title: Evaluation of a Clostridium difficile infection management policy with clinical pharmacy and medical microbiology involvement at a major Canadian teaching hospital.
abstract: OBJECTIVE
  Clostridium difficile infection (CDI) represents a spectrum of disease and is a significant concern for healthcare institutions. Our study objective was to assess whether implementation of a regional CDI management policy with Clinical Pharmacy and Medical Microbiology and Infection Control involvement would lead to an improvement in concordance in prescribing practices to an evidence-based CDI disease severity assessment and pharmacological treatment algorithm.
  
  
  METHODS
  Conducted at a tertiary care teaching hospital, this two-phase quality assurance study consisted of a baseline retrospective healthcare record review of patients with CDI prior to the implementation of a regional CDI management policy followed by a prospective evaluation post-implementation.
  
  
  CONCLUSIONS
  One hundred and forty-one CDI episodes in the pre-implementation group were compared to 283 episodes post-implementation. Overall treatment concordance to the CDI treatment algorithm was achieved in 48 of 141 cases (34%) pre-implementation compared with 136 of 283 cases (48·1%) post-implementation (P = 0·01). The median time to treatment with vancomycin was reduced from five days to one day (P < 0·01), with median length of hospital stay decreasing from 30 days to 21 days (P = 0·01) post-implementation. There was no difference in 30-day all-cause mortality.
  
  
  CONCLUSIONS
  A comprehensive approach with appropriate stakeholder involvement in the development of clinical pathways, education to healthcare workers and prospective audit with intervention and feedback can ensure patients diagnosed with CDI are optimally managed and prescribed the most appropriate therapy based on CDI disease severity.
authors.affiliation: BC Provincial Academic Detailing Service, Fraser Health Authority, Vancouver, BC, Canada.
authors.forename: S S T
authors.initials: SS
authors.lastname: Yeung
authors.affiliation: Lower Mainland Pharmacy Services, Fraser Health Authority, Vancouver Coastal, Providence Health Care, Provincial Health Services Authority, Vancouver, BC, Canada.|Pharmaceutical Sciences, Vancouver General Hospital (VGH), Vancouver, BC, Canada.|Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, BC, Canada.
authors.forename: J K
authors.initials: JK
authors.lastname: Yeung
authors.affiliation: Pharmaceutical Sciences, Vancouver General Hospital (VGH), Vancouver, BC, Canada.|Faculty of Pharmaceutical Sciences, University of British Columbia (UBC), Vancouver, BC, Canada.|Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, UBC, Vancouver, BC, Canada.
authors.forename: T T Y
authors.initials: TT
authors.lastname: Lau
authors.affiliation: Infection Control, Vancouver Coastal Health (VCH), Powell River, BC, Canada.
authors.forename: L A
authors.initials: LA
authors.lastname: Forrester
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, UBC, Vancouver, BC, Canada.|Division of Infectious Diseases, VGH, Vancouver, BC, Canada.
authors.forename: T S
authors.initials: TS
authors.lastname: Steiner
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, UBC, Vancouver, BC, Canada.|Division of Infectious Diseases, VGH, Vancouver, BC, Canada.
authors.forename: W R
authors.initials: WR
authors.lastname: Bowie
authors.affiliation: Division of Medical Microbiology and Infection Control, VCH, Vancouver, BC, Canada.|Department of Pathology & Laboratory Medicine, Faculty of Medicine, UBC, Vancouver, BC, Canada.
authors.forename: E A
authors.initials: EA
authors.lastname: Bryce
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002170:Canada; D016360:Clostridioides difficile / Q000187:drug effects*; D003015:Clostridium Infections / Q000188:drug therapy*; D003428:Cross Infection / Q000517:prevention & control; D019468:Disease Management; D005260:Female; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008829:Microbiology / Q000592:standards*; D008875:Middle Aged; D010607:Pharmacy Service, Hospital / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014640:Vancomycin / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: antibiotics; antimicrobial stewardship; clinical pharmacy; clostridium difficile infection; evidence-based pharmacotherapy; guideline adherence; infection control; medical microbiology