Process Improvement to Reduce Healthcare Associated C. difficile Infections: A Bundled Approach

Abstract

<h3>Background</h3> A community hospital experienced an increase in Healthcare Associated C. difficile infections in Fiscal Year 2017. Over 70% of the cases were identified in a single unit and were associated with common rooms. Utilizing a continuous improvement process, it was determined that we had multiple opportunities within environmental cleaning, antibiotic utilization, appropriate and prompt testing, compliance with hand hygiene and isolation precautions. <h3>Methods</h3> Front line staff assisted in creating standard work for room stripping and cleaning. Another opportunity was to streamlining our cleaning chemicals. At one point, we utilized two different chemicals and application methods. This variation lead to confusion and compliance downstream. March 2018, UV-C was deployed to treat bathrooms after daily cleaning and after terminal cleaning. Refreshing our Hand Hygiene Campaign was another intervention to increase awareness around appropriateness hand hygiene and tackle barriers to compliance. Our data also showed many of our positive patients received a laxative within 24 hours of testing. We refreshed our education and developed a best practice advisory in our electronic medical record. To ensure prompt collection, a magnetic visual cue was created for the patient's door. A protocol to assist in de-escalating Proton Pump Inhibitor was developed in addition to a process for prophylactic antibiotics for patients with a recent history of C diff. <h3>Results</h3> We have celebrated many new milestones since starting our process improvement journey. From FY 17-FY19, we had a 51% decrease in the number of infections and a 47% reduction in our Standardized Infection Ratio. <h3>Conclusions</h3> We began our journey towards reducing C. diff infections in May 2017 and continue working towards our ultimate goal of zero patient harm. In order to develop solutions and achieve results, we needed to have the front line staff voices heard and work together for what was best for our patients.