S0219 It Takes a Village to Bend the Curve for HO-CDI: A Quality Improvement Initiative

Abstract

Introduction: In 2015, the Centers for Disease Control (CDC) reported that Clostridium difficile infections (CDI) had become the most common microbial cause of health care-associated infections in the US. There are three types of C Diff infection for surveillance purposes: Healthcare facility-onset HO-CDI; Community-onset, healthcare facility–associated (CO-HCFA) CDI Community-associated (CA) CDI The Memphis VAMC has high rates of HO-CDI at 8.5/10,000 patient days in June 2019, which was double as compared to the national and local rates at other hospitals in the Memphis area. Methods: To combat the high rates of HO-CDI, a quality improvement (QI) CDI Prevention team was formed in June 2019 to work on a QI project to decrease the rates of HO-CDI at the Memphis VAMC. Highlights of the QI Project: Problem Statement: High rates of HO- CDI at the Memphis VAMC @ 8.5/10000 patient days as compared to national and local standards. Aim Statement: Decrease the rates of HO-CDI by 50 percentage in 6 months by December 2019 Core Metrics to be followed: Monthly HO-CDI rates Monthly rates of C Diff PCR orders Gap Analysis and Interventions: As showed in the GAP analysis table attached with the submission Results: Rates of HO CDI: Decrease in HO-CDI rates from 8.5/10,000 patient days to 2.3/10,0000 patient days in December 2019 as shown by the U chart with the submission. Number of C diff PCR tests ordered per month: Average of 81.5 tests/month in the preintervention period Average of 43.8 tests/month, a decrease by 46% as shown by the run chart in the submission. Conclusion: It really took a village and a combined effort from all the different departments as depicted in the gap analysis table to obtain the results that we were able to achieve. Electronic algorithms and protocols can be bypassed very easily, hence compliance monitoring with the note template is necessary even after completion of the QI Project. We all understand the importance of antibiotic stewardship, but the concept of diagnostic stewardship is equally important when you have a test with high sensitivity like the PCR for C.diff toxin.Table 1.: Gap Analysis TableFigure 1.: U chart showing the monthly rates of HO-CDI with the control limits.Figure 2.: Run chart showing the monthly number of C. Diff PCR tests ordered.