Clostridium difficile
Testing for a Cure: Why Not to Test
Many participating facilities have had questions regarding testing of adult residents, repeat testing, or testing to ensure residents are “cured” of the infection (to remove from isolation). We ask that you share this information with your nursing staff members or peers to ensure an understanding of this guidance and best practices.
 
The 2017 update to the clinical practice guidelines for C. difficile were released early this year from the Infectious Disease Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA).
Key recommendations pertaining to testing include: https://academic.oup.com/cid/article/66/7/e1/4855916
What is the role of repeat testing, if any? Are there asymptomatic residents in whom repeat testing should be allowed, including test of cure?
  • Do not perform repeat testing (within 7 days) during the same episode of diarrhea and do not test stool from asymptomatic residents (strong recommendation).
  • There is no clinical value in testing for a cure; More than 60% of residents may remain positive after treatment.
What is the preferred population for C. difficile testing?
  • Residents with unexplained and new-onset, ≥3 unformed stool (conforms to the specimen container) in 24 hours, are the preferred target population for testing for Clostridium difficile Infections (CDIs).
  • Do not test residents for CDI who have had laxatives in the previous 48 hours. If symptoms persist after discontinuation, testing may be necessary.
Testing for a cure should not be done.
  • Studies have shown that both toxin A+B EIA and TC may remain positive for as long as 30 days in residents who are asymptomatic.
  • Nearly 57% of residents in long-term care facilities can be carriers.
  • False positive “test of cure” specimens may complicate clinical care and result in additional courses of inappropriate treatment.
Additional Resource
Please enter your August CDI data by September 10.
Centers for Disease Control and Prevention (CDC)
to Protect Patients, Follow Clinical Guidelines
When Prescribing Fluoroquinolones
The U.S. Food and Drug Administration (FDA) recently strengthened its black box warning regarding fluoroquinolone use

Appropriate fluoroquinolone prescribing is important for patient safety. A recent study published in Clinical Infectious Diseases reports that fluoroquinolones are commonly prescribed for conditions when antibiotics are not needed at all, or when fluoroquinolones are not the recommended first-line therapy.

Improving antibiotic prescribing is important to prevent serious adverse events and potentially life-threatening Clostridioides difficile (C. diff) infections. Healthcare providers can protect their patients and give the best care by prescribing fluoroquinolones only when they are the recommended therapy for a patient’s illness.

CDC recently released a Medscape Expert Commentary to provide support and guidance for healthcare providers as they weigh the risks and benefits of prescribing fluoroquinolones.

The FDA recently updated its black box warning to include the association between fluoroquinolones, disabling, and potentially permanent side effects. The updated warning urges healthcare providers to limit fluoroquinolone use in patients with less serious bacterial infections.

To learn more about optimizing antibiotic prescribing and use, visit: https://go.usa.gov/xU6R3 .
Upcoming Webinars
TeamSTEPPS® Webinar
Thursday, September 13, 2018
2 to 3 p.m. ET | 1 to 2 p.m. CT

Webinar Objectives
  • Explain the value of utilizing TeamSTEPPS communication strategies.
  • Describe the different TeamSTEPPS communication strategies available that may improve care quality and safety.
NNHQCC Outcomes Congress Webinar
Thursday, September 27, 2018
2 to 3 p.m. ET | 1 to 2 p.m. CT

Webinar Objectives
  • Review the NNHQCC goals for the quality measure composite score and antipsychotic medication and their outcomes.
  • Review progress being made with CDI reporting with NHSN.
  • Analyze success stories from NNHQCC nursing homes and the next steps for 2018 and beyond.
Contact HSAG if you Need Assistance Entering NHSN Data.
Please contact us immediately if you have any questions or concerns.
Sonia E. Alvarez, BS, M(ASCP), CIC, CPHQ
813.865.3326 | salvarez@hsag.com

Gazelle Zeya, MBA, MS, RAC-CT
813.865.3188 | gzeya@hsag.com

Jo Ann V. Bukovinsky, MBA, BSN, RN, LHCRM, RAC-CT
813.865.3196 | jbukovinsky@hsag.com
This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Florida, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
Publication No. FL-11SOW-C.2-08282018-01