New data presented at the Society for Healthcare Epidemiology of America (SHEA) conference highlights considerable lapses in compliance with Clostridioides difficile infection (CDI) testing guidelines in Veteran Affairs (VA) hospitals. The study, which echoes concerns voiced in previous non-VA research, uncovers demographic and situational factors influencing non-adherence, presenting a pressing need for improved diagnostic stewardship. CDI continues to be a major threat within the healthcare system, resulting in approximately half a million infections and 30,000 fatalities annually in the US alone.
Despite the existence of clear guidelines cautioning against CDI testing in close proximity to the administration of laxatives, many healthcare providers overlook this directive, potentially leading to incorrect diagnoses. The study examined 7,326 tests conducted on 4,888 patients across VA Medical Centers in Illinois, Wisconsin, and Michigan. The patients, predominantly white (61.8%), male (95.6%), and with an average age of 70 years, demonstrated significant instances of non-compliance. Strikingly, nearly 59% of the tests were carried out within 48 hours post laxative use, contrary to established guidelines.
The data also revealed that Black and Hispanic patients were less likely to undergo guideline-noncompliant testing, and tests from remote facilities, long-term support units, as well as ICUs experienced higher non-compliance. Further research is warranted to better understand the implications of this inappropriate testing, including the potential for unnecessary treatments and ballooning healthcare costs. Evidently, a stronger emphasis on diagnostic stewardship could facilitate greater adherence to CDI testing guidelines across VA hospital settings. This spotlight study lends critical insights into the need for improved adherence to testing guidelines, underscoring the necessity of ongoing education and awareness around infection prevention.