Bedside nurses comprise the largest personnel group in a hospital and are intimately familiar with a patients day to day clinical status. They can be an effective group to engage and empower to assist with hospital-wide Clostridium difficile infection (CDI) reduction efforts. The objective of this study was to evaluate the impact of a nursing driven intervention bundle on CDI rates at a 365 bed community hospital.
Daily nursing led CDI and invasive line assessment rounds were implemented in April 2017. Nurses were empowered through a pre-approved protocol to place symptomatic patients in isolation and order a test for C. difficile. Additionally, patient care rounds that included nursing leadership, the antibiotic stewardship program physician director, infection preventionist and bedside nurses were conducted three times weekly. During these rounds, all Foley catheters, central lines, and CDI cases were discussed and a root cause analysis was performed for healthcare associated infections (HAIs). CDI standardized infection ratio (SIR) was the primary metric tracked to assess outcome and trends by quarter over a two year period were evaluated.
CDI SIR rates for the two full quarter after program implementation (July to September 2017 and October to December 2017) declined by 27.8% and 51%, respectively when compared to matching quarters from 2016 (Figure 1). Overall calendar year 2016 rates were similar to 2017 rates, but this was due to a significant increase in CDI incidence in first quarter 2017.
A formalized program for CDI reduction that incorporated the bedside nurse, nursing leadership, infection prevention, and the ASP team was effective in reducing CDI rates as measured by SIRs for the two quarters after full program implementation when compared to 2016 baseline rates.
Figure 1: SIRS Comparison by Quarter (2016-2017)
J. Newton Jr.,
S. Benedetti, None
J. Huneycutt, None
R. Cowie, None