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Probiotic order panel to decrease hospital-onset C. Diff

18 Feb 2018

New order starts March 19, part of bigger plan

By: Robert Ponec, MD, Salem Gastro Consultants and Martin Johnson, MD, Salem Pulmonary Associates

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As you may know, hospitals are fighting to reduce Clostridium difficile (C-Diff) colitis. Salem Health is attacking the problem from at least three main angles: 

  1. Antibiotic stewardship
  2. Reduction in excess proton pump inhibitor use (which increases risk of C-diff), and
  3. The addition of probiotic therapy in patients with C-diff or at high risk for it. 

Although Salem Health teams are working on all three, this story focuses on probiotics. Evidence supports that probiotics helps patients with an active C-diff infection — and those with infections that are high-risk for recurrence due to hospitalization, especially when they get broad spectrum antibiotics. (Overall the risk may be reduced by as much as 50 percent.) Since evidence is the best in these two groups, we formed an algorithm for probiotic use at Salem Health. 

When an inpatient has active C-diff colitis, he/she will be entered into the active C-diff algorithm. This includes standard C-diff treatment in addition to probiotic therapy. When an inpatient has a history of C-diff colitis within the last 18 months, he/she will be entered into a different probiotic algorithm. 

The probiotics include either Kefir liquid (that can be given PO or per NG) or Saccharomyces boulardii capsules (one brand is Florastor). Note that the saccharomyces should not be given to immunosuppressed patients. The proper use of these will be clearly spelled out in the algorithm. The plan is for patients to continue the probiotic for two weeks after the completion of any antibiotics, so most patients will be sent home with instructions about continuing this therapy. 

Expect to be contacted by nursing when these patients are identified, so they can be entered into the treatment algorithm. We will have order sets to make it easy.

Again, this is just one part of a multipronged attack on C-diff at Salem Health. We have confidence that this coordinated system will really help!