Sustainability of Improvement: The Effects of the Illinois Campaign to Eliminate Clostridium Difficile over Time

BACKGROUND: Healthcare-associated Clostridium difficile infections (CDIs) have been increasing in incidence and severity in recent years. In 2012 the Illinois Department of Public Health launched the Illinois Campaign to Eliminate C. difficile (ICE C. diff) to educate and engage healthcare facilities in quality improvement efforts to prevent CDIs. This study aimed to examine the effects of the campaign on infection control practices and CDI rates in acute-care hospitals.  

METHODS: Activities of ICE C. diff took place March to September 2012 and consisted of facility leadership signing a commitment form and agreeing to participate in five webinars and an in-person workshop, establish a CDI prevention team, and set facility-specific CDI prevention goals. Campaign sign up was voluntary, and hospitals that did not sign up were not prevented from participating in campaign activities. January 2012 to June 2014 hospital-level quarterly C. difficile standardized infection ratios (SIRs) were obtained from the National Healthcare Safety Network (NHSN). Hospitals were grouped into a campaign and non-campaign group based on official campaign sign on. Joinpoint regression was used to analyze SIR trends with annual percent changes (APCs) and to detect significant changes in trends over time. A post-campaign survey sent to all hospitals was analyzed to assess facility response to the campaign.  

RESULTS: Of the 185 acute-care hospitals in Illinois, 113 (61%) signed up for the campaign. Among campaign participants, joinpoint regression detected one marginally significant (p-value=0.07) inflection point. This group had a declining SIR (APC=-2.01) from quarter 1 of 2012 to quarter 2 of 2013 and an increasing trend (APC=4.95) from quarter 2 of 2013 to quarter 2 of 2014. Non-participating hospitals had an increasing SIR (APC=1.48) throughout the same period of time, with no significant inflection points. Although NHSN data were not available prior to 2012, hospital discharge data of CDI rates showed an increase and plateau in the past decade. Eighty-two hospitals completed the post-campaign survey. Among hospitals that responded, 34 organized a CDI prevention team and 59 implemented at least one new intervention to prevent CDIs as a result of the campaign.   

CONCLUSIONS: The analysis suggests that the campaign spurred hospitals to enhance infection control measures, which may have resulted in an initial decline in CDIs. However, the effect was not sustained one year after the campaign, suggesting an ongoing need for public health agencies to engage and educate healthcare facilities in effective infection prevention strategies.