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Clostridium Difficile Testing in the Infectious Disease Clinic – Adult – Ambulatory [107]

Clostridium Difficile Testing in the Infectious Disease Clinic – Adult – Ambulatory [107] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols



Delegation Protocol Number: 107

Delegation Protocol Title:
Clostridium Difficile Testing in the Infectious Disease Clinic - Adult - Ambulatory

Delegation Protocol Applies To:
UW Health Infectious Disease Adult Clinic

Target Population:
Adult patients seen in UW Health Infectious Disease Clinic experiencing diarrhea indicative of
potential clostridium difficile (c-diff) infection

Delegating Protocol Champions:
David Andes, MD – Department of Medicine – Infectious Disease
Nasia Safdar, MD – Department of Medicine – Infectious Disease

Delegation Protocol Reviewer:
Jennifer Bellehumeur, MS, RN – Infections Disease & Immunology

Responsible Department:
Department of Medicine- Infectious Disease

Purpose Statement:
The purpose of this protocol is to delegate authority from the Infectious Disease Provider to
Registered Nurses (RNs) to place the lab order panel for C DIFF TOXIN B PCR, NAP 1 IF POSITIVE.

Who May Carry Out This Protocol:
Registered Nurses (RNs) in the UWHC Infectious Disease Clinic who are trained in the use of this
delegation protocol.

Guidelines for Implementation:
1. The patient must be experiencing diarrhea which is defined as greater than or equal to 3
unformed stools in a most recent 24 hour period (documented or by history). If patient is
experiencing diarrhea with a likely etiology other than Clostridium difficile (e.g. chronic
diarrhea, lactulose administration, pancreatic insufficiency) the RN must consult with the
Infectious Disease Provider first.
2. The patient must be on oral or parenteral antibiotics, or have recently finished a course of
antibiotics within the last 8 weeks.
3. If the patient is currently receiving treatment for Clostridium difficile, no further action is
required.
4. The RN will review Health Link for existing orders and results from the past 7 days.
4.1. If there is no lab order for “C DIFF TOXIN B PCR, NAP 1 IF POSITIVE”, proceed to step 5
5. If there is a lab ordered within the past 7 days or there has been a positive result, the RN
will place the lab order “C DIFF TOXIN B PCR, NAP 1 IF POSITIVE”.
6. The RN will send the order to lab and instruct the patient to present to lab to collect the
specimen, or will send the order to Home Health or other care provider, depending on the
patient’s location, to obtain specimen.
6.1. Formed stool should not be sent for testing because it will be rejected by lab and the
patient would be excluded from this delegation protocol.
7. If patient is present in clinic, implement Isolation-Enhanced contact- Clostridium Difficile
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


precautions for suspected or confirmed cases.

Order Mode: Cosign Required, Protocol/Policy

References:
UW Health Lab Test Directory: Clostridium difficile toxin B PCR, NAP 1 if positive

Collateral Documents/Tools:
UW Health - Prevention, Diagnosis and Treatment of Clostridium difficile Infection –
Adult/Pediatric – Inpatient/Ambulatory Clinical Practice Guideline. October 2015. Accessed
March 10, 2017
UWH Health Clinical Policy 11.14: Collection of Stool Specimens for Laboratory Examination
(Including Ova and Parasites) (Adult & Pediatric). Accessed March 10, 2017.
UW Health Clinical Policy 4.1.8: Standard Precautions Isolation. Accessed March 10, 2017.

Approved By:
UW Health Ambulatory Protocol Committee: August 2014; *April 2017
UWHC Antimicrobial Use Committee: November 2014; *May 2017
UW Health Lab Practices Committee: October 2014; *May 2017
UWHC Medical Board: December 2014; *May 2017
UW Health Chief Medical Officer: December 2014; *May 2017

Effective Date: May 2017

Scheduled for Review: May 2020
*Expedited Review Process
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org