Clostridium difficile is the most common cause of healthcare-associated infections in U.S. hospitals. The National Healthcare Safety Network (NHSN) surveillance system tracks C. diff infections (CDI), one of the measures used by Centers for Medicare & Medicaid Services (CMS) to determine a hospital’s total Hospital-Acquired Conditions (HAC) score and ranking among other hospitals. This is then used to calculate Value-Based Purchasing pay-for-performance incentive payments, which may lead to significant reductions in a facility’s reimbursement if rates are too high. The objective of this study was to assess the effectiveness of a multicomponent intervention bundle in reducing our healthcare facility-onset (HO) CDI rates.
This was a pre-post quasi-experimental retrospective study comparing CDI rate per 1,000 patient days and Standardized Infection Ratio (SIR) in the pre-intervention period from Jan 1, 2017 to December 31, 2017 to the intervention period from January 1, 2018 to March 31, 2018 in a 319-bed teaching hospital in northwest Ohio. We implemented a testing algorithm to guide physicians and nurses, focusing on increasing early detection and decreasing inappropriate testing. We enforced re-testing criteria, which did not allow re-testing within 7 days and in those who were positive during the admission. Infection Preventionists provided staff education. A dedicated C. diff isolation cart was created. Contact isolation, hand hygiene, enhanced environmental cleaning and disinfection were reinforced. Treatment guidelines were established and antimicrobial stewardship reviews were performed on all cases to discourage unnecessary medications, encourage judicious use of antimicrobials, and ensure appropriate treatment.
Our C. diff rate per 1000 patient days decreased from 0.826 in the pre-intervention period to 0.495 in the post-intervention period, which resulted in 60% reduction in HO-CDI rate. The SIR also decreased from 1.207 to 0.677, yielding a 55% reduction.
Implementing a C. diff multicomponent intervention bundle that emphasizes early and appropriate testing may reduce HO-CDI rates.
M. Ahrens, None
M. Eckhart, None
G. Suleyman, None