Nurse-Ordered C difficile Testing Hastens Infection Identification, Likely Cutting Costs

Allowing bedside nurses to order Clostridioides difficile testing without physician approval significantly reduced the time it took to receive results, suggesting the policy change has the potential to decrease the spread of patient infections and the corresponding economic burden. Researchers published the findings online in the American Journal of Infection Control. 

“Given the implications of C difficile infection (CDI) on both a hospital and patient level, incentives exist for improving approaches to the prevention and spread of this infection in the clinical environment,” said study lead author Ashley Bartlett, MD, Fargo VA Healthcare System, Fargo, North Dakota. “Our findings suggest that allowing bedside nurses with appropriate training to order C difficile testing based on patient symptomology could be a valid strategy to help health care systems achieve this goal.”

For the study, researchers examined the effect of a policy change at a single Veterans Affairs health care site in Fargo that allowed bedside nurses independently to order stool testing for C difficile in patients with CDI symptoms rather than requiring a physician’s electronic signature. The study compared several outcomes for 2 time periods: the 44 months before the policy change and the 59 months after the change.

The percentages of positive and negative test results before and after the policy change were relatively unaffected, according to the study, suggesting that nurse ordering of tests did not increase unnecessary laboratory resource use or costs. However, the average time to obtain the test result dropped from 2.1 hours before the policy change to 1.3 hours afterward.

The time to initiate treatment before and after the policy change was a stable 1.7 hours. Researchers suspect this reflects a standing process of notifying physicians to initiate antibiotics. In other words, nurses do not receive the test results directly, nor can they order antibiotic treatment, under current policy.

“We need practical strategies to reduce the significant burden of CDIs,” said Patricia Jackson, RN, BSN, MA, CIC, FAPIC, president of the Association for Professionals in Infection Control and Epidemiology. “This study highlights one such strategy that health care facilities should consider to expedite appropriate C difficile testing and speed up implementation of appropriate treatment and infection control measures.”

References: 
Bartlett A, Montgomery A, Hammer K, et all. Does clinician-initiated Clostridioides difficile testing improve outcomes of patients with Clostridioides difficile infection? American Journal of Infection Control. Published online May 11, 2023. doi.org/10.1016/j.ajic.2023.02.017

Study shows hospital policy allowing nurses to initiate C. difficile testing could reduce infection spread and associated morbidity. News release. Association for Professionals in Infection Control; May 11, 2023. Accessed August 10, 2023.