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The Use of a Computerized Provider Order Entry Alert to Decrease Rates of Clostridium difficile Testing in Young Pediatric Patients

Published online by Cambridge University Press:  21 February 2017

Maribeth R. Nicholson ,
Peter N. Freswick ,
M. Cecilia Di Pentima ,
Li Wang ,
Kathryn M. Edwards ,
Gregory J. Wilson  and
Thomas R. Talbot
Maribeth R. Nicholson*
Affiliation:
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
Peter N. Freswick
Affiliation:
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Helen DeVos Children’s Hospital, Grand Rapids, Mighigan
M. Cecilia Di Pentima
Affiliation:
Division of Pediatric Infectious Diseases, Atlantic Health System, Morristown, New Jersey
Li Wang
Affiliation:
Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
Kathryn M. Edwards
Affiliation:
Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
Gregory J. Wilson
Affiliation:
Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
Thomas R. Talbot
Affiliation:
Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
*
Address correspondence to Maribeth R. Nicholson, MD, MPH; Division of Pediatric Gastroenterology, Hepatology, and Nutrition; Monroe Carell Jr. Children’s Hospital at Vanderbilt; 2200 Children’s Way; Nashville TN 37232 ([email protected]).
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Abstract

BACKGROUND

Infants and young children are frequently colonized with C. difficile but rarely have symptomatic disease. However, C. difficile testing remains prevalent in this age group.

OBJECTIVE

To design a computerized provider order entry (CPOE) alert to decrease testing for C. difficile in young children and infants.

DESIGN

An interventional age-targeted before-after trial with comparison group

SETTING

Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, Tennessee.

PATIENTS

All children seen in the inpatient or emergency room settings from July 2012 through July 2013 (pre-CPOE alert) and September 2013 through September 2014 (post-CPOE alert)

INTERVENTION

In August of 2013, we implemented a CPOE alert advising against testing in infants and young children based on the American Academy of Pediatrics recommendations with an optional override. We further offered healthcare providers educational seminars regarding recommended C. difficile testing.

RESULTS

The average monthly testing rate significantly decreased after the CPOE alert for children 0–11 months old (11.5 pre-alert vs 0 post-alert per 10,000 patient days; P<.001) and 12–35 months old (61.6 pre-alert vs 30.1 post-alert per 10,000 patients days; P<.001), but not for those children ≥36 months old (50.9 pre-alert vs 46.4 post-alert per 10,000 patient days; P=.3) who were not targeted with a CPOE alert. There were no complications in those children who testing positive for C. difficile.

CONCLUSIONS

The average monthly testing rate for C. difficile for children <35 months old decreased without complication after the use of a CPOE alert in those who tested positive for C. difficile.

Infect Control Hosp Epidemiol 2017;38:542–546

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 5 , May 2017 , pp. 542 - 546
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Kim, J, Smathers, SA, Prasad, P, Leckerman, KH, Coffin, S, Zaoutis, T. Epidemiological features of Clostridium difficile-associated disease among inpatients at children’s hospitals in the United States, 2001–2006. Pediatrics 2008;122:1266–1270.Google Scholar
2. Adlerberth, I, Huang, H, Lindberg, E, et al. Toxin-producing Clostridium difficile strains as long-term gut colonizers in healthy infants. J Clin Microbiol 2014;52:173–179.CrossRefGoogle ScholarPubMed
3. Holst, E, Helin, I, Mardh, PA. Recovery of Clostridium difficile from children. Scand J Infect Dis 1981;13:41–45.Google Scholar
4. Matsuki, S, Ozaki, E, Shozu, M, et al. Colonization by Clostridium difficile of neonates in a hospital, and infants and children in three day-care facilities of Kanazawa, Japan. Int Microbiol 2005;8:43–48.Google Scholar
5. Jangi, S, Lamont, JT. Asymptomatic colonization by Clostridium difficile in infants: implications for disease in later life. J Pediatr Gastroenterol Nutrit 2010;51:2–7.Google Scholar
6. Schutze, GE, Willoughby, RE. Clostridium difficile infection in infants and children. Pediatrics 2013;131:196–200.Google Scholar
7. Committee on Infections Diseases. Policy statement. Clostridium difficile infection in infants and children. Pediatrics 2013;131:196–200.Google Scholar
8. Sandora, TJ, Fung, M, Flaherty, K, et al. Epidemiology and risk factors for Clostridium difficile infection in children. Pediatric Infect Dis J 2011;30:580–584.Google Scholar
9. Kim, J, Shaklee, JF, Smathers, S, et al. Risk factors and outcomes associated with severe clostridium difficile infection in children. Pediatric Infect Dis J 2012;31:134–138.CrossRefGoogle ScholarPubMed
10. Solomon, DH, Hashimoto, H, Daltroy, L, Liang, MH. Techniques to improve physicians’ use of diagnostic tests: a new conceptual framework. JAMA 1998;280:2020–2027.Google Scholar
11. Neilson, EG, Johnson, KB, Rosenbloom, ST, et al. The impact of peer management on test-ordering behavior. Ann Intern Med 2004;141:196–204.Google Scholar
12. Walsh, KE, Landrigan, CP, Adams, WG, et al. Effect of computer order entry on prevention of serious medication errors in hospitalized children. Pediatrics 2008;121:e421–e427.Google Scholar
13. Kociolek, LK, Bovee, M, Carter, D, et al. Impact of a healthcare provider educational intervention on frequency of Clostridium difficile polymerase chain reaction testing in children: a segmented regression analysis. J Pediatr Infect Dis Soc 2016. pii:piw027.Google Scholar
14. Nicholson, MR, Thomsen, IP, Edwards, KM. Controversies surrounding Clostridium difficile infection in infants and young children. Children (Basel, Switzerland) 2014;1:40–47.Google ScholarPubMed
15. Tullus, K, Aronsson, B, Marcus, S, Mollby, R. Intestinal colonization with Clostridium difficile in infants up to 18 months of age. Eur J Clin Microbiol Infect Dis 1989;8:390–393.Google Scholar
16. Boyanton, BL Jr, Sural, P, Loomis, CR, et al. Loop-mediated isothermal amplification compared to real-time PCR and enzyme immunoassay for toxigenic Clostridium difficile detection. J Clinl Microbiol 2012;50:640–645.Google Scholar
17. Koo, HL, Van, JN, Zhao, M, et al. Real-time polymerase chain reaction detection of asymptomatic Clostridium difficile colonization and rising C. difficile-associated disease rates. Infect Control Hosp Epidemiol 2014;35:667–673.Google Scholar
18. Longtin, Y, Trottier, S, Brochu, G, et al. Impact of the type of diagnostic assay on Clostridium difficile infection and complication rates in a mandatory reporting program. Clin Infect Dis 2013;56:67–73.Google Scholar
19. Polage, CR, Gyorke, CE, Kennedy, MA, et al. Overdiagnosis of Clostridium difficile infection in the molecular test era. JAMA Intern Med 2015:1–10.Google ScholarPubMed
20. Masse, V, Valiquette, L, Boukhoudmi, S, et al. Impact of methicillin-resistant Staphylococcus aureus contact isolation units on medical care. PloS One 2013;8:e57057.Google Scholar
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