What type of study is this?

This is a Quasi-Experimental study.

What question did this study set out to answer?

This research aimed to evaluate the effectiveness of an EHR-based order set for improving oral vancomycin prescribing in patients at risk for CDI.

January 14, 2026Open Access

Closing the Gap in Clostridioides difficile Infection Prevention: An EHR Driven Approach to Oral Vancomycin Optimization

Key Points

This research aimed to evaluate the effectiveness of an EHR-based order set for improving oral vancomycin prescribing in patients at risk for CDI.
Conducted a quasi-experimental performance improvement project
Included adults prescribed systemic antibiotics with positive CDI tests
Measured OVP prescribing rates pre- and post- implementation of an EHR order set
OVP prescribing rates were similar before and after intervention (34.2% vs 24.5%)
Adherence to OVP protocol significantly improved post-intervention (100% vs 45.3%)
Breakthrough CDI cases decreased from 4 pre-intervention to 1 post-intervention
Median length of stay decreased from 14 to 8 days
Systemic antibiotic duration reduced from 10 to 6 days

Abstract

Abstract Background Systemic antibiotics significantly increase the risk of Clostridioides difficile infection (CDI) recurrence, particularly within the first 2-4 months following an initial episode. Studies have demonstrated that low-dose oral vancomycin prophylaxis (OVP) reduces CDI recurrence in these patients. Although OVP is recommended in our institution protocol, adherence has been inconsistent. To improve OVP prescribing, we implemented an electronic health record (EHR) embedded CDI prophylaxis order set. Methods This single-center, quasi-experimental, performance improvement project evaluated adults prescribed systemic antibiotics with a positive Clostridioides difficile PCR or toxin test within the past 12 months. The primary outcome was OVP prescribing rate pre- and post- order set implementation. Secondary outcomes included adherence to institutional protocol, rates of CDI breakthrough or recurrence, systemic antibiotic duration, and length of stay (LOS). Results A total of 204 patients were included, with 155 in the pre-intervention group and 49 in the post-order set group, (table 1). OVP prescribing rates were similar between groups (34.2% vs 24.5%, P= 0.178). Among patients who received OVP with systemic antibiotics, adherence to institutional protocol for OVP frequency significantly improved in the post- order set group compared to the pre-intervention group (100% vs 45.3%, P=0.002). Breakthrough CDI occurred in 4 patients pre-intervention and 1 patient post-intervention, while recurrent CDI within 2 months occurred in 2 and 0 patients, respectively. Median LOS decreased from 14 to 8 days (P= 0.002), and median systemic antibiotic duration decreased from 10 to 6 days (P= 0.013) in the pre-intervention group and the post-order set group, respectively, (table 2). Conclusion Implementation of an EHR embedded CDI prophylaxis order set did not increase OVP prescribing rates but successfully standardized prescribing practices. Introducing an EHR best-practice advisory (BPA) is the next step to further enhance OVP utilization in patients with a history of CDI receiving systemic antibiotics. Disclosures All Authors: No reported disclosures

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