“Hard Stop” Alert May Reduce C difficile Orders for Laxative-Taking Patients

c difficile in petri dish
c difficile in petri dish
A "hard stop" requiring providers to think critically about C difficile testing in the presence of laxative use or absence of documented diarrhea strengthened CDI testing stewardship.
This article is part of Infectious Disease Advisor’s coverage of IDWeek 2017™, taking place in San Diego, CA. Our on-site staff will be reporting on the latest breaking research and clinical advances in infectious diseases. Check back regularly for highlights from IDWeek 2017.

SAN DIEGO – A “hard stop” alerting system may effectively cause providers to discontinue C difficile orders among patients taking laxatives or those with an absence of documented diarrhea, according to study findings presented at IDWeek 2017.

“Patients may be over-diagnosed with C difficile infection (CDI) due to colonization, especially if laxatives are used,” noted the investigators. “Our objective was to strengthen our C difficile testing stewardship by creating a ‘hard stop’ to require providers to think critically about C difficile testing.” they added.

Investigators initiated a laxative alert at their 2-hospital community-based academic healthcare system. The alert started >36 hours following admission, and the system evaluated patients for documented diarrhea (defined as >2 episodes/24 hours).

According to the findings, an average of 9 (SD, 4-14) daily orders of C difficile testing were observed at baseline. Implementing the hard stop alert resulted in a decrease in daily testing by 30%. Additionally, the hospital-onset CDI frequency decreased by 45% during the first month of the hard-stop implementation. The investigators comment that they have not “detected delayed diagnoses or empiric treatment without testing” to date.

Related Articles

“Given [polymerase chain reaction’s] high sensitivity for C difficile, testing stewardship is critical to minimize false positive cases of CDI, which lead to inappropriate treatment, prolonged length of stay, and hospital penalties,” concluded the researchers. In addition, requiring a phone call to order C difficile testing “in the setting of laxative use or minimal diarrhea effectively reduced testing and was well accepted by nurses and providers.”

Visit Infectious Disease Advisor’s conference section for continuous coverage live from IDWeek 2017.


Drees M, Dressler R, Taylor K, et al. Testing stewardship: a ‘hard stop” to reduce inappropriate C. diff testing. Presented at: IDWeek 2017; October 4-8, 2017; San Diego, CA. Oral abstract 79.