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      Diagnostic stewardship to improve patient outcomes and healthcare-associated infection (HAI) metrics

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          Abstract

          Diagnostic stewardship seeks to improve ordering, collection, performance, and reporting of tests. Test results play an important role in reportable HAIs. The inclusion of HAIs in public reporting and pay for performance programs has highlighted the value of diagnostic stewardship as part of infection prevention initiatives. Inappropriate testing should be discouraged, and approaches that seek to alter testing solely to impact a reportable metric should be avoided. HAI definitions should be further adapted to new testing technologies, with focus on actionable and clinically relevant test results that will improve patient care.

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          Most cited references51

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          Stool form scale as a useful guide to intestinal transit time.

          S J Lewis, K W Heaton (2009)
          Stool form scales are a simple method of assessing intestinal transit rate but are not widely used in clinical practice or research, possibly because of the lack of evidence that they are responsive to changes in transit time. We set out to assess the responsiveness of the Bristol stool form scale to change in transit time. Sixty-six volunteers had their whole-gut transit time (WGTT) measured with radiopaque marker pellets and their stools weighed, and they kept a diary of their stool form on a 7-point scale and of their defecatory frequency. WGTT was then altered with senna and loperamide, and the measurements were repeated. The base-line WGTT measurements correlated with defecatory frequency (r = 0.35, P = 0.005) and with stool output (r = -0.41, P = 0.001) but best with stool form (r = -0.54, P < 0.001). When the volunteers took senna (n = 44), the WGTT decreased, whereas defecatory frequency, stool form score, and stool output increased (all, P < 0.001). With loperamide (n = 43) all measurements changed in the opposite direction. Change in WGTT from base line correlated with change in defecatory frequency (r = 0.41, P < 0.001) and with change in stool output (n = -0.54, P < 0.001) but best with change in stool form (r = -0.65, P < 0.001). This study has shown that a stool form scale can be used to monitor change in intestinal function. Such scales have utility in both clinical practice and research.
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            Diagnosis of Clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories.

            Carey-Ann D. Burnham, Ronan K Carroll (2013)
            Clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of C. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. For many years, the mainstay of C. difficile disease diagnosis was enzyme immunoassays for detection of the C. difficile toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of C. difficile. This review covers the history and biology of C. difficile and provides an in-depth discussion of the laboratory methods used for the diagnosis of C. difficile infection (CDI). In addition, strain typing methods for C. difficile and the evolving epidemiology of colonization and infection with this organism are discussed. Finally, considerations for diagnosing C. difficile disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described. As detection of C. difficile in clinical specimens does not always equate with disease, the diagnosis of C. difficile infection continues to be a challenge for both laboratories and clinicians.
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              Overdiagnosis of Clostridium difficile Infection in the Molecular Test Era.

              Christopher Polage, Clare E Gyorke, Michael Kennedy … (2015)
              Clostridium difficile is a major cause of health care-associated infection, but disagreement between diagnostic tests is an ongoing barrier to clinical decision making and public health reporting. Molecular tests are increasingly used to diagnose C difficile infection (CDI), but many molecular test-positive patients lack toxins that historically defined disease, making it unclear if they need treatment.
              Article 0 comments Cited 92 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Infect Control Hosp Epidemiol
                Journal ID (iso-abbrev): Infect Control Hosp Epidemiol
                Journal ID (publisher-id): ICE
                Title: Infection Control and Hospital Epidemiology
                Publisher: Cambridge University Press (New York, USA )
                ISSN (Print): 0899-823X
                ISSN (Electronic): 1559-6834
                Publication date (Print, pub): April 2024
                Publication date (Electronic, pub): 11 January 2024
                Volume: 45
                Issue: 4
                Pages: 405-411
                Affiliations
                [ 1 ]Division of Infectious Diseases, Weill Cornell Medicine , New York City, New York
                [ 2 ]Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy , Baltimore, Maryland
                [ 3 ]Department of Medicine–Infectious Diseases, Duke University School of Medicine , Durham, North Carolina
                [ 4 ] Infection Prevention and Control , Children’s Mercy Kansas City, Missouri
                [ 5 ]Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center , Boston, Massachusetts
                [ 6 ]Medical Director, Infectious Disease, eviCore Healthcare , Bluffton, South Carolina
                [ 7 ]Section of Infectious Diseases, Department of Medicine, Virginia Mason Hospital and Seattle Medical Center , Seattle, Washington
                [ 8 ]Division of Pediatric Infectious Diseases, Johns Hopkins Medicine , Baltimore, Maryland
                [ 9 ]Division of Infectious Diseases, Rush University Medical Center , Chicago, Illinois
                [ 10 ]Department of Epidemiology and Public Health, University of Maryland School of Medicine , Baltimore, Maryland
                [ 11 ] Veterans’ Affairs Maryland Healthcare System , Baltimore, Maryland
                [ 12 ]Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, Iowa
                [ 13 ]Division of Infectious Diseases, Department of Medicine, Maine Medical Center , Portland, Maine
                Author notes
                Corresponding author: Harjot K. Singh; Email: has9032@ 123456med.cornell.edu
                Author information
                https://orcid.org/0000-0001-6895-604X
                https://orcid.org/0000-0001-5162-6482
                https://orcid.org/0000-0001-5363-4742
                https://orcid.org/0000-0001-7832-4011
                https://orcid.org/0000-0001-8498-8682
                https://orcid.org/0000-0002-4603-8501
                https://orcid.org/0000-0002-2933-6208
                Article
                Publisher ID: S0899823X23002842
                DOI: 10.1017/ice.2023.284
                PMC ID: 11007360
                PubMed ID: 38204365
                SO-VID: d630b9a0-d395-4182-b79c-8776f6e28c04
                Copyright © © The Author(s) 2024
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

                History
                Date received : 06 November 2023
                Date revision received : 22 November 2023
                Date accepted : 24 November 2023
                Page count
                Tables: 2, References: 60, Pages: 7
                Categories
                Subject: SHEA Position Paper

                Data availability:

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