2416. Effect of Sequential Universal Bleach Cleaning and Best Practice Alerts on Clostridioides difficile Infection Rates

Abstract Background A gap analysis prompted consideration of expanded bleach disinfection beyond rooms housing patients in isolation for Clostridioides difficile infection (CDI) and emphasis on CD testing stewardship at the University of Minnesota Medical Center (UMMC), a tertiary care center spanning two campuses in close proximity with adult patients on the East Bank (EB), adult and pediatric patients on West Bank (WB). Methods An electronic best practice advisory (BPA) went live in April 2018 on both the EB and WB (Figure 1). The BPA first discourages CD testing in the event of a prior positive within 10 days or a prior negative within 7 days. Second, the BPA discourages CD testing in patients with fewer than 3 loose stools in a 24 hour period, who have received laxatives in the last 48 hours, or who lack CDI symptoms (fever > 38C, abdominal pain, or leukocytosis > 11,000). Providers can bypass the BPA based on clinical judgment; those who override the BPA are provided just-in-time education via email. Following a successful pilot in three wards, the EB Environmental Services (ES) team expanded the use of bleach to include all terminal cleaning regardless of isolation status in June 2018 (Figure 1). Daily cleaning on the EB was excluded from universal bleach utilization, as were daily and terminal cleaning on the WB. CD testing throughout the study period occurred via polymerase chain reaction (PCR) of the toxin B gene. ES performance, assessed by adenosine triphosphate (ATP) bioluminescence testing, and hand hygiene rates were unchanged throughout the study period. Results Adult-only hospital-onset (HO)-CDI rates decreased during the study period on both hospital campuses, with the EB exhibiting a greater decrease, (Fig 1), while community-onset (CO) and community-onset healthcare facility associated (CO-HCFA) rates remained steady during the study period (Fig 3). Whole-house (adult and pediatric) CD testing was largely unchanged while the proportion of tests triggering the BPA decreased (Fig 2). Conclusion Universal bleach utilization during terminal cleaning combined with an electronic BPA were associated with decreased adult HO-CDI rates. However, the BPA did not impact CD testing rates, suggesting that decreased HO-CDI rates may be unattributable to testing stewardship. Disclosures All authors: No reported disclosures.