Improved education could keep clinicians from ordering laxatives and stool softeners just prior to ordering Clostridium difficile tests, improving the specificity of such testing.

In a 4-month prospective cohort study of pediatric inpatients, most clinicians were aware that their patients were receiving laxatives or stool softeners before they were sent for C. difficile tests.

But testing for C. difficile infection (CDI) within 48 hours of receiving a laxative or stool softener “can decrease the positive predictive value of the result if patients are colonized but have loose stool from the laxative,” said Joanne Kinlay, RN, and Thomas J. Sandora, MD, of Boston Children’s Hospital.

Misclassifying colonized patients as having CDI reduces the utility of interfacility data comparison and may potentially result in inappropriate penalties for hospitals, they added.

From August to November 2015, 217 pediatric inpatients underwent 278 C. difficile tests that were eligible for inclusion in the study. There were 48 episodes of CDI in 44 patients in which bowel medications were administered prior to the test.

Of the 48 tests sent after receipt of bowel medications, either the ordering clinician or the bedside nurse completed the qualitative survey in 42 instances (88%). The response rate was higher among nurses (71%) than clinicians (48%). Awareness of bowel medication administration before testing was acknowledged by 78% of ordering providers and 88% bedside nurses. A majority of nurses (70%) and providers (71%) reported the medical team wanted the test.

“The main reasons for testing included a change in stool quality from baseline, other changes in clinical status, and the presence of risk factors for CDI,” Ms. Kinlay and Dr. Sandora said.

Read more in the American Journal of Infection Control (2017 Mar 13. doi: 10.1016/j.ajic.2017.01.035).