BACKGROUND: Despite being a national priority as outlined in the United States Health and Human Services (HHS) Action Plan to Prevent Healthcare Associated Infections (HAI), Clostridium difficileinfections (CDI) remain at historically high levels. State health departments (SHD) and Quality Innovation Network-Quality Improvement Organizations (QIN-QIO) have individually been charged with reducing incidence of CDI in acute care facilities. Both entities possess unique subject matter expertise, which together can facilitate reduction of infections, conserve resources and improve patient safety.
METHODS: Kansas Department of Health and Environment (KDHE) partnered with Kansas Foundation for Medical Care (KFMC), the Kansas QIN-QIO, to recruit hospitals with a National Healthcare Safety Network (NHSN) Standardized Infection Ration (SIR) >1 into the Kansas Clostridium difficile Prevention Collaborative. Data were collected during the baseline period of January – June 2013 for inclusion. Participating facilities were asked to
- establish a multidisciplinary CDI team,
- reduce NHSN SIR to <1, and
- establish or strengthen existing antimicrobial stewardship efforts.
- on-site consultative services provided by KFMC and KDHE HAI program staff,
- multidisciplinary team learning sessions,
- monthly coaching calls,
- quarterly cross-setting educational webinars (including partners from long term care (LTC) settings and community providers), and
- a comprehensive resource toolkit including prevention guidelines, recommendations, sample policies, and patient and staff educational materials.
RESULTS: Thirteen of 16 (81%) eligible facilities were recruited into the Kansas Clostridium difficile Prevention Collaborative. Baseline data of participating facilities collected January – June 2013 via NHSN revealed a collaborative CDI SIR of 1.06. Six months into the Kansas Clostridium difficile Prevention Collaborative, the CDI rate of participating facilities was 0.88, representing a 16.98% relative improvement rate. Ten facilities (77%) demonstrated positive relative improvement from baseline. All participating facilities (100%) established a multidisciplinary team to specifically address CDI reduction issues and either established an antimicrobial stewardship program or enhanced their existing antimicrobial stewardship efforts by formalizing policies and providing targeted education regarding prescribing practices.
CONCLUSIONS: SHD/QIN-QIO partnerships are beneficial in times of increasingly competing patient safety initiatives and dwindling resources. Aligning prevention priorities at a statewide level encourages facility participation and focuses infection prevention priorities. Basic quality improvement education provided at initial learning sessions combined with monthly contact via coaching calls with newly developed CDI teams facilitated rapid cycle improvement. Cross-setting educational webinars supported conversations between care settings regarding other mutual interests (e.g. readmissions, patient transfers, etc.) outside of the C. difficile Prevention Collaborative.