CDIFFerently: A Bundled Approach to Clostridium difficile Reduction

Abstract

Background: Since 2015 the rate of healthcare facility-onset Clostridium difficile infections (HO CDI) at Faxton-St Luke’s Healthcare (FSLH) has remained higher than both New York state and federal benchmarks, despite the use of traditional prevention efforts. Methods: We used the define-measure-analyze-improve-control (DMAIC) process improvement model to better understand the reasons that our rates remained high and to develop a comprehensive reduction strategy.•Define: High HO CDI rates. NHSN SIR consistently above 1.0•Measure•Diagnostic stewardship. Are patients being tested appropriately?•Antibiotic stewardship: Do prescribing practices follow best-practice recommendations?•Environmental cleanliness: Are staff following standard and transmission based precautions? How effective are current cleaning practices? What is being done to limit contamination of the environment of care?•Perform a gap analysis of CDI prevention strategies at FSLH vs current best practice recommendations, emerging strategies in scientific literature and successful approaches at other health-care facilities.•Analyze•Staff do not have a clear understanding of symptoms and risk factors of CDI and often initiate testing inappropriately.•Overuse of broad spectrum antimicrobial agents. No antibiotic time outs. Limited Pharmacy staff available for auditing and feedback regarding prescribing practices.•UV disinfection system under-utilized. Shared patient care equipment not cleaned between uses. Delay in implementation of contact precautions. Lack of opportunities for patient hand hygiene.•Improve•Algorithms for screening and testing built into Electronic Medical Record Orders for testing coupled with orders for contact precautions•Align antimicrobial prescribing with best practice•Audit and reward compliance with UV light utilization, environmental cleaning Reduce shared patient care equipment, replace with disposable items•Provide products for patient hand hygiene•Implement marketing campaign to tie elements together•Control•Audit compliance with testing and isolation policies•Laboratory rejection of formed stools•Audit cleaning processes with adenosine triphosphate (ATP) monitor•Track ultraviolet light usageFunding: NoneDisclosures: None