BACKGROUND: The primary objective of the Clostridium difficile infection (CDI) prevention collaborative is to decrease rates of CDI while optimizing antimicrobial use in acute care hospitals (ACH) within the state. Strategies include improving early detection techniques, communication between transferring facilities, infection control and environmental cleaning, and antibiotic stewardship.
METHODS: Facilities targeted for enrollment were based on the combined ranking of facilities by community-onset cumulative attributable difference (CO-CAD) and hospital-onset standardized infection ratio (HO-SIR). A total of 8 facilities agreed to participate. Seven facilities were visited while one was assessed via online questionnaire and phone interview. Site visits included open-ended interviews with executive leadership, department directors, and front-line staff including nurses, CNAs, and environmental services staff and a walk-through assessment of the physical environment. Frontline staff also completed an online facility assessment survey (Likert-type scale).
RESULTS: Laboratorians reported rejection of formed stools “Always” at 50.0% and duplicate stools as “Always” at 42.9%. Facility percent positivity over the previous 6 months (# positive tests/total # performed) ranged from 3.9% to 25.9%. When asked “How often do physicians adhere to hand hygiene policies” only 15.5% of respondents responded “Always”. Facility-wide antibiograms were published and available in most facilities for use as prescriber tools. Responses by administration to the online-survey were not significantly different when compared to those of frontline staff for infrastructure-related questions. Healthcare onset rate for participants decreased during collaborative period but not significantly (Figure 1). An assessment report with resources was provided after each visit. A webinar series was produced covering the common gap areas.
CONCLUSIONS: Common gaps present amongst facilities include hand hygiene (particularly among physicians), lack of documented indications for prescribed antibiotics, and adherence to appropriate testing guidelines. The downward trend in healthcare-onset rate was not significant; however, the collaborative highlighted several areas of improvement for each facility. The partnership between the state health department and quality improvement organization increased success of the collaborative.