Reducing Clostridium difficile infection in acute care by using an improvement collaborative.

Area of Science:

• Healthcare-associated infections
• Infectious disease epidemiology
• Antimicrobial stewardship

Background:

• Salford Royal Hospital faced high Clostridium difficile infection rates in 2006, ranking fourth in North West England.
• Despite existing infection control measures, Clostridium difficile infection (CDI) remained a significant challenge.

Purpose of the Study:

• To evaluate the effectiveness of revised antimicrobial guidelines and a collaborative learning model in reducing CDI.
• To assess the impact of these interventions on CDI incidence in a university teaching hospital.

Main Methods:

• An interrupted time series design compared five collaborative wards (intervention) with 35 non-collaborative wards (control).
• Data on Clostridium difficile infection cases per 1000 occupied bed days were collected.
• Revised antimicrobial guidelines were implemented in February 2007, followed by a collaborative improvement initiative from March to December 2007.

Main Results:

• Non-collaborative wards showed a baseline CDI rate of 1.15 cases per 1000 occupied bed days.
• Following interventions, CDI cases in non-collaborative wards decreased by 56% to 0.51 by August 2007, a reduction that was sustained.
• Collaborative wards experienced a baseline CDI rate of 2.60 cases per 1000 occupied bed days, with a 73% reduction to 0.69 observed in April 2007, which was also maintained.

Conclusions:

• Judicious antimicrobial drug use is crucial for controlling Clostridium difficile infection.
• A collaborative learning model effectively facilitates the testing and implementation of changes to accelerate, amplify, and sustain CDI control.