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Surgical Intensive Care Unit; Department of Quality and Safety

Position/Job Title

Clinical Nurse Specialists; Manager of Infection Prevention and Control


Background: Patients with C. difficile will have liquid, loose, mucous like, or non formed stools. These infections can occur in both the inpatient and community settings and can range from diarrhea to life threatening illness. C. difficile positive stool samples collected within the first three calendar days of hospital admission is considered community acquired. Positive stool samples for C. difficile calendar day 4 or greater are considered hospital acquired. In 2019 and 2020, the P4 surgical intensive care unit (SICU) at Henry Ford Hospital (HFH) experienced high rates of hospital acquired C. difficile infections (CDI).

Aim: The purpose of this project was to utilize an electronic health record (EHR) report to conduct early screening for patients to capture CDI during the community acquired timeframe rather than during the hospital acquired timeframe.

Methods: Pre-post quasi-experimental retrospective study. Institutional Review Board approval was obtained. Incidence and rate of hospital acquired CDI were tracked from 2019-2022. All community-acquired CDI identified using the stool report were tracked from 2021-2022.

Findings: Significant reductions occurred in unit incidence and rates of hospital acquired CDI (Table 2). During the study timeframe, 15 community acquired CDIs were successfully detected within the first 3 calendar days of hospital admission (7 in 2021, 8 in 2022). These infections were detected with the use of the stool report tool and CNS and/or IPC follow up. Without this tool, these CDIs may not have been identified during the community acquired infection timeline.

Discussion: October 2021: A Loose Stool Best Practice Alert (BPA) was implemented. This electronic health record BPA alerts nursing staff of potential CDI during the community acquired window. The stool report remains a useful monitoring tool in the event that the Loose Stool BPA is bypassed. The CNS and IPC continue with daily screening of the stool report and follow up with nursing for all potential CDI patients. This quality improvement project is in the process of being expanded to additional units at the hospital.

Implications: Delay in CDI detection can cause negative outcomes for patients and can result in inflated hospital acquired rates. Utilizing an electronic report in conjunction with clinical nurse specialist follow up, is an effective method for early screening for C. difficile.

Publication Date


Improving Early Detection of C. difficile Infections