Clostridium Difficile Specimen Selection Checklist

Friday, 22 February 2019

Jordin Rex, SN
School of Nursing, Sam Houston State University, Magnolia, TX, USA
Mona Cockerham, PhD, RN, CPHQ
School of Nursing, Sam Houston State University, The Woodlands, TX, USA

Purpose: The purpose of this quality-improvement project is to decrease the amount of inappropriate stool samples sent to the laboratory for Clostridium difficile testing that result in inaccurate Clostridium difficle infection (CDI) diagnosis.

Problem Statement: "In acute care medical surgical staff, what is the effect of using a policy-based checklist for C. difficile specimen collection compared to not using a checklist for C. difficile specimen collection on the understanding of hospital policy over a 7-week period?"

Background: Evidence shows that stool samples sent to the laboratory for detection of CDI are often inappropriate, leading to an increasing rate in hospital-acquired CDI in the US. Clinical decision making tools have been shown to be more effective than written notices in increasing compliance with CDI specimen selection protocol.

Approach: Staff were surveyed on their knowledge of the hospital policy for C. difficile specimen selection over a 3 week period. A checklist outlining each step of the CDI specimen selection process was created according to SHEA-IDSA guidelines. Staff were then invited to a staff meeting where instructions for completing the policy-based specimen selection checklist were presented. Staff were surveyed again on their knowledge of the hospital C. difficile specimen selection policy for 3 more weeks after the implementation of a policy-based checklist.

Results: The introduction of a decision-making checklist improved the number of correct answers by 15% among clinical staff. The number of correct answers given by staff on the appearance of stool in C. difficile infected patients increased by 17% after the intervention was introduced. Correct answers for the number of days stool samples can be sent before positive results are considered hospital-acquired increased by 26% after the intervention was introduced. There was a 2% increase in the staff’s correct answers for the purpose of the hospital policy on C. difficile specimen selection.

Discussion/Implication to practice: Using a decision-making checklist to guide specimen selection is effective in increasing the staff knowledge of appropriate C. difficile stool specimen selection to decrease the amount of inappropriate C. difficile samples sent to the lab.