Background: Children aged <1 year are usually colonized with Clostridium difficile: colonization rates range between 30% and 70%. In children, other infectious causes of diarrhea are more common than C. difficile. Molecular testing for C. difficile yields very high sensitivity. Clinical judgement is required for testing children with suspected infectious diarrhea. Inappropriate C. difficile testing may lead to antibiotic overuse. Methods: Initially, for the years 2016–2018, we collected data for positive C. difficile nucleic acid amplification tests (NAATs) at Sanford Children’s Hospital. In 2017, a physician-driven protocol was implemented to replace the current nurse-driven protocol for testing. We implemented national guidelines for testing and treatment in pediatric patients. Microbiology lab was given autonomy to use Bristol stool criteria to process stool samples for C. difficile. Formed stools were rejected for testing for C. difficile. The result was suppressed in patients aged <1 year. We presented the available data at the SHEA spring conference in 2020. We collected new data until June of 2019 to measure the sustainability of the intervention. Results: In 2016, there were 78 C. difficile tests: 17 were positive and 11 were categorized as an HAI. From January 1 to June 30, 2017, there were 26 C. difficile tests: 8 were positive and 3 were categorized as an HAI. Furthermore, 16 C. difficile tests were obtained from July 7 to December 31, 2017: 4 were positive and 1 categorized as an HAI. In 2018, there were 18 tests and 2 were positive; 1 was categorized as an HAI. In 2019, there were 16 tests and 2 were positive; 1 of these was categorized as an HAI. Conclusions: Implementing 2 interventions (removal of a nurse-driven protocol and microbiology lab autonomy for rejecting formed stool samples) for improving C. difficile testing accomplished a reduction of >80% in the number of tests obtained. Overall, there was a sustained reduction in the number of positive tests and HAIs in the years 2018 and 2019. The 2 interventions have been sustainable over time.

Funding: None

Disclosures: None