Preventable Patient Harm: a Multidisciplinary, Bundled Approach to Reducing Clostridium difficile Infections While...

Area of Science:

• Infectious Diseases
• Healthcare Epidemiology
• Clinical Microbiology

Background:

• Health care facility-onset Clostridium difficile infections (HO-CDI) are a significant cause of morbidity and mortality.
• HO-CDI rates impact hospital performance metrics and reimbursement, notably by the Centers for Medicare and Medicaid Services (CMS).
• Facilities face pressure to reduce HO-CDI, prompting reevaluation of diagnostic methods like nucleic acid amplification tests (NAATs).

Purpose of the Study:

• To assess the impact of implementing a multidisciplinary infection prevention intervention program on HO-CDI rates.
• To determine if significant reductions in HO-CDI could be achieved without modifying the existing laboratory diagnostic algorithm.

Main Methods:

• A multidisciplinary group was formed to implement and monitor eight key categories of infection prevention interventions.
• The intervention period lasted 13 months, with a goal to reduce CDI rates by 10%.
• The institution's established two-step diagnostic algorithm (glutamate dehydrogenase/toxin immunochromatographic assay/NAAT) remained unchanged throughout the study.

Main Results:

• A statistically significant reduction of 42.7% in the HO-CDI rate was achieved.
• The reduction surpassed the organizational goal of 10%.
• No modifications were made to the laboratory's diagnostic testing algorithm for C. difficile.

Conclusions:

• Comprehensive infection prevention interventions can effectively reduce HO-CDI rates.
• Achieving substantial reductions in HO-CDI is possible even when maintaining existing sensitive laboratory diagnostic methods.
• This approach offers a viable strategy for hospitals facing reimbursement pressures related to hospital-acquired infections.