointestinal symptoms, including diarrhea and colitis, leading to increased morbidity, prolonged hospital stays, and elevated health care costs. In the United States, it is estimated that C difficile is responsible for nearly 500,000 infections annually. Hospital-acquired C difficile refers to cases that occur 4 or more days after a patient's admission to the hospital, according to the CDC's National Healthcare Safety Network System (NHSN).

Within the last 5 years (2018-2022), the medical center where Melissa Palter, LVN, CIC, T-CHEST, and Rishwa Patel, MPH, CIC, work, Keck Medicine of USC (University of Southern California), had a facility-specific standardized infection ratio (SIR) that remained higher than the internal benchmark goal. Palter and Patel developed a novel approach to promptly detect patients with C difficile by utilizing stool documentation in the electronic medical record (EMR). This method aimed to identify early opportunities for collecting stool samples for C difficile testing. They presented their findings at the Association for Professionals in Infection Control and Epidemiology (APIC) 2023 Annual Conference and Exhibition, held in Orlando, Florida, June 26 to 28, 2023.

Data from the EMR was extracted to create a daily stool status report or, as they called it, a “poop report.” Patients with Bristol Stool Type 6 or 7 and with bowel movements that may have been flushed/discarded/not observed were included in the report. A mushy consistency, with fluffy pieces with irregular edges, characterize type 6 stools. Type 7 stools are completely liquid in form, lacking any solid pieces. These stool types often indicate the presence of diarrhea, as they exhibit loose consistency. Additionally, they may appear lighter in color compared to normal stools. The stool status report was distributed to nursing leadership and unit managers twice daily and identified patients that should have their stool collected for C difficile testing.

After 6 months post-implementation, there was a 3-fold increase in the identification of community-acquired cases (27 cases), while hospital-onset cases decreased by 4 (18 cases). Their medical center’s SIR also significantly decreased compared to prior years. SIR remained higher than the goal despite our facility’s comprehensive process which includes infection prevention best practices as well as stringent environmental cleaning protocols.

Palter and Patel concluded that the early identification of these patients that needed testing resulted in prompt isolation, early treatment, a decreased risk of environmental transmission, and accurate classification of infections (community-acquired vs hospital-acquired). C difficile infections can be incorrectly classified as hospital-acquired due to delays in testing stool specimens.

Understanding the causes, risk factors, and strategies for preventing and managing hospital-acquired C difficile infections is essential for health care professionals to provide optimal care and reduce the burden of this infectious disease in hospital settings.

Using IT resources, such as EMRs, data analytics, and communication platforms, can enhance infection prevention practices and ultimately improve patient outcomes. By harnessing the power of technology, health care facilities can strengthen their infection prevention efforts, reduce the incidence of health care-associated infections, and ultimately enhance patient safety and outcomes. There are critical data stored in EMRs that infection preventionists may need to tap into with the assistance of their IT departments.

Reference
Palter M., Patel R. Using Stool Documentation in the Electronic Medical Record to Capture Clostridioides difficile Infections. APIC 2023 National Conference & Exposition. Orlando, Florida.