Sustained Reduction of Hospital Onset Clostridium difficile for Community Hospital Through Multimodal Multidisciplinary Performance Improvement

Abstract

<h3>Background</h3> Clostridium difficile (C.diff) is a bacterium that can cause life-threatening diarrhea. Recent antibiotic exposure is the most common risk factor, but hospitalization and coming in direct or indirect contact with C.diff, such as from contaminated hands, equipment, or the environment, also increases disease susceptibility. Hospital-onset C.diff infections (HO-CDI) can significantly increase patient length of stay and hospital costs. Our hospital is a 391-bed community acute care hospital approximately 30 miles from New York City that has historically experienced HO-CDI rates at or above state average. With the goal of reducing HO-CDI rates and improve patient outcomes, the hospital developed a multi-disciplinary team approach that has successfully reduced and sustained low HO-CDI rates. <h3>Methods</h3> Infection Prevention practices include early identification, testing and isolation for patients with suspected Clostridium difficile infection (CDI). C.diff testing algorithm was implemented for appropriate testing of patient specimens submitted after 3 days from admission. Yearly antibiogram pocket cards are distributed by the Antibiotic Stewardship program that includes empiric therapy guidelines. Antimicrobial prescribing trends are reviewed by a dedicated pharmacist who also identifies areas for improvement; including recommendations for and monitoring of broad to narrow spectrum antibiotic use. Environmental Service practices include a 2-step daily sporicidal cleaning agent for all isolation rooms. Additional disinfectant cleaning (3-step) for all identified C.diff rooms upon discharge includes a dry fogging application of 5% hydrogen peroxide. <h3>Results</h3> HO-CDI incidence rates remains significantly lower than New York State average since 2017 with 2018 rate at 1.2 per 10,000 patient days. <h3>Conclusions</h3> A multidisciplinary team approach was utilized to tackle HO-CDI rates over a number of years. Through numerous multidisciplinary interventions made by all, a successful reduction was seen in HO-CDI rates and has been sustained for over 2 years. HO-CDI reduction was successful because every healthcare worker was a steward in providing safe patient care.