2098. Initiation of a Performance Review Committee (PRC) with Multi-Disciplinary Healthcare Team Members and the Impact on Hospital-Acquired Clostridium difficile Infection (CDI)
Session: Poster Abstract Session: Clostridium difficile: Outcomes, Testing, Prevention
Saturday, October 29, 2016
Room: Poster Hall
Background: Clostridium difficile infection (CDI) is considered an urgent public health threat. A 2012 evaluation of CDI cases identified an increased length of stay of 7.19 days with an additional $12,500 in costs compared to cases without CDI. The CDC provides a CDI prevention primer toolkit of best practices with approaches for hospital-acquired CDI (HA-CDI) reduction. The senior leadership at Florida Hospital Orlando recognized the importance of reduction of HA-CDI and tasked a multi-disciplinary healthcare team as a performance review committee (PRC) to implement the CDC toolkit and best practices.

Methods:  This was a quasi-experimental study design implementing a bundle of interventions. The hypothesis was made that if the following occurred the incidence of HA-CDI would decrease: 1. Early identification of community onset CDI, 2. Reduce or eliminate environmental reservoirs of the spore, 3. Skin contamination is minimalized, 4. Antimicrobial and acid suppression agents are used judiciously.

The interventions were implemented over one year rather concurrently at our 1,289- bed, acute care community hospital. The PRC convened weekly with recommendations for process improvements. An A3 document was updated with data and follow-up items. The PRC reported out biweekly to senior leadership who supported the changes, assigned responsibilities, and approved resources and funding. Daily emails were sent from the PRC with performance feedback to all clinical departments.

Results: We achieved a mean rate reduction in HA-CDI by 33.6% (p value = 0.02) from 6.81 (5.1-8.63) to 4.5 cases (2.86-11.84) per 10,000 patient days over 12 months period of time. Antibiotic days of therapy (DOT) fell by mean reduction of 6% (p value = 0.007) from 738 (711-760) to 696 days of therapy (679-724) per 1,000 patient days.

Conclusion: Many evidence based strategies in a multipronged approach were employed to target CDI during a period of very high patient capacity. Increasing awareness and standardizing how we care for CDI patients were important strategies to decreasing the incidence of CDI. The PRC will continue to identify areas to sustain and improve CDI rates by continuous quality assurance of prevention measures and observing leading and lagging indicators over time.

Kristie Zappas, PharmD, BCPS (AQ-ID)1, James Mcclelland, MD2, Kerry Schwartz, MD, FACC, FACP3, Jason Price, MBA, MSN, RN4, Cathy Stankiewicz, MSN, RN, CPHQ5, Alba Cruz-Betancourt, MSN, RN, CCNS6, Hermanda Milton, MSN/Ed7, Patrice Berwager, MSN, RN, CEN8, Kurry Lewis, RN5, Julie Hess, MT(ASCP)9 and Brian Jones, BS10, (1)Pharmacy, Florida Hospital Orlando, Orlando, FL, (2)Florida Hospital Orlando, Orlando, FL, (3)Supply Chain, Florida Hospital Orlando, Orlando, FL, (4)Medicine, Florida Hospital Orlando, Orlando, FL, (5)Quality, Florida Hospital Orlando, Orlando, FL, (6)Cardiovascular, Florida Hospital Orlando, Orlando, FL, (7)Infection Prevention, Florida Hospital Orlando, Orlando, FL, (8)Cardiac Stress Lab, Florida Hospital Orlando, Orlando, FL, (9)Laboratory, Florida Hospital Orlando, Orlando, FL, (10)Transportation, Florida Hospital Orlando, Orlando, FL

Disclosures:

K. Zappas, None

J. Mcclelland, None

K. Schwartz, None

J. Price, None

C. Stankiewicz, None

A. Cruz-Betancourt, None

H. Milton, None

P. Berwager, None

K. Lewis, None

J. Hess, None

B. Jones, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.